Surgical sperm collection (PESA, PTSA, TESE)
Sperm should be surgically obtained for microinjection in azospermic patients. Surgical sperm collection is an important point in male infertility treatment. In obstructive azospermia, a fine needle is inserted to the blocked ducts and sperm is aspirated (PESA). PESA obtains sperms in 99.6% of cases. Nonobstructive cases present a more difficult problem. A very limited production of sperm in some foci of testes is possible in these cases. So, multiple biopsies of the testes is required in these cases. Biopsies can be obtained either by a fine needle (PTSA) or by an open surgical procedure (TESE). These procedures reveal sperm in 60% of cases.

Assisted hatching
Half of patients undergoing IVF treatment do not achieve a pregnancy despite good quality embryos. Rate limiting step at this stage is probably implantation. Once the embryo is placed within the uterine cavity, embryo grows, divides, gets rid of the zona pellucida and adheres to the endometrium. Failure in removal of zona pellucida is thought to be a rate limiting step in implantation. So, before embryo transfer, a hole in the zona pellucida can be created using chemical or mechanical forces. Researches proved an increase in clinical pregnancy rates by this way. The procedure is performed as follows: the embryo is held stable via a pipette. Two holes a created on the zona pellucida via a micro-needle.


 
Blastocyst transfer
Recent advancements in IVF cultures made embryo development for a longer time in vitro possible. This created the advantage of day 5 or 6 transfers, which is associated with higher pregnancy rates. Last form of the embryo before it adheres to the endometrium is called as the blastocyst.

Embryo freezing
Freezing of human gametes and embryos has an important place in IVF practice. Transfer of a maximum of 3 embryos is a routine application of IVF procedures to decrease high order pregnancies. Then comes to mind the fate of excess embryos. Freezing of excess embryos provides the patient both an economical and psychological advantage. Furthermore, cost of thaw cycles is less than fresh cycles as ovulation induction is not needed. Embryo freezing is an important part of IVF procedures which increases success rates.

Procedure is performed as follows: for freezing the embryo, cryoprotectants are added and liquid nitrogen is added to achieve -196°C. When transfer of freezed embryos will be performed, cryoprotectants are removed. Pregnancy rates of thaw cycles vary among 10 to 25%. Law permits keeping excess embryos freezed for three years in Turkiye since 1997, once informed consents of the couples are obtained.