Sometimes conventional IVF – leaving the sperm and egg to do their thing in our laboratory – needs a helping hand.
Intracytoplasmic Sperm Injection (ICSI) is a lab technique that may be appropriate for you if your sperm need a bit of extra help to achieve successful fertilisation. Your embryos, created using the ICSI technique, are then transferred in exactly the same way as in standard IVF.
Your eggs are collected in the same way as IVF, and a single sperm is injected into the centre of each mature egg to assist fertilisation in the laboratory. We use ICSI in conjunction with an IVF cycle when we believe that fertilisation is unlikely to occur using conventional IVF.
In the same way as a conventional IVF cycle, one or two of the resulting embryos can then be transferred to your uterus, and any additional suitable embryos can be frozen for your future use.
Bourn Hall’s fertility experts have performed ICSI since 1993, making us one of the most experienced centres for this type of fertility treatment technique in the UK.
We might recommend ICSI when:
- Your sperm count is low
- Your sperm motility – movement – is poor
- You have a high number of abnormal sperm
- Your sperm has been collected surgically
- Your semen contains levels of antibodies
- You have previous, unexplained, unsuccessful conventional IVF treatments, or when very few eggs have fertilised following IVF
- Tests of your sperm function have shown that the sperm would be unlikely to achieve fertilisation, or embryo quality and implantation may be compromised
- You have chosen to use donated gametes
Your treatment cycle is exactly the same as for conventional IVF. The only difference is that our embryologists use micromanipulation techniques in the laboratory to fertilise your eggs, instead of placing sperm and eggs together in a tissue culture dish.
Incredibly powerful microscopes are used to help select the best sperm for ICSI.
IMSI stands for Intracytoplasmic Morphologically-Selected Sperm Injection and is used in conjunction with ICSI. The IMSI process involves the assessment of sperm at a much greater digital magnification than ICSI (about 6000x magnification compared with 200x).
Our embryologists examine potential defects within the sperm head, as well as checking for more conventional shape, size and motility abnormalities. Once chosen, the selected sperm is injected into the egg in exactly the same way as with the standard ICSI procedure.
Research has shown that IMSI may have a positive impact in the following cases:
- Men who have elevated levels of DNA fragmentation
- When there have been recurrent miscarriages
- Where implantation hasn’t worked on several occasions following ICSI treatment
- Where previous embryos have developed poorly
- Male factor infertility – when there’s a high number of abnormal sperm
As IMSI is a selection process, it may not be suitable for samples with extremely low numbers of sperm.
Your treatment cycle is exactly the same as for IVF with ICSI. The only difference is that our embryologists use the IMSI magnification process in the laboratory to select the sperm with fewest defects for the ICSI technique with the aim of improving your chances of conceiving.
Sometimes the only way to access your sperm is through surgical retrieval. We know this can sound a bit daunting and the terms can be confusing, with lots of acronyms.
Here, we’ve given a brief explanation of each procedure, to help you understand which one may be most suitable for your situation.
Surgical Sperm Retrieval is a minor surgical procedure that’s used to harvest sperm directly from your testicles or associated tubing. When surgically collecting sperm at Bourn Hall, we use various clinical techniques for different circumstances.
Below, we have laid out the key processes, but please do get in touch if there is anything you’d like to discuss further.
PESA stands for Percutaneous Epididymal Sperm Aspiration. This is where a fine needle is inserted into the epididymus, above the testis, and sperm may be obtained by gentle suction. This treatment is usually appropriate if you do not have any sperm within the ejaculate, because of some form of blockage.
Testicular Sperm Aspiration (TESA) is when a fine needle is inserted into the testis and samples of tissue containing sperm are obtained by gentle suction. If insufficient sperm are obtained using this technique, then your consultant may decide that Testicular Sperm Extraction (TESE) is the best course of action.
TESE involves taking a tissue sample – a biopsy – through a small incision in the scrotum. These procedures are usually appropriate if you have no sperm within the ejaculate, because of defective sperm production. This may be because of previous testicular surgery, previous medical treatment, or a genetic problem.
Micro-TESE is Microsurgical Sperm Retrieval from the Testicle. This involves an operation performed through a small midline incision in the scrotum, through which one or both testicles can be seen.
The surgeon examines the testicle(s) under the microscope, which provides up to 20x magnification, in search of areas where the seminiferous tubules – small areas of testicular tissue – are dilated and therefore more likely to contain sperm. The surgeon then removes these areas, and we examine them in our laboratory for the presence of sperm. We continue examining different areas of the testicle(s) until we find sperm, or until we’ve examined and taken a biopsy from all sites of the testicle(s) without seeing any sperm.
This procedure is usually applicable if other SSR techniques have been unsuccessful, or if you don’t have any sperm within the ejaculate because of defective sperm production. In this latter case, it may be the result of previous testicular surgery, earlier medical treatment, a genetic problem, or other male factor infertility issue. The consultant will be able to recommend if this procedure is the most likely to succeed in obtaining sperm in your particular case.
SSR is used for men who have no sperm in their semen – a condition known as azoospermia. In half of these cases, sperm production is normal but a blockage – obstructive azoospermia – prevents sperm from entering the semen. This may be because of:
- Failure of the sperm passages to develop (congenital absence of the vas deferens)
- A blockage of the sperm transport tubules (rete, epididymis or vas deferens)
- A previous vasectomy operation (male sterilisation)
For the other half, there’s insufficient sperm production and this can be caused by:
- A congenital problem
- A previous disease
You’ll have a consultation with one of our Consultant Urologists who specialises in fertility treatment. The Consultant will examine you and organise any appropriate tests, such as hormone analysis, chromosome analyses (in particular looking at the Y chromosome), and virology screening. You’ll agree a treatment programme together and decide when you’d like to have your SSR operation.
Depending on the reason for a lack of sperm in your semen, the Consultant will suggest the most appropriate form of retrieval in your case. We can perform several different procedures (PESA, TESA, TESE or Micro-TESE), which involve either local or general anaesthetic. In all cases, you’ll be able to go home the same day, although having a general anaesthetic will mean you’re unable to drive yourself home after the operation.
Usually, we’ll perform the SSR before the IVF cycle. The suitable sperm that we retrieve will be frozen and stored for use in future IVF treatment cycles. We always use SSR in conjunction with ICSI during the IVF cycle, as this gives us a better chance of achieving fertilisation.
If sperm is frozen and stored for you at the clinic following any of these procedures, we’ll contact you each year and ask you to confirm your wishes for the next 12 months. If you wish to continue storage with us, there is an annual storage fee.
If you’ve previously faced issues with unexplained fertility, this in-depth sperm analysis may be the key to starting your own family.
As well as our routine semen analysis, we are also able to measure the actual damage in individual sperm.
At Bourn Hall, we use the SpermComet® DNA Test which, when combined with our laboratory’s standard semen analysis – sperm count, shape and swim strength – gives you the full picture on your individual sperm’s health.
Having a detailed analysis of the sperm DNA damage means that we are better equipped to provide you with personalised advice and treatment, which can make a dramatic difference in creating your family.
Sperm DNA damage can be quickly improved by making simple lifestyle changes such as reducing alcohol, smoking and drug use.
Couples can be advised to start with ICSI treatment rather than IVF, saving valuable time and cost by avoiding inappropriate treatments.
The test can highlight a potential reason for recurrent miscarriages, giving hope for future pregnancies.
Factors such as stress, smoking, alcohol, recreational drugs, obesity and other avoidable lifestyle elements can affect sperm quality. Even healthy sperm have some DNA damage, but it’s the amount of damage that matters.
Recent tests have shown that up to 80% of men with unexplained infertility have problems in their sperm DNA – problems that can only be detected using the SpermComet® test.
As well as going a long way to diagnose unexplained infertility, sperm DNA damage has also been linked to recurrent miscarriage.
Samples will be taken and processed in our laboratory, then transferred to Lewis Fertility Care, which undertake the SpermComet® Test on our behalf.