Sperm Collection and Preparation
Sperm is usually provided the morning of the egg retrieval. Occasionally the sperm is collected ahead of time and frozen for use after the egg retrieval. We can obtain sperm from the male partner through normal ejaculation or through more advanced sperm retrieval procedures such as microepididymal sperm aspiration (MESA), or testicular sperm extraction (TESE).
If your partner will be providing a semen specimen on the day of the egg retrieval, we recommend abstaining from intercourse for at least two days prior to the IVF procedure but not more than 6 days. This will help to obtain optimal sperm quality for the IVF procedure. Donor sperm may also be used; it will be thawed and prepared by the laboratory staff the morning of the retrieval.
If your partner has a normal sperm sample, the lab will add the sample to the eggs within five hours of egg retrieval. If the sperm quality is abnormal, then the embryologist may elect to use a procedure called intracytoplasmic sperm injection (ICSI) to ensure that fertilization takes place.
Sperm Prep and IVF Insemination
After the lab receives the semen, the andrologist will first rinse the sample with a special solution that removes dead sperm and cellular debris while also protecting the living sperm. The andrologist then takes one ml of the sperm solution and removes extra fluid by centrifuging, spinning the sperm cells through a special medium to bring the concentration up to 30,000 motile sperm per ml. This concentrated sperm solution is then used to inseminate the eggs by adding a very small quantity of the sperm to each drop of culture medium containing the eggs.
Intracytoplasmic Sperm Injection (ICSI)
In cases where the sperm volume is too low, there is a reduced sperm count, too many deformed sperm, or poor sperm motility, the embryologist may decide to use a process called intracytoplasmic sperm injection (ICSI) to ensure fertilization of the egg. With ICSI, the technician uses a needle to inject a single sperm into each mature egg. This precise, revolutionary micromanipulation procedure is performed in the Presbyterian ARTs lab and can treat severe male factor infertility, allowing couples to bypass sperm defects and achieve a successful pregnancy. ICSI treatment may also help men who have undergone a failed vasectomy reversal. With ICSI, even men with little to no moving sperm can produce a successful fertilization.
Fertilized egg
The ICSI process
First, the egg is isolated in the culture dish and held in place with a suction pipette, a thin, glass straw. The embryologist selects a single healthy sperm and removes the tail portion with the sharp end of a micro needle. After removal of the tail, the sperm is gently sucked into the glass needle and injected through the outer shell of the egg into its center.
Following the injection, the embryologist returns the culture dish to the incubator, which offers the optimal environment for fertilization to occur. Currently, we partner with Presbyterian ARTs and our ICSI fertilization rates are at 82 percent. Dr. Douglas sees pregnancy rates with ICSI that are comparable to those seen in IVF cycles of couples with no male factor infertility and normal sperm.
