Special treatment options

There are many new developments in the IVF laboratory that can increase the chances of pregnancy. Here, too, we carefully weigh up together which of the possible therapy options could help you personally.

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Sperm

Since the causes of involuntary childlessness are more or less equally common in men and women, the examination of the ejaculate is one of the basic examinations. The sperm sample obtained through masturbation is examined microscopically for the shape, mobility and concentration of the sperm cells. An ejaculate examination is important because it provides information about the sperm's ability to fertilise. Additional tests may provide information on vitality, anti-sperm antibodies or sperm fragmentation. Since sperm quality can fluctuate greatly, the spermiogram should be performed twice at intervals of about 3 months. The most suitable treatment method is then selected depending on the sperm findings.
 


A TESE is necessary if no or only very few motile sperm are found in the spermiogram. The cause may be an obstruction of the spermatic ducts or a disorder of spermatogenesis. A TESE is usually carried out before the planned ICSI therapy. Sperm from TESE samples can be searched for under the ICSI microscope after special preparation of the tissue and placed in a drop with special medium using a fine glass capillary. ICSI can then take place. In rare cases, no sperm can be found in the biopsy.
 

A relatively new sperm preparation method is the Zymot chamber. It was designed so that the semen processing does not require centrifugation. The sperm have to swim actively through a specially designed membrane in a suitable medium. Only morphologically normal and well-motile sperm can pass through the membrane. The sperm obtained in this way have a lower level of DNA fragmentation, which can lead to higher fertilization, euploidy and pregnancy rates.
 

The CatSper test is a specialized diagnostic procedure performed as part of a semen analysis, particularly in cases of unexplained male infertility. It examines the function of specific ion channels (CatSper) in sperm. These channels are crucial for enabling sperm to move toward the egg and fertilize it. If the CatSper channels are impaired, fertility may be compromised—even if the sperm appear healthy in a standard semen analysis. In such cases, ICSI (intracytoplasmic sperm injection) is an effective treatment method. Studies show that approximately 1% of men with good sperm count and quality exhibit CatSper dysfunction. This evaluation is recommended for men whose semen analysis is normal but who are still unable to achieve pregnancy. 
 

Egg cells

If the fertilisation rate is lower than 30 percent after ICSI treatment, a lack of activation of the oocytes can be assumed as the cause. By additionally bathing the oocytes in a calcium-containing solution, it is possible to increase the calcium concentration in the oocyte after ICSI in order to achieve a better fertilisation rate.

Standard treatment with IVF or ICSI ends with embryo transfer on day 2 or 3 after egg collection. However, many embryos stop developing and do not reach the blastocyst stage. Well-developed blastocysts have the highest probability of implantation.

Prolonged culture until the fifth or sixth day of development serves the purpose of identifying from several embryos those with the best developmental potential and so which will increase the chance of pregnancy for each embryo transfer. However, the procedure requires the collection of several eggs and a good fertilisation rate.

Time-lapse cultivation in the Embryoscope® ensures particularly gentle and stable culture conditions for embryos. These do not need to be removed from their preferred environment during culture, eliminating fluctuations in temperature and environmental conditions. The embryoscope continuously takes photos of the developing embryos. Trained embryologists can thus select the cells that have the best chances of implantation based on their developmental potential. The cultivation period is usually 5 to 6 days.

Fertilised oocytes and embryos are located in an envelope called the zona pellucida. The embryo must hatch out of this shell in order to implant in the uterus. Assisted hatching can facilitate the hatching of the embryo by thinning out a small area of the zona pellucida under the microscope with a laser. If implantation was not successful after several embryo transfers, if the patient is older than 35 years or if the zona pellucida is thickened, assisted hatching can help the embryos to hatch.

EmbryoGen® / BlastGen™ are sequential culture media. Special growth factors (e.g. GCSF) were added to the nutrient solutions to promote the division and differentiation of the embryos in their various stages of development. A study by the manufacturer3 shows a positive effect on implantation and pregnancy rates. The corresponding proof in large scientific studies is still pending. According to the manufacturer, EmbryoGen® and BlastGen™ are particularly suitable for women with repeated miscarriages.

3 Sfontouris et al. 2013 Hum. Reprod. 28 (suppl 1): i60-i62 / Effect of granulocyte-macrophage colony-stimulating factor (GM-CSF) on pregnancy rates in patients with multiple unsuccessful IVF attempts