Fertility is the natural capability to produce offspring and is a simple and natural experience for most couples. However, for some couples it can be very difficult to conceive. This difficulty can occur due to infertility (male or female). One of the most common reason for male infertility is the low sperm count in semen. Other common reasons include obstruction in sperm transport, hormonal disturbances, sexual problems (erection and ejaculation problems), and sperm antibodies. Female infertility is almost equally responsible for difficulty in conceiving. Reasons for female infertility includes ovulation disorders eg. Polycystic ovary syndrome, hormonal disturbances, damage to fallopian tubes, uterine or cervical causes, age, various environmental factors and some unknown reasons. Therefore, the treatment options for infertility depends on the cause, raising many possible competitors for sperm preservation start-ups banking on the future of this space. Recently launched Legacy will be looking at these competitors.

Competitors for Sperm Preservation Start-Ups

Competitors for sperm preservation start-ups like Legacy include various assisted reproductive technologies such as IVF, IUI, GIFT, ZIFT, ICSI, advanced medications to treat hormonal imbalances, erectile dysfunction, fertility drugs, surgery, and cryopreservation of Spermatogonial stem cells. Let’s see the possible competitors for sperm preservation start-ups.

1. Assisted Reproductive Technologies (ART)

Assisted reproductive technologies refer to the treatment and medical procedures that aim to achieve pregnancy or to treat infertility. This technology is also referred as fertility treatment and belongs to the field of reproductive endocrinology and infertility. Let’s know about the various forms of assisted reproductive technologies. 

• Intrauterine Insemination (IUI)

Intrauterine insemination or artificial insemination is the placement of a man’s sperm using a long and narrow tube into the woman’s uterus. Indications for IUI is most effective in:

• The women having scarring or defects in the cervix
• Men having low sperm counts
• Men having low mobility sperm
• Erection dysfunctions
• Couples with difficulty in intercourse
• Men with retrograde ejaculation (a condition where the sperm are ejaculated into the bladder instead of out of the penis)

The success rate of IUI depends upon the cause of infertility, age of women, insemination frequency, medications in use etc. intrauterine insemination can also be used with medications stimulating ovulation. This can increase the chances of pregnancy. Monthly inseminations with fresh or frozen sperm increases the success rate to as high as 20 percent. With IUI, couple can conceive even with very low sperm counts, which is one of the most common infertility problem in men. Multiple ejaculations can be collected for insemination leading to successful IUI. Attain fertility is a start up especially working on IUI.

• In-Vitro Fertilization (IVF)

In-vitro fertilization is a process in which fertilization of the male gamete (sperm) and female gamete (egg) occur outside the body, by incubating them in the laboratory to produce an embryo. This embryo is then placed into the woman’s uterus, where it may implant resulting into successful pregnancy. The process of IVF is basically consists of 4 steps- superovulation, retrieval of the egg, fertilization and embryo transfer.

• Superovulation

In this step, medications are given to the woman to stimulate the ovaries to make many mature eggs at one time. This step is also known as ovarian stimulation or stimulation of egg maturation. Health care provider closely monitors the development of the eggs by using transvaginal ultrasound and blood tests. When the eggs are mature, an injection of the hCG hormone initiates the ovulation process. Egg retrieval is then done to take out the eggs 34 to 36 hours after the hCG injection.

• Retrieval of Egg

This process includes the removal of eggs from the ovaries for fertilization. The procedure for egg retrieval includes insertion of ultrasound probe into the vagina to visualize the ovaries and follicles containing the eggs. Eggs are retrieved with the help of ultrasound, needle and suction.

• Fertilization

Semen sample from the man is taken and centrifuged to reduce the volume and concentrate. The sample is then placed in a dish with the egg and kept overnight in an incubator for fertilization. Usually fertilization occur on its own, if it does not happen then ICSI is useful for assisting fertilization. Embryos developing from IVF are placed into the uterus 1-6 days after the retrieval.

• Embryo Transfer

A long, thin tube is inserted into the vagina by the health care provider to inject the embryo into the uterus. The embryos can be frozen or thawed for embryo transfer at a later date. This is useful in cases where fresh embryos fail to implant. If a woman wants to preserve her eggs in order to become pregnant years later, then frozen embryos can be used.

There are many start ups working in the field of infertility. One of which is Nimaaya, having expertise in both IVF and male infertility like erectile dysfunction, premature ejaculation and psychosexual disorders. Swagene is a start up working in the field of IVF, recurrent miscarriage and preeclampsia, male infertility and Y chromosome microdeletions. Nora Therapeutics is a biopharmaceutical start up focused on developing therapeutics to address IVF failure and recurrent pregnancy loss. IGENETICS, is an another start up to treat infertility.

• Intracytoplasmic Sperm Injection (ICSI)

In case of IVF, usually fertilization occur on its own. Sometimes the sperms are not able to fertilize the egg on its own, then a single sperm is injected into the egg with the help of a needle. This process is known as Intracytoplasmic sperm injection.

• Gamete Intrafallopian Transfer (GIFT)

In this procedure, the gametes (eggs are mixed with sperm in a lab) are injected into the fallopian tubes by laparoscopic surgery so that the fertilization can occur naturally inside the body. GIFT is rarely used now a days, since the development of IVF and ICSI. The chances of twins or multiples are more likely because more than one egg is usually placed in the fallopian tubes. The laparoscopic incision takes time to heal. The success rate of GIFT is similar to IVF.

• Zygote Intrafallopian Transfer (ZIFT)

ZIFT is an almost similar process to GIFT, but in this procedure the health care provider makes sure that the eggs are fertilized and become one celled embryos known as zygotes. The zygotes are then placed in the fallopian tubes using laparoscopic surgery. In this procedure, there is an increased risk of twins or multiples is there because of placement of more than one zygote. Similar to GIFT, ZIFT has a longer recovery time due to laparoscopic surgery. Gonadotropins are usually given to most women before GIFT and ZIFT, which can cause mood swings, soreness at the site of injection and in breasts, headache, and bloating. The success rate of ZIFT is similar to IVF.

2. Medications

The most commonly used fertility drugs are Clomiphene and Gonadotropins. These medications regulate the reproductive hormones and trigger the release of one or more eggs in each ovulation cycle. Health care providers prescribe them for three to six months to most women, before conceiving or trying a different kind of treatment. The side effects of these fertility drugs include the increased risk of twins or more. Clomiphene can cause hot flashes, breast tenderness, ovarian cysts, mood swings, pelvic pain, thick and dry cervical mucus, headaches, and mild depression. About 80 percent of women treated with clomiphene ovulate in the first three months of treatment and 30 to 40 percent of them conceive by their third treatment cycle.

3. Surgery

Surgery is useful in genetic defects, fibroids, endometriosis, open blocked fallopian tubes, and polycystic ovarian syndrome. Laparoscopy and laparotomy are the two most commonly used surgical procedures. Laparoscopy uses thin instruments and a lighted camera inserted through several small incisions in the abdomen. Laparotomy is done through a larger abdominal incision. The side effects of laparoscopy usually includes discomfort in back and shoulders. Incision may cause soreness for a few days and may take some time to heal.

4. Third party- Assisted ART

When couples do not conceive pregnancy from the traditional infertility treatments, then they may choose to use a third party assisted ART to conceive. Third party assistance can consist of egg donation, sperm donation, embryo donation, surrogates and gestational carriers.

• Donor Eggs and Embryos

When a woman does not produce healthy eggs for fertilization, an egg donated by another woman is mixed with the sperm of the man and transferred to uterus of the man’s spouse. Egg donation is particularly helpful in women with primary ovary insufficiency, cancer treatment therapies, surgical removal of ovaries and menopausal women. Similarly donor embryo can also be transferred to the uterus. In case of donor embryo, medications are given to the woman to prepare the uterine lining for pregnancy before the embryos are transferred to the uterus.

The main drawback of this technique is that one may feel a sense of loss by not having their baby genetically. Choosing the donor may also take long time and process. The success rate is quite fair with this procedure.

Start up like Future Family, provides easy and affordable plans for both egg freezing and IVF.

• Surrogates and Gestational Carrier

When a woman is unable to carry a pregnancy to the term, then the couple may choose a surrogate or gestational carrier. Surrogate is a woman, who is inseminated with the sperm form the male partner of the couple. The resulting child is biologically related to the surrogate and the male partner.

In case of gestational carrier, the embryo is implanted in her. So, the resulting child is not biologically related to her. These processes are legally complex and require a considerable amount of money, time and patience to succeed.

• Sperm Donation

Couples can opt for donated sperm, if the man has very low sperm count or motility, does not produce sperm or has a genetic disease. Donated sperm can be used with IUI or IVF technologies.

5. Cryopreservation of Spermatogonial Stem Cells or Testicular Tissue

Spermatogonial stem cells or testicular tissue may be cryopreserved by slow freezing using 1.5 M dimethylsulphoxide and 0.15 M sucrose as cryoprotectants. The research investigating this to restore fertility is ongoing. Spermatogonial stem cells can also be successfully cultured in vitro without losing their stem cell properties.

Start ups like Parents of Fertility, Carrot, Rinovum, and Progyny  are basically providing various infertility treatment procedures.

Although sperm preservation is an established and effective mode of preserving fertility in at-risk patients and for treating couples who would otherwise be unable to conceive, but there are several competitors for it including various methods of ART, medications, surgery, and Spermatogonial stem cells. These advanced methods are helpful to treat infertility with good success rates.