New technique in assisted reproduction

Calcium Ionophore is a substance that is used in Assisted Reproductive Technology, or ART, to help increase fertility and solve problems of infertility, heightening the possibilities of having children for those struggling to become pregnant. 
Samitivej Sukhumvit Hospital has conducted extensive research and joined in the development of the technology for this type of treatment, resulting in the possibility for its use to help solve issues of infertility. Samitivej Hospital first used this technology on July 12, 2010, 
Current treatments for issues of infertility employ the use of ART in solving the problem. 
For some groups of patients – such as cases where the male has a very low sperm count, weak sperm health, or severe abnormalities, or if the female’s eggs have hard or thick shells, making it difficult for the sperm to penetrate normally and thus rendering it unable to fertilise the eggs – treatment is carried out with a procedure in which a single sperm is injected directly into an egg.
After incubation, eggs that are successfully fertilised become embryos, at which time the embryo transfer procedure is then used to physically place the embryo in the woman’s uterus, where, if the treatment works, pregnancy will occur and the embryo will grow into a baby. 
We call this method Intracytoplasmic Sperm Injection (ICSI). We have found that within groups treated using ICSI, only about three to five percent of patients experienced either fertilisation failure or a less than 50-per-cent fertilisation rate, where the main cause of failure stemmed from sperm abnormalities.
Once the sperm has been injected into the egg, the sperm must signal to the egg (the sperm factor) that it has arrived and should allow their nuclei to be fused together, after which the male sperm nucleus then fuses with the female nucleus. 
If, however, the sperm has abnormalities, for example, problems with sperm morphology (the size and shape of the sperm) or sperm motility (the ability to move forward normally), it will be unable to signal the egg properly. 
That results in the egg pronucleus being unable to form and its genetic material being unable to arrange itself in order to fuse and combine with the pronucleus of the sperm. When it comes time for fertilisation to occur, therefore, only the nucleus of the sperm will be present, but not that of the egg, and the fertilisation is unable to occur. Calcium ionophore is a way to solve the problem.
The basic principle of the technique is as follows: We take the egg that has been injected with the sperm and we transfer it to a medium containing calcium ionophore produced by Bangkok’s Samitivej Sukhumvit Hospital and allow it to incubate for about 15 minutes. The medium then enters the egg and acts as a signaller to the egg that the sperm has arrived. 
The egg is then activated for pronucleus formation and can begin the process of fertilisation. Finally, both the eggs and sperm, having begun the process of fertilisation, are cultivated and matured according to the standard procedure.
This technique will be used in cases of: 

•  Low fertilisation after undergoing ICSI (< 50 per cent)
•  Very low sperm quality including low sperm count, weak sperm health, or severe abnormalities
•  Sperm morphology or abnormal sperm size and shape
•  Sperm motility (the ability to move forward normally)

In solving problems of infertility using ART, we must consider carefully what kind of method is appropriate for each individual case. If an examination finds that the male’s sperm is abnormally shaped, that is, the sperm heads are very large, or in cases where ICSI has already been performed and was unsuccessful, we will then immediately employ the calcium ionophore technique in treatment. Although such cases are uncommon, Samitivej Sukhumvit Hospital is committed to providing comprehensive solutions to the problems of infertility and to meeting the needs of couples facing this difficult issue in whatever way possible. 

DR BOONSAENG WUTTHIPHAN is an OB/GYN specialising in |reproductive medicine at Samitivej Sukhumvit Hospital. |Call (02) 022 2555-6.