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What is PICSI?

PICSI is the abbreviation for "Physiological ICSI".

How does PICSI work?

In addition to the morphology of the sperm cells, the maturation of the sperm cells is also important when using ICSI. The shell of the egg contains hyaluronan (hyaluronic acid) and in case of a natural fertilization, only mature sperm cells that contain the correct receptors (hyaluronidase) can come into contact with the shell of the egg and enter the egg hence leading to fertilization. The ability of sperm to ingest hyaluronan, therefore, reflects the natural fertilization process, and better predicts sperm behaviour during fertilization. In the laboratory it is possible to mimic this by means of a specially developed Petri dish, and to select these mature sperm cells for use in the ICSI procedure, given a sufficient amount of sperm cells to select from.

Why PICSI?

Studies show that sperm cells with the correct receptors appear to contain less DNA damage and fewer chromosomal abnormalities than sperm cells selected by eye under the microscope. This appears to increase embryo quality, the chance of implantation and the chance of the birth of a healthy child, while the risk of miscarriage appears to decrease with the use of PICSI.

For whom and when is PICSI recommended?

PICSI is advised in case of a high degree of DNA fragmentation, low normal sperm count (morphology), low fertilization rate with regular IVF/ICSI, suboptimal embryo development or poor embryo quality in prior IVF/ICSI attempts, implantation failure and/or repeated miscarriages. The indication is set by your attending gynecologist. The additional costs of PICSI are usually not reimbursed by your health insurance company.

Please contact us for more information.

What is the Microfluidic Sperm Sorting Chip?

The Microfluidic Sperm Sorting Chip (also called "Fertile Chamber") is a sperm selection method for IVF and ICSI treatments. There are also chips that can be used for insemination treatments.

How does the Microfluidic Sperm Sorting Chip work?

With a specially developed instrument, which looks like a transparent chip with microchannels (free of chemicals) up to a size of a few hundred µm, sperm cells without DNA damage can be selected and then used for fertility treatment, such as insemination (IUI), IVF or ICSI. The chip operates with very small volumes, imitating the natural flow and cell size, given a sufficient number of sperm cells to select from. The advantage is that the chip does not at any time damage vital sperm cells, and does not ignore the barriers to sperm cells that are present in nature. In this way natural selection can be imitated.

Why the Microfluidic Sperm Sorting Chip?

With regular fertility treatments, the sperm must be processed to make it suitable for insemination, IVF or ICSI. These are usually more lengthy methods in which the sperm cells are for instance centrifuged and possibly damaged. Part of the sperm cells naturally have DNA damage (oxidative damage), which can increase by processing the sperm cells. This may lead to DNA fragmentation and therefore poorer results in fertility treatments. The chip is able to mimic the natural sperm cell selection in a fast and gentle way, so that the sperm cells with better motility, and without DNA damage or chromosomal abnormalities, have the advantage. This seems to increase the embryo quality, the chance of implantation and the chance of the birth of a healthy child, while the chance of miscarriages with the use of the chip seems to decrease.

For whom and when is the Microfluidic Sperm Sorting Chip recommended?

The use has a certain overlap with the PICSI method. The chip is therefore recommended in case of a high degree of DNA fragmentation, low normal sperm count (morphology), low fertilization rate with regular IVF/ICSI, suboptimal embryo development or poor embryo quality in prior IVF/ICSI attempts, implantation failure and/or repeated miscarriages. The indication is set by your attending gynecologist. The additional costs of PICSI are usually not reimbursed by your health insurance company.

Please contact us for more information.

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What is DHEA?

DHEA is the abbreviation for "dehydroepiandrosterone", and is a steroid hormone which is – amongst other organs – produced by the adrenal glands from cholesterol. It plays an important role in for instance metabolism, muscle strength and sexuality. In addition, it has immuno- and neuromodulatory properties. DHEA can be converted into androstenedione, testosterone and other steroids (including estrogens). The storage form of DHEA is DHEAS. Between the ages of 20 and 30, the adrenal glands show a peak in DHEA production, after which the production capacity declines steadily. DHEA is used "off-label" for all kinds of purposes (including depression, immune problems, prevention of cardiovascular disease and the prevention of osteoporosis). Contrary to popular belief, DHEA is not an anabolic steroid, even though it is sometimes used in the gym. However, it has never been shown that this hormone has a muscle-building effect.

DHEA and fertility

For many years there has been extensive attention to the role of steroid hormones in reproductive medicine, especially in women with low AMH and / or age > 35 years. The idea is that the environment that plays a role in the development of an egg may be positively influenced by DHEA. As a result, more eggs may become more sensitive to stimulation during a treatment, and possibly fewer genetically abnormal eggs may be develop. There are many studies that show that the number of pregnancies and live births in IVF and ICSI, provided the correct indication and under supervision of a doctor, are positively influenced by DHEA. However, it is not yet so far that the use of DHEA is seen as "evidence-based medicine", although there are plenty of studies which unmistakably report a positive effect. That has also been our experience for years.

Indication, dosage and control

DHEA is a precursor hormone/prohormone and should therefore not be taken on your own initiative. First, it should be determined by blood tests whether there is a possibility to take DHEA at all, without a major risk of side effects. It may then also be better determined which dosage can be useful. Quite typically, dosages of 25-75 mg per day are used for at least 6 weeks before a new hormone stimulation can be started as part of an IVF/ICSI treatment. It is often started with 25-50 mg per day, depending on the blood values. A few weeks after starting the medicine, another blood test should be performed to test the levels and adjust the dose if necessary. The use of DHEA is strictly "off-label".

Side effects

DHEA is certainly not suitable for everyone; therefore assessment and monitoring is important. Side effects may occur, although they are practically rarely seen (<10% of patients), and such is also our experience. Possible negative side effects may include unwanted hair growth or hair loss, acne/oily (scalp)skin, cycle and menstrual bleeding disorders, voice change (<1%) and agitation (irritability and restlessness), which have been reported in the literature. Theoretically, the risk of (hormone-sensitive) cancers could be increased. This is essentially the case with the use of any hormone, and remains a particularly controversial topic of discussion among experts. In addition, it should be realized that the DHEA level often drops rapidly from the age of 30, and that in women around the menopause, other hormones sometimes become elevated for a long time.

Positive side effects are often also reported: many women report more energy, a better mood, sometimes increased sexual desire, better brain function and more endurance.

Reimbursement

DHEA is commonly not reimbursed by your health insurance company. However, on the basis of primary or secondary adrenal insufficiency with a reduced quality of life, an application for reimbursement - only if you have a Dutch health insurance - can be submitted to your health insurer. The positive effect on general functioning, psychological well-being and sexuality, may be a reason to reimburse DHEA for an indefinate period. You can here find an application form with which you can submit an application.

Please contact us for more information.

During insemination treatment, sperm cells are inserted into the uterine cavity using a catheter. If the partner's sperm is used, this is referred to as a 'homologous IUI'. If sperm from a donor is used, this is referred to as a 'heterologous IUI' or 'A-IUI'.

Insemination treatment can be considered in various situations, e.g.:

• The quantity and/or quality of the semen is only slightly impaired
• The cervix and/or cervical mucus does not allow sperm to pass
• A pregnancy has not occurred for a long period of time without a clear cause ('idiopathic sterility')
• Sexual problems that prevent sperm from entering the vagina
• The absence of a male partner, necessitating insemination treatment with donor sperm. Please inform yourself separately about the legal and other requirements for this (e.g. the nationwide Samenspender-Register). 

Insemination only offers a chance of success if it takes place in direct connection with ovulation. The treatment can be carried out in a natural or stimulated cycle. In a natural cycle, the day of insemination depends on the time of the positive LH test (urine self-test). If the maturation of the oocytes is disturbed, or if the aim is to develop more than one follicle, the ovaries can be stimulated with hormones (injections or tablets) in order to increase the chances of pregnancy. In this case, the cycle should always be monitored using ultrasound, and ovulation is triggered hormonally, on the instructions of the doctor treating you.

On the day of insemination, the man must provide a fresh sperm sample, which is processed. Certain substances and bacteria are removed from the semen and the mobile sperm cells are concentrated. Depending on the process, this can take 1-2 hours. In the case of treatment with donor sperm, this is thawed on the day of insemination; this usually takes half an hour.

The insemination takes place on the gynecological chair. After inserting the speculum, the doctor inserts a catheter (thin, soft and flexible tube) directly into the uterine cavity under visual control, and the sperm cells are slowly injected into the uterine cavity. This is rarely associated with pain. However, the uterus may have to be stretched a little with an instrument, which can be uncomfortable. However, this is rarely necessary. After the insemination you can basically do everything you normally do, except for smoking and drinking alcohol. Sexual contact is also allowed. You can find out from your doctor whether other advice applies to your individual case.

After about 14 days, a pregnancy test can be carried out using a urine or blood sample, and further arrangements are made. It is not uncommon for multiple insemination treatments to be required to result in pregnancy. The success rate is 10-20% per treatment cycle. The best results are achieved with only minor impaired semen parameters, use of donor sperm, short duration of fertility problems, younger age and healthy weight of the woman, and non-smokers. Despite all due diligence, success cannot be guaranteed. Upon request or indication, the patency of the fallopian tubes can be checked before or during the treatment.

Like most centres, we do not have our own sperm bank. However, in Europe, certain parties have focused on selling donor sperm. It goes without saying that we have our own cryo storage facility so that straws with donor sperm that you have bought can be stored without any problems.

The risks of insemination treatment are very small but cannot be ruled out. Despite all care, complications can occur that require further treatment/operations. Your doctor will be happy to discuss this with you.

Please contact us for more information.