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The granddaddy of all fertility treatments, artificial insemination dates back to the late 18th century. In those days, the method involved healthy sperm and something like a turkey baster. Today, sperm is "washed" and carefully placed in the uterus, using a procedure called intrauterine insemination, or IUI.

what is IUI

IUI can help you conceive if your partner has a low sperm count or poor sperm motility. (Poor motility simply means that sperm has a hard time reaching an egg.) IUI also helps if you're taking medication to ovulate or produce extra eggs and insemination is timed to boost your chance of pregnancy.

How does IUI work?

IUI requires ovulation, at least one open fallopian tube, and a semen sample with healthy sperm. Each IUI treatment is referred to as a "cycle" – the time from the first day of your period to ovulation and insemination and then a pregnancy test two weeks later.

The timeline for IUI treatment usually goes something like this:

  • Egg production. The ovaries produce eggs for fertilization in a couple of ways. Your doctor may recommend an "unstimulated," or natural, IUI cycle, meaning no fertility drugs are used. Or a doctor may give you a fertility drug at the beginning of your period to stimulate the ovaries to produce several mature eggs. (Women typically release only one egg a month.)
  • Tracking the eggs. An ovulation detection kit can help you pinpoint ovulation, which is necessary for timing insemination. When an egg bursts from its follicle, the kit shows a telltale surge in luteinizing hormone, and insemination usually happens the next day. Your doctor can also figure out when ovulation occurs by doing an ultrasound.
  • Washing the sperm. Once you ovulate, it's time for your partner to produce a sperm sample, which is then "washed." This process concentrates the hardiest sperm into a small amount of fluid.
  • Insemination. Your doctor uses a thin, long tube (a catheter) to put the concentrated sperm directly into the uterus through the cervix. The procedure is usually painless, but some women feel mild cramping.
  • Testing for pregnancy. A pregnancy test is done about two weeks after insemination.

What Is IVF

In vitro fertilization (IVF) is a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child. During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs (embryos) are transferred to a uterus. One full cycle of IVF takes about three weeks. Sometimes these steps are split into different parts and the process can take longer. IVF is the most effective form of assisted reproductive technology. The procedure can be done using a couple's own eggs and sperm. Or IVF may involve eggs, sperm or embryos from a known or anonymous donor. In some cases, a gestational carrier — someone who has an embryo implanted in the uterus — might be used. Your chances of having a healthy baby using IVF depend on many factors, such as your age and the cause of infertility. In addition, IVF can be time-consuming, expensive and invasive. If more than one embryo is transferred to the uterus, IVF can result in a pregnancy with more than one fetus (multiple pregnancy). Your doctor can help you understand how IVF works, the potential risks and whether this method of treating infertility is right for you.

Assisted reproductive technology – IVF and ICSI

  • IVF (in-vitro fertilisation) and ICSI (intracytoplasmic sperm injection) are assisted reproductive treatment (ART) procedures in which eggs are fertilised outside the body.
  • IVF and ICSI involve a series of steps taken over several weeks.
  • Your personal circumstances and medical history may affect your chance of having a baby with IVF or ICSI.
  • When handled by experts, IVF and ICSI are safe, and medical complications are rare.

What IVF and ICSI involve

IVF and ICSI are forms of assisted reproductive treatment (ART) in which eggs are fertilised with sperm outside the body. IVF is used for female infertility and unexplained infertility, and ICSI is used when there is a male cause of infertility.

Sometimes ICSI is offered when there is no male cause of infertility, but research shows that this does not increase the chance of having a baby.

The steps involved in IVF and ICSI treatment are:

  • Hormone stimulation – the woman’s ovaries are stimulated with a course of injectable fertility drugs.
  • Egg retrieval – when the eggs are mature, they are retrieved while the woman is under light anaesthetic.
  • Embryo development – when using IVF, sperm from the male partner or a donor are added to the eggs to allow them to be fertilised. When using ICSI, the scientist picks up a single sperm and injects it into each egg using a microscopic needle. The eggs and sperm are then kept in the laboratory for 2 to 5 days (depending on clinic practice) for embryos to develop.
  • Embryo transfer – if the eggs fertilise and embryos develop, one embryo (or sometimes 2) is placed in the woman's uterus. (Sometimes several embryos develop, and they can be frozen for use in later embryo transfer procedures.)

Comparison between intracytoplasmic sperm injection and intracytoplasmic morphologically selected sperm injection IVF/IMSI

Objective

The aim of this study was to evaluate the efficiency of the intracytoplasmic morphologically selected sperm injection (IMSI) technique compared with conventional ICSI and previous ICSI attempts in oligo-astheno-teratozoospermia (OAT) patients.

Methods

The sperms were selected under high magnification (6,600×) and used to induce fertilization in previous ICSI patients by IMSI. These results were compared with previous conventional ICSI cycles in patients with OAT infertility.

Introduction

ICSI has been utilized as an ordinary fertilization method in artificial reproductive technological cycles to overcome severe male infertility, since its introduction in 1992 Injected spermatozoa are typically randomly selected, and the selection by an embryologist is based on only the sperms' morphological characteristics and motility in the ICSI technique. However, many studies have reported that the presence of various defects in the spermatozoa is associated with reduced fertilization, and pregnancy rates, and with an increased risk of miscarriage Sperm selection is usually performed under an optical magnification of approximately 200× or 400× in ICSI techniques. However, the low magnification used in routine microscopy results in limitations in identifying sperm organellar malformations, particularly vacuoles in the sperm head, where major defects, such as abnormal sperm head size proportions and midpiece abnormalities were observed [5]. Evaluation of the normal morphology of the nucleus in sperm should be performed accurately using a high magnification and resolution. Bartoov et al. [10,11] have developed a new method known as motile sperm organellar morphology examination (MSOME), which evaluates the real-time movement of sperm. They made it possible to obtain a perfect sperm with a normal nucleus by combining MSOME and micromanipulation technology. This process is known as the modified IVF process, or intracytoplasmic morphologically selected sperm injection (IMSI), because only one moving sperm is selected when performing ICSI using MSOME. We adopted IMSI for patients who underwent ICSI due to oligo-astheno-teratozoospermia (OAT) in previous cycles since February 2011. The aim of the present prospective study was to assess the clinical advantages of the IMSI procedure in the treatment of patients with male factors, particularly OAT, by comparing the outcomes of the previous ICSI cycles.

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