By Sola OGUNDIPE
GOOD news for Nigerian couples faced with the challenge of male-factor infertility that is attributable to the problem of low sperm count and poor sperm motility. Such couples now have access to IMSI – a novel assisted reproduction technique that boosts chances of men with the problem of low sperm count and low sperm motility to father their own biological children.

IMSI, acronym for Intra-Cytosplasmic Morphologically-Selected Sperm Injection, enables the direct selection of good sperms from the man and then injecting into the woman’s egg to successfully achieve pregnancy.

Sperms carry half the genetic material necessary to make a complete human being. The egg holds the other half. Increasingly, experts are reporting that genetically fragile sperm may be very important factors in male infertility. Such sperm have fragmented DNA chains, which make them less capable of fertilisation and may also contribute to low quality.

Described as a build up on a previously existing treatment for male-factor infertility treatment procedure called Intra-Cytosplasmic Sperm Injection, ICSI, IMSI allows doctors to choose only those sperms with the best morphology for use in the assisted reproduction process, using a high resolution microscope that allows exploration at several thousand times magnification.

Double potential

Pioneer of the technique in West Africa, Nordica Fertility Centre, Lagos,  says it doubles the chances of men with the problem of abnormally low sperm count and poor sperm motility to biologically father their own children. “The major indication for the new technique is for men with very bad sperm parameters,” notes Dr. Abayomi Ajayi, Medical Director, Nordica Lagos, where series of pregnancies have already been successfully achieved through the pioneering initiative.

In his words: “Exploring sperm at this very high magnification shows defects in sperm heads, shapes and sizes and any sperm abnormalities associated with high DNA fragmentation that cannot be seen in conventional microscopes used for ICSI, and only the best morphological sperms will be micro-injected into the eggs, which would lead to higher pregnancy success. A study in Rome shows that success rate with IMSI is quite better than with ICSI.”

According to Ajayi, “IMSI was first developed in 2004 by a gentleman in Israel. “What it involves is just to use higher magnification to pick the sperm that is injected into the eggs. This has been shown to produce better embryos, higher blastocyst rates, increased pregnancy rates and reduced abortion rates in prgnancies effected by men with low sperm count.

In ICSI the sperm is magnified 200-400 times, but in IMSI, the sperm is magnified 6,000-7,000 times, so one is seeing the sperm completely and is able to select the good ones from the bad ones. The challenge in ICSI has always been to ensure that the selected sperm does not have a genetic defect, and this is exactly what IMSI does,” he stated.

Declining male fertility

Clinical records show that in Nigeria, 25 percent of couples are infertile, half of the causes due to male factor issues. Further, more than 90 percent of male infertility cases are due to low sperm counts, poor sperm quality, or both. In 30-40 percent of cases of sperm abnormalities, the cause is unknown. Experts says it may be the end result of one or a combination of factors that include chronic illness, malnutrition, genetic defects, structural abnormalities, and environmental factors. Partial obstruction in the long passages through which sperm pass can also reduce sperm counts.

Justifying the need for such novel assisted reproduction technique, Ajayi observed that, all over the world, male infertility is going up. “Male infertility is on the rampage, and Nigeria is not left out. We used to think the problem was only genetic in nature, but studies have shown otherwise.

There are no specific figures for Nigeria, but in Europe, it is known that an average of 1 in 18 men have low sperm count. People who are affected are increasing. We are seeing more men who are having bad sperm, abnormal sperm, so we decided to explore a suitable intervention. The essence to meet the growing proportion of men that need help in this direction.”

“Exploring sperm at this magnification shows defects in sperm heads, shapes and sizes and any sperm abnormalities associated with high DNA fragmentation that cannot be seen in conventional microscopes used for ICSI, and only the best morphological sperms will be micro-injected into the eggs, which would lead to higher pregnancy success. environmental factors and lifestyle factors are more responsible for the downward trend of sperm counts globally.

“There are many things in the environment are causing what is described as oestrogenisation of men. Findings have shown that things such as paint, exposure to petrol and even insecticides can affect sperm count. People working fuel stations are known to suffer from low sperm counts.

Sperm count and motility

Sperm motility is the sperm’s ability to move. If movement is slow, not in a straight line, or both, the sperm have difficulty invading the cervical mucous or penetrating the hard outer shell of the egg. If 60 percent or more of sperm have normal motility, then the sperm is at least average in quality. If less than 40 percent of sperm are able to move in a straight line, the condition is considered abnormal.

A normally fertile man has sperm count over 48-60 million per milliliter of semen. To attain pregnancy naturally, doctors say a man must have a sperm count of at least 13.5 million and in addition have sperm motility (movement) of more than 63 percent. Below 30-32 percent sperm motility is undesirable. Also, a man is most likely to be fertile when more than 12 percent of the sperm has a normal shape and structure. He is least likely to be fertilr when fewer than 9 percent of the sperm have normal appearance.

Sperm morphology

Morphology or the shape and structure of the sperm, may be even more important than count or motility in determining potential fertility. Abnormally shaped sperm cannot fertilize an egg. At least 60 percent of the sperm should be normal in size and shape for adequate fertility. The perfect structure is an oval head and long tail. Abnormally shaped sperm may include a number of variations ranging from a very large round head, an extremely small pinpoint head, a tapered head, a crooked head, two heads and a tail with kinks and curls.

Sperm quality

Essentially, quality of sperm is determined by its motility and its morphology. The quality of the sperm is often more significant than the count.

The bottom line is that IMSI provides a good correlation between test results, pregnancy rates, and fertilisation in vitro for the individual patient. The method is particularly helpful for patients with repeated failed IVF-attempts, to men whose sperm count is low, or men with large number of abnormal or immobile sperms.

It is no secret that every man wants to know what a “normal” sperm count is, especially when only one “good” sperm is needed to fertilise an egg. So for men who have been wondering if they can have their own biological children and how they can achieve such feat, IMSI is a dream come true.