You are a clinician working in a fertility clinic. A couple presents with diffic
ID: 218973 • Letter: Y
Question
You are a clinician working in a fertility clinic. A couple presents with difficulties conceiving. The female was found to have normal fertility, however semen analysis indicated poor quality semen.
Sperm concentration and viability were within the normal range, however sperm were immotile. Many of the sperm had an abnormal morphology.
Which of the following treatment options would you recommend for this couple?
Select one:
A. In vitro fertilisation
B. Artificial insemination
C. Intracytoplasmic sperm injection
D. Donor Egg
E. Preimplantation genetic diagnosis
Explanation / Answer
Fertility tests are conducted for both men and women, for fertility evaluation before treatment. Male Fertility evaluation involves, semen analysis, which involves both quantitative and qualitative analysis of sperm.
Some important tests conducted during semen analysis (per ejaculation) and their standard value (the lower limits) as per WHO are:
1. Semen volume: 1.5 to 2.0 ml.
2. Total sperm count: 33 to 46 million.
3. Sperm concentration: 12 to 16 million.
4. Viability: 55 to 63 %.
5. Sperm morphology: 3 to 4% normal.
6. Total motility: 38 to 40 %.
In the given case: Semen analysis revealed normal sperm concentration and viability.
Abnormality was observed in sperm motility and morphology.
Sperm motility measures the percentage of sperms that can move. Motility is important for sperms, as they must swim through the female reproductive parts to fertilize the egg. Two types of motility are measured during sperm analysis: A) Total motility- sperm motility in all directions. B) Progressive motility- sperm motility in forward direction.
Reduction in motility of sperm may occur in an individual due to conditions like: smoking, certain illness, certain medications, deficiencies, poor hygiene, etc.
The condition of abnormal sperm motility is called asthenozoospermia (asthenospermia).
In this case the person has complete asthenozoospermia, or immotile sperms.
Sperm morphology measures the shape of the sperm, as per WHO determined criteria, referred to as Kruger’s criteria. Condition in which a person has sperms of abnormal morphology, is called teratozoospermia.
Certain techniques that are used as a treatment to cope with conditions of infertility may be (as mentioned in the given case):
A. In vitro fertilization (IVF): It is popularly known as procedure for “Test tube babies”. IVF technique involves fertilization of eggs with sperm outside body under optimized laboratory conditions. The resulted embryo is engrafted back to uterus. IVF is applicable in cases like, problems in ovulation, problems in female reproductive tracts, (fallopian tube, uterus), inability of sperm to penetrate or survive the cervical mucous.
B. Artificial insemination: Involves intrauterine insemination technique by which, sperms are directly injected into cervix, fallopian tube, or uterus of the female partner. It is mainly done in case of male infertility, including low sperm count or inability of sperm to cross the cervix.
C. Intracytoplasmic sperm injections (ICSI): It is the direct injection of the sperm into the egg directly, during IVF techniques. ICSI is mainly applicable in case of male infertility like, low sperm count, no ejaculation, impaired sperm motility, abnormal sperm morphology.
D. Donor egg: involves egg donation usually during artificial fertilization. It is used due to female fertility problems, like premature menopause, previous history of birth failure, diminished ovarian reserve, poor egg quality.
E. Preimplantation genetic diagnosis: involves the genetic testing of embryo during IVF. Genetic screening is done on the embryo, before implantation, to detect genetic abnormalities or anomalies.
As per the give scenario, the couple should be initially referred with treatment of:
Option C- Intracytoplasmic sperm injections (ICSI), with involvement of IVF.
Related Questions
Navigate
Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.