Couples assessing infertility clinics should confirm whether the clinical setting can offer contemporary infertility treatments like Micromanipulation.
Micromanipulation Basics
Micromanipulation is among the most specialized of procedures used during infertility treatments. Micromanipulation is used as a part of assisted reproductive technologies (ART) wherein clinical intervention is needed to overcome fertility-related problems to increase chances of establishing pregnancy.
Micromanipulation involves the use microscopic instruments for maneuvering the female egg (oocytes) or the sperm. The most common applications of micromanipulation are seen during IVF treatment. Here, micromanipulation is used in the form of:
- Assisted Hatching
- Intracytoplasmic Sperm Injection—ICSI
- Preimplantation Genetic Diagnosis—PGD
Among these, Assisted Hatching and ICSI are needed for addressing cases of extreme male factor infertility, while PGD is recommended when genetic disorders are indicated in the medical or family history of an IVF couple.
Importance of Micromanipulation in IVF
Handling the tools used during micromanipulation requires specific skills found among trained technicians or embryologists only. These tools are often referred to as micro-tools due to their extremely small size. These tools are operated through microscope-assisted vision only. Some of the tools have robotic functions. The view available to the embryologist or the clinical technician is displayed on a monitor to ensure greater precision.
Expertise of the micromanipulation technician greatly impacts the overall success of an IVF treatment plan and the eventual costs. For instance, if an increased number of embryos are destroyed during micromanipulation, fertilization-related procedures need to be repeated, which raises the duration and costs of the IVF treatment.
ICSI
Severe male factor infertility is indicated when the fertilization potential is extremely low due to problems with the sperm quality or quantity. In such cases, ICSI is among the most recommended of treatments. ICSI-assisted IVF treatments are recommended even when minimal sperm-related issues are indicated. This is because ICSI has an appreciable success rate in ensuring that the sperm is able to fertilize the female egg.
ICSI is commonly recommended when the sperm has impaired potency or vitality. This means that the sperm cannot survive in the female reproductive tract or remain effective for a sufficient time to fertilize the egg. Similarly, sperm with reduced motility is indicated for ICSI.
This approach can establish fertilization even with immature sperm that is extracted from the epididymis. ICSI is most commonly recommended for men suffering from azoospermia, i.e. both obstructive and non-obstructive azoospermia.
PGD: Inherited Disorders and Micromanipulation
PGD is not recommended for all IVF couples. However, if a genetic condition is indicated in either of the IVF partners, there is a need for PGD testing. This done to ensure that the embryo created externally, in clinical conditions, is tested for the presence of any genetic disorder.
PGD allows decoding such embryos and removing them from the group of embryos meant for implantation into the IVF female, directly reducing chances of the newborn suffering from inherited diseases. Downs Syndrome is one such genetic disorder that can be easily avoided through a timely PGD test.
Assisted Hatching
This is among the most specialized applications of micromanipulation, applicable when the embryo is not able to permeate through its outermost covering. This is critical since the embryo needs to attach itself to the inner lining of the uterus for which it should emerge through its outermost covering. Thus, the embryologist assists the embryo by weakening its outermost layer (called zona pellucida).
Assisted hatching is critical for women who have suffered repeated IVF failures due to the inability of the embryo to implant itself. Women that usually need Assisted Hatching include those:
- Above the age of 35
- With elevated FSH levels
- Undergoing IVF using frozen embryos
