The number of couples with male factor infertility probably exceeds the number with tubal factors.  This has caused an evolution of techniques in the laboratory designed to deal with severe sperm problems.  Micromanipulation of the individual sperm cells was developed.  This technique allows the embryologist to capture and inject a single sperm into an egg.

There are several methods currently used to facilitate fertilization.  One is Zona manipulation.  The zona pellucida is the tough outer coating around the egg.  Under normal conditions, the sperm head must first make physical attachment and fuse with the zona.  If the sperm is unable to accomplish this, or if sperm motility is too sluggish, fertilization cannot occur.  The first laboratory treatments were directed at weakening the membrane with locally applied acidic solution. This carries a potential for toxicity to the egg.  Partial zona drilling (PZD) consists of drilling a small hole in the zona to allow easier entry of sperm in the space within.  Motility is still necessary, and the problem is one of interference with the normal reaction of the egg, which prohibits fertilization by more than one sperm.

Multiple fertilization results in an excess of chromosomes, resulting in non-cleavage or miscarriage.  Subzonal insertion was another attempt to assist the fertilization of the egg, but ICSI, the process of actually injecting a single sperm into the egg, has surpassed earlier methods and has offered many couples new hope in male factor infertility.

Fertilization and normal pregnancy can be achieved with sperm that has no motility at all.  This enables patients with vasectomies that have been unsuccessful, or that choose not to have one, able to have sperm collected by aspiration used for ICSI.  Due to the fragile nature of sperm collected in this manner, a high tech procedure must be performed.  MESA or TESA sperm is not suitable for in office insemination.

ICSI has been performed since 1994, with significantly positive results.  If you would like more information on ICSI, please contact Dr. Nemiro, Medical Director of ACFS.