TID is the placement of donor sperm directly into the uterus of the patient.

In cases of severe male factor infertility, i.e., very low sperm count and/or motility, or no sperm at all, TID may be indicated. TID may also be used if the male partner carries a genetic disorder.

1. Monitor and stimulate the development of healthy egg(s) in the ovaries.

2. Collect the eggs.

3. Secure the sperm.

4. Combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and early embryo growth.

5. Transfer embryos into the uterus.

Step 1: Fertility medications are prescribed to control the timing of the egg ripening and to increase the chance of collecting multiple eggs during one of the woman's cycles. This is often referred to as ovulation induction. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. Egg development is monitored using ultrasound to examine the ovaries and urine or blood test samples to check hormone levels.

Step 2: Your eggs are retrieved through a minor surgical procedure which uses ultrasound imaging to guide a hollow needle through the pelvic cavity. Sedation and local anesthesia are provided to remove any discomfort that you might experience. The eggs are removed from the ovaries using the hollow needle, which is called follicular aspiration. Some women may experience cramping on the day of retrieval, which usually subsides the following day; however, a feeling of fullness or pressure may last for several weeks following the procedure.

Step 3: Sperm, usually obtained by ejaculation is prepared for combining with the eggs.

Step 4: In a process called insemination, the sperm and eggs are placed in incubators located in the laboratory which enables fertilization to occur. In some cases where fertilization is suspected to be low, intracytoplasmic sperm injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.

Step 5: The embryos are usually transferred into the woman's uterus anywhere from one to six days later, but most commonly it occurs between two to three days following egg retrieval. At this point, the fertilized egg has divided to become a two-to-four cell embryo. The transfer process involves a speculum which is inserted into the vagina to expose the cervix. A predetermined number of embryos are suspended in fluid and gently placed through a catheter into the womb. This process is often guided by ultrasound. The procedure is usually painless, but some women experience mild cramping.

ICSI is a procedure used in conjunction with IVF to help couples with moderate to severe male factor infertility, unexplained infertility, failed fertilization, and other conditions. ICSI involves the injection of a single sperm directly into an egg after withdrawal from the ovarian follicles in a stimulated IVF cycle. Before ICSI, the only option for couples with moderate to severe male factor infertility was to use donor sperm.

If the male produces enough viable sperm in his ejaculate, it is collected by masturbation. ICSI also makes it possible for men with little or no sperm in their ejaculates to father children. Procedures such as testicular sperm aspiration (TESA) and microscopic epididymal sperm aspiration (MESA) allow retrieval of sperm directly from the reproductive tract. Sperm are extracted from the testicles in TESA and from the epididymis (numerous small tubules within the scrotum) in MESA.

The sperm are specially washed and prepared for injection into the eggs. This is accomplished using a microscopic pipette while the eggs are visualized and held in place by an instrument known as a micromanipulator. This is a very delicate procedure requiring dexterity and precision. Our embryologists, have extensive ICSI experience and they consistently produce high fertilization rates. Normal fertilization is expected in approximately 70% of the eggs that are injected and the pregnancy rates are similar to those achieved with routine IVF and are dependent on female age and other factors.

In some semen samples there may be no sperm present in the ejaculate. There can be a variety of reasons for an absence of sperm known as Azoospermia.

• There may be a blockage of the tubules that carry the sperm from the testicles to the penis.

• The passages themselves may not have developed so sperm cannot be transported. This is known as absence of the vas deferens.

• In some cases sperm may be produced but in low numbers, and therefore not seen in the semen sample.

• The male may have had a vasectomy performed which means that the passages that carry the sperm have been severed.

Testicular Sperm Extraction (TESE)

This procedure may be performed under GA or local anaesthetic with sedation. A small sample of testicular tissue is extracted from the testes. This can be achieved by either a fine needle being inserted into the testes or a small incision being made.

Sperm that is extracted by the above procedures will then be used in conjunction with an ICSI cycle.

Micro-epididymal Sperm Aspiration:(MESA)

MESA is a procedure to retrieve sperm from the epididymis in men who have a diagnosed  blocked vas deferens It is normally carried out under general anaesthetic. The sperm that is taken from the epididymis usually has poor motility so doctors usually proceed to ICSI on the same day.

Sperm can be cryopreserved in cases where the male might have difficulty in producing a specimen at a given time. If sperm were retrieved microsurgically, excess sperm may be stored to avoid having to repeat the invasive surgical procedure. Also, for patients planning to undergo chemotherapy or radiotherapy (for cancer), sperm may be cryopreserved as the therapy may diminish their sperm production. Sperm can also be frozen for persons wishing to donate their sperm to infertile couples.

 
Sperm retrieved by masturbation, testicular biopsy or microsurgical epididymal sperm aspiration are placed together with a cryoprotectant and stored in cryostraws in liquid nitrogen at a temperature of -196°C. This can be thawed at any time, and the cryoprotectant can be removed and the sperm used for ART procedures.

Embryo freezing, called embryo cryopreservation, has helped thousands of infertile couples have healthy babies since the mid-1980s. The process of unthawing frozen embryos and implanting them into a women’s uterus is called frozen embryo transfer (FET). Candidates for this process are:

• Couples who undergo IVF and have excess embryos they’d like to use later on. They can have a few more chances at pregnancy without having to endure another IVF process involving hormone injections, surgical procedures, numerous doctor’s visits, and emotional and financial tolls.

• Couples in which one partner must undergo chemotherapy or radiation treatment that may destroy their ability to produce healthy eggs or sperm.

• Single men and women facing cancer treatment that may render them infertile. They can preserve their sperm or eggs (gametes) and use donor gametes to produce embryos to be used after recovery.

The Process

Embryos can be frozen from one to six days after fertilization. The freezing process involves mixing the embryos with a solution that prevents ice crystals from forming between the cells, which can destroy them. The embryos are then placed in glass viles which are secured in liquid nitrogen freezers and are cooled slowly to -196° C (-400°F). When needed, the embryos are thawed, and bathed in solutions to remove the freezing cryoprotectants.

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Sperm Donation

The donation of sperm for the use by infertile couples with severe male factor infertility.

Indications for using donor sperm:
Donor sperm may be used when the male partner has azoospermia or severe male factor, has a know hereditary/genetic disorder that could be carried over to biologic offspring, or has had previously failed IVF attempts and do not choose to have ICSI. Donor sperm may also be used in females without male partners.

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Oocyte Donation

Many women who’ve not been able to conceive but want to experience pregnancy and childbirth turn to egg donation. Poor egg quality due to a woman’s advanced age is the most common reason why single women and couples turn to egg donation.

Egg donation is commonly used by:

• Couples in which the woman has poor quality or no eggs, but who want a biological child using the husband’s sperm

• Women with no ovaries but an intact uterus

• Women with genetic factors that they don’t want to pass on to their children

The first known pregnancy achieved with a donated egg occurred in 1984. Today, an estimated 10,000 babies a year are born worldwide from donated eggs.

The Process

Eggs, called oocytes, are surgically retrieved from healthy young women, generally between 21 to 30 years old - at their reproductive prime and old enough to give informed consent. Egg or oocyte donors undergo psychological and medical screening, which includes a thorough medical history and workup. .Next, donors receive hormone injections to induce a superovulation (five or so eggs versus one, which women naturally release each month). A doctor then surgically removes eggs from the donor’s ovaries. The lab will attempt to fertilize several eggs in vitro (in a laboratory) using the recipient’s partner’s sperm . Fertilized eggs (embryos) are then inserted into the recipient’s uterus. If successful, the embryo will attach to the uterine lining and develop into a healthy baby.

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Preimplantation Genetic Diagnosis

Preimplantation genetic diagnosis (PGD) involves testing one cell of 3-day-old embryos that are created via in vitro fertilization (IVF).

Surrogacy or gestational care is a family building option for those who want a child with genetic ties and have not had success with other “first-line” assisted reproductive technology (ART) treatments.

Traditional and Gestational

Two types of surrogacy - traditional and gestational - are practiced today. In traditional surrogacy, a woman called a “surrogate mother” carries an embryo conceived with her own egg and the sperm of a male who, with his partner, wants a baby. In gestational surrogacy, the surrogate, called a gestational carrier, gives birth to a baby conceived with an egg and sperm of a couple or a donor egg or sperm. The majority of surrogates today are gestational carriers.

Traditional surrogacy can be done via intrauterine insemination IUI or in vitro fertilization (IVF). With gestational surrogacy IVF is used to fertilize the eggs in a laboratory. If the fertilization is successful, a doctor transfers some or all of the resulting embryos (often 2 or 3) into to the surrogate’s uterus. If all goes well, the surrogate/gestational carrier delivers the baby and immediately relinquishes him/her to the parent(s).

Candidates for surrogacy are:

• Couples and single women who have had multiple miscarriages, or difficulty conceiving and/or carrying a fetus to term. Surrogacy enables them to have a child genetically related to one or both.

• Couples or single women in which the woman has no uterus or a congenital anomaly of her uterus but has intact ovaries.

What to Consider

Surrogacy involves many legal, ethical and financial considerations. Usually potential parents pay the surrogate a fee for carrying the child, along with her medical expenses. Costs can start at $20,000 or more, up to $120,000. Legal contracts are required before the process begins to protect the rights and responsibilities of the parents, surrogate, and intended child. Both the third party and intended parents should have separate legal counsel.

surrogates already have had a child/children of their own, are healthy medically and emotionally, and are not motivated solely by financially considerations.