Infertility eNews Spring 2012
Single Sperm Freezing Results in One Happy Family
In situations where both partners experience fertility issues, special attention and teamwork are necessary to achieve pregnancy. In the case of one couple recently treated at Cleveland Clinic, male fertility issues called for a novel solution to a problem that has challenged investigators for almost 15 years.
With severe male factor infertility, the number of sperm available may be very limited. The laboratory needs to be able to reliably isolate and freeze the few sperm that can be found. One sperm is all that the fertility experts had to work with in the case of Jason and Jennifer Schiraldi, and fortunately for the couple, one sperm is all it took to achieve conception.
This patient’s successful outcome resulted from the collaborative efforts of the In Vitro Fertilization Lab Director Nina Desai, PhD., and Edmund Sabanegh, MD, Director of the Center for Male Fertility at the Glickman Urological & Kidney Institute.
After a standard course of testing to address fertility concerns, it was discovered that this couple was experiencing issues on both sides of the equation: Jason Schiraldi was diagnosed with azoospermia, and Jennifer Schiraldi had a diminished capacity to produce eggs.
Dr. Sabanegh elected to perform a delicate microsurgical testicular biopsy on Jason Schiraldi with the hope of extracting enough sperm for the couple to proceed with an IVF cycle. Dr. Desai’s lab was responsible for assessing the tissue samples for the presence of sperm and ultimately freezing the tissue for Jennifer’s treatment cycle.
Very few sperm were present. The laboratory elected to freeze a single motile sperm that they were able to find and isolate after extensive screening. The hope was that if all the tissue was screened, more viable sperm would be found.
The Single Sperm Freezing process starts with very careful microsurgical biopsy of the testicles by a male reproductive surgeon to identify potential small areas of sperm production. In the IVF laboratory, a sample is screened at 300 times magnification for presence of sperm. Living sperm are identified and picked up with a glass needle. After incubation with a cryoprotectant, sperm are ready to be frozen.
The sperm are moved with a fine glass needle, and the use of the microscope, to the freezing device. The sperm is sequestered in one microliter or less of fluid and then placed on a plastic capillary tube with a preformed gutter. The capillary tube is then placed into another straw and sealed. The straw is then slowly cooled before storage in liquid nitrogen.
On the day of Jennifer’s egg retrieval, after another 3-4 hours of searching, with three technicians, no living sperm could be found. The decision was made to use the single sperm that had been initially found and frozen to inject one oocyte. Jennifer’s remaining eggs had to be frozen due to lack of sperm.
Fortunately for the couple, one sperm was all it took. The egg was successfully fertilized and developed normally. After three days, the embryo was transferred to Jennifer's uterus. Sixteen days later, Jennifer and Jason learned that they were to become parents. Daughter Kenley was born on April 20, 2010, after a normal pregnancy.
To learn more about this procedure, contact Dr. Desai at firstname.lastname@example.org or 216.839.2907.
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NextGen(SM) Offers Sperm Banking in the Privacy of Your Home
All of Cleveland Clinic’s endeavors focus on putting the patient first. In keeping with this long-established tradition, the Reproduction Lab recognizes that many patients may view sperm donation as a personal and private activity.
The Andrology Lab and Reproductive Tissue Bank has established the new and novel NextGen™ Home Sperm Banking Service. Individuals opting for this service will receive a specially-designed donor kit which is delivered with instructions. Home donation alleviates the anxiety that may accompany donations in a clinic donation room. This program is ideal for men with cancer or underlying subfertility; pre-vasectomy patients who may want to cryopreserve in advance of their vasectomy; men with a desire to insure potential future fertility and military personnel going on long-term deployment.
Those interested in exploring this service may call 866.922.6546 (866.9BANKIN) Monday through Friday between 7:30 a.m. and 4 p.m., ET, to speak with a specialist who will explain the process in detail. He or she will acquire the necessary information and accept a credit card payment for the service during the conversation. The specialist will then place the order for the sample-collection kit. This kit contains collection materials, complete instructions and some additional forms that require signatures. Once the sample is collected, it is returned to the Andrology Lab. Tests will be conducted and results will be reported quickly.
Cleveland Clinic offers two means of donating sperm, both of which require referral from a physician and completion of the appropriate paperwork. In additional to home sperm banking, a donor can visit the Andrology Laboratory and Reproductive Tissue Bank in the Glickman Urology & Kidney Institute on Cleveland Clinic’s main campus. Following completion of the appropriate paperwork, he will complete the donation process in private in a room designed for that purpose.
Trophectoderm Biopsy for PGD Offers Greater Diagnostic Confidence, Increases Potential for Successful Pregnancy Outcome
Cleveland Fertility Center now provides patients access to a cutting-edge technique for genetic screening of patient embryos that offers several advantages over traditional PGD techniques that remove a single cell on day three. This powerful new technique, known as Trophectoderm Biopsy, allows the removal of multiple cells at the blastocyst stage. Embryos can be screened for inherited genetic disorders as well chromosomal abnormalities. By selecting only normal embryos for transfer, the patient's opportunity for a pregnancy with a healthy baby is increased.
Trophectoderm biopsy is performed on day five, at the 16- to 32-cell blastocyst stage when the embryo has the highest implant potential. A laser is used to open the zona pellucida and excise five or six cells from the trophectoderm as it begins to herniate. The inner cell mass is unaffected. The cells are analyzed using a highly valid and rapid microarray technology offered by Genesis Genetics.
This technology examines all 24 chromosomes for abnormalities by comparing the sample against a known normal control. A computer-generated chromosome map is produced for each embryo sample. Embryos found to be abnormal are discarded and only the chromosomally normal embryos are implanted. The screen is completed within 24 hours, allowing patients to have fresh embryo transfers in the same in vitro fertilization (IVF) cycle.
Because trophectoderm biopsy looks at multiple cells at a point in which the embryo has shown developmental potential, it offers greater diagnostic confidence and a higher likelihood for a successful implantation and healthy pregnancy outcome. The technique is especially powerful for patients of advanced maternal age who have a high rate of aneuploid embryos, patients with naturally recurring miscarriages as well as unsuccessful IVF cycles, patients with unexplained infertility, and those concerned about passing on known inherited genetic mutations.
For more information about this procedure, contact Cleveland Clinic's Fertility Center at 216.444.8360.
The Richard E. Jacobs Health Center is Now Open in Avon
Cleveland Clinic care is now available in western Cuyahoga County and beyond with the opening of the Richard E. Jacobs Health Center. Located at 33100 Cleveland Clinic Drive, the new facility features not only fully equipped medical offices, but also services to help meet the needs of those seeking infertility advice and treatment.
The 190,000-square-foot building includes a pharmacy, on-site laboratory and full conference facilities. Four operating rooms, four procedure rooms and 23-hour overnight stay capabilities round out the facility. A 24-hour emergency department with helipad will open in the future. Internal medicine and family medicine specialists and obstetricians and gynecologists now see patients. Infertility services also include a full-service Andrology lab.
Cleveland Clinic also offers infertility services at main campus, Beachwood Family Health & Surgery Center, Solon Family Health Center, Strongsville Family Health & Surgery Center and the Twinsburg Family Health & Surgery Center.
To schedule an appointment for infertility services, call 216.444.6601.