Author: Dr Tasos Christodoulou


The two methods that are the most commonly used in the field of Assisted Reproduction Therapy (ART) for the treatment of subfertile couples are:

a) In vitro fertilization (IVF) ("in vitro" is Latin for "in glass")

b) Intra cytoplasmic sperm injection (ICSI)


In Subfertile couples where women have blocked or absent fallopian tubes, or where men have low sperm counts, in vitro fertilization (IVF) and Intra cytoplasmic sperm injection (ICSI) (a great scientific achievement of the ’90s) offer a chance at parenthood to couples who until recently would have had no hope of having a "biologically related" child.


A brief summary for the different definitions of sperm cells concentrations is listed below.



                                           Million sperm cells /millilitre

Azoospermia                         0

Cryptozoospermia                 <1

Oligozoospermia                   <15

Normozoospermia                15–250

Polyzoospermia                     >250



These sperm cell concentrations play a very important role in the choice of any Assisted Reproduction Therapy and nowadays it is more obvious the importance of examining the so-called “male factor”, that is the male partner. In the case of In vitro fertilization (IVF) the amount of sperm cells needed per egg (oocyte) is in ideal cases about 150,000 sperm cells /oocyte, while in the case of Intra cytoplasmic sperm injection (ICSI) ONE sperm cell is needed to be injected (in a very complex procedure) in order to fertilize an oocyte.



Whereas classic indications for both treatment options are widely accepted, for example severe tubal damage which cannot be

micro-surgically repaired, cryptozoospermia, severe OAT (oligo-astheno-teratopermia) syndrome and repeated failure of fertilization in normal IVF, Intra cytoplasmic sperm injection (ICSI) might be indicated in a wider range of indications as well.


A number of additional ICSI indications are defined, for example minor forms of andrological subfertility, reinsemination

of nonfertilised oocytes on the day after conventional IVF, reduced motility of cryopreserved sperms, reduced quality of oocytes or even ICSI after one cycle of unexplained fertilization failure in IVF.


Some of the most important ABSOLUTE Indications for IVF therapy

are the following:


Salpingectomy on both sides

Andrological Subfertility

Idiopathic Sterility


Some of the most important ABSOLUTE Indications for ICSI therapy are the following:


Severe OAT (oligo-astheno-teratopermia)

Sperms obtained by MESA/TESE methods




Immotile Sperms Syndrom


So it is very important that the indications of any Assisted Reproduction Therapy are thoroughly discussed between the obstetrician/gynecologist and the subfertile couple, as the desire to have children, and be parents is one of the most fundamental aspects of being human.



Dr.Tasos L. Christodoulou


Fertility Specialist

University of Bonn, Germany

Apollonio Private Hospital Nicosia

Tel.+357 22469000 Mob. +357 99643922


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