In this session, Laura Van Os, MSc, Embryologist at IVF-Spain, Alicante, Spain, has talked about sperm and how it is prepared for ART treatment.
In principle, if your husband has asthenozoospermia, if the concentration of the sperm is normal regular processing of the sperm sample, if it’s not something extreme, Density gradients and Swim-up should improve it a lot. Just doing the Swim-up should improve it.
Also, using ICSI could yield a lot of better results. If you have not performed an advanced test, perhaps I would recommend doing it to make sure there is no high DNA fragmentation or high apoptosis, for example. If this is the only thing that is going on, a normal sperm preparation with the ICSI technique should be enough to improve the results.
It’s not that one or the other is better but that they are indicated for different things. FertileChip would be the technique I would recommend if you were diagnosed with high DNA fragmentation, and MACS would be the technique that I would recommend if you have high apoptosis.
I think in most clinics, FertileChip is used a little more because it’s really easy to use, so there are laboratories that use this to process most sperm samples, but I wouldn’t say that one is better than the other, just that they are recommended for different cases.
Yes, I would say, if you have a sample not with low normal forms but with a really low concentration, then perhaps it would not make so much sense to use the MACS technique where you cannot make a big selection. However, it could make sense to use MACS for normal forms, not because the normal forms themselves will be solved by the MACS technique, which is not the case, but perhaps the fact that you have teratozoospermia might be an indication that also molecularly the sperm is not doing so well you might want to extra select sperm which have good molecular integrity and MACS would help with this.
It’s not really like MACS is indicated for teratozoospermia. What I would recommend is to do an advanced sperm analysis, and if everything comes out okay depending on your previous history, if you have some history, then perhaps it would not be necessary. If there is something in your history suggesting there is something more going on, and the tests you perform will show that something strange is going on, it could be an indication for you then.
Some patients request this test, and we perform it. If the result of the FISH test shows that you have a little higher percentage of abnormal chromosomal content in the sperm cells than you expected, what you should do is perform PGS. In many of our patients, we will be directly recommending this because of high advanced female age, the previous history of the patients, etc. When we’re going to do PGS, we do not perform FISH analysis because eventually, an altered result of FISH would lead to PGS anyway, but we do perform this in some specific cases.
You can keep trying, and perhaps someday you will be lucky, but the problem is that when you turn 35 years old and onward, your fertility decreases, so you should get checked and see your hormonal values, your ovarian reserve, etc. If you already have been trying for more than a year, then you should get checked. Sometimes people go to their gynaecologist, and they say just keep trying, and they do not get tested.
When they get tested, they realize it’s too late because they don’t have enough ovarian reserve anymore, and now the picture is a lot more complicated, and it gets more difficult. You can perform some tests to see how much time you have, but be aware that from 35 years old, your fertility will decrease, the quality of the eggs and the euploid of the embryos will also decrease. Depending on the results and how long you have been trying, I would go to a physician. Have a fertility check, and follow the doctor’s recommendations.
In this case, as there is both a female factor and a male factor involved, it can make it a little more complicated. The fertility specialist will be handling the female part and will try to improve the egg quality, to try to have the best stimulation possible, obtain the best eggs possible, which will have a major role in the cycle. The morphology problem we will solve in the laboratory, or we will try to improve it in the laboratory. Perhaps this would complicate your chances of having a natural pregnancy.
However, in the laboratory, it’s quite easy to solve it. We will prepare the sample because we will have millions of sperm cells, and out of these millions of sperm cells, we will only take the best ones eventually unless it’s a very extreme factor for us. In the laboratory, it’s not such a difficult point. It can sometimes diminish a little of the blastocyst rate, so how many embryos you get from a cycle, but it’s something that we can quite easily sort in the laboratory because of this big selection of sperm cells.
The thing about PICSI is that it’s such an easy technique to use and not time-consuming in the laboratory. We might use it also when we have just a suspicion that something might be going on because, in any case, it will not harm. A super indication for PICSI would be when we perform an SCSA (Sperm Chromatin Structure Assay) test, and we see there is a big population of immature cells, which we have seen sometimes.
Another indication would be if there is a slight DNA fragmentation, which is high, or there’s some suspicion that something is going on with the sperm because it will not harm it, so if there are any sperm factors or suspicion of sperm factors, we could perform PICSI.
There are a lot of master degrees available to become an embryologist. I would recommend picking the master’s which offers you the biggest chance to do internships. The theory you can learn easily, and you will study it during your work anyway. However, the training that gives you some hands-on training that will allow you to make contacts in the IVF world would be the best master’s degree.