Male Infertility Treatment

Sperm DNA Fragmentation Index (DFI)

What is DFI?

The Sperm DNA Fragmentation Index (DFI) is a tool for assessing the quality of semen and determining potential damage to DNA.

Why is DFI needed?

Around 50% of most conditions of infertility could be connected to a male element. Furthermore, the presence of fragmented DNA in the sperm has been found to impact the development of the embryo.

Thus, Sperm DNA Fragmentation Index (DFI) is a standard technique to evaluate sperm concentration, motility, and morphology. However, it won't provide any precise information about the genetic structure of the sperm, which is essential for healthy embryo development.

What is the procedure of DFI?

The DNA fragmentation index of sperm (DFI) is measured using a simple procedure, similar to a standard semen assessment.

First, the man is asked to provide a sample of his semen for analysis. The level of sperm DNA fragmentation is then assessed using a variety of diagnostic techniques by our specialists.
A brief overview of male infertility

Who needs to asses Sperm DNA Fragmentation Index?

Most fertility specialists do not advise this testing as a primary course of treatment, although they do acknowledge its use in the following situations:

  • After failures in Assisted Reproductive Treatments (IUI, IVF, or ICSI)
  • Presence of clinical varicocele
  • Ongoing genital infections
  • Multiple miscarriages
  • Unexplained infertility
  • Smokers
  • Age over 40
  • Human exposure to hazardous chemical agents
  • History of exposure to radiotherapy or chemotherapy
DNA image

Physiological Intra-Cytoplasmic Sperm Injection (PICSI)

What is Physiological Intra-Cytoplasmic Sperm Injection (PICSI)?

Similar to ICSI, PICSI involves the screening of motile sperm for injection, however instead of just choosing sperm based on their morphology and motility, it involves selecting mature sperm that bond to hyaluronic acid. The cumulus complex, which surrounds the egg or oocyte and acts as a protective layer to keep out sperm with functional defects during in vivo fertilization, contains a significant amount of hyaluronic acid (within the body). It does this by only allowing a sperm that carries a hyaluronan-specific receptor to bind and enter the cumulus complex of the oocyte.

Therefore, a sperm's capacity to adhere to hyaluronic acid (HA) is a biological indicator of the sperm's maturity and DNA integrity, which is the genetic material in humans and nearly all other organisms.

sperm insertion procedure in IVF treatment

How is PICSI performed?

The PICSI dish is manufactured in the United States and comprises three (3) micro drops of hyaluronan attached to the interior bottom of a sterile polystyrene culture dish.

Prepared sperm from PICSI is then added to the micro-droplet and given a period to exhibit binding (this is usually between 15-30 mins).

Thus, a sperm’s ability to stick to the hyaluronan hydrogel helps the embryologist with selecting functionally competent mature sperm for injection.

In comparison to traditional ICSI, hyaluronan binding is associated with enhanced sperm DNA integrity, better sperm maturity, and a normal chromosomal complement, which results in higher-quality embryos for selection and conception.

Moreover, studies have revealed that picking spermatozoa with impaired quality during ICSI can lead to early pregnancy loss.

Who may benefit from PICSI?

PICSI is not advised for all individuals because the process involves more handling than is necessary and exposes the oocytes to the environment afterward (i.e. changes in temperature and pH).

Only about 15% of ICSI patients have been observed to produce sperm samples with defective HA binding, PICSI would only be helpful for these patients.

Below is a list of patients for which PICSI may be recommended:

  • Previous recurrent miscarriage/ early pregnancy loss
  • Males with known high DNA fragmentation
  • Previous poor fertilization after conventional ICSI
  • Poor embryo development between days 3 and 5 (blastocyst conversion rate)

Note: Not all patients who are candidates for conventional ICSI will be able to undergo PICSI as sperm binding is reliant on sperm concentration.

TESE/ Micro TESE/ PESA

What is TESE/ Micro TESE/ PESA?

If a man is unable to naturally generate or release sufficient number of healthy sperm, techniques like Microscopic testicular sperm extraction (MicroTESE), or PESA are used to directly remove sperm from the testicular tissue of a man's reproductive system.

A man may occasionally be producing sperm in his testes, but due to a flaw in the sperm delivery mechanism, those sperm are not able to come out of the testes. So, even when the male gets a report of azoospermia in a semen study, we can still get sperm from his testes.

In some circumstances, one may not be able to produce enough sperm. In these situations, the couple might increase their chances of becoming pregnant by getting stronger sperm from the testes.

Despite these problems, a couple can still become pregnant using their own sperm by using IVF-ICSI with those sperm.

testing spem in ivf clinic in AHmedabad
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