A Workbook on Human Spermatozoa and Assisted Conception Sonia Malik, Ashok Agarwal
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1 A Workbook on Human Spermatozoa and Assisted Conception
2A Workbook on Human Spermatozoa and Assisted Conception
Editors Sonia Malik DGO MD FICOG FIAMS Programme Director Southend Fertility and IVF Centre Holy Angels Hospital Vasant Vihar, New Delhi, India Ashok Agarwal PhD HCLD (ABB) EMB (ACE) Director Center for Reproductive Medicine Professor Case Western Reserve University and Lerner College of Medicine Cleveland Clinic Cleveland, Ohio 44195 USA
3
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A Workbook on Human Spermatozoa and Assisted Conception
First Edition: 2012
9789350255179
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4Contributors 5 6 7 8 9 10 11Prologue
The sperm was discovered many centuries ago—much before man got the first glimpse of the oocyte, yet male infertility remains an enigma today. Even advances like intracytoplasmic sperm injection (ICSI) in the management of male infertility have not been able to increase pregnancy rates. This is because very little attention has been paid to this cause of infertility. The last decade has, however, seen an explosion in research in this area. Some clouds are parting but a lot needs to be done before we can see bright sunshine.
Southend Fertility and in vitro fertilization (IVF) centre, New Delhi, India, has been striving for academic excellence ever since its inception in 2001. Our practice in all these years helped us to recognize these gaps in the treatment of the male. It was this need that drove us to organize this workshop and symposium.
Reactive oxygen species (ROS) and deoxyribonucleic acid (DNA) damage lead to unhealthy sperms which may not lead to a pregnancy. It is, therefore, important to look more closely at the sperm function and morphology. New advances in this field are the highlights of this workshop. Intricate details of intracytoplasmic sperm injection (ICSI) are found in the chapter on micromanipulation but even that is now said to be incomplete without selection of the morphologically normal sperm or intracytoplasmic morphologically-selected sperm injection (IMSI), a new advance in ART that needs to be mastered by all practicing ICSI.
Exemplary work in this field has been done by Dr Ashok Agarwal and his team at Cleveland Clinic. It is our great fortune and good luck that we have been able to organize this workshop with him, Prof Juan G Alvarez and Dr Sandro C Esteves, all stalwarts in andrology. We are also fortunate to have an equally reputed national faculty.
As an introduction to the subject, the first few chapters in the workbook describe the equipment and media, simplified protocols for semen analysis, semen preparation in various situations. A lucid description of semen banking can be found in the workbook since it forms an integral part of any assisted reproductive technology (ART) unit.
We thank our faculty for demonstrating in this extraordinary workshop that describes not only the basic structure and function of the sperm but also its use in intricate procedures like IMSI and ICSI.
The workshop is an attempt to present evidence-based procedures and practices that are presently evolving or are being carried out on the human spermatozoa in ART. This workbook is a compilation of what is being demonstrated in the workshop. We hope this will be a useful tool for all practicing ART.
Aug. 2011
New Delhi
Sonia Malik DGO MD FICOG FIAMS
12Introduction
The field of human-assisted reproduction is growing by leaps and bounds with recent advances in areas of embryo culture, vitrification, Preimplantation genetic diagnosis (PGD), new WHO guidelines for semen examination and the latest techniques for the surgical retrieval and methods for the selection of best spermatozoa. However, the advances in this promising field are being severely threatened due to the lack of rigorous training and availability of laboratory personnel qualified to work in the human embryology clinics in less developed or in more developed countries.
I am pleased that the hands on training workshop on Human Spermatozoa and AssistedConception being organized on 12th August, 2011 at the India Habitat Center, New Delhi, India, is a bold attempt to empower reproductive professionals interested in in-depth training and knowledge of some of the most important techniques and protocols related to andrology and embryology.
The information compiled in this workbook is taken from both international and Indian experts engaged in assisted reproductive procedures. The 17 chapters included in this book contain practical information, step by step protocols, list of supplies and equipment and selected references.
I am confident that manual will be of immediate help to all those interested in the field of assisted reproductive technologies (ARTs). The readers can learn and master various sophisticated techniques included in this manual and in turn contribute to improvements in ART outcome of individual clinics.
Sincerely,
Ashok Agarwal PhD HCLD (ABB) EMB (ACE)
Director, Center for Reproductive Medicine
Professor, Case Western Reserve University and
Lerner College of Medicine
Cleveland Clinic
Cleveland, Ohio 44195, USA