Dr. Hammam Mandourah

Dr. Hammam Mandourah is our Urology, Male Infertility & Andrology Consultant at HealthPlus Fertility Center in Jeddah, KSA. He specializes in diagnosis and treatment of male sexual dysfunction, diagnosis and treatment of male infertility and treatment of Urological problems.
Dr. Hammam completed andrology – male infertility fellowship program at King Faisal specialist
Hospital, Riyadh, Saudi Arabia, 2022, he is Saudi Board certified in Urology, 2017. He earned his bachelor’s degree in Medicine and Surgery from king Abdulaziz University, Jeddah, Saudi Arabia, 2011.

Intra Cytoplasmic Sperm Injection (ICSI)

During Intra Cytoplasmic Sperm Injection method (ICSI), a single sperm is injected directly into the cytoplasm of the egg by an embryologist, having selected the sperm that are most active and healthy. It is indicated when sperm is either of low quality or quantity, when the sperms are surgically retrieved, when there has been previous failed or low fertilization with IVF (In Vitro Fertilization).Hence,  ICSI allows the use of sperm that may not otherwise have been able to fertilize an egg.  

The egg is examined for signs of fertilization as soon as 17–20 hours after ICSI. Over time, it has been found that around 80% of the eggs will be fertilized, except for couples that have severe infertility factors. 2% of all the “normal” looking sperm and eggs do not get fertilized even when the ICSI method is used. 

 Embryos are usually found in different stages and grades after being fertilized. The quality of the embryo is assessed by an embryologist, who will then provide you with the necessary information. The embryos thus formed, are transferred back to the uterus either after 2, 3 or 5 days or frozen for future use.

It is important to note that every couple is different. So it is important that proper tests are taken and that their medical history is discussed with a specialist before choosing to go for a particular method. 

HealthPlus is fully committed to ensuring that every patient’s dream of becoming a parent is achieved.

Assisted Reproduction

Assisted reproduction involves a set of processes by which eggs, sperm, or both are handled outside the body. There are several assisted reproduction methods that are now commonly used. They include in vitro fertilization (IVF), intrauterine insemination (IUI).

Intrauterine Insemination

During an intrauterine insemination (IUI) procedure, a small catheter is used to insert sperm into the uterus. This helps to increase the number of healthy sperm that reaches the woman’s fallopian tube when she is fertile, thereby increasing the chances of fertilization. IUI has become popular because it is cheaper than in vitro fertilization and is not as invasive.

In Vitro Fertilization

The most common form of assisted reproduction treatment is in vitro fertilization (IVF). Vast majority of IVF cycles are performed with some type of ovarian stimulation. Ovarian stimulation is usually started on the second or third day of your menstrual cycle. Ovarian stimulation involves using fertility medications to cause multiple eggs to grow and at the same time prevent premature ovulation. Once the eggs (follicles) are ready for egg retrieval, you will be administered an injection to trigger ovulation. Following the final trigger, egg retrieval is performed under anesthesia. Egg retrieval is known by several names, including ovum pick up, egg pick up and egg collection. During this procedure, the physician inserts an ultrasound probe into the vagina and then uses a needle to withdraw the egg from each follicle (takes approximately 15-30 minutes) depending upon how many follicles are present. After the retrieval procedure, the eggs are combined with sperm in a laboratory dish so they will fertilize. This produces an embryo. The embryo that is produced is then placed back into her uterus on the 2nd, 3rd or the 5th day, where it implants and begins to grow. When more than one embryo is transferred, there is a possibility of having multiple births, such as twins or even more.

Many people view in vitro fertilization as the last resort for all infertility problems. But of all the assisted reproduction techniques, it has a high success rate. 

Since the introduction of assisted reproduction, it has become more likely for all couples to have a healthy pregnancy. There are methods that would suit anyone as long as their medical history is analyzed properly by their specialists. These methods also ensure that you have control over your body concerning when you want to become pregnant and the kind of spacing you want between children.

Contact HealthPlus today to make an appointment with a specialist who will attend to you and to whom you can ask all the questions that you may have.

Pre-implantation Genetic Testing (PGT)

At HealthPus, there is an ultramodern genetics laboratory that is fully equipped to perform genetic testing on the embryos that are created using in vitro fertilization (IVF). 

Through genetic testing, a large amount of information can be acquired about an embryo before it is transferred to the uterus. After the formation of an embryo via an IVF cycle that occurs following the egg collection and ICSI, the embryo is tested by taking a few cells from it. The embryo is not transferred to the uterus until the results are released.

  1. Comprehensive Chromosomal Screening (CCS): Here, all the 24 chromosomes are screened to determine the gender as well as to find out if there are any missing or additional chromosomes. Abnormalities in chromosomes are one of the major causes of miscarriage.
  2. Gender Selection: This is the screening of the embryos so that the gender can be determined as well as for chromosomal abnormalities.
  3. Pre-implantation Genetic Testing: The embryos can be tested for all the 24 chromosomes before they are transferred into the uterus. This is called pre-implantation genetic testing.
    • PGS (screening) – involves testing of embryos for chromosomal abnormalities.
    • PGD (diagnosis) – involves testing the embryos for a specific known genetic or hereditary disease to ensure that the child does not have it as well.
  4. HLA matching: An HLA (HumanLeukocyte Antigens) matching is used to identify embryos that are HLA compatible with a child who needs bone marrow or cord blood transplant. The child (or the future sibling) of such tissue is often called  a Savior sibling. 

There are three different methods that can be used to identify hereditary diseases in an embryo. After tests and counselling, a method of testing will be settled on. Pre-implantation Genetic Diagnosis (PGD) is usually recommended during the IVF cycle if a genetic mutation is found so that the disease is not transferred.

  • Mutation screening is used to detect mutations present in small genes or genetic diseases that can only be caused by a small number of mutations.
  • Exome Screening is used to check for hereditary diseases that have yet to be identified or for diseases that involve the interaction of two or more genes. Exome Screening has the capacity to analyze tens of thousands of genes at a time.

Blood tests can also be carried out to ensure that there is very little chances of children having the same hereditary diseases as the parents. A common example is the Premarital or Preconception Screening that is done for couples that have a known hereditary disease in their family history and want to be sure that there is no possibility of their children inheriting such a disease.

Surgical Sperm Retrieval

Surgical Sperm Retrieval is a method by which sperm is collected directly from the testis or epididymis of a man. The procedure is usually planned ahead and is done while the patient is under a general or local anesthesia, but it can also be done immediately, if necessary, in the case of an emergency. This is usually in a situation where the man is not able to produce semen on the day his partner’s egg is to be collected.

Techniques of Surgical Sperm Retrieval

There are different techniques by which sperm can be retrieved surgically. The technique used depends on whether the testicles do not produce enough sperm during normal ejaculation or the sperm are not able to reach the seminal fluid because of a blockage in the tube that carries the sperm from the testis.

 1. Percutaneous Epididymal Sperm Aspiration (PESA)

PESA is a very quick SSR procedure and relatively painless. It is the least invasive technique and does not require surgical incision. The process is carried out by inserting a needle into the epididymis from which fluid is removed. The fluid removed is examined by embryologists for sperm content and motility. If no viable sperm is found, then another method will be used.

2. Testicular Sperm Aspiration (TESA)

In TESA, a fine needle together with a biopsy gun is used to remove small lengths of the seminiferous tubule that produce sperm. These tubules are then dissected carefully and examined under a microscope to detect sperm which can be used for ICSI or frozen for later use.

3. Micro-epididymal Sperm Aspiration (MESA) 

A small cut is made which passes through the scrotum and into the epididymis instead of using a needle as in PESA. The fluid removed is then examined under the microscope for viable sperm following the same technique.

4. Testicular Sperm Extraction (TESE) / Micro TESE

This method is used only if no sperm is found when the others are used. In TESE, the tissue is gotten after an incision has been made to open the scrotum. The tissue is cut and taken to the IVF lab where it would be prepared.

Micro TESE, is performed under general anesthesia by a surgeon (usually a urologist) using an operating microscope. A scientist takes samples and seeks live sperm in the samples removed from the testis. This is highly skilled work.

Dr. Fawaz Edris

Dr. Edris is a consultant at HealthPlus Fertility and Women Health Center in Jeddah, KSA. Before Joining HealthPlus, Dr. Fawaz worked in many reputable medical organizations in KSA and Canada. He is an Associate Professor at Umm Al-Qura University, Makkah, KSA.

Dr. Edris received his Medical Degree (M.D) from King Saud University (1997). He completed his residency training in Obstetrics and Gynecology at the University of British Colombia, Canada (2003). Dr. Fawaz has a Fellowship in Maternal Fetal Medicine (MFM) at the University of Ottawa, Canada (2005), a Fellowship in Reproductive Endocrinology and Infertility (REI) and Minimally Invasive Surgery at the University of Western Ontario, Canada (2007).

He is a Member of several societies, to name some: The Society of Obstetricians & Gynecologists of Canada, The American College of Obstetricians and Gynecologists, The American Association of Gynecologic Laparoscopists, The International Society of Cosmetogynecology, and The American Academy of Cosmetic Surgery.

Dr. Edris is married with 5 children. His hobbies are swimming and gymnastics (former KSA National Team)

Dr. Edris is fluent in Arabic and English.

Laparoscopic Ovum Pick-up Technique

Laparoscopic Ovum Pickup technique is a method by which an egg is collected for use in IVF. 

This method involves using a fibre-optic nerve to which a small camera is attached and being inserted into the abdomen via a small cleft under the belly button. The abdominal cavity is then filled with carbon dioxide to produce working space. After the eggs have been collected, the clefts are then stitched closed using absorbable stitches.

Three instruments are inserted into the abdomen during a laparoscopy procedure for ovum pick up. As a result, three small incisions are made, of which one or two will need to be stitched.

The laparoscope is placed through a small incision made at the lower edge of the belly button. This allows the doctor to see the ovaries and follicles holding the eggs. The second incision is made on one side of the abdomen, and an instrument used to hold the ovaries in place is inserted through it. In the third incision, the needle that will be used to remove the eggs is inserted.

Vaginal Ultrasound Collection

In this procedure, the eggs to be used are collected using the vaginal ultrasound egg collection method. During this procedure, the physician inserts an ultrasound probe into the vagina and then uses a needle to withdraw the egg from each follicle (takes approximately 15-30 minutes) depending upon how many follicles are present. Using the ultrasound as a guide, it is a lot easier to insert the needle and then extract fluid from every follicle because the image of what has been done is shown on the ultrasound screen.

As with every procedure, there are certain risks associated with it, and there is no certainty concerning the result. But at HealthPlus, you can be sure that you will be attended to by the best specialists around. Contact us to book an appointment or ask any questions that you might have in mind.

Dr. Mazin Bishara

A consultant in Obstetrics and Gynecology, Reproductive Endocrinology and Infertility (IVF), and Endoscopic (Minimally Invasive) Surgery.

Dr. Bishara has over 28 years of experience and has worked in many leading medical organizations in KSA and Canada.

Dr. Bishara earned his medical degree (MD) from King Abdulaziz University (KSA) in 1991. After that he completed residency training of OB/Gyn from University of Manitoba in Winnipeg, Canada in 2000. Followed by fellowship training in Reproductive Endocrinology and Infertility (IVF) and Endoscopic Surgery from McGill University in Montreal, Canada in 2002.

Dr. Bishara was appointed at King Faisal Specialist Hospital and Research Center from 2002 as a Consultant and Chairman of OB/Gyn Department and head of Assisted Reproductive Technology Department (IVF).

Dr. Bishara has many publications and participated in writing more than one book chapter in his field and has presented several papers in national and international conferences.

Dr. Bishara is a member of several medical societies like the Society of Obstetricians and Gynecologists of Canada, The American College of Obstetrics and Gynecology and The American Society of Reproductive Surgery.

Dr. Bishara is married with 5 children.

Dr. Bishara is fluent in Arabic and English.

Dr. Razan Ghaith