Microfluidic techniques (Fertile)
Microfluidic techniques are based on the selection of the spermatozoa in the ejaculate that have the best motility so that they can be used in IVF-ICSI treatments. These spermatozoa will be those that are most likely to fertilise an oocyte and achieve a spontaneous pregnancy, because they will be the first to arrive.
They are also the sperm with the greatest genetic integrity — this means that the DNA is undamaged, and so offers the best chance of producing a viable pregnancy.
The technique is carried out using a device that aims to mimic the process of sperm selection as it occurs naturally in the female reproductive tract. It is a simple procedure, and involves no risk to the spermatozoa, as there is no use of chemical compounds that might threaten the integrity either of the sperm itself, or of the embryos generated.
The use of the technique is recommended where the sperm in the ejaculate show a high level of DNA damage (sperm DNA fragmentation or SDF), which can be the cause of miscarriages, suboptimal embryo quality, and failed implantation in previous IVF cycles. For this reason the sperm that offers the greatest guarantee of producing the birth of a healthy baby is selected.
Annexin V columns (MACS)
This is the method used for the selection of the spermatozoa that have the best chance of producing viable embryos, as any that are apoptotic (apoptosis is a form of programmed cell death) are eliminated from the semen sample. Therefore the spermatozoa obtained using this technique are those that have the greatest chance of successfully fertilising the oocyte, and so are the ones that are then used for insemination or the microinjection of the oocytes.
It is used in certain cases, such as where there has been repeated failure of implantation in a young woman, or where the assessment is totally negative.
In certain cases there are no spermatozoa in the ejaculate. This can be due to problems of obstruction or of secretion. The biopsy will enable us to diagnose the cause, and retrieve spermatozoa at the testicular level. There is the possibility of freezing the sample, or of obtaining fresh sperm on the day of follicular puncture.
It consists of a simple surgical procedure carried out under sedation and on an outpatient basis, which can either be done on the same day as follicular puncture, or alternatively in advance. In the latter case, it can then be used in the future when necessary.