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5. Male Infertility-Andrology

Recent surveys have shown that male infertility is probably the largest single cause of infertility. At least half of all human infertility is male factor related. A full assessment of the male, detailed analysis of the seminal plasma and sperm function tests are important for a comprehensive evaluation. Currently, knowledge of sperm function and its relation to infertility is rudimentary. Since specific tests to determine the fertilizing ability of the sperm are not available a treatment schedule has been developed. Success of these treatments is based on large clinical trials. Intrauterine insemination is the first step in the treatment ladder and ICSI with ejaculated and testicular sperm is at the top end.

6. Surgical Sperm Retrieval TESA, MESA, PESA

PESA (Percutaneous Epididymal Sperm Aspiration) - This is a non-invasive method of sperm recovery and has excellent potential for patients who have had a vasectomy and do not wish to undergo reversal, or patients who have had an attempted reversal which has failed. In percutaneous epididymal sperm aspiration sperm are aspirated through a fine needle that is placed into the epididymis.
TESA (Testicular Sperm Aspiration) - This is a surgical sperm retrieval procedure used in fertility treatment for men who have no sperm in their ejaculate. The extraction of sperm is achieved through a fine needle inserted into the testes. Where this is not successful, then a microsurgical testicular biopsy is done.

7. Cryopreservation (Freezing of Semen, Testicular tissue and Embryos)-Slow Freezing & Vitrification

Cryopreservation (Freezing and Storage)

a) Cryopreservation (freezing and storage) of embryos Following IVF maximum of three/four embryos are transferred in each cycle. The remaining embryos may be frozen for embryo transfer at a later date. Only good quality embryos are frozen since they have a better survival rate on thawing .It is important to note that even good quality embryos may not survive the freezing and thawing process. We currently are using the latest technique in cryopreservation called ‘vitrification’.

b) Cryopreservation (freezing and storage) of sperm The preservation of sperm by freezing is now a fully accepted routine procedure. Most, although not all, semen samples can be frozen/preserved for long periods and thawed without loss of fertility. In patients going through an IVF/ICSI cycle, semen is cryopreserved prior to cycle commencement. This is important because at times (generally due to stress or sudden illness) the husband is unable to give the sample on the day of egg retrieval. This facility also allows women to continue with their treatment cycles when the partner is not available.

 8. Donor Programme (Semen, Oocyte, Embryos)

Facilities for gamete donation are available. Detailed screening of the donor is carried out prior to his/her acceptance into the program. Anonymity of both the donor and recipient is maintained.

a) Donor Insemination (DI) All donors are very carefully screened for sexually transmitted diseases, Hepatitis B & C. A detailed history is obtained to rule out current or past diseases and inherited disorders. Donors are matched as closely as possible for physical characteristics to the male partner of women receiving the donor sperm. Donor anonymity is maintained as per ICMR regulations / ART bill.

b) Egg Donation Some women are unable to produce their own eggs due to hormonal deficiency, genetic predisposition or other medical conditions. Others choose to have egg donation because they carry a genetic illness, which may be passed on to any babies born or they have poor quality eggs or recurrent miscarriages. Through egg donation these women have the opportunity to give birth. The patient receiving the donated eggs (the recipient) is treated with hormones to prepare the lining of the uterus to receive the embryos. Eggs are recovered from the donor who has to go through ovarian stimulation to form multiple eggs and then these are recovered under anaesthesia under ultrasound guidance. The entire procedure is carried out vaginally. The sperm from the recipient’s husband is used to inseminate the eggs (either by IVF or the ICSI technique). The resulting embryos are transferred two/three days later to the recipient’s uterus.

c) Embryo Donation Some couples, for a variety of reasons, are unable to produce their own genetic gametes (i.e. sperms or eggs). In such cases both donor sperms and donor eggs can be used to produce a donor embryo. The woman’s uterus is prepared with hormonal tablets to receive the embryo.

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