What We Do and Why We Do It Jumana Adham husseini Lab Director/Senior Embryologist

2. What We Do and Why We Do It What We Do and Why We Do ItJumana Adham husseiniLab Director/Senior Embryologist

3. Our Bundles Of Joy

4. The Inside Story

5. HighestPregnancy RatesInUAE

6. Semen Analysis • Liquefaction • Volume • Count /ml / (Total) • Motility • Progression • Morphology • Agglutination • WHO (Criteria) 5th edition 2010-2013 • Lower reference limit • Conc. 15m/ml (total 39m/ml) • Volume (1.5mls) • Total motility 40% • 32% progressive motility • Normal forms 4%, (yet 15% normal forms defines teratozoospermia.)

7. Important Point to Remember • Severe reduction in fertilization might arise when < 4%strictly normal forms are present.

8. Abnormal spermatozoon under scanned microscope

11. Other Parameters Color Odor • Opaque and grayish white • Changes to yellowish white as days of abstinence ↑. • Blood gives it a reddish brownish color. • ↓ conc. And WBCs ► transparent and watery consistency. • The odor of the flower of the chestnut plant. • Odor is caused by oxidation of the spermin secreted by the prostate. • Absence of odor ► Abnormal prostate function due to infection

12. The pH • SHOULD BE WITHIN RANGE ( 7.2-8) • Human semen should liquefy at pH 6.9-8.8 within 20- 30 minutes. • > 8 → Acute prostatitis, vesiculitis or bilateral epididymites. • <7 → Obstruction of ejaculatory ducts, only prostatic fluid secreted. • <7.2-► <6 → chronic infection.

13. Liquefaction • Vesiculase • Seminine • (Alpha) α-chymotrypsin • Lysozyme • Hyaluronidase • α- Amylase • Prostatic spec. antig. / prost. Acid phos. • None Liquefaction ≥ 1 hr. ► Prostatic infection or other pathological state!?

14. 1-FRUCTOSE • A sperm metabolite • Done to check that ducts are normal. • Fructose levels are androgen dependant • ↓Low levels →androgen deficiency

15. 2- L-CARNITINE Epididimal function is marked by L- carnitine. (↑ levels →none -Obstructive azoospermia. ↓ levels→ obstructive azoospermia. (post epididymal)

16. 3- (PAP) Prostatic Acid Phosphatase • Prostatic Activity is Measured by seminal Acid Phosphatase (PAP) • ↑ Acid phosphatase → obstructed ejaculatory ducts. (↓ semen volume, ↓ fructose.) • PAP test determines the health of the prostate.

17. Other tests 4-Transferrin 5- Zinc and Selinuim Sertoli cells are the source of 80%. Very ↓ indicate Azoospermia. ↓ Low in oligospermia. ↑Highestin normal men. • Essential for germinal cell differ., and normal spermatogenesis, and sperm function. • Selenium deficiency leads to anomalies of neck and midpiece. • Zn ►chromatin decondensation.

18. Important Definitions • Normozoospermia • Oligoz0ospermia • Asthenozoospermia • Teratozoospermia • Oligo-astheno-terato-zoospermia • Necrozoospermia • Azoospermia • Aspermia • Cryptozoospermia

19. RECOMENDATIONS Repeat /Semen Analysis IUI/ IVF/ ICSI SURVIVAL EVALUTION VITALITY STAIN (EOSIN) SSU (♀♂) Selective swim up DNA FRAGMENTATION. SPERM ANEUPLOIDY

20. Vitality staining

21. The Sperm Marathon

26. FERTILIZATION

27. From Fertilization to Implantation

28. EGG COLLECTION

29. Cumulus Oocyte Oopherus

30. Abnormal oocytes

31. Mature & Immature eggs IVF image of a mature egg on the day of egg retrievalWe call this the metaphase II, or "M2" stage The presence of the polar body (red arrow) shows that the egg is mature • Photo of a very immature egg • Corona and cumulus cells are tightly packed around the egg

32. IMPORTANT DEFENITIONS IVF ICSI COMBINED IVF/ICSI (split) CRYOPRESERVATION (VITRIFICATION) PESA/TESA/TESE PGS PGD

33. IVF ...

35. ICSI

36. 2PN stage Embryo

37. Embryos

38. THE HATCHING BLASTOCYST

39. THE DIFFERENCE BETWEEN IVF AND ICSI • IN IVF  NATURAL SELECTION THE ZONA PELLUCIDA IS ABLE TO IDENTIFY GENETICALLY ALTERED SPERMATOZOA • GENETICALLY ALTERED SPERMATOZOA WITH POOR MOTILITY AND DNA DAMAGE HAVE LOW FITNESS IN OOCYTE FERTILIZATION • IN ICSI THE NATURAL PROCESS OF SPERM /OOCYTE INTERACTION IS BYPASSED.

40. PESA/TESA

41. (FNA)Fine Needle Aspiration

42. TESA / TESE

43. Cryopreservation