| Procedure | Description | Indication | Remarks |
| Artificial insemination | Large numbers of healthy sperm are
injected at the entrance of the cervix or high in the uterus,
bypassing the cervix and giving direct access to the fallopian
tubes.
Prior to injection, sperm is specially prepared in the laboratory
to maximize its fertilizing ability.
| Existence of sperm antibodies in a
woman's cervical mucus.
Male infertility due to low sperm count or low number of healthy
sperm (see also ICSI).
Other sperm abnormalities which prevent fertilization (see also
ICSI).
| A minimum of viable sperm needs to
be available - chances of success decrease if sperm count is low or
if only a few spermatozoa are motile. |
| IVF (In Vitro Fertilization) | Hormone therapy with gonadotropins
is given to stimulate the ovaries to produce several mature
eggs.
Eggs are retrieved and fertilized in vitro with
either the partner's or donor sperm.
If fertilization occurs within 24 to 28 hours, one or more
embryo(s) are placed in the uterus. | Treatment of infertility due to
fallopian tube occlusion and endometriosis.
Male infertility due to sperm abnormalities which prevent
fertilization.
Some cases of unexplained infertility. | As fertilization
occurs in vitro, IVF used in male infertility can
serve to detect specific sperm abnormalities, such as the inability
of seemingly good quality sperm to fertilize. |
| GIFT (Gamete Intra-Fallopian
Transfer) | Follows same procedures as IVF
except that fertilization occurs in the body (in
vivo).
Spermatozoa and eggs are placed directly into the fallopian tubes
where fertilization can occur. | Infertility due to endometriosis
and cervical mucus disorders.
Unexplained infertility.
Some cases of male infertility. | Can only be practiced if fallopian
tubes are healthy.
There is no way to verify that fertilization has taken place, since
it occurs in vivo.
|
| ZIFT (Zygote Intra-Fallopian
Transfer) | Same procedures as IVF except that
fertilized eggs are placed in the fallopian tubes at a certain
stage of embryo development (zygote). | Same as for GIFT. | Can only be practiced if fallopian
tubes are healthy. |
ICSI
(Intracyto- plasmic Sperm Injection)
| An in vitro
microsurgical fertilization technique in which a single sperm is
selected and injected into an egg.
Performed with eggs obtained after ovulation stimulation, as per
IVF. | Male infertility when very few
normal sperm are available
and/or
Fertilizing ability of sperm is dramatically reduced.
| Has become an alternative to
artificial insemination with donor sperm |
MESA
(Microsurgical Epididymal Sperm Aspiration) | Spermatozoa are retrieved directly
from the epididymis (area in the testes where spermatozoa mature
and are stored).
Fertilization is then attempted with ICSI. | Severe male infertility.
Absence of sperm in the ejaculate (azoospermia).
Congenital abnormalities (e.g. absence of vas deferens).
| Usually enough sperm can be
retrieved from one procedure to be frozen for later use if
required. |
TESE
(Testicular Sperm Extraction) | Biopsy of the testes is performed
in order to obtain spermatozoa directly from testicular
tissue.
Fertilization is then attempted with ICSI. | Severe male infertility.
Absence of sperm in epididymis.
Absence of epididymis. | Option if MESA is not
possible. |
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