Assisted Reproductive Technology Laboratory Procedures
Core concepts
Understand the andrology lab's role in ART: semen preparation for intrauterine insemination, IVF, and intracytoplasmic sperm injection (ICSI), plus surgical sperm retrieval processing (TESA, PESA, micro-TESE). Know the principles of oocyte insemination timing, sperm concentration targets for insemination versus ICSI, and the handling of severe oligozoospermia and azoospermia. Understand cryopreservation of sperm and testicular tissue, including cryoprotectant toxicity, controlled-rate freezing, and post-thaw recovery assessment. Recognize the importance of chain of custody, sample identification, and witnessing procedures to prevent misidentification.
Traps
Questions blur the distinction between conventional IVF (requires adequate motile sperm concentration) and ICSI (selected single sperm, useful for severe male factor). Watch for claims that ICSI overcomes all male factor causes-it does not correct DNA damage or aneuploidy. Another trap: assuming post-thaw motility equals pre-freeze quality; recovery is always lower and must be documented. Also be alert to timing errors in insemination and to the requirement for double witnessing during gamete handling.
Worked example / rule of thumb
For a sample with 0.5 million total motile sperm and 2% morphology, conventional IVF is unlikely to succeed; ICSI with processed sperm is indicated. Rule of thumb: match the insemination method to the absolute motile sperm count available, and verify identity with two independent identifiers at every transfer step.