Media o nas
In Vitro (Latin: in glass) – is a method of assisted reproductive treatment in which ovum and sperm are combined in laboratory, outside a woman's body. Obtained from this fusion embryos are then transferred into the uterus, where they grow into a baby.
- Female factor:
- blocked or damaged fallopian tubes
- a PCOS (Polycystic Ovary Syndrome)
- problem with ovulation
- hormonal imbalance
- insemination failures
- low ovarian reserve
- Male factor:
- poor sperm quality (including sperm count and sperm motility)
- history of genital infection
- testicular trauma
- exposure of the genitals to high temperatures
- Idiopathic infertility (unexplained infertility) – is referred to patients whose fertility problems cannot be diagnosed by standard fertility tests.
- antibodies problems that harm sperm or eggs
- patients with HIV and HCV infection
- age (women over 35 years old)
- genetic diseases
- no pregnancy within 3 years of unprotected sex
- cancer treatment
IVF treatment is a complex procedure which includes:
Ovarian stimulation is used to stimulate patient's ovaries to develop multiply mature eggs ready for fertilization (during normal menstrual cycle only one egg is produced. Thank to stimulation there is possibility to obtain 5-10 egg). The process of stimulation is based on so-called stimulation protocol which is created for every patient individually.
The patients injects the stimulation medications daily. While taking injections few visits are scheduled with the doctor who monitors follicles development and controls estradiol level. At the proper moment the puncture procedure (retrieval of oocytes) is scheduled. The stimulation phase ends with co-called trigger shot - injection of hCG hormone which stimulates ovulation.
EGGS RETRIEVAL AND SPERM COLLECTION
Puncture - eggs retrieval
Within 36 hours from the moment of hCG injection the oocytes puncture is performed. The doctor using ultrasound and thin needle inserted through vagina removes eggs from the follicles. The procedure takes about 15-20 minutes and it is performed under short-term general anaesthesia.
After the procedure the patient rests at Gyncentrum Clinic for about 2 hours. The doctor prescribes medications which need to be take after the puncture to prepare endometrium for embryos implantation.
If sperm parameters allows fertilization, the fresh sperm is collected at the day of puncture. It is provided at Gyncentrum Clinic in a special room which guarantees discretion and intimate atmosphere. 3-5 days alcohol and sexual abstinence is recommended.
In Vitro procedures (IVF)
In the laboratory the embryologist prepares oocytes and the sperm sample for fertilization:
- oocytes, retrieved during the puncture, are isolated and cultured
- the sperm is "washed", and the most valuable cells are prepared for fertilization
IVF – In Vitro Fertilization
In classic in Vitro Fertilization the collected sperm is processed and mixed with oocytes in culture media on a special dish several hours after the puncture. The plate is left in incubator which provides conditions similar to the woman's womb: temperature 37oC, high humidity, a proper concentration of CO2 and O2. Fertilization occurs within 18-20 hours. The embryo transfer is performed 2 or 3 days after egg retrieval. Embryos may also grow for 5 day till blastocyst stage. The decision is always based on the number and quality of the embryos. Currently, to increase chances of fertilization, classic in Vitro is replaced by ICSI/IMSI techniques.
ICSI (Intracytoplasmic Sperm Injection) is the method of in Vitro Fertilization where individual sperm cell is selected by embryologist, placed in a specialized micromanipulation tool, and then injected directly into cytoplasm of the oocyte. Cells are kept in incubator like in classic in Vitro. The next day, approximately, after 18-20 hours the oocytes are cleaned of the granule cells layer and it can be determined which ones have been fertilized. Mostly, 2-3 day after egg retrieval the embryo transfer is performed.
When ICSI is used?
Reasons used for performing ICSI involves male infertility factor: poor sperm parameters (law sperm counts, motility, and concentration, poor sperm morphology), and previous attempts of in Vitro with no success fertilization.
IMSI (Intracytoplasmic Morphologically Selected Sperm Injection) is the most advanced method of in Vitro Fertilization where the best quality spermatozoa is examined at a very high magnification (about 1008x optical, 6000x digital) and selected for fertilization. IMSI method increases chances of getting pregnant and reduces the number of miscarriages.
When IMSI is used?
The procedure is recommended especially for couples with male infertility factor:
- increased sperm DNA fragmentation
- while using sperm obtained directly from the testis or epididymis (after TESA/PESA procedure)
IMSI is also recommended for those couples who have been unable to have offsprings after earlier ICSI procedures.
Fertilized oocytes become embryos which are transferred into woman's body once they mature. The process is called embryo transfer.
How the procedure looks like?
The embryo transfer is performed either on the 2nd, 3rd, or 5th day from the day of puncture. At this stage the embryo consists of four- to eight cells or they are blastocyst (with a cavity filled with fluid and surface cells that are beginning to separate into placenta). Depending on the patient's age and diagnosis one or two embryos are transferred into the uterus by inserting a thin catheter through cervix. The whole procedure is painless and does not require anaesthesia. Afterwards, the patient is able to go home.
Recommendation after the procedure
After the embryo transfer the patient may return to daily activities. However, it is recommended to avoid sexual intercourses and orgasm within one week afterward to prevent cramps. The doctor prescribes proper medication which need to be take to increase chances of embryo implantation. If any worrying symptoms, like bleeding or pain occur, the patient should immediately contact the health care provider.