Q: I have been trying to conceive by IVF using the tequnique ICSI. My partner has had a vasectomy and the sperm is taken directly from the testis. I have had 3 full cycles with good fertilisation rates but no pregnancy has occured. I fear that I have an implantation problem although my uterus lining has always been above the required thickness. Does my partner's sperm have to be of good quality? Could this be the reason that I have not conceived yet? I have a history of endometriosis diagnosed by a laparoscopy 4 years ago, when I had a chocolate cyst removed. I have been diagnosed with another chocolate cyst, which I will get removed in someitme.

A:The initial tests done an infertile couple are based on the findings from the history and physical examination. These include: Testing for ovulatory function; Testing for male factor; Testing for tubal disease; Testing for cervical disease, Testing for uterine disease and Excluding endocrinal (hormonal) abnormalities problems. Assisted reproductive techniques include: 1. Gamete intrafallopian transfer (GIFT), designed for women with unexplained infertility. During this procedure, the patient undergoes a controlled ovarian hyperstimulation, the oocytes are retrieved transvaginally under ultrasound guidance, and 3-4 oocytes are placed via laparoscopy into one of the fallopian tubes along with sperm; 2. Zygote intrafallopian transfer (ZIFT) is used for couples with a significant male factor. The oocytes are retrieved similar to GIFT, but they are allowed to fertilize in vitro in the laboratory. At the 2-pronuclear stage (usually 24 hours later), 3-4 embryos are transferred via laparoscopy into one of the fallopian tubes. If the embryos are allowed to develop to greater than a 2-cell stage, the procedure is termed tubal embryo transfer (TET). The only benefit to a ZIFT or TET versus the more traditional IVF is for women who are thought to have compromised embryo quality due to embryo culture in vitro. Placing these zygotes or embryos back into their own natural incubators is thought to enhance subsequent development, with improved pregnancy rates; 3. Intracytoplasmic sperm injection (ICSI) is the treatment of choice for couples in whom the male partner has azoospermia or severe oligospermia. ICSI is also indicated for men with significant antisperm antibodies, low sperm motility, or significantly abnormal sperm morphology or when poor fertilization occurs with regular insemination techniques in the laboratory. Sperm can be obtained from the ejaculate or directly from the epididymis. Your treating physician is best placed to advise you.