Fortunately, treatments exist to treat abnormalities in sperm production and function even when the underlying cause is not addressed. Although some of these procedures may be performed in the office, others require a specialized facility which is designed to provide advanced techniques for manipulating human sperm and eggs. We are fortunate to work with the Toll Center for Reproductive Sciences at Abington Memorial Hospital which consistently has some of the best results for in vitro fertilization in the Philadelphia area. In fact, Abington's Toll Center ranks in the top 20% of programs nationally for IVF success.

Intrauterine Insemination (IUI) - Intrauterine insemination is a treatment for poor sperm density (count) and motility (movement). At times, it may also help to improve pregnancy rates in couples with isolated morphology problems or antisperm antibodies.

Intrauterine insemination is performed in the office by either a gynecologist or urologist. The insemination itself is performed at the time when the female is ovulating and requires monitoring of her cycle. At times, the woman will be placed on either oral or injectable medications to improve follicular development. The woman's menstrual cycle is monitored and the insemination is planned for the day of ovulation.

On the day the insemination is to be performed, a semen sample is collected from the male partner. This is then processed ("sperm wash") in the laboratory. The sperm wash separates the sperm from the remaining seminal fluid and concentrates the sperm into a much smaller volume. Semen itself can not be inseminated into the uterus since chemicals in the semen would produce painful uterine contractions. After the sperm is washed (and/or filtered) it is introduced directly into the uterus by a small catheter.

In vitro Fertilization (IVF) - In vitro fertilization refers to fertilization of an egg outside of the body. This is commonly referred to as the "test tube baby". This procedure which was originally performed in 1978 resulted in the birth of Louise Brown. This procedure was originally developed to treat severe scarring or abnormalities of the fallopian tubes. Since eggs are removed directly from the ovaries, the fallopian tubes are bypassed. After the eggs are fertilized in the laboratory, the embryos (fertilized eggs) are transferred into the uterus after 48 hours.

A woman's ovary usually produces one mature egg each month - the ovaries alternate which one will produce the mature egg. During IVF, a woman's ovaries are stimulated by medications to produce multiple follicles in each ovary. This ovarian stimulation increases the number of eggs produced so that multiple eggs can be obtained with each cycle of IVF. Ovarian stimulation should only be done safely by a specially trained gynecologist known as a Reproductive Endocrinologist. For ovarian stimulation to be performed safely, the woman must undergo regular blood tests to monitor estrogen levels and ultrasounds to monitor follicle size.

Intracytoplasmic Sperm Injection (ICSI) - The most significant advancement in male infertility over the past decade, has been ICSI. This procedure, which was originally performed in 1992, allows a single sperm to be injected directly into an egg. This procedure is now used for most cases of severe male infertility including significant abnormalities in sperm count, motility, or morphology. In fact, ICSI may be the only successful treatment in men with sperm counts of less than 1 million, motility less than 20%, and severe morphology problems.

Some men may have no sperm in their ejaculate but may have some sperm in their testicles. Using ICSI, sperm may now be surgically extracted from testicular tissue obtained from a testicular biopsy by a procedure called TESE (testicular sperm extraction). These sperm can then be used via ICSI to fertilize eggs and achieve pregnancies. Since only 1 sperm is needed for each egg, ICSI can be performed even if a man has only 10 or 20 sperm in his testicles!