What techniques can be used to access the best sperm for fertilization?
When we consider infertility carefully, there are both female and male problems and causes. This is a truth that is confirmed by all scientific sources. In addition, sometimes the cause of infertility lies on both sides, and sometimes it is unknown.
We can start by listing all the diagnostic tools used for male infertility, such as:
- general sperm analysis,
- sperm antibody test,
- Hyaluronan Binding Test (HBA),
- Chromatin dispersion test or oxidative stress measurement
- DNA sperm fragmentation.
In addition to sperm testing, male sterility can also be diagnosed by genetic testing, hormonal testing or early observation of embryonic development.
In natural pregnancies, the interaction between the egg and the sperm determines the choice of the best sperm. When extracorporeal fertilization methods are used, this great responsibility lies with the embryologist.
How do embryologists know which sperm to choose for fertilization?
First of all, embryologists may not always be 100% right in their thinking. However, they use some techniques to be as confident as they choose. If they have a choice, they always choose moving sperm. Deciding which sperm is best can be further facilitated because fortunately, today embryologists have techniques to distinguish between two groups of sperm. For example, using magnetic separation can select the best sperm and use it for ICSI.
The second technique is called pICSI. Here, the prefix ‘p’ stands for physiology. pICSI involves pre-selection of sperm based on whether or not it binds to hyaluronan. If the sperm is correct, it has the hyaluronic acid receptor.
Embryologists can also help patients who have azoospermia (patients whose ejaculate does not have sperm). There are various causes for this condition. Sometimes the testes produce sperm, but the vascular glands are clogged and sperm do not appear in the ejaculate. Otherwise, sperm are produced in the testis, but unfortunately in a very small amount. In both these cases, embryologists can perform TESE (testicular sperm removal) – testicular puncture or microTESE methods to obtain sperm directly from the testis and use it for ICSI methods in IVF.
As a last resort to male infertility, there is always the possibility of using donated sperm in IVF programs. Also, there is the possibility of combining an IVF program with a TESE or microTESE method and a program with donated sperm. In this way, in the same cycle, the male partner is given the opportunity to try again with their own genetic material, and if the fertilization with the male partner’s sperm does not occur, embryos previously created in a separate donor sperm vessel can be used in the same cycle.
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