Get in touch
with us for individual advice regarding your best fit clinics.
In cases of non-obstructive azoospermia, when the level of spermatogenesis is very low, the most suitable examination method is biopsy with multiple tissues.
With this method, an expert urologist surgeon, using a microscope, cuts the healthier testicular tubules in which spermatozoa are most likely to be found. A clinical embryologist, who, with the help of another microscope during the surgery, checks the samples for the presence of spermatozoa, directly inspects these samples. If mature sperm are found, they will be frozen or used directly to fertilise the female partner’s oocytes.
Objective and non-invasive imaging of embryo characteristics allows detection of abnormal cleavages leading to the occurrence of chromosomal malsegregation which are a major cause of spontaneous miscarriage or birth defects.
Scanning and analysing embryo development is a breakthrough approach in assessing human embryos in a culture medium. It is performed by a computer which continuously monitors the embryo’s development. The embryos are not disturbed during their extracorporeal development by constant examinations as the entire monitoring process happens behind closed doors of the incubator. Subsequent analysis is based on acquired digital records.
The developmental abilities of human embryos can be predicted by measurement of their cell cycles. Continuous non-invasive embryo monitoring allows an exact measurement of these phases of human embryo development. The duration of the first 4 interphases and synchrony of the daughter cells cleavages are expressed in Embryo Cleavage Rating (ECR) and correspond with regular ooplasmic metabolites and organelles distribution and with embryonic genome activation (EGA).
With the assisted hatching method, an opening is created in the egg shell surrounding the embryo. This opening simplifies the hatching process of the embryo and increases the chance of it coming in direct contact with the mother’s endometrium.
The method of assisted hatching seems to improve prognosis in certain types of recurrent failures, such as in cases:
• of multiple implantation failures
• after thawing of embryos
• of structural abnormalities of the egg shell
• of higher age in women
The process of assisted hatching is carried out just before embryo transfer, when the number of embryos to be transferred has been determined and it is perfectly safe for the embryos themselves.
Assisted hatching may increase the chance of pregnancy in couples undergoing IVF.
Laser-Assisted Zona Thining
On the 5th or 6th day of its development, the embryo leaves its protective outer layer (zona pellucida), which among other things has protected it till now from extracorporeal manipulation. This process of breaking out or “hatching” is necessary for the embryo to establish contact with uterus cells in which it becomes implanted.
Some embryo implantation problems in patients with recurrent implantation failure may be explained by the inability of the embryo to hatch out of its zona pellucida. This may occur naturally or hardening process can arise after vitrification. In such cases, zona pellucida can be thinned in one part using the laser technique to improve the pregnancy, implantation and delivery rates. LAZT offers many advantages over traditional assisted hatching (AH).
Mainly, it does not involve opening of the protective layer and internal environment of the embryo remains intact. The risk of immunosuppressants from white cells and any local inflammatory are more harmful to the blastomeres of total zona pellucida assisted hatching. Furthermore, LAZT is not associated with an increased rate of identical monozygotic twins as opposed to zona opening methods.
There is no need of concerns about using laser since the target in reaction process is controlled accurately and has been shown to have no mechanical, thermal or mutagenic effect.
Developments in micro-injection and technological enhancements in microscope lenses enable the most effective tracking of healthy sperm.
The latest studies, confirm that when the intracytoplasmic sperm injection (ICSI) method is combined with the injecting morphologically selected sperm (IMSI) method, it improves:
• the fertilisation rate,
• the rate of embryos reaching the blastocyst stage, increasing the chance of pregnancy and obtaining healthy children, while the rate of miscarriages decreases.
Magnetic-Activated Cell Sorting
Genetic integrity of the spermatozoon is essential for normal embryo development. A high level of DNA fragmentation in sperm cells can negatively affect embryo cleavage and subsequent development leading to blastocyst arrest or early miscarriage. DNA damage represented by fragmentation and subsequent sperm apoptosis may be a cause of male infertility that standard methods – sperm concentration, morphology assessment and motility analysis cannot detect.
A major causative factor for sperm DNA damage is oxidative stress generally increasing with the age and/or inflammatory infections, cigarette smoking, drug use, exposure to environmental pollutants and elevated testicular temperature.
Therefore, MACS System was designed to selectively remove these defective although morphologically indistinguishable cells from sperm preparations. The procedure begins with magnetic labelling of unwanted cells and then, they are passed through a separation column where they are selectively retained. Intact living spermatozoa without DNA fragmentation pass through the column and are collected for later use (ICSI or cryopreservation).
Gain of the sperm ready for fertilization represents the key advantage over traditional DNA fragmentation tests (e.g. SCSA/SDIA, see Tab. below) in which patient obtain only impractical information on percentage of damaged cells. Similarly, methods for morphological assessing, like IMSI, cannot provide sufficient picture about the state of the DNA in the sperm nucleus.
Laser-Assisted Immotile Sperm Selection
This method, which uses a laser to identify viable sperm cell for subsequent ICSI, is recommended in MESA/TESE IVF cycles and any other cases of immotile spermatozoa.
Sperm viability is a prerequisite for a successful ICSI treatment, because the injection of a nonviable spermatozoon into an oocyte generally results in fertilization failure. To identify viable sperm in patients presenting with complete sperm immotility is a challenging but very important step. Using LAISS a single laser shot is applied close to the tip of the sperm tail using a non-contact 1.48 µm diode laser system. In a few seconds, two possible reactions can be observed, either the tail of the spermatozoa starts curling after the laser shot, or the spermatozoa show no reaction at all.
Spermatozoa showing a curling reaction are considered to be viable and can be used for ICSI treatment immediately. In contrast to another methods e.g. hypo-osmotic swelling test, the laser selection can be performed directly in IVF medium with no additional micromanipulation.
LAISS is regarded as a safe procedure since a shot applied to the far end of the flagellum does not affect the sperm head containing the genetic material. Moreover, this novel technique used in a specific group of patients increase the chance to select viable spermatozoa capable of fertilization.
Asynchronous Embryo Transfer
So called „window of implantation“ (WOI) is a short period of time when the female uterus is capable of accepting a viable embryo for further development, pregnancy. Normally, the endometrium is embryo-receptive around days 19 to 21 of each menstrual cycle. In other days, or in cases of endometrial dysfunction, the female uterus is not ready for pregnancy, and healthy embryos are rejected and die (implantation failure).
As a part of infertility therapy, hormonal treatment can positively modulate the embryo-friendly changes in the female uterus before embryo transfer in IVF cycles. Moreover, the endometrium preparedness can be monitored during each menstrual cycle by ultrasound examination. However, some infertile women still fail to develop pregnancy, despite having high-quality embryos and good-looking endometrium. Endometrial dysfunction (endometrial factor) can be further tested on a molecular level by invasive Endometrial Receptivity Array (ERA test), for which a small piece of uterine mucosa is surgically biopsied and examined for function of several hundreds of genes related to embryo implantation (paid services in specialized laboratories).
In selective clinics, asynchronous embryo transfer (ASET) is available for patients with compromised endometrial receptivity confirmed by laboratory, as well as for patients with suspected endometrial factor. The level of endometrial receptivity may vary from cycle to cycle, and the occurrence of implantation window (WOI) may vary as well. Therefore, some embryos can be postponed, so that 2 or 3 embryos of different developmental stages (asynchronous) are transferred. This way, delays in WOI peak or occurrence from 1 to 5 days can be compensated for.
How can I use your travel
After booking your treatment, we will make you a few suggestions on travel packages. You can decide whether you would like to go ahead and get one of those. Travel packages are paid to Redia in full.
Our aim is to be able to understand your needs and to devote ourselves to their satisfaction, ensuring value for money combined with superior quality, in all our services.
In this way we wish to build up a mutually trusting relationship. Our team welcomes you