In Vitro Fertilisation (IVF) and Intracytoplasmic Sperm Injection (ICSI) Melbourne
IVF produces good results for couples with male infertility treated by Dr Barak.
Standard IVF procedures produce good fertilisation rates unless the sperm morphology, motility or concentration is very low, or there are sperm antibodies or specific problems with the fertilisation process. For severe semen disorders, for example, if there are less than 2 million normal motile sperm in the semen, sperm morphology is >95% abnormal or sperm are obtained from above obstructions in the genital tract there is a substantial chance of failure of fertilisation with standard IVF. In these situations ICSI is used to improve the chances of fertilisation occurring.
ICSI is now the method of choice for treating severe sperm problems. With this technique a single sperm is injected into the substance (cytoplasm) of each oocyte with a fine glass needle. This procedure may also be applied in situations where fertilisation could fail because of sperm antibodies or certain specific disorders of sperm motility, shape or function. Provided that a live sperm can be found for each oocyte, good results can be obtained with average normal fertilisation rates the same as those for normal semen in standard IVF.
The pregnancy rate following IVF or ICSI depends on the number of embryos transferred. Usually one or 2 embryos are transferred at a time and between 10-20% will implant. With single embryo transfers the pregnancy rate is about 20% with fresh embryos and 15% with frozen embryos and with two embryo transfers: 35 and 25% respectively. The cumulative chance of a first successful pregnancy with transfer of fresh and frozen embryos from repeated oocyte collections for IVF/ICSI is shown in the table for different female age groups.
|Age group||Cumulative percentage live birth pregnancy rate after 1, 3 or 6 oocyte collection procedures|
|< 35 years||50||85||90|
|40 + years||15||25||40|
Other factors affecting the success of IVF/ICSI, in addition to number of embryos transferred and female age are: number of unsuccessful treatments, quality and number of cells in the embryos and previous successful IVF treatments. IVF/ICSI is not always successful and a number of couples with failures of fertilisation or implantation will still need to learn to live with the infertility and consider other alternatives such as donor insemination, adoption or child free living.
Severe disorders of sperm production: sperm collection from semen, testes or genital tract
With ICSI it is now possible to treat couples where only a few live sperm are produced by the man because of an untreatable severe disorder of spermatogenesis. Generally multiple semen collections are performed in the hope of obtaining some live sperm to be stored frozen in liquid nitrogen. If this is unsuccessful a diagnostic testicular biopsy may be performed with a fine needle under local anaesthesia to determine the type of spermatogenic problem. If maturing sperm can be seen it should be possible to use the same biopsy method to obtain sperm for ICSI. If no maturing sperm can be seen it still may be possible to obtain sperm with open biopsies under general anaesthesia with sampling of multiple sites. However, success rates are variable (20-60%) and depend on the type of problem with spermatogenesis, being poor for germ cell arrest and Sertoli cell only syndrome, but better for Klinefelter syndrome. Patients wishing to have treatment attempted under these circumstances should consider the use of donor sperm in case the biopsy procedure fails to provide sperm for ICSI. Contact our IVF Melbourne Clinic for more information.