MALE INFERTILITY, ICSI, and NSA

Outstanding medical care, years of focused experience, and state of the art technologies have made Genetics & IVF Institute a renowned center for the diagnosis and treatment of male infertility. Our dedication and willingness to treat the most difficult male infertility problems, and our success in doing so, has made our Institute a world leader in its field. Among infertile couples, either partner may contribute to the failure to conceive. It is estimated that 30-40% of infertility is due to female abnormalities, another 20% to a combination of various factors, and about 30-40% to problems with the male.

An important component in the treatment of men with infertility is establishing the correct diagnosis. Genetics & IVF Institute medical specialists conduct a thorough clinical evaluation of each couple. State of the art semen analysis and specialized sperm function testing are available, including measurement of sperm capacitation and acrosome reaction, computer assisted sperm motion analysis (CASA), sperm antibody, and leukocyte quantitation. An appropriate individualized treatment is then implemented.

ICSI (Intracytoplasmic Sperm Injection)

Intracytoplasmic sperm injection (ICSI), the direct injection of sperm into eggs obtained for in vitro fertilization (IVF), is a major program at Genetics & IVF Institute. Genetics & IVF Institute accomplished the first U.S. pregnancies with this technique, originally developed in Belgium. We have a very large experience with this powerful technology and have established over 1,865 ICSI pregnancies (January 2004). ICSI frequently permits the establishment of pregnancy in even the most difficult types of male infertility, including men who have fewer than 100 sperm in their semen. For men with no sperm at all in their semen, we have recently developed a new method for obtaining sperm directly from the testis at the Institute without the need for hospitalizations, anesthesia or prolonged post-operative discomfort.

NON-SURGICAL SPERM ASPIRATION (NSA)

Patient Information

Non-surgical sperm aspiration (NSA), performed in our clinic under sedation, allows us to easily and quickly obtain adequate numbers of sperm for ICSI in many men who have no sperm in their semen because of vasectomy or other causes of blocked ducts; in men who cannot ejaculate including men with spinal cord injury; and in some men who do not have any duct obstruction (non-obstructive azoospermia) with or without changes in testicular size.

Men who lack living sperm in their ejaculate frequently have at least some sperm in the testicles, where sperm are made. Testicular sperm can fertilize if they are injected directly into eggs obtained for in vitro fertilization (IVF) through a process called ICSI (intracytoplasmic sperm injection). The Genetics & IVF Institute was the first American medical institution to achieve pregnancies through ICSI and has helped couples from around the world initiate over 1,865 ICSI pregnancies (January 2004) using this technique.

NSA is performed under sedation, and is painless and rapid. A tiny needle is used to extract sperm directly from the testis. While the ejaculate normally contains 100 million to 300 million sperm, aspiration of as few as 100-200 sperm by NSA have been enough to achieve pregnancy when it is combined with ICSI. Using ICSI technology, more than 171 clinical pregnancies have been achieved at Genetics & IVF Institute after NSA (January, 2004).

Prior to the development of NSA, men with no sperm in their ejaculate had to undergo surgery to remove sperm either from their testes or from tubes connected to the testis. The operation required a hospital stay and a lengthy recuperation, and costs of such surgeries generally ranged from $2000 to $10,000. Non-surgical sperm aspiration is rapid, performed right at Genetics & IVF Institute, does not require hospitalization, is pain-free when done under sedation, and recovery is virtually immediate. Cost for non-surgical sperm aspiration currently is less than $1,300.

The technique will be immensely helpful to men who have had vasectomies and later decide that they want to have children. It is possible to reverse a vasectomy by having bypass surgery, but the operation is frequently not successful, especially for men with long-standing vasectomies. Additionally, sperm quality after vasectomy reversal is often reduced and ICSI is required even if sperm appear in the ejaculate. For many men, non-surgical sperm aspiration eliminates the need for vas reversal surgery.

NSA will also help infertile men who lack sperm in their semen because the route out of the testes has been blocked by prior infection or congenital lack of development, as well as men who have had their prostates removed and can no longer ejaculate but make sperm. Men who cannot ejaculate due to spinal cord injuries or neurological conditions like multiple sclerosis can also become fathers through the new technique. There is also a large group of infertile men who simply have no sperm or only dead sperm in their semen although their ducts and ejaculatory process are normal, and who can have testicular sperm obtained through NSA.

NSA must be done with ICSI because testicular sperm cannot enter eggs by themselves. The female partner receives a series of medications to increase the number of eggs created by the ovary as in a conventional IVF cycle. When the eggs grow to adequate size, they are extracted non- surgically at the Institute under sedation, and NSA is scheduled the same day. After egg retrieval and sperm aspiration, our embryologists will inject each egg with a single sperm. Two days after the procedures, definite information regarding fertilization of the eggs and the number of embryos will be available. Embryos will be transferred back to the uterus two or three days following fertilization; additional embryos may be cryopreserved (frozen), as requested.

It should be noted that for some men a single NSA procedure may yield enough sperm to permit sperm freezing for several subsequent ICSI attempts.

Our male infertility medical team, supported by a well trained and dedicated staff, provide the highest standards of patient care. Genetics & IVF Institute is conveniently located in Fairfax, Virginia (suburban Washington, DC), and is easily reached from the Washington-Baltimore area's three international airports. Patients come to the Institute from throughout the United States and many foreign countries for ICSI and NSA treatments. Please contact the Institute's Male Infertility Program at 1-800-552-4363, fax (703) 698-0609, or email GIVF@GIVF.com.  We look forward to hearing from you.

Click here to view the New York Times articles on ICSI and NSA.

Click here to jump to Ovarian Reserve, FSH levels, Clomiphene Challenge Tests, and Pregnancy Rates: Frequently Asked Questions.

Click here for review covering these and other topics: Recent Advances in Reproductive Genetic Technologies.

Click her to read our GIVF's History of Excellence.

Click here to go to our Cryobank page