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A Solution
For Infertility?
WENDY ELLIMAN SPECIAL TO THE JEWISH NEWS
round 10 percent of all cou-
ples who want children in
the Western world are in-
ertile. In almost half these
cases, it is because of problems as-
sociated with the production or
delivery of sperm.
"Despite this, almost all infer-
tility research has focused on
women," says Professor Neri
Laufer, head of the Department
of Gynecology and Obstetrics at
the Hebrew University-Hadas-
sah Medical Center on Mount
Scopus and chairman of the Is-
rael Fertility Society. "It's in the
female reproductive system that
the NIH, for example, has in-
vested most of its infertility re-
sources. Knowledge about male
infertility is still rudimentary,
which makes the techniques
we've introduced in Israel very
important."
Nature is so extravagantly ex-
cessive in producing sperm (there
are as many as 300 million of
them in the teaspoon of ejaculate
expelled during each sexual cli-
max), that there would seem to
be little problem in at least some
getting through to the egg. But
even in fertile men, no more than
50 of the hundreds of millions of
sperm in each ejaculate ever
reach the egg. Very large quanti-
ties of perfectly formed sperm are
thus essential.
Sperm, however, can become
nonviable for a wide range of rea-
sons. "Environmental conditions
can damage sperm production:
Overcrowding, stress, alcoholism,
smoking, chemical pollution, ra-
diation and poor nutrition are
some of them," explains Profes-
sor Laufer. "Congenital abnor-
malities also damage male
fertility. Cystic fibrosis is among
these: One of its non-pulmonary
aspects is lack of exit vessels from
the man's testicles. And infection
can be a third cause: infections of
the sexual organs, venereal dis-
ease, prostatitis, epididymitis and,
of course, mumps."
The harm done to male fertil-
ity by all this, however, can now
be countered by a technique
developed three years ago in
Belgium and extended and de-
veloped at Hadassah.
"The technique is known as In-
tra Cytoplasm Sperm Injection or
ICSI," says Professor Laufer. "It
involves drawing sperm cells out
of the ejaculate and injecting
them directly into the ovum or
egg, sparing them the long, diffi-
cult journey up into the fallopian
tube. All we need to succeed are
a few normal sperm cells, which
need not even be mobile."
To this Belgian method, Pro-
fessor Laufer and his team added
their own expertise in in vitro fer-
tilization. "Since 1988, we've been
working with Professor Aaron
Lewis of Hadassah's Laser De-
partment; we've created a laser
that can drill a microscopic hole
into an ovum — the ovum itself,
remember, is no bigger than a
grain of sand — without damag-
ing any of the surrounding struc-
tures. In doing this, we not only
spare the sperm cell the trouble
of breaking through the egg's
`shell,' but also significantly im-
prove chances of the embryo
hatching."
Some 20 couples have become
pregnant at Hadassah with ICSI
followed by micromanipulation,
among them several for whom re-
ligion and culture ruled out donor
insemination as an option. Pro-
fessor Laufer and his team are
also using ICSI in men who have
no sperm at all in their ejaculate.
These patients fail to ejaculate
sperm because of a blockage
somewhere along the line, in or
around the epididymis which
stores mature sperm, or in the vas
deferens, the duct through which