<unk>  is generally performed following a transvaginal oocyte retrieval procedure to extract one or several oocytes from a woman. In<unk>  IVF, the male partner or a donor provides a sperm sample on the same day when the eggs are collected. The sample is checked in the lab, and if no sperm is present, doctors will extract sperm from the epididymis or testicle. The extraction of sperm from epididymis is also known as percutaneous epididymal sperm aspiration (PESA) and extraction of sperm from testicle is also known as testicular sperm aspiration (TESA). Depending on the total amount of spermatozoa in the semen sample, either low or high, it can be just washed or capacitated via swim-up or gradients, respectively. A medical animation still showing the<unk>  procedure. The procedure is done under a microscope using multiple micromanipulation devices (micromanipulator, microinjectors and micropipettes). A holding pipette stabilizes the mature oocyte with gentle suction applied by a microinjector. From the opposite side a thin, hollow glass micropipette is used to collect a single sperm, having immobilised it by cutting its tail with the point of the micropipette. The oocyte is pierced through the oolemma and the sperm is directed into the inner part of the oocyte (cytoplasm). The sperm is then released into the oocyte. The pictured oocyte has an extruded polar body at about 12 o'clock indicating its maturity. The polar body is positioned at the 12 or 6 o'clock position, to ensure that the inserted micropipette does not disrupt the spindle inside the egg. After the procedure, the oocyte will be placed into cell culture and checked on the following day for signs of fertilization. In contrast, in natural fertilization sperm compete and when the first sperm penetrates the oolemma, the oolemma hardens to block the entry of any other sperm. Concern has been raised that in<unk>  this sperm selection process is bypassed and the sperm is selected by the embryologist without any specific testing. However, in mid-2006 the FDA cleared a device that allows embryologists to select mature sperm for<unk>  based on sperm binding to hyaluronan, the main constituent of the gel layer (cumulus oophorus) surrounding the oocyte. The device provides microscopic droplets of hyaluronan hydrogel attached to the culture dish. The embryologist places the prepared sperm on the microdot, selects and captures sperm that bind to the dot. Basic research on the maturation of sperm shows that hyaluronan-binding sperm are more mature and show fewer DNA strand breaks and significantly lower levels of aneuploidy than the sperm population from which they were selected. A brand name for one such sperm selection device is PICSI. A recent clinical trial showed a sharp reduction in miscarriage with embryos derived from PICSI sperm selection. 'Washed' or 'unwashed' sperm may be used in the process. Live birth rate are significantly higher with progesterone to assist implantation in<unk>  cycles. Also, addition of a GNRH agonist has been estimated to increase success rates. Ultra-high magnification sperm injection (IMSI) has no evidence of increased live birth or miscarriage rates compared to standard<unk> . A new variation of the standard<unk> -procedure called Piezo-ICSI uses small axial mechanical pulses (Piezo-pulses) to lower stress to the cytoskeleton during zona pellucida and oolemma breakage. The procedure includes specialized Piezo actuators, microcapillaries, and filling medium to transfer mechanical pulses to the cell membranes. The Piezo technique itself was for example established for animal<unk>  and animal ES cell transfer.
Intracytoplasmic sperm injection
Intracytoplasmic morphologically selected sperm injection
Testicular sperm extraction
Sacrohysteropexy
In vitro fertilisation
Spermatocelectomy
Sperm donation
Assisted reproductive technology