All information about in vitro fertilization
- IVF. Indications for the use of the method
- Check ups before in vitro fertilization. Going through IVF
- Stages of IVF in details
- Cultivation of embryos
- How to choose the most appropriate method to overcome infertility in IVF?
When using assisted reproductive technologies,the female egg cell is fertilized by male sperm in a test tube and is transferred back into the uterus a few days later. The use of global IVF of treatment is most effective when getting pregnant through other methods is not possible - in these cases IVF is used for treatment of infertility. IVF criteria are the follows:
- In the case of treatment of tubal infertility factor. Tubal infertility occurs after extrauterine pregnancy, when the tube was removed or after they become impassable after an inflammatory disease
- treatment of male factor of infertility is also an indication for the use of the IVF procedure.Iin this case it is ICSI (intracytoplasmic injection of sperm into the egg)
- treatment of unexplained infertility or idiopathic infertility when pregnancy does not occur for a long period despite the external welfare of the couple
- ineffectiveness of other, simpler methods of assisted reproduction, such as artificial insemination
Decree N 107 of Ministry of Health of the Russian Federation, which regulates the activities of medical institutions in the field of IVF, also describes a number of contraindications for the treatment of infertility by in vitro fertilization method:
- physical or mental illness
- ovarian or uterine tumors, benign or malignant
- acute inflammatory processes in the body.
Prior to treatment by the IVF method the man and the woman should be screened to detect the absence of contraindications which allows to start stimulation of the woman’s ovaries. Our clinic recommends to pass all medical check ups to avoid IVF complications and read some precautions.
Check ups of women can be divided into several sections:
- By general somatic signs, ultrasound, ECG, photoroentgenography, check up by a therapist, complete blood count urinalysis, hemostasiogram, blood biochemistry, smear on the flora and oncocytology
- Screening for infection - HIV, syphilis, hepatitis B and C, simple herpes virus antigenes, antibodies to rubella virus
- Screenings , which give an idea about the state of the reproductive system, anti-myullerian hormone, thyroid hormones and reproductive hormones
- General clinical check ups, which are conducted prior to each treatment.
For men it’s primarily semen analysis and check up for HIV, syphilis, viral hepatitis B and C.
A full list of check ups is defined by the Decree N 107 Russian Ministry of Health, but your physician reproductologist, after a careful study of your history will do the remaining check ups.
Therefore, making an appointment in a good clinic with an experienced gynecologist-reproductologyst is something with which one should start the treatment of infertility through IVF. The reproductologist after studying your history and related tests and check ups shall appoint the date of the visit to the clinic in accordance with the IVF program, which he plans for you. IVF infertility treatment method consists of several steps:
- Stimulation of superovulation
- Puncture of the received egg cells which resulted from stimulation
- Fertilization of egg cells with the sperm of the husband or partner of the woman
- Cultivation of embryos derived from IVF
- Transfer of one or two embryos
Remember, the selection of the best method of treatment of infertility by IVF requires detailed specialist advice!
After the transfer of embryos into the uterine cavity the Doctor appoints supporting hormonal therapy and the date of delivery of the medical tests on human chorionic gonadotropin, indicating whether the pregnancy has begun.
Stimulation of superovulation is done with the help of hormones that allow a woman's ovaries to produce not just one egg cell as it happens in a natural cycle, but the amount that is maximum possible for the body of the woman, in accordance with its follicular reserves. There are several different options for superovulation stimulation protocols in IVF cycle.
For example treatment of infertility through long protocol. The method generally begins at the end of the previous menstrual cycle and begins with the introduction of Gonadotropin Releasing Hormone analogue. It takes daily administration of it. "The long protocol" is used less frequently today in IVF than the antagonist protocol.
The highest performance is achieved through the use of in vitro fertilization program with the use of antagonists of pregnancy in the treatment of the patient .The administration of medications containing GnRH-A usually begins upto 7 days before the next menstrual cycle. Pharmaceuticals containing FSH mostly 2 or 5 days of the cycle.
This protocol is typical for the older age group - patients who have chosen IVF method of treatment, but their response to stimulation remains relatively small - the ovaries don’t produce enough follicles (usually in this group the ovarian reserve is significantly reduced).
Today ardent discussions are conducted on the experience of foreign IVF clinics on which is the most favorable protocol in the case of "poor" response to stimulation: antagonist protocol or a short protocol, or protocol, " stop agonist".
Puncture in IVF is appointed by the reproductologist 36 hours after the introduction of the so-called trigger-hormonal drug that causes the final maturation of the egg cells grown as a result of stimulation. During the aspiration of follicles the doctor uses a special method to take the fluid from the egg cells through the vaginal wall for later fertilization, by the sperm of husband or partner of the woman. Puncture in IVF is generally considered minimally invasive and low-impact procedure, but sometimes there can be little bleeding, lethargy, and weakness. When there is pain several methods can be used, one of which is taking painkiller medication, but in the case of severe pain, discharge, or weakness one should immediately consult a doctor.
Sperm of the woman's husband or partner is specially prepared by a biologist and is used for fertilization of the eggs resulting from IVF. Our embryology lab is using the high class IVF equipment.
Egg cell fertilization procedure may be done in two different ways:
Classical IVF program (in vitro fertilization) and the ICSI (intracytoplasmic sperm injection). Depending on the causes of infertility and the treatment the doctor himself will choose the suitable method of fertilization.
Invitro fertilization is used in medical practice in the case when the man’s semen quality is excellent - good or of satisfactory quality. In this case, this method can only be used in the case of female infertility. The procedure is done as follows: a certain time after the puncture, the egg cells of the woman connect with the sperm themselves. The medium in which they are put actively contributes to their life and activity. The Clinic’s Embryologist puts the Petri dish into an incubator for 4-20 hours with strict temperature conditions of 37 degrees Celsius. After some time a single sperm reaches it’s goal - to fertilize the woman's egg. The sperm penetrates the egg through the plasma membrane and facilitates the successful fertilization.
After a lapse of 20 hours the embryologist can determine whether the fertilization has occurred or not. The egg cell that has been fertilized has a dual-core, called pronucleus. One belongs to the father, another to the mother. At the stage of formation of the cell it is called the zygote. Zygote can not be called an embryo, because the cells have not fully formed yet. Then, the embryologist chooses the best zygotes for the transfer into the uterus. The remaining embryos at the patient's request, can be frozen or used in the following IVF attempts. In some cases, some anomalies or deviations in the development of the embryo do not allow the formation of a zygote. As a result the transfer into the uterus during the use of the IVF method may be delayed. Sometimes the embryos can not even be vitrified for the future, as a result, the patients are advised to dispose of them.
ICSI (intracytoplasmic sperm injection) is used for infertility treatment with the application of a method of in vitro fertilization in the case of a severe male infertility factor. It is a relatively new technique, used to treat infertility - the first procedure was performed in 1992. Since then, it has won the trust of all reproductive community.
When using the ICSI procedure the embryologist places the sperm with the egg in the embryonic development block. Usually an ultra-thin glass needle of micro sizes is used for this. The program of in vitro fertilization is not any different in the early stages of the standard protocol of IVF: the patient begins receiving hormonal agents prescribed by the doctor, which differ significantly considering the type of program and the duration of the cycle. These drugs or injections contribute to the growth of follicles in the women’s ovaries. The procedure for obtaining sperm may vary depending on the IVF program. If using the sperm of the husband, separate spermatozoa are taken from the sperm that was handed in, which are then cultivated in a special embryological environment. Donor material can also be used for conception by IVF method - from a sample of frozen donor fluid. After the sperm are placed in the environment a selection is made depending on their structure, morphology. In fact, at the same time the maturity of the egg development is estimated. If all the parameters are normal, the selected sperm is sucked into a thin syringe and injected into the egg cell.
At this stage, the embryologist samples the best eggs for subsequent injection of biomaterial of the husband or donor. The embryos are usually grown to the stage of blastocyst (day 2-5 of development), choosing the most viable and transfer them to the patient's uterine cavity.
In the next phase of the treatment of infertility by IVF method which is cultivating - it is necessary to obtain sperm from the man and the egg cells of the woman which are ready for insemination. The reproductologyst suctions the follicular fluid as a result of a puncture. The liquid is placed in a sterile tube and is transferred to the embryonic development block. After that, it is necessary to get the sperm. As described above it can be the sperm of her husband, a man close to the patient or can be acquired in the Cryobank of the clinic or any other bank of donor material. It is important to note that after the transvaginal ovarian puncture was performed, for a successful pregnancy as part of infertility treatment by in vitro fertilization it is necessary to deliver the sperm in the same day as the puncture.
How does the process with the egg cell and the sperm happen? At the beginning embryologist looks at the cells through a microscope - there must be cells that are ready for fertilization. Then they count and embed them in a special solution, which is identical to the content of the fallopian tubes leaving them in the incubator room for some time - usually from 2-48 hours.
At the same time, another embryologist is working with the sperm, preparing it in the best way for the eggs. The culturing step is very important - the success of infertility treatment by in vitro fertilization largely depends on its results. The most well-formed and developed cells are selected by the doctor in the lab.Then the process of adding sperm to the egg cells in advance strict order takes place - and they must attach themselves and get inside. The action takes place inside the incubator, in which the conditions created are similar to intrauterine.
Next, after the successful in vitro fertilization, the fertilization is conducted. The doctor calculates the number of embryos, and only then he plans the date of transferring them to the patient.Different methods are used - if only a small amount of embryos is received resulting from the in vitro fertilization, then the transfer can take place on the second day (there is a risk that the embryo will not grow to the 5th day of development). Transfer can also be planned for 3-5 days of development, depending on the amount. The greater the number of fertilized embryos, the bigger the chance of success as a result of infertility treatment using IVF methods ( the embryologist has a selection of the best embryos for successful transfer).
Practice shows that embryos that acclimatize the best are those that have grown upto 5 days of development - they are able to develop better than the others, and the percentage of pregnancy resulting from infertility treatment by the IVF methods is the highest and reaches to 50% (in the case of using your own egg cells). But, as practice shows, even an embryo, which has grown to the blastocyst phase of development may stop in its development anв a missed abortion may occur.
To date, the fluids used,are close to intrauterine in composition and structure. They are almost the natural female environment which enables the growth upto 5 days of development and the selection of the most viable embryos. As a result of treatment of infertility through extracorporeal techniques allows the achievement of the desired effect.
- Age expectant mother over 35 years, as age increases the density of the shell
- Several unsuccessful IVF attempts. Sometimes the embryos obtained through in vitro fertilization, may reduce the level of an enzyme that promotes the splitting of the shell
- Transfer "unfrozen" after cryopreservation of embryos
- Anomalies containment
- High blood levels of FSH mother (follicle stimulating hormone).
A reproductologyst under the control of an ultrasound machine and using a specialized catheter transfers one embryo. Clinic NGC is an active promoter of selective technology transfer - the patient gets only one embryo in the uterus.
After the transfer in the next few days the embryo implants itself (attaches) to the uterine wall, which causes the growth of human chorionic gonadotropin in the blood. 10 days after the transfer the values of hCG become significant and pregnancy can be determined.
Today, IVF is the most effective treatment for infertility. Depending on the results of the system evaluation, the success of IVF attempts varies from 30 to 72% and depends primarily on the age of the patients, the quality of the eggs and the correct selection of an IVF program for the patients.
In some cases,the effectiveness of biochemical pregnancies is evaluated after the results of blood tests on hCG. After taking a supervisory ultrasound we can determine clinical pregnancy. Sometimes the impact of fertility treatment in IVF is evaluated by the number of children born as a result of the procedure.
First of all, you must make an appointment in a good clinic to a competent doctor-Reproductologist, who, after careful examination of your history will select the necessary treatment.
The NEXT GENERATION CLINIC is offering the patients a large number of program options which are effective for treatment of infertility.
- The basic or classical IVF is used when a sufficient number of eggs has matured in a woman's ovaries and the response to hormonal stimulation allows the collection of a significant number of eggs for the purpose of fertilization and further cultivation.
- IVF with egg fertilization by ICSI may be necessary in cases of male infertility factor and is different from the previous one because in this case during the fertilization of the egg, a direct introduction of the sperm is made into the cytoplasm of the egg, allowing fertilization in 90-95% of cases.
- IVF with minimal stimulation is applied when there is no adequate ovarian response to stimulation , or if at the beginning of the treatment the doctor sees a small number of antral follicles.
- IVF in a natural cycle is used when hormonal stimulation for the patient is forbidden, or there is a low ovarian reserve.
- IVF using donor egg cells or donor sperm may be necessary when one of the partners has a compelling reproductive disorder.To optimally treat them, in the clinic we have set up an extensive Cryobank of sexual gametes, from which you can make a choice of a donor using 30 different parameters.
- The most effective way to date is the use of pre-implantation screening technologies in IVF. Preimplantation diagnosis method(ACGH) allows to examine the resulting embryo throughout the chromosome set and to transfer only the tested embryos to the uterus, which increases the chances of a successful implantation to one and a half times and, most importantly, prevents the risk of a missed abortion and allows only the healthy children to be born. The discovery of this technology was a breakthrough of modern US medicine in IVF. Program is carried out without without the use of CBC methods. Despite its relatively high cost, which is connected to the high cost of scanners and microchips used, as well as the consumables for the analysis of chromosomes, the method can significantly reduce the total price for the patients which conduct the IVF program to achieve a positive treatment outcome.
- "Delayed motherhood" is used when a woman plans to postpone childbearing until a certain age in connection with the search of a spouse, employment or other life circumstances. In this case the mature egg cells resulting from IVF are vitrified and stored in the clinic’s bank until the patient is ready to carry out the second stage of the method associated with fertilization and transferring them to the uterus.
Various programs of banking egg cells and embryos are variations of IVF treatments in a natural cycle, when the resulting biomaterial is frozen and stored in the clinic’s bank to carry out the pre-implantation diagnosis of embryos program.
Obstetrician, Fertility specialist