IVF in male infertility

In vitro fertilization or IVF is the most effective method of combating infertility. During this procedure, the fertilization of the egg is not in the body of a woman, but in a test tube. ECO includes several stages:

• stimulation of ovulation with the help of hormonal preparations and monitoring of follicles;
• puncture of follicles in order to obtain eggs;
• fertilization of eggs with partner spermatozoa;
• embryo culture;
• transfer of received embryos into the uterine cavity;
• hormonal support of the woman's body.

Modern assisted reproductive technologies help to overcome infertility caused by both female and male factors. At the same time one of the main problems solved by IVF is the poor quality of sperm. Several methods have been developed aimed at obtaining a sufficient number of full spermatozoa:

• microsurgical epididymal sperm aspiration( MESA);
• extraction of spermatozoa from the testis( TESE).

MESA

Microsurgical epididymal aspiration of spermatozoa is a microsurgical procedure aimed at obtaining a large number of spermatozoa from the epididymis. Only a few cubic milliliters of epididymal fluid make it possible to identify millions of sperm that are suitable for the fertilization of the egg. That's why often a certain part of the received material is subjected to cryopreservation or freezing, which allows saving spermatozoa for subsequent IVF attempts.

The MESA procedure can be performed in two ways:

• using a micropocket and a blunt micropipette - during the operation, the epididymis is opened with subsequent sperm collection;
• using a micropuncture pipette - does not require dissection of the epididymal coat. A micropuncture pipette, whose tip diameter does not exceed 0.25-0.35 mm, the doctor performs several punctures of the spermatic cord.

TESE

Extraction or extraction of spermatozoa from the testicles is an open technique of testicular biopsy. When performing the manipulation, the surgeon chooses an avascular area on the surface of the testicle, produces a cut, and then dissects about 500-700 mg of testicular parenchyma. The operation can be performed under both local and general anesthesia.

An advanced technique for obtaining a sufficient number of spermatozoa is Micro-TESE.During this operation, only 3-5 mg of testicular tissue is removed. Despite the small amount of extracted material, thanks to the selection of the most suitable seminiferous tubules, it is possible to obtain a large number of spermatozoa. In addition, the exact identification of the circulatory network of the testicle is carried out, which minimizes the risk of damage to blood vessels and testicular tissue.

Features of IVF in male infertility

Intracytoplasmic injection of spermatozoa is exactly the technique that allows fertilization of the egg cell with sperm obtained. Application of ICSI in the IVF procedure significantly increases the chance of obtaining a viable fetus. As with conventional in vitro fertilization, the partner's body is prepared with the help of hormonal preparations. After receiving eggs and spermatozoa with the help of microsurgical manipulations, specialists start to perform IVF directly.

When using the ICSI method, the sperm performs the fertilization of the egg not independently, but under the supervision of a doctor. When preparing for the procedure, a specialist selects the most complete spermatozoa under a four-hundred-fold increase in a special micromanipulation system. The isolated spermatozoon is placed in a special viscous solution, which prevents damage to the cell. Then the embryologist deprives the spermatozoon of the ability to move, destroying the membrane of his tail. After this sperm is absorbed into the cavity of the microneedle, which is introduced into the egg.

The probability of achieving a positive result in the treatment of male infertility largely depends on the causes of infertility in a married couple. Undoubtedly, the more sperm of satisfactory quality it is possible to get during the TESE and MESA procedures, the higher the chance of success. Not the least role is played by the woman's age. So, if the partner is younger than 35 years, the percentage of conception with IVF is 35%.For women aged 40-42 years, this figure is only 14%.

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