Additional techniques can also increase the chances of successful treatment.
In cases where there is a complete absence of sperm in the semen, for example, vas deferens blockage or malfunction of semen production in the testes, sperm can be obtained by surgical procedure from the epididymis or testis.
In some cases, infertility is due also to the fact that the shell of the egg – and subsequently also embryonic shell – is thickened. Fertilization as a first step is made more difficult (remedied by ICSI), but also the second step, the "hatching" of the embryo, which must be done before implantation.
In "assisted hatching" the shell of the embryo is thinned, selectively by laser, so that, when the time comes, the embryo can easily leave its shell.
The proper preparation of the endometrium for implantation is essential for the onset of pregnancy. In addition to hormonal factors, some contributing elements may also stem from the seminal fluid. A number of studies have shown that treatment of the endometrium with processed semen (seminal plasma rinse) often has a positive effect on pregnancy rates in IVF.
The term "embryo glue" also refers to an implantation aid. A special combination of substances which is added to the embryo transfer media, increases the embryo's ability to attach itself inside the uterine cavity. This process can significantly improve pregnancy rate, namely when special basic conditions are present.
In some cases, the endometrium is very thin – too thin for successful implantation of the embryo – and cannot be stimulated to grow by the administration of hormones. In such cases a special treatment of the endometrium with growth factors can lead to a desired result.
We recognize the great physical and psychological stress of one or more miscarriages and here at Döbling Fertility Center we have developed a diagnostic program designed to find possible reasons and their potential causes.
In collaboration with national and international research centers, we analyze blood samples and examine small sections of the endometrium.
In the blood analysis we look for abnormalities such as clotting disorders or immune system problems.
The endometrium is examined for NK cells and plasma cells.
Some IVF patients may experience recurrent implantation failure due to an altered timing of the window of implantation of the embryo.
In order to identify this so-called “window of implantation” as the cause, we do an ERA-TEST (Endometrial Receptivity Array, INGEOMIX) at our institute. An endometrial biopsy is performed with a thin suction curette (Pipelle) and sent to a special laboratory in Spain.
The standard process of sperm preparation for in vitro fertilization or insemination involves centrifugation of the ejaculate. In addition to separating the sperm from the ejaculate, this process also enables the immotile or degenerated sperm to be separated from the motile sperm.
The ZyMōt chamber provides an alternative to the standard process of sperm preparation using centrifugation. Motile sperm with low DNA fragmentation are able to migrate through a special membrane. This mimics the physiological barrier of the cervical canal. This method is gentler on the sperm and the sperm harvested have better DNA integrity. According to the manufacturer, this method increases the probability of obtaining a chromosome normal embryo.
PICSI involves adding a check under the microscope to select the sperm for ICSI treatment. The sperm are not only evaluated by their appearance and motility, but also assessed by their degree of maturity. Mature sperm form receptors that are capable of binding to hyaluronic acid. These sperm are subsequently selected for ICSI. Selecting the right sperm can significantly reduce the rate of miscarriage.
If fertilization is unsuccessful or if the fertilization rate following ICSI treatment is <30%, then it is recommended to use a calcium-enriched culture medium to activate the egg cell. The sperm is normally responsible for activating the egg cell; the intracellular calcium concentration in the egg cell increases following a signaling cascade. This is then followed by fertilization.
There is a higher proportion of immotile sperm present in cases of severe asthenozoospermia (reduced sperm motility) or with TESE material. A reagent can be added that has an energetic effect in order to discover whether the sperm are in fact still alive. The sperm temporarily become motile when theophylline is added and they can then be used for an ICSI treatment.