Submitted by Dr. Hesham Al-Inany, M.D. Lecturer, Gynaecology & Obstetrics dept. Kasr El-Aini hospital, Cairo University, Egypt.
In the last ten years, marked progress has occurred in the field of assisted reproductive technology. However, the expectation of IVF and GIFT in the treatment of cases of oligospermia, and other male factor problems (particularly multiple ones), have been disappointing (Ng. et al,1989).
Union of male and female gametes, either in vitro or in vivo, requires sperm penetration through the cumulus oophorus and the zona pellucida. Failure of fertilization despite of the increased number of spermatozoa introduced into the oocyte's vicinity by IVF has been shown to be directly related to abnormalities in sperm cell morphology and motility (Ng. et al, 1989).
This has prompted the development of a new approach called "Gamete Micromanipulation", a procedure in which one or more sperms are injected through the zona pellucida of the oocyte to assist the union of the male and female gametes. This is achieved with the aid of a micromanipulator.
Great advance in micromanipulative strategies has been developed over the past five years, and this improved technology has made it possible to circumvent the oocyte barriers to sperm penetration, thereby greatly reducing the number of normal sperm cells needed to achieve fertilization .
Other exciting prospects on the horizon are the possibilities of gene transfer for the treatment of certain genetic diseases and diagnostic application of embryo biopsy (Kim, 1990).
These new technologies have also generated serious ethical and legal issues. Any ethical or legal guidelines affecting new reproductive technologies should be developed to protect all participants in micromaniplulation programs. Ethical guidelines and appropriate legislation with contribution from the medical and scientific community are gradually being established worldwide (Kim,1990).
The aim of this article is to review the major strategies of micromanipulation which have been developed over the past five years, patient selection and the methods of sperm preparation to improve the yield of the applied technique. Finally to discuss the ethical aspects involving the micromanipulative techniques.
For a short account on gametogenesis, click here.
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