More on ICSI
This assisted reproductive technique was developed to help bypass the need for sperm to penetrate the shell of the egg (called the zona pellucida). The primary indication for ICSI includes male factor infertility, as it significantly improves fertilization rates. Threshold semen parameters at IVF Phoenix™ includes sperm concentration <5 million/mL, motility <5%, and largely abnormal shape of the sperm.  It is also indicated for preimplantation genetic testing (PGT), to help reduce contamination from other sperm when performing the embryo biopsy for genetic evaluation (because conventional insemination can result in extra sperm attaching to the outer shell of the egg) as well as for fertilization of cryopreserved eggs, since the freeze-thaw cycle causes the shell to harden, making it difficult for sperm to penetrate.
After your egg retrieval, cells surrounding the eggs are carefully removed. Only mature eggs are selected are then selected for fertilization, and remaining immature eggs are cultured and examined for possible in vitro maturation and later fertilization. During the ICSI procedure, a single sperm is selected and immobilized by a micropipette. This injection pipette then pierces the egg at the 3 o’clock position. To facilitate this process, the egg is held in place by a holding pipette at the 9 o’clock position. The injection of sperm will then trigger oocyte activation and hopefully, fertilization. Activation of mature eggs after ICSI is 70% or more.
Based on older studies, ICSI may predispose to imprinting disorders (limiting expression of genes from one parental copy-either maternal or paternal), particularly Beckwith-Wiedemann syndrome, Angelman syndrome and maternal hypomethylation syndrome. More recent studies have failed to show this increased risk and the slightly increased is primarily attributed to infertility rather than ART techniques and the incidence of these disorders remains very rare (<1/12,000 births).
The remaining steps are similar to convention IVF.
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FAQs
Can semen parameters indeed fluctuate from week to week? Various factors can influence the quality and quantity of sperm in semen, leading to variations over time. Here are some potential reasons:
- Abstinence Period: The length of time between ejaculations can affect semen volume and sperm concentration. Longer periods of abstinence can lead to higher sperm counts but may also increase the proportion of sperm that are morphologically abnormal or less motile.
- Lifestyle Factors: Factors such as stress, diet, alcohol consumption, smoking, and drug use can all impact semen parameters. For example, excessive alcohol or substance use can negatively affect sperm production and function.
- Illness or Infection: Illness, especially if accompanied by high fever, can temporarily reduce sperm count and quality. Some infections can also impact semen parameters.
- Heat Exposure: Exposure to heat (like in hot tubs, saunas, or through keeping a laptop directly on the lap for extended periods) can increase the temperature in the scrotum and impair sperm production, leading to temporary reductions in sperm quality.
- Medication: Certain medications can affect sperm production and function, leading to changes in semen parameters.
- Hormone Levels: Fluctuations in hormone levels can impact sperm production. For instance, testosterone levels can have a direct impact on sperm production, and these levels can fluctuate based on a variety of factors.
- Age: While this doesn’t account for week to week fluctuations, it’s important to note that as a man ages, there can be a gradual decline in semen quality.
Remember that semen analysis at a single point in time can give a snapshot of a man’s fertility, but because sperm parameters can fluctuate, sometimes multiple tests are needed to get a more accurate picture. If you have concerns about semen parameters, it’s a good idea to discuss these with your fertility expert who can offer advice tailored to your situation.
Many researchers believe environmental causes explain an ongoing decline in make infertility. Exposure to toxic substances can be harmful, as can exposure of the genitals to elevated temperatures (such as with hot baths, whirlpools or steam rooms), Also problematic is in-utero exposure to Diethylstilbestrol (DES), a synthetic form of estrogen, the female hormone. Finally, men facing the burden of a cancer diagnosis should be aware of the negative effects on fertility of medical treatments such as surgery or radiation.
Behavioral male factors
A higher risk of male infertility is tied to unhealthy behaviors such as smoking, using alcohol or illicit drugs, and being overweight. Other behavioral factors are having certain past or present infections or taking medications for ulcers, psoriasis, depression or high blood pressure.
Get help with male factors
Infertility challenges are frustrating, but we can address all the factors associated with male infertility. Call us today at (602)765-2229 or email us at info@ivfphoenix.com to learn more and get tested. We’ll give you all the information and assistance you need to achieve your goal of starting a family or adding another child.
Infertility isn’t solely a women’s challenge. At IVF Phoenix ™ we want you to understand male infertility factors, which account for half of all cases, according to the American Society for Reproductive Medicine.
Sperm disorders – the most common male infertility factor
Difficulties making healthy sperm can cause male infertility. There may be too few sperm or sperm may be immature, abnormally shaped or unable to swim. Several causes of sperm disorders are commonly reported in men who experience male infertility.
- Infections or inflammatory conditions such as having the mumps after puberty
- Hormone or pituitary gland irregularities
- Immune problems that generate antibodies against sperm
- Genetic diseases such as cystic fibrosis or hemochromatosis
- Erectile dysfunction or premature ejaculation
- Men who have had groin injuries or surgeries either as an adult, or when they were children
- Men who have taken anabolic steroids, most notably testosterone
Structural or inherited male factors can cause issues
Anything blocking the genital tract can hamper the flow of semen. Some items that our fertility specialists or urologists look for:
- A history of a sexually transmitted disease that causes infection or inflammation
- Scar tissue from surgery or twisted or swollen veins in the scrotum
- Liver or kidney disease
- Treatment for seizure disorders
- Any trauma to the testicles, or a prior vasectomy or major abdominal or pelvic surgery
- A history of undescended testicles
- Medication history, most notably the use of testosterone
- Being born with a fertility disorder or having a blood relative with a fertility disorder
- Certain medical conditions such as tumors or chronic illnesses such as sickle cell disease
However, nearly one-third of all infertility cases are related to male factors such as low sperm concentration, poor motility, and abnormal sperm shape. While some men require treatment for their infertility, there are a number of things you can do on a daily basis to boost your male fertility naturally.
Hysteroscopy is the inspection of the uterine cavity that allows for the diagnosis and treatment of various uterine conditions. Some of which, could lead to fertility problems.
Uterine Septum (Septate uterus)
This is the most common uterine malformation and a common cause of miscarriage. It is unclear whether a uterine septum increases the chances for infertility or not. A wedge of tissue is present inside the uterine cavity, which divides it into two halves (also called uterine horns).
When seen through a hysteroscope, the uterine horns are seen as two dark openings separated by a wedge of tissue. By introducing an electrode through the hysteroscope, the septum can be shaved or vaporized all the way to the top of the cavity. The finished product is a uterine cavity that is unified into one large space instead of divided in two.
Polyps
These are uterine growths a few millimeters to centimeters in size. Polyps arise from the uterine lining (endometrium). A polyp may be attached to the uterine wall directly or by a thin “stalk”.
Patients often have no symptoms from polyps but will occasionally notice irregular vaginal bleeding. This bleeding may occur in between periods or cause the period to be longer in duration or heavier than normal.
Polyps are also associated with an increased risk for miscarriage. Large polyps, which occupy the majority of the uterine cavity, are also probably responsible for infertility. Small polyps can be most easily vaporized in place. Polyps which are attached by a stalk can sometimes be removed by cutting through the stalk and removing the entire polyp through the cervix. Larger polyps may have to be removed by shaving small strips one at a time until the polyp is completely gone, or slightly deeper, taking a margin of the myometrium. This tissue is sent out for pathology.
Fibroids
These benign tumors arise from the muscle layers of the uterus. Often they will stay in the muscle layer but on occasion, fibroids can grow into the uterine cavity. Like polyps, fibroids can cause bleeding, infertility, and as well as miscarriage. Removal of fibroids from the uterine cavity is performed using the same methods as for polyps.
Scar tissue
Scar tissue inside the uterine cavity, also called adhesions, can arise from infection or trauma to the uterine lining. Although rare, the most common cause for uterine adhesions to form is from a previous D&C procedure. Scar tissue inside the uterus can be small and isolated to a certain spot. This type of adhesion looks like a band running from one wall of the uterus to another. Sometimes adhesions take the form of two walls that are stuck together causing the cavity at that spot to be completely obliterated. In rare instances, the entire cavity can be obliterated. Uterine adhesions can cause infertility or miscarriage. If the uterine cavity is partially or completely obliterated, a woman may notice that her period are lighter or even stop altogether. Band adhesions can be easily cut restoring the normal anatomy of the uterine cavity. When the walls are stuck together, the surgeon must carefully dissect between them in order to separate the walls. This can be a very difficult process if there is little normal uterine cavity that remains to serve as a guide.
You will be able to watch the sonohysterogram on a monitor while it is being performed. Afterwards, the doctor will review the findings with you and answer any questions about those findings. If there are any abnormalities that are found on the inside of your uterus, don’t worry! Nearly all of these conditions are easily corrected with minimally invasive, outpatient surgery (usually with hysteroscopy).
Occasionally, a woman might experience some cramping during or after a hysterosonogram. If she desires, she may take 1-2 tablets of ibuprofen (Motrin or Advil) 1-2 hours before the procedure to decrease cramping. This may be repeated 3-4 hours later in the unlikely event that cramping persists.
The procedure for performing a sonohysterogram is very simple and usually takes about 5 minutes. In order to schedule a sonohysterogram, you will need to call with the first day of your period. You will be given an appointment for some time point after the bleeding from the period has ended but before it is thought that ovulation might occur. This ensures that the uterine lining is as thin as possible. This is important since it will assist the doctor in the visualization of the cavity. The hysterosonogram is performed in the office. Using a speculum, a very thin, soft, flexible plastic catheter will be inserted through the vagina and cervix into the lower part of the uterine cavity and a balloon is inflated. Â The speculum is then carefully removed so as not to disturb the catheter. A vaginal ultrasound probe is then placed into the vagina. Through the catheter, a small amount of saline (sterile salt water) is injected into the uterine cavity to separate the walls.
During a sonohysterogram, the ultrasound probe can be rotated to show the long axis of the uterus or a transverse axis. In the long axis, the uterine cavity appears long and ovoid. Sometimes after the procedure, a small amount of the saline fluid may leak out of the vagina. It is also possible that the patient may experience some bleeding or spotting. It is recommended that the patient wear a light pad or tampon for the rest of the day.
Testimonials
Dr. Courvaras is the best there is in the infertility world!! Our first baby is here because of him and his team. Our baby is 17 and will be graduating from high school in less than a month!! We have never forgotten him and the gift he helped us have!!
From the moment we met Dr. Couvaras, My husband and I felt totally comfortable, secure, and well informed. Additionally, the nurses and staff at IVF Phoenix provided prompt, efficient care with both expertise and patience. Whether ordering prescriptions, educating me on how to properly administer medications or explaining options and probable outcomes of specific treatment protocols, Dr. Couvaras, and his team were simply remarkable. I never felt alone, and appreciated the close guidance they provided throughout our entire treatment. I couldn’t be happier with the results! My husband and I are now 12 weeks pregnant, and are absolutely thrilled! I would recommend Ivf Phoenix to anyone who is interested in finding the cause of their infertility. We love and appreciate everyone at Ivf Phoenix, they are a 2nd family to us. We still can’t thank them enough for making our dreams come true!
My husband and I are so thankful for Dr. Couvaras and staff. We were struggling to have a family and stumbled across the IVF Phoenix website. We are from Canada and the staff was fantastic to deal with and very accommodating to work with. We always had support no matter what time of the day. We now have the most perfect beautiful little boy to complete our family!!! So grateful and blessed!!!
The staff and Dr. Couvaras were so kind and understanding. They called me by name as soon as I walked in. Dr. Couvaras was incredibly knowledgeable and knew from the first visit what was going on and after tests came back he was 100% right. He was informative, personable and took care of my health needs as a priority. I never felt left on the back burner. Innovative for sure because now I have 3 amazing children!
This is hands down the BEST fertility clinic in all of Az. Dr. Couvaras and Rhoda are amazing!! Not only are they compassionate and helpful beyond expectations they really look at the whole body and systems and get to the root of the problem. If you are even thinking about fertility go see this place first!
IVF Bundled Packages
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* Once you have completed your consultation with one of our providers, we would be happy to customized a multi-cycle package for you if you are considering embryo banking.
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Please note that the following listed insurance companies are those that we currently partner with. Please call your insurance provider and check to see if your treatment or procedure will be covered.
IVF Phoenix™ is proud to be a Center of Excellence with Optum
Arizona Foundation (AZFMC)
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