IVF has been a great source of hope for couples who cannot have children naturally. Indeed, in about half of the cases suffering from infertility, pregnancy can be achieved in this way. In vitro fertilization studies around the world started 40 years ago. Louise Brown is the first child born by IVF method in England. In these initial trials, sperm taken from the male were deposited around the egg collected from the female and expected to enter the egg spontaneously. However, if the number of sperm is too low or if the sperm is too weak to penetrate the membranes of the egg, unfortunately, fertilization cannot take place and the desired result cannot be obtained. In order to solve these problems, Prof. Gianpiero D. Palermo from Cornell University introduced the technique known today as ICSI or intracytoplasmic sperm microinjection for the first time by placing a single sperm cell into the egg with the help of a hair-thick needle. Thus, the number of couples benefiting from IVF has increased significantly. Soon after, in vitro fertilization with TESE or testicular sperm retrieval technique came to the fore to make azoospermic men fathers.
Today, studies are continuing to increase the success of microinjection technique. Thus, we can obtain satisfactory results even in very difficult cases. There are 4 conditions for the success of IVF; sperm, egg, the uterus in which the embryo is placed, and laboratory. Each of them has its own rules that require a lot of attention. Therefore, when an IVF attempt fails, these 4 factors should be evaluated together.
Half of the genetic material required for a normal embryo development and achieving a healthy birth comes from the sperm. It is not only the genetic cargo carried by the sperm, the centriole that will initiate fertilization, the proteins that will awaken the egg, and many nutritional molecule particles also come with the sperm. Therefore, the quality of the sperm used in IVF/ICSI is important.
In general, in order to consider a sperm healthy, its shape and motility characteristics are expected to be normal. However, in recent years, it has been understood that the intact structure of the sperm is also a determining factor in the success of fertilization. When sperm samples with high DNA damage are used, serious problems arise both in embryo development and in maintaining pregnancy. Indeed, we encounter sperm DNA damage more frequently in cases of recurrent miscarriages. DNA damage in sperm is also important for women with advanced age or reduced egg quality. Because the damaged DNA content of the sperm is partially repaired in the egg. If the egg does not have the capacity to repair it, then the embryo development will be at risk. When an already weakened egg consumes its remaining energy to repair the sperm, the healthy development of the embryo will also be impaired. In the last guide of the World Health Organization, it was recommended to include sperm DNA damage investigation among the routine tests of infertile men.
For all these reasons, it is important to evaluate sperm DNA quality as well as motility and morphology in a man who is a candidate for IVF. Since even a single sperm will be enough to be inserted into the egg during IVF-ICSI, it does not make sense to have low sperm concentration in routine tests. However, if the sperm production of the testicles is impaired, the quality of the sperm they produce will also deteriorate, resulting in a decrease in pregnancy success. Therefore, pre-treatment to improve sperm quality before in vitro fertilization is important for a healthy embryo development and delivery. Considering this fact, we also check oxidative stress, mitochondrial capacity and DNA damage in sperm during routine examinations. In fact, in cases where the sperm number and quality of the ejaculate is insufficient, it is recommended to perform in vitro fertilization with sperm obtained from the testis.
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Prof.Dr. Kaan Aydos
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