Home Fertlility Treatments In Vitro Fertilization (IVF)





Successfully performed for the first time in the UK in 1978 by Robert Edwards and Patrick Steptoe, in vitro fertilization caused a revolution in human infertility treatment. From their initial procedures, done through rudimentary techniques, large advances have been achieved. In 1998, in the US only, some 59,000 cycles of IVF were performed, causing the birth of some 14,800 babies.

The main indications for this technique are:

- Male factors: Low sperm count, low motility, morphological disorders, presence of anti-sperm antibodies.
- Female factors: Hormonal alterations with ovulatory disorders, endometriosis, obstructing tube injure.
- Unexplained infertility.

In vitro fertilization consists in removing a patient’s eggs, their laboratory fertilization with her husband semen and transfer of the resulting embryos to the womb. To carry this some stages most be observed:

1- Patient is to be thoroughly evaluated and to produce all clinical tests required to a max efficiency procedure. The tests are: hormonal evaluation with blood test, transvaginal ultrasound, hysteroscopy, hysterossalpingography, Pap smear and spermogram.

2- After the preliminary evaluation a protocol with medication is to be issued so that we may attain a suitable number of eggs to be fertilized. During ovarian stimulation, transvaginal ultrasound and blood tests are to be performed to ensure the precise moment of egg retrieval.

3- Patient admission for follicle aspiration and obtaining eggs. In this day, the fasting patient is referred to the surgical room, a thoroughly sterilized environment, where she will undergo endovenous sedation and we will view the ovary and follicles through transvaginal ultrasound. A special needle is connected to the transvaginal transductor that will puncture at the follicles so as to obtain the eggs necessary to the fertilization process. The liquid arising from the follicles contain the eggs. It is sent to a biologist for microscope examination and afterwards sent to the incubator. The incubator is the equipment that reproduces the human body environment. The eggs lay there awaiting sperm fertilization. The eggs lay inside small plastic dishes soaked immersed in a liquid that simulates the fallopian tube environment where they would be fertilized. After eggs selection and incubation a semen sample is obtained from the male partner and prepared for the fertilization process. Depending on circumstances, some 100 to 500 thousand spermatozoids are added to the egg dish and left for a period of 17 to 18 hours for fertilization. The dishes are then inspected and fertilization is confirmed through the presence of 2 pro-nucleus in the egg. Daily follow-up is carried to evaluate the new embryo cellular division.

4- The patient is then re-admitted into the clinic to receive the embryos. It may occur between the second and the seventh day after egg retrieval. The process consists of placing embryos in a highly flexible, soft plastic catheter, which is introduced in the uterus. This may be an ultrasound-guided procedure. Patient is afterwards kept to rest for a few hours in the clinic and later for some 48 hours at home.



ICSI radically changed infertility treatment especially in relation to the male factor. This technique consists of injecting only one spermatozoid inside the female egg’s cytoplasm. This procedure was made possible only due to the development of special microscopes and micromanipulators, allowing for ultra-thin microscopic movements through which eggs, sperm and embryos are carefully manipulated. The technique favors men with very low sperm count, without motility or patients whom prior IVFs have failed.

This procedure is a “modified” IVF with identical primary stages. The difference lays exactly in the fecundation process: Whilst in the classic IVF egg is incubated with up to 500 thousand spermatozoids, in ICSI only one is utilized per egg.

According to an American Fertility Society report in 1998 some 16,650 ICSIs were performed in patients with ages under 35 reaching a gestation rate of 35.7%. For patients over 40, 4,350 procedures were performed with a 10.3% rate

Initially performed in severe cases of male infertility, ICSI is largely utilized nowadays even in cases where there’s no sperm alterations. Presently for all fertilization cases, some clinics perform ICSIs only.



This method is used where is impossible to obtain eggs from the female or when there is total impossibility to fertilize the obtained eggs. Specially selected donors’ -- bearing similar characteristics to the patient – eggs are utilized. A donor full check-up is performed to ensure good health conditions and to collect healthy eggs. In this case both women’s – donor and receptor - the menstrual cycles are synchronized through the use of medications and at the ideal date IVF is performed. Part of the eggs is fertilized with the receptor’s husband sperm. The resulting embryos are placed in the womb through classic IVF process.





Ovulation Induction

Artificial insemination

Other Treatments

PGD

HLA-G

Infertility and Immunology






In Vitro Fertilization:



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Intracytoplasmic Injection:



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Pipette versus a hair string:



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