Intracytoplasmic sperm injection (ICSI) is performed when sperm quality is poor due to a very low sperm count. The head of the sperm is injected into the egg using an extremely small glass needle to pick up the sperm and place it in the egg.
The sperm used for ICSI can be obtained by masturbation or directly from the testes by surgical procedure. Sperm can be extracted directly from the epididymis via aspiration or microsurgical techniques, such as microsurgical epididymal sperm aspiration (MESA) or by sperm aspiration or from the tested as testicular sperm aspiration (TESA). Congenital absence of the vas deferens or seminal vesicles or failed sterilization (vasectomy) reversal, inability to ejaculate are reasons why MESA or TESA might be necessary.
Assisted Hatching involves creating an opening in the outer covering, or Zona pellucida, of the embryo is created using micromanipulation techniques. This technique is used for embryos with thickened zona pellucida.
Not every growing embryo will be transferred. It is recommended that only one or two embryos be transferred to most patients. Untransferred embryos can be frozen (cryopreserved) and stored for future transfers. Louisiana State law requires that all embryos which are not immediately transferred and continue to grow must be cryopreserved. Once embryos are stored, they can remain frozen for long periods of time. Half to two thirds of embryos will survive the freezing and thawing process. Cryopreservation allows for further attempts at pregnancy without further surgery.
Conditions requiring the use of donated eggs include premature ovarian failure, genetic abnormalities, prior ovarian surgery, radiation, or chemotherapy, repeated failure of in vitro fertilization, unexplained and repeated miscarriages and advanced age. Egg donation programs may use two types of donors: known or Anonymous. Known donors can be friends or relatives who undergo ovarian stimulation in order to help the recipient. Anonymous donors may be patients who have produce a large number of eggs and are willing to donate their excess eggs or women who are paid to donate their eggs. The Fertility Institute of New Orleans performs egg donation only for known donors and women willing to share eggs from their own IVF cycle (Egg Sharing Program).
In the absence of a functional uterus, a patient may choose to have another woman carry the genetic baby conceived from her eggs and her partner's sperm. Eggs are retrieved and fertilized in the same manner as for IVF, except that the resulting embryos are transferred into the host uterus to develop. This procedure is performed only after careful psychological evaluation is performed on both couples involved and a legal agreement is in place between the couples.
Preimplantation Genetic Diagnosis (PGD)
PGD (Pre-implantation Genetic Diagnosis) is performed in the same manner as PGS but is indicated for patients who are at risk for inherited genetic disorders. Genetic disorders for which PGD is used include Cystic Fibrosis, Tay Sachs, Thalassemia, and sex linked genetic disorders, such as muscular dystrophy. New programs under development will allow PGD to be used to screen for increased risk of cancer, cardiovascular disease and diabetes.
GIFT and ZIFT
Other ART procedures that are sometimes used include gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT), provided that the fallopian tubes are open.
In GIFT, conception (uniting of the sperm with the egg) occurs inside the woman instead of in the laboratory. Therefore, it is acceptable to couples that would otherwise not have the benefit of IVF and advanced technologies for religion reasons. ZIFT involves transfer of developed embryos into the fallopian tubes by laparoscopy. ZIFT is performed when it is not possible to transfer embryos into the uterus by the vaginal route, as is done in regular IVF.
Egg sharing allows couples who require IVF, and expect to have more eggs then they need, to share their excess eggs with another couple who need eggs due to age or other reasons. In return for sharing their eggs, part of the expenses of the IVF cycle is paid for by the couple who receive eggs. Both couples benefit: the couple who share eggs because part of their IVF cycle is paid for and they have the satisfaction of helping another infertility couple; the recipient couple because otherwise eggs would have to be obtained from a paid egg donor. The woman planning to share her eggs should be younger than 35 years, with no chronic health problems and should expect to develop 8 or more mature or nearly mature eggs during ovarian stimulation.