1. Artificial insemination:
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).
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).
A. Male causes: oligospermia.
B. Female: 1. Tubal factor of infertility. 2. Cervical factor of infertility. 3. Immunological infertility. 4. Endometriosis.
C. Unexplained infertility.
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).
A. Male infertility: abnormal semen i.e. semen prepared then injected.
B. Female causes: endometriosis externa & hostile cervical mucus.
C. Failure of IVF.
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).
1. Failure of IVF for 3 cycles.
2. Male causes: marked oligospermia <80,000 in the specimen & immotile alive sperms.
3. Anti-sperm antibodies.
single sperm (nuclear material) is injected into the cytoplasm of the oocyte by micropipette under microscopy at the site 3 o’clock.