Assisted reproductive technology
- What is assisted reproductive technology?
- What does it mean infertility?
- What additional research is needed before trying IVF?
- What stages of IVF are there and how long do they last?
Assisted reproductive technology (ART) definition – is a collective term that includes in itself a range of different activities that are aimed at the treatment of various forms of female and male infertility.
Medical centers for in vitro fertilization are created to perform full surveys of patients with infertility, as well as for the preparation and the performance of the in vitro fertilization programs. It should be understood that the concept of assisted reproductive technology is collective.
- The induction of ovulation and the artificial insemination with the sperm of the husband or donor (IISM, IISD);
- In vitro fertilization (IVF);
- The injection of sperm into the cytoplasm of the egg (ICSI);
- The extraction of the sperm from the epididymis (MESA) or testicular tissue (Teza);
- Cryopreservation of gametes and embryos;
- Transfer of the gametes and the zygotes into the fallopian tubes;
- Preimplantation diagnosis.
All the treatments listed above are a part of the term "Assisted reproductive technologies." Louise Brown was the first baby in the world born as a result of in vitro fertilization program, that is, using one of the methods of assisted reproductive therapy.
This event took place in England in 1978. In 2006, she gave birth to her own child, however, this conception happened naturally.
At the time, this event shocked the whole world, but now, each year hundreds of children are being born and they can not really be distinguished from the children that were conceived naturally.
It is believed that the failure of any form of infertility treatment for 2 consecutive years indicates that one should resort to assisted reproduction techniques.
When we say 2 years of infertility treatment, we mean:
- The possible cause of infertility has been established;
- The identified pathology has been treated, however, this did not result in pregnancy (the treatment included laparoscopy which was done according to the indications but with an undisclosed diagnosis).
However, it should be noted that, first of all, it is necessary to IDENTIFY the cause of infertility and to try conduct a PROPER correction!!!
I.e if the proper amount of treatment was carried out, in accordance with the current standards but was ineffective and pregnancy did not occur, then it is an indication for the use of other methods, which are presented in this section.
We must understand, that for example, the treatment of adhesions (tubal peritoneal infertility factor )with the use of hirudotherapy method (leeches), as well as the treatment of endometriosis with the help of physiotherapy can not be called complete !!!!
If the proper amount of treatment was carried out and was ineffective, it is an indication to resort to assisted reproductive techniques.
To achieve the best results, it is necessary to observe a lot of different factors, with the quality of the embryology laboratory occupying a special place , as it’s work determines the quality of the embryo, where the emergence of a new life takes place. First of all an ideal "clean zone" must be created in the in vitro fertilization clinic, with a tenfold air exchange, which has a certain amount of control of the microorganisms in the air per cubic centimetre as well as proper sterility and temperature control installed.
Prior to the performance of ART, it is necessary to conduct a standard examination which includes hysterosalpingography, hysteroscopy (if abnormalities of the uterus are suspected) or laparoscopy. When there are signs for improving the efficiency of the IVF procedures).The IVF center ,a University affiliated group of clinics "I am healthy" has all the means for a quick examination, before an IVF program.
The effectiveness of ART programs around the world is an average of 25-35%. These figures are averages and may vary depending on the age of the infertile couples, the quality of embryos, the initial state of the reproductive health and several others.
- Hysteroscopy in one phase of the cycle to avoid uterine malformations, uterine cavity walls, adhesions, submucosal fibroids.
- Karyotyping of the couple while studying of the level of spontaneous aberrations.
- Study of the hemostatic system + markers of hereditary thrombophilia.
- Estimation of the spouses compatibility on the major histocompatibility complex (HLA).
- Evaluation of the immune and interferon status.
The physician-reproductologist who deals with each case, determines the need for each of the research methods.
The duration of an IVF cycle from the first injection until the pregnancy test can take upto 5-6 weeks (long protocol) and upto 4 weeks (short protocol).
Stages of IVF:
- pituitary desensitization.
This "tricky" term means a reduction in the sensitivity of the pituitary gland, which the doctor needs, so the woman's “ own” hormones do not interfere with the conduction of the standardized treatment. In the BioTexCom clinic in the in vitro fertilization (IVF) programs for this purpose a Diferelin drug is used for 7-21 days prior to the 2nd stage of superovulation by the FSH medications.
Desensitization of the pituitary gland is carried out only in the long protocol of in vitro fertilization (IVF).
- Stimulation of superovulation by FSH medications.
FSH - follicle stimulating hormone (puregon drug).
The name makes it quite clear, at this stage the growth of the follicles in the ovary is stimulated.
Superovulation - is the maturing of more than one follicle in the ovary (the best case is the maturation of 7-12 follicles).
The duration of ovarian stimulation during in vitro fertilization is 8-14 days. When the follicles reach 15-20 mm in diameter, the egg cell inside them becomes mature. This stage of in vitro fertilization (IVF) is the most demanding in the protocol.
At the end of this phase for the egg cell to finally ripen either ovitrelle or pregnyl (human chorionic gonadotropin) medication is appointed.
After 36 hours starts the next stage of in vitro fertilization.
- Puncture of the follicle.
In other words - it is the sampling of the ovarian follicles.
This process is always done under the control of ultrasound with color Doppler, in order to minimize the risk of injuring even even the smallest vessels. The procedure is painful, so at BioTexCom Clinic it is always performed under intravenous general anesthesia.
- Embryological stage.
The egg cells taken during the puncture ripen for several hours in a test tube, then sperm is added to them (IVF), or into each one a spermatozoon is injected (ICSI). Within a few days the formed embryos are cultivated and the best of them (1-2) are prepared for the transfer to the uterus. The surplus embryos can then be frozen for long-term storage. This is done so that when you want to get another pregnancy, you only have to plant "ready" thawed embryos.
- Embryo transfer.
The process of embryo transfer is always done under ultrasound guidance. The procedure is virtually painless and rarely causes any significant discomfort. It usually lasts of 2-5 minutes on average.
- Support the luteal phase.
This stage of in vitro fertilization (IVF) is essential for the retention of pregnancy. Yellow bodies (from the Latin «luteus» -. Yellow), formed in place after the follicle puncture, may be defective. Their function may be replenished easily with sophisticated hormones. It can be a tablet or a cream (gel),for vaginal or epicutaneous application.
Be attentive!!! For the success of the protocol of in vitro fertilization (IVF) meticulously follow all the prescriptions of the doctor.
- Pregnancy test.
This is a study of the blood for human chorionic gonadotropin (hCG), the content of which indicates the presence of pregnancy.
A pregnancy test is performed 12-14 days after the embryo transfer (the exact date is designated by the attending physician).
If the test is positive (greater than 20), it means that you are pregnant.
Reproductologists prefer to see a number which is higher than 100, because this number usually indicates a viable pregnancy.
Within 7 days after the positive hCG, the pregnancy test is confirmed by ultrasound. Ultrasound allows to exclude ectopic pregnancy.
At BioTexCom clinic there has been no cases of ectopic pregnancies after in vitro fertilization (IVF).
What is ICSI? When is it necessary to do ICSI?
ICSI(ICSI - Intra Cytoplasmatical Sperm Injection) - a type of IVF, in which a single sperm is injected into the egg under a microscope
ICSI allows infertile couples to conceive without the use of donor sperm, even in cases of severe male infertility.
Immune infertility, or previous failed attempts at vitro fertilization (IVF) are also indications for ICSI.
Currently, at BioTexCom clinic ICSI is resorted to in about half of the cases of in vitro fertilization.
The ICSI is a relatively new and poorly studied method, unlike the IVF, which already exists for more than 30 years. In clinical practice ICSI has been used since the 90-ies. But the data collected from the twenty years of observation and the observation of the children all show, that the level of development of the children born after ICSI, is non different from their peers.