1. Artificial insemination:
Indications:
A. Male causes:
a) Failure of deposition of semen e.g. hypospadius.
b) Oligospermia. c) Asthenospermia.
B. Female causes:
a) Hostile cervical mucus
b) Severe RVF (external os).
c) Vaginismus.
Technique:
1. Induction of ovulation, then rupture follicle by hCG when the follicle is 18 mm or more in diameter.
2. Processed semen (0.5 ml) is injected inside the uterine cavity 12-36 hours after rupture of follicle using special catheter
3. The injection maybe in any where of genital tract e.g. intracervical, intrauterine (the commonest), intratubal, intrafollicular & intraperitoneal.
N.B.: Processed semen: preparation of semen for selection of highly motile sperms& removal of PGs that may cause uterine contractions.
2. IVF & ET (in vitro fertilization & embryo transfer).
Indications:
A. Male causes: oligospermia.
B. Female: 1. Tubal factor of infertility. 2. Cervical factor of infertility. 3. Immunological infertility. 4. Endometriosis.
C. Unexplained infertility.
Technique:
1. Induction of ovulation: as artificial insemination.
2. Multiple ova are aspirated using U/S directed needle under local or general anesthesia (32 hours after HCG injection)
3. Fertilization: prepared semen added to the aspirated ova in a culture media.
4. Embryo transfer: 8-cell stage is transferred to uterus by transcervical catheter.
3. GIFT (gamete intrafallopian transfer).
Indications:
A. Male infertility: abnormal semen i.e. semen prepared then injected.
B. Female causes: endometriosis externa & hostile cervical mucus.
C. Failure of IVF.
Technique:
1. Induction of ovulation: as IVF.
2. Aspiration of ova: as IVF.
3. Mixed gametes (ova and sperms) are injected into ampullary part by laparoscope.
4. ZIFT (zygote intrafallopian transfer) (not widely used).
♦ As GIFT but gametes kept some time forming zygote which is injected into tube.
5. SUZI(subzonal sperm injection)
Indication: failure of IVF.
Technique: sperm is injected into subzonal space through a hole made in zona pellucida.
6. ICSI (intracytoplasmic sperm injection).
Indications:
1. Failure of IVF for 3 cycles.
2. Male causes: marked oligospermia <80,000 in the specimen & immotile alive sperms.
3. Anti-sperm antibodies.
Technique:
single sperm (nuclear material) is injected into the cytoplasm of the oocyte by micropipette under microscopy at the site 3 o’clock.