The selection of sperm that is to be penetrated into the egg is very important. Sperm that have genetic problems or failure to fertilise an egg due to various problems may affect fertilisation process negatively. This may decrease pregnancy rates and cause fertilisation failures and embryos that have poor quality or genetic disorders. The primary aim is to produce high quality sperm and then to obtain pregnancy from the sperm that is selected by using various advanced technological methods.
Evaluation Of Sperm Parameters
It is the evaluation of sperm cells in terms of quantity, motility, and shape. The data obtained from these investigations give valuable information about the delay of spontaneous pregnancy. Kruger’s strict criteria are a
standard for measuring sperm morphology, or its shape.
DNA Damage Analysis
This is the evaluation of most valuable asset of a sperm cell which is the one and only cargo that these cells carry –the genetic material. It is of critical importance that the DNA carried by the sperm cells must be in good condition and free of DNA damage. Obesity, age, tobacco and alcohol consumption, stress, genetically modified foods, and genetic factors can result in personal distortions. This may lead to the diagnosis unexplained infertility. Sperm DNA damage analysis, reveals any problems with the quality of DNA carried by the sperm cells and this parameter is in-
dependent from the other routinely used sperm tests. Therefore, sperm DNA damage levels should be investigated in cases with early pregnancy loss and/or recurrent IVF failures. Later, if there is an increase in sperm DNA damage levels, a suitable treatment and support scheme should be put in order to increase the chances of a healthy baby. The use of spermwithout any damage or disruption is the first stop on the path to success.
ROS Test (sORP Test)
Semen analysis is indicative only in measurement of visual (motility, count,morphology) parameters of sperm cells. In the light of recent studies, we know more about cell biology. According to the latest developments, the antioxidant capacity of semen is crucial in infertility treatments. Increased reactive oxygen species (ROS) in semen cause sperm DNA damage. In addition, it causes severe damage in sperm cell membrane. As a result of these damages, sperm’s capability to fertilize an egg and chance of getting a healthy embryo decrease. As it can be seen from Balancing Concept, these ROS molecules must also be in equilibrium. Therefore, ROS balance in semen should be measured
and the correct treatment should be applied to correct the balance or unnecessary treatment should not be applied.
Sperm Function Tests
In Gürgan Clinic Embryology Laboratory, several semen parameters are used to identify the problem and in general all these test panels are called SFT. These tests are highly predictive of IVF outcome results and assist in decision making. We offer healthy pregnancy and delivery with healthy embryos.
Retrieving Sperm From the Epididymis
Azoospermia, which means the absence of sperm cells in the semen, is one of the important causes of male infertility cases. Azoospermia occurs in 1% of all males and in 10-15% of males with infertility problems. In these
cases, sperm cells can be obtained from the reproductive canals or testis tissue and microinjection can be performed. After the investigation and diagnosis of Azoospermia, suitable treatment plans (hormone therapy, empirical treatment) schedule in order to increase the chances of retrieving viable sperm cells. Surgical sperm retrieval operations (MESA, PESA, TESA, TESE, Micro TESE) are the final choices to retrieve sperm. Our first goal is to find viable sperm in the semen. In case of sperm absence, the method of surgical intervention with the highest rate of sperm detection is determined and executed. In the case of obtaining sperm from the testis by the surgical method, mature sperm must be identified and selected very carefully.
In the method we call FIBER; under the microscope, the pieces taken from the testicle are separated mechanically and enzymatically into the fibers. Then each testis sample is examined by more than one embryologist for approximately for four hours of sperm. Once the presence of sperm is confirmed, the most mature sperms under special microscopes are selected with polarized light and fertilized the eggs with the microinjection process. Thus, the percentage of sperm retrieval is reduced to the highest levels and the quality of the embryos will be higher by using these sperm. The sum of all these operations; positively reflects pregnancy rates and live birth rates.
With the use of surgical sperm retrieval, 100% of the azoospermia patients with duct obstruction and 65% of the non-obstructed azoospermia cases have sperm.
ROSI (Round Spermatid Injection)
In cases where no mature sperm cells were found, precursor sperm cells called round spermatids can be used for fertilization. Although the chance of healthy baby with this extremely specialized technique is lower, there is still chance for a healthy baby. This method is currently the best hope for patients with non-obstructive azoospermia with negative sperm retrieval to have a baby of their own genetic material.
It is an application based on the prediction of sperm problems that may arise due to genetic predisposition, tobacco and alcohol consumption, stress, obesity, advanced age or various diseases. Relevant treatment modalities shall be applied to correct any identified problems.
Special tests that determine the rate of defect in sperm function are used to detect and repair the problem(s). For the establishment of hormonal balance, needles and medications should be used to replace missing hor- mones. A supportive medicine, vitamins and antioxidant treatment helps to obtain better quality and healthy sperm can be obtained.
Methods Applied For This Purpose
• Diet, obesity and insulin resistance control
• Lifestyle changes, psychological support
• Help with tobacco and alcohol consumption
• Hormonal treatments
• Antioxidant therapies
• Vitamin treatments
• Microbiota editing
Sperm Selection and Related Special Techniques
The sperm that is used to fertilize the egg should be selected from a mature sperm population and should have an intact/damage-free DNA. To this end, experienced personnel should apply various personalized techniques. According to the data obtained in our center; the use of specific diagnostic and therapeutic approaches in men with no sperm, with no sperm count, movement and abnormal developmental problems increase treatment success.
Micro fluidic chip method is used for the selection of sperm that is better in physiological and genetic terms by eliminating the damage of classical methods such as centrifugation. This technique, which involves creating a of the
natural-like environment found in the female reproductive system, allows the selection of the sperm cells that can pass through the micro-channels as close to the nature. It can contribute to increasing the success as a
promising treatment with additional methods especially in male factor problems. It was found that the sperm quality was better when the sperms were selected initially with the current chip technology and the genetic quality of the sperm was chosen again with a new chip. Therefore, in advanced male factor cases, the sperm selection technique we call DOUBLE CHIP is important for obtaining the sperm cells with the highest quality.
This is the technique of selecting the right sperm using the double-refraction property of light with a Polarized microscope. In this technique, a special light is sent on sperm samples. The difference in the light reflection of the sperms, which are DNA fragments or the problem of fertilisation, ensures that the problematic sperms are separated from the healthy ones and not used for fertilisation. The selection of good sperms for fertilisation makes the embryo
development more competent.
Microinjection with High Magnification
It is a technique of sperm selection by utilizing special microscope lenses and computer software to achieve high-resolution and very high magnification live images. Conventional sperm selection using a micromanipulator
is performed under 400xmagnification. However, some sperm cell defects are nor visible under that magnification (such as acrosomal vacuoles). However, by utilizing the magnifying power of specialized lenses under a specifically arranged microscope we can obtain ~6600xmagnification in order to identify those defects (that are normally not visible with conventional methods). Under experienced and scientific hands, this technique is a powerful tool
in order to select the most competent sperm cells to be used for fertilisation. Some studies show that this process has positive effects on fertilization and embryonic development and therefore has positive effects on live birth rates.
Hyaluronan Binding Assay (Physiological Microinjection / Membrane Binding Technique)
When the sperm is prepared for microinjection (ICSI), which is the process of fertilizing the eggs, the most mobile and smooth ones are selected by special techniques. In this method, sperm for microinjection is selected in special solutions. These solutions differentiate the quality of DNA from the healthy sperm according to their ability to bind
hyaluronan (a compound found in the matrix that surrounds the oocytes physiologically). Sperm cells that are bound to this compound were shown to have normal morphology, are mature, also have low DNA fragmentation. Scientific studies show that physiological ICSI increases the rate of fertilization and embryo quality while decreasing abortion rates.