IVF and Sperm: When They Need Each Other

I just finished his sperm retrieval and told him the good news: “If sperm were money, you’d be retired. You have enough sperm for many IVF cycles.” He smiled and then it fell away in thought. After a pause, he said: “If I have so much sperm, why can’t we do something simple and use turkey basting instead of IVF to conceive?”

Not All Sperm Are Alike

In general, there are 3 levels of technology available for baby making: Sex (“no-tech”), intrauterine insemination (IUI, “low-tech”) and assisted reproduction with in vitro fertilization (IVF, “high-tech”). A simple truth is that only sperm found in the ejaculate can be used with “low-tech” approaches. Everything else, meaning any sperm taken from a man’s body that has not yet been ejaculated, needs “high-tech” or IVF to make babies. More expensive and less fun for sure. But why?

Crawling Not Running

One reason is quite simple. Aspirated or retrieved sperm do not move very well. Remember, sperm have to travel 8-12 inches or so to get from where they are deposited to reach the egg with low-tech procedures. That’s a long and geographically tough road in sperm world, which is probably why it takes so many sperm to naturally fertilize a single egg. In research that we published over a decade ago, we learned that about ½ (50%) of ejaculated sperm move, whereas only 1/5 (22%) of epididymal sperm move, and a mere 1/20 (5%) of testicular sperm move. Not only that, aspirated sperm do not move as purposefully as we’d like to see. Poor forward progression in sperm-speak.

A Tad Immature

But there’s a much bigger barrier to using retrieved sperm for low-tech procedures. Although their genetic payload may be in great shape, aspirated sperm have functional “issues” due to their developmental immaturity. Normally, ejaculated sperm beeline for the ovulated egg upon release, not because they can “see” it, but because they can “smell” it. Aspirated sperm have not yet acquired the “chemosensors” necessary to “smell” the follicular fluid released with the egg. As a consequence, their motion resembles that of air-driven ping-pong balls in a lottery box. Utterly random.
Even if by sheer luck they happen to reach the egg, retrieved sperm just bounce right off of it. This is because there are other physiological features of aspirated sperm that affect their fertility. They are not able to undergo “capacitation” and “acrosome react,” both of which are critical for the sperm to penetrate the egg. In fact, sperm develop these attributes after they leave the testicle and as they pass through the epididymis for a two-week training course in how to be fertile.
So, some kinds of sperm absolutely depend on IVF to make babies, whereas others do not. However, despite these profound developmental differences, once eggs are fertilized, sperm of all kinds produce babies with remarkably similar efficiency. So, what the Monty Python song said is actually true: Every sperm really is sacred.

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5 thoughts on “IVF and Sperm: When They Need Each Other

  1. Hi Dr. Turek, my husband recently underwent a very difficult vasectomy reversal. The initial physician that performed the vasectomy soldered way too much of the vas. During the reversal, the surgeon had to pull quite hard to be able to connect the ends and the vas was under a lot of tension during recovery. The semen analysis has now shown zero sperm (even though he has had no trouble having children in the past) and we were told that our only option now was IVF. Your site has shown us that there are more roads to go down before resorting to IVF. We are looking into getting tested for obstructions or to see if the surgery was even successful. IF there is a blockage or he requires a re-do of the surgery, is it even possible to do any further surgeries considering there was not much vas left to work with?
    Thank you so much!

    1. Dear Sheena, vasectomy reversal cases with too little plumbing left to work with can be difficult. Was this the case on BOTH sides or just one? I recently did a case with a 6.5cm (almost 3 inch) gap between vasal ends that went beautifully but the testicles had to be repositioned a little. The patient is not bothered and things are going well with him. So, in essence, further surgery is possible but depends on exactly what the findings are as summarized in the Operative Report dictated by the surgeon and the surgeon’s experience. I would also consider banking sperm at the time of any further attempts to reverse the vasectomy. Consider a call to learn more.

  2. Dear Dr Turk,
    I just found your contact and website regarding obstructive azoospermia. My age is 32 After six month of my marriage I went for semen analysis and there was no sperm in sample in 2 tests. So then I went for LH, FSH, Prolatin and TESA and MRI. My reports details are below
    1- Semen analysis (2 test result)
    Duration:6 days
    Volume :0.5
    sperm count- Zero
    Pus cell: 3-4
    2-FSH: 2.2 mIU/ml
    3-LH: 4.2 mIU/ml
    4-Prolatin: 245 mIU/ml
    5-TESA Left:
    1-2 Sperms found/ HPF, Normal Forms: 21%with
    Head Defects: 30%, MidPiece Defects: 32% and Tail Defects 17%
    100% Immotile
    Impression: Dilated tortuous cyt5ic lesion in left seminal vesicle is obstructed ejaculatory duct. Signal void area is possible stone/ retained thick secretions.(Towards mid line in left. Seminal vesicle measuring 10x11mm.
    Right Seminal vesicle is normal. Prostate is unremarkable.)
    Please advice me that should I go for IVF or ICSI and advice also the appropriate gap for TESA after 1st TESA test. Is there any possibility of normal sperm ejaculation for me if I don’t want TESA ?
    I had slight pain in my right tactical, after taking Lagon Tab for six days now I am feeling ok.
    John A.

    1. Dear John A: I love these kinds of cases! Low ejaculate volume and azoospermia with normal hormones is obstruction until proven otherwise. And the obstruction is at the level of the ejaculatory ducts (either blocked or absent). Your TESA procedure just confirmed that a blockage is present. However the MRI doesn’t tell me exactly what’s going on.. is there anything missing or dilated? I believe that it is better to fix blockages in men to build families rather than take the default approach and use IVF-ICSI. Consider a Second Opinion with us!

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