intrauterine insemination (IUI)

During sexual intercourse, the ejaculate (seminal fluid containing sperm) is deposited in the vagina close to the neck of the womb (uterus). The sperm cells swim through the cervix – aided by the cervical mucus – enter the uterus and continue into the fallopian tubes where fertilisation occurs.

During intrauterine insemination (IUI), however, selected sperm cells taken from the male partner are placed directly in the uterine cavity (intrauterine). As a result, they are nearer to the site of fertilisation.

IUI is used for the treatment of a number of different types of fertility problem. Couples may be considered for IUI if there is reduced sperm quality or a low sperm count; if the cervical mucus is hostile to the sperm or if anti-sperm antibodies are present. IUI can also be used with couples with unexplained subfertility. The procedure is very simple and must be carried out around the time of ovulation in the doctor’s consulting room. To improve the chances of pregnancy, IUI is often combined with drug therapy in the woman. The chance of pregnancy is approximately 10% per IUI cycle.

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in vitro fertilisation (IVF)

In vitro fertilisation is the most commonly used procedure and has become increasingly popular since the first IVF child (Louise Brown) was born in 1978. IVF is a multistage process, in which the egg is taken from the woman’s ovary, fertilised in a laboratory using the male partner’s sperm, allowed to develop into an early embryo and then replaced into the woman’s uterus (womb). Usually, three embryos are replaced in the woman’s uterus after fertilisation. The average success rate per IVF cycle is approximately 20%.

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intracytoplasmic sperm injection (ICSI)

Intracytoplasmic sperm injection (ICSI) is used in conjunction with IVF to improve the chance of fertilisation if severe sperm abnormalities are present. It involves injecting a single sperm cell into an egg in the laboratory with the help of a microscope and special instruments. This method was first described in 1992. It is not just used in couples with severe male infertility: it is also used in those whose sperm quality is normal if a conventional IVF procedure has produced no, or only a very few embryos. The average success rate per ICSI cycle is approximately 25%.

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MESA/TESE

If the man produces sperm cells, but the sperm is ‘trapped’ within the testicles as a result of occlusion or a hereditary condition, the sperm can be collected surgically. An operation to collect sperm from the epididymis is called MESA (microsurgical sperm aspiration); while an operation to collect sperm from the testicles is called TESE (testicular sperm extraction).

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PESA

This treatment is a new option for couples where the male has absolutely no sperm in his ejaculate as a result of a blockage in the sperm ducts. In this case a needle is punctured into the testicles and sperm cells may be obtained from the epididymis. These sperm cells can be used in a conventional ICSI procedure to bring about fertilisation.

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