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Tan Xiaojun
·Senior reproductive medicine expert
·Postdoctoral fellow at Peking University
·PhD candidate at Xiangya School of Medicine, Central South
University
·Master’s tutor at Central South University
· Master's degree candidate in reproductive
medicine at the University of South China
· Professional training at Huazhong University
of Science and Technology and Tongji
Hospital Reproductive Center
Expertise:
diagnosis and treatment of infertility, first/second/third generation IVF (including
egg/sperm donation), microsperm retrieval, embryo freezing and resuscitation, artificial
insemination (including husband's sperm and sperm donation), paternity testing, chromosomal
disease
diagnosis, high-throughput gene sequencing, endometrial receptivity gene testing and other
clinical
technology applications. Many of these technologies are at the leading level both domestically
and
internationally.
How does Kyrgyzstan Tulip International Reproductive Center solve the problem of weak sperm motility, assisted reproduction with weak sperm motility, IVF in Kyrgyzstan, sperm optimization technology, intracytoplasmic sperm injection, male infertility solution, ICSI adapting to the population.
Ways and methods to solve the problem of weak sperm motility in Tulip International Reproductive Center of Kyrgyzstan
1. Definition: What is asthenospermia and its clinical significance in assisted reproduction?
Sperm motility is weak, which usually means that the proportion of sperm moving forward in semen is below the lower limit of reference value in assisted reproductive medicine. According to the 5th edition of the World Health Organization's Laboratory Manual for Human Semen Examination and Processing, if the proportion of sperm moving forward is less than 32%, it can be diagnosed that sperm motility is weakened. This situation will reduce the probability of natural conception, and it is also one of the important reasons for the failure of in vitro fertilization-conventional fertilization.
In the clinical practice of assisted reproduction, weak sperm motility does not mean that pregnancy cannot be achieved. Medical research shows that some people with weak sperm motility can still obtain usable embryos and complete the embryo transfer process through appropriate laboratory techniques and individualized insemination programs. In view of this clinical problem, the Tulip International Reproductive Center in Kyrgyzstan has established a systematic treatment path from semen evaluation, sperm optimization to insemination mode selection.
Expert tip:
Weak sperm motility does not mean "azoospermia" or "completely unfertilized". Clinical data show that some patients with severe asthenospermia can still obtain usable embryos through ICSI and other technologies. The key is to accurately evaluate the functional status of sperm, rather than just focusing on the vitality value.
Second, the technical core: laboratory treatment and insemination technology for weak sperm motility.
2.1 sperm optimization technology combination
The Tulip International Reproductive Center in Kyrgyzstan adopted the double optimization strategy of gradient centrifugation combined with morphological screening for samples with weak sperm motility. Density gradient centrifugation can remove dead sperm, white blood cells and debris components according to the difference of sperm density and motility, and enrich sperm population with relatively good motility. Subsequently, morphological screening was carried out under high magnification microscope, and sperm with acceptable motility and normal head morphology were selected for subsequent operation.
For samples with extremely low vitality, the laboratory also introduces sperm dormancy activation technology, which can temporarily improve the activity performance of some sperm by adjusting the osmotic pressure of culture solution or adding specific energy substrates, so as to facilitate the operators to complete the capture.
2.2 intracytoplasmic sperm injection: the core means to break through the limitation of vitality
ICSI has become a common choice in clinic when sperm motility is seriously reduced and it is not enough to complete conventional IVF fertilization. Through the micromanipulation platform, the embryologist selects a single live sperm and injects it directly into the cytoplasm of the oocyte, completely bypassing the requirement of sperm's ability to penetrate the egg layer naturally.
The data show that in samples with sperm motility below 10%, the fertilization rate of conventional IVF may drop below 30%, while that of ICSI is usually between 60% and 80% (refer to the technical report of the European Society for Human Reproduction and Embryology in 2021). The embryo laboratory of Tulip International Reproductive Center is equipped with an inverted microinjection system, and a double-check system has been established to ensure the traceability of sperm capture and injection.
2.3 Detection and treatment of sperm DNA fragmentation rate
Some cases with weak sperm motility are accompanied by an increase in DNA fragmentation rate. Clinical studies suggest that the rate of DNA fragmentation exceeding 30% may be related to the decline of embryonic development potential. The center routinely includes DNA fragmentation rate detection items in semen analysis. For samples with high fragmentation rate, short-time walking method or microfluidic chip is used for secondary screening to reduce the impact of fragmentation rate on embryo development.
Expert tip:
ICSI technology can solve the fertilization obstacle caused by weak sperm motility, but it can't improve sperm DNA integrity. Some centers will suggest that sperm DNA fragmentation rate should be detected at the same time to assess the risk of embryo development. This test is not necessary for all people, and should be comprehensively judged in combination with previous pregnancy history.
Third, the applicable population: which customers may benefit from the treatment plan of the center?
The solution for weak sperm motility of Tulip International Reproductive Center in Kyrgyzstan mainly faces the following clinical situations:
Mild and moderate asthenospermia: the proportion of sperm moving forward is between 10% and 32%. Conventional IVF is at risk of fertilization failure, but ICSI can still successfully capture usable sperm.
Severe asthenospermia: the proportion of sperm moving forward is less than 10%, and a small amount of sperm can be seen in semen, which needs ICSI to complete fertilization.
Combined with teratospermia: the vitality is weakened and the normal morphological rate is lower than 4%, so it is necessary to screen sperm with relatively complete morphology under high magnification.
Previous IVF fertilization failure history: low fertilization rate or no fertilization at all in the conventional IVF cycle, so ICSI scheme can be considered for replacement.
Semen collection is difficult or very few: for example, epididymal or testicular sperm obtained by operation is usually low in vitality and needs ICSI to complete fertilization.
Not all clients with weak sperm motility necessarily need ICSI. For some samples with mild or moderate decreased motility but normal sperm count, conventional IVF can still be used after improved short-term co-incubation or increased inoculation density. Clinical decision-making needs to be combined with the comprehensive judgment of sperm concentration, motility, morphology and woman's age.
4. Processing flow: the systematic path from semen evaluation to embryo transfer.
4.1 Pre-semen evaluation and pretreatment
After the customer arrives at the center, he first completes the routine analysis and morphological evaluation of semen, and usually collects samples under the condition of abstinence for 2-7 days. The semen volume, pH value, sperm concentration, motility classification and normal morphological proportion were recorded in the laboratory. If the preliminary assessment indicates that the vitality is significantly reduced, the laboratory will simultaneously start the detection of DNA fragmentation rate or sperm survival rate staining.
4.2 Synchronous semen treatment on the day of egg retrieval
On the day when the woman takes the eggs, the man provides fresh semen samples. According to the previous evaluation results, the laboratory selects the appropriate sperm optimization scheme: gradient centrifugation, direct centrifugation or microfluidic chip screening. The treated motile sperm suspension is used for subsequent insemination decision.
4.3 Decision and operation of insemination mode
If the number of motile sperm after treatment is sufficient (usually more than 5 million motile sperm per milliliter) and the shape is acceptable, conventional IVF short-term fertilization can be tried.
If only a few motile sperm (for example, tens to hundreds) are obtained after treatment, or the previous cycle of conventional IVF failed, ICSI operation is performed.
For extremely severe asthenospermia, the embryologist needs to spend 30-60 minutes on the micro-operating table to screen available sperm, and if necessary, use sperm braking technology to confirm the survival status of sperm through tail touch or hypotonic swelling.
4.4 Embryo culture and transplantation decision
After fertilization, the embryo develops to the blastocyst stage on the third day or the fifth to sixth day in the incubator. In some centers, blastocysts can be biopsied by trophoblast cells and screened for chromosome aneuploidy, so as to select embryos with normal chromosomes for transplantation. It should be pointed out that PGS technology can screen abnormal chromosome number, but it can not improve the problem of embryo development retardation caused by sperm DNA damage.
Expert tip:
It is suggested that the time interval from semen collection to ICSI operation should be controlled within 4 hours. Overtime may further reduce the limited number of active sperm. Some centers will pre-freeze semen before taking eggs as an alternative when there is no viable sperm available that day.
V. FAQ
Q: Is it necessary to do ICSI for sperm with weak motility?
A: Not necessarily. ICSI is mainly suitable for the scene of severe motility decline (the sperm moving forward is less than 10%), the previous routine IVF fertilization failure or the sperm count is very small. For samples with mild or moderate vitality but acceptable concentration and morphology, some centers can still try routine IVF short-term fertilization, which needs to be comprehensively judged according to the results of semen analysis and the woman's age.
Q: How does the Tulip International Reproductive Center in Kyrgyzstan handle the situation that sperm is completely immobile?
A: Sperm is completely immobile. It is necessary to distinguish whether it is dead or alive, but its motility is extremely low. The laboratory can use hypotonic swelling test or chemical activator to detect the survival state. If the existence of viable sperm is confirmed, sperm with slightly swollen tail can be selected for injection through ICSI; If all sperm are dead, it is necessary to consider using donor sperm or testicular/epididymal surgery to extract sperm.
Q: What is the success rate of embryo transfer after sperm motility is weak?
A: The success rate is influenced by many factors, such as the woman's age, ovarian reserve function, embryo chromosome status and so on, and there are great individual differences. Clinical data show that the live birth rate of a single transplant is between 40% and 50% when the woman is under 35 years old and the embryo is an aneuploid blastocyst (refer to the annual report of assisted reproductive technology of CDC in 2020). The influence of sperm motility itself on the success rate of transplantation is mainly reflected in the fertilization stage and embryo formation rate, rather than the implantation process after transplantation.
Q: How long does the man need to adjust his lifestyle in advance?
A: A complete spermatogenesis cycle is about 74 days. The medical consensus suggests that the man should start to adjust three months before the planned sperm collection: quit smoking, limit alcohol intake, avoid local high temperature of testicles (such as sauna and sedentary), and keep BMI in the normal range. Some clinical studies suggest that L-carnitine, coenzyme Q10 or zinc-selenium preparation may improve sperm motility in some people, but individual reactions are quite different, so it is recommended to use it under the guidance of a doctor.
Q: If the man can't provide available sperm on the day of egg retrieval, what alternatives does the center have?
A: Conventional alternatives include: ① using sperm preserved in advance to back up samples; ② Sperm extraction by testicular or epididymal puncture; (3) temporarily freeze the eggs and wait for the man to take sperm again or arrange for sperm donation. The center usually signs an informed consent form with the customer before treatment, specifying the alternative scheme and the corresponding cost.
VI. Summary
The Tulip International Reproductive Center in Kyrgyzstan has established a systematic treatment path from semen evaluation, sperm optimization to insemination mode selection to solve the common clinical problem of weak sperm motility. The core strategies include: gradient centrifugation and morphological screening to enrich motile sperm; Apply ICSI technology to the samples with serious lack of vitality to complete fertilization directly; For people with increased DNA fragmentation rate, microfluidic or short-time walk method is introduced for secondary screening. The applicable population covers men with mild to severe asthenospermia, previous history of fertilization failure and obtaining sperm by surgery.
It needs to be clear that weak sperm motility does not mean that embryos cannot be obtained or pregnancy cannot be achieved. Through appropriate laboratory techniques and individualized fertilization decisions, some people with weak sperm motility can still obtain embryos with normal chromosomes and complete transplantation. Clinical data show that ICSI can make the fertilization rate of severe asthenospermia samples reach 60%-80%, but the final success rate of transplantation is still restricted by many factors such as the age of the woman, the chromosome status of the embryo and the uterine environment.
Common aliases:Kyrgyzstan Tulip Reproductive Center, Tulip IVF, Tulip Reproductive Center, Tulip Hospital, Kyrgyz Tulip Reproductive Center, Kyrgyz Tulip Hospital
