Men with infertility, especially those with a testicular cause of infertility, can try one of several techniques to give their sperm the highest chance of achieving fertilization.
In-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are techniques in which a sperm cell is brought in direct contact with the egg to be fertilized. Not only do these techniques provide a solution for women who have fertility issues, but for men as well.
To prepare a sample of sperm for IVF or ICSI, sperm must be isolated without being damaged. The technique should be rapid and inexpensive. It is also important that an enriched fraction of motile sperm cells are separated from cellular debris, microorganisms, prostaglandins and cellular components found in the semen. By increasing the quality of the sample, the chances for fertilization to occur become likewise increased.
There are several methods of sperm preparation techniques available in the Philippines. Simple washing, among the oldest and most affordable methods, removes only the seminal fluid. Cellular debris and non-motile are retained along with the more viable sperm. Sample washing is most useful for patients with a low sperm count, and the procedure of choice is intrauterine injection (IUI).
Another method, aptly named Swim-up From Pellet Method, is the most widely used technique for sperm separation. This method builds upon the sample washing, adding the element of separating motile sperm cells from their non-motile counterparts with the use of a centrifuge. Cellular debris is also separated from the semen sample. This technique is based on the principles of active self-migration.
The Swim-up From Ejaculate Method is widely considered to be an ideal method of sperm preparation. Unlike the other techniques, Swim-up From Ejaculate does not require the process of centrifugation.
The Sedimentation Method, or Layering With Paraffin method is currently the technique used only for patients undergoing IVF with ICSI. It is also the only method to succeed for men with cases of low motility and low sperm count. Although the technique is highly effective in isolating healthy sperm from debris and non-motile sperm in a semen sample, the preparation process is lengthy. After washing, the pellet of healthy sperm is placed under paraffin oil at 37˚C and incubated for one to 24 hours, depending on the progression of the sperm cells. Debris, non-motile sperm, and other waste products gravitate toward the bottom of the droplet and are separated from healthy sperm found at the top. For male patients with very low sperm counts, this is a useful and highly effective technique for ICSI.
The Discontinuous Gradient Centrifugation Method uses the creation of gradient solutions in a tube. Cellular debris and immobile and abnormal sperm cells accumulate at interfaces where one gradient meets the next. After multiple centrifugations are performed, a pellet of healthy sperm is formed at the bottom of the tube. The pellet is thereafter washed with culture medium and used for insemination.