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Friday, 12 September 2014

Surgical sperm collection

Surgical removal of sperms is done in men with no sperms in the semen (azoospermia). The reasons for azoospermia may be due to a blockage in the tubes that carry the sperms from the testes (Vas Deferens) or due to a vasectomy. Some men may also have a congenital absence of the Vas Deferens. Lack of sperms may also result from a slowing or stopping of sperm production in the testes. 

Men who are unable to ejaculate may also require to undergo this procedure. In this scenario PESA is not done to avoid injury to the otherwise normal anatomy.

These procedures are generally done under local anaesthesia either on the same day as the egg collection of the wife or as an stand-alone technique. In the latter case, sperms may be frozen for later use. The disadvantage of freezing is that a significant proportion of sperms are lost in the freeze-thaw process. 

The surgical retrieval sperms is done from either the testes or the epididymis. The procedures that are commonly done are

PESA - Percutaneous Epididymal Sperm Aspiration is commonly used where there is either a blockage or an absent Vas Deferens. By aspirating fluid from the Epididymis, sperms that have been produced by the testes but are unable to go forward can be retrieved and used for fertility treatments and surplus sperms can even be frozen for future use.

TESA - Testicular Sperm Aspiration is employed where there is a slow production of sperms. A needle is used to aspirate fluid from the testes and this fluid is scanned under the microscope for presence of sperms. 

TESE - Testicular Sperm Extraction involves removal of  one or more tubules in which sperm production normally occurs. Sperms are then extracted from these tubules.

Friday, 5 September 2014

Donor egg IVF

Donor egg IVF is the modality of fertility treatment where eggs are taken from a donor (through ovarian stimulation and egg collection); these are fertilised using the husband's sperms and transferred into the uterus of a recipient after 2-5 days of culture. 

Donor egg IVF can be opted for in a number of situations. The women in whom ovarian reserve is either very low or who have entered menopause can opt for a donor egg. This may be either because of prior surgeries, chemotherapy or radiotherapy (for cancer treatment). In situations where the embryos formed are poor quality or there is a persistent failure of fertilisation, donor egg can be used to achieve a pregnancy. Successful outcome from IVF declines with age, so this option can be taken by women who are older than 40-42 who are keen to increase their chances of conception. Last but not the least, if the women is the carrier of inheritable disease that can be passed on to the child, donor eggs can be used to prevent the disease transmission to the child. In the last scenario where facilities are available and where the gene defect can be tested, PGD can be used to screen embryos before transferring.

The cycles of the donor and the recipient are synchronised either with hormone pills. The donor undergoes ovarian stimulation while the recipient has estrogen tablets to help prepare the lining of the uterus. In addition, the recipient may also be given an an injection to prevent any ovarian activity as this could interfere with the cycle. Once the donor is ready for egg collection, the couple are informed. On the day of egg collection, the donor's eggs and the sperms from the male partner are used to form embryos. The recipient now starts taking progesterone hormone (most commonly in the form of pessaries) to enable the best chances of conception. Embryo transfer is done as usual after selection of embryos. Surplus embryos may be frozen for later use.

Donor egg opens the door to the possibility of conception in many couples and can be a very precious gift for the couple trying to conceive.