Medicaly-assisted procreation or In Vitro Fertilization (IVF) represents a method of assisted reproductive technology.
Medically-assisted procreation or In Vitro Fertilization (IVF), represents a method of assisted reproductive technology (ART). A key feature of this technology is taking both male and female gametes (semen and egg cells) in appropriate manners, which are then combined in the lab (the so-called In Vitro conditions). After that, the created embryo is entered into the body of the women.
Louise Brown is the first IVF baby in the world. The day she was born 25.07.1978., is considered the birthday of this procedure that brought happiness and provided hope for many infertile couples. For this achievement Patrick Steptoe and Robert Edwards won the Nobel Prize in medicine, with nearly 3 decades of delay, in 2010. Through this method, over 5 million children around the world was born, in some countries even every twentieth child that is born, is born from the IVF procedure.
In vitro fertilization is a safe and effective procedure of treating infertility, for both women and after a newborn baby, for which today there are numerous scientific proofs. Although not representing "a magic wand", the success rate per cycle of about 30%, which today is the European average, is more effective than spontaneous conception in a healthy young couple.
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After a complete diagnostic and appropriate analyzes, physician subspecialist of infertility, makes the decision on the indication for the procedure IVF. The most common indications are male factor infertility, fallopian tube obstruction, severe endometriosis, ovarian reserve is exhausted, the unknown cause of infertility and many other conditions where current treatment has not given results.
Adequate patient preparation includes a detailed ultrasound, endoscopic, hormonal and other analyzes aimed to identify and eliminate all conditions that would reduce the chance of success, so that the patient enters a process prepared at the most.
After completing of these findings physician determines therapeutic plan for each couple separately, individually and specifically, depending on the day of the cycle and the characteristics of the patients, as well as their attitudes.
This represents the beginning of the proceeding itself. The aim of this first phase, which lasts an average of 10 days, is to apply the appropriate medicines (primarily hormone injections) stimulating ovaries to develop an optimal number of follicles and the optimum number of egg cells.
Doctor that conducts the procedure, based on the findings of the woman, chooses a scheme of stimulation which is expected to give the best result. There are numerous protocols, the most famous being long scheme with a GnRH agonist and GnRH brief scheme with antagonists, as well as numerous modified protocols of stimulation with a mild stimulation or even carrying out the procedure in the spontaneous cycle, without hormonal stimulation.
It should be noted that there is no single recipe for all couples, but every couple deserves a scheme designed especially for them, based on their characteristics.
Although the procedures with mild stimulation are sometimes the best option and are very popular with patients, it should be noted that in most cases the rule is that the more of egg cells the greater the chance for success, and that is obtained only by classical or conventional stimulation with the use of hormonal stimulation.
Further course of this phase involves serial examinations of patients, starting from the fifth day of the therapy (usually every 2 days) where ovarian response is estimated on the basis of ultrasound exams and hormonal analysis. If necessary, treatment is adjusted, and the final moment to give - stop dose which causes the end maturation of egg cells is determined. This moment is estimated by the physician conducting the procedure based on a number of parameters. Normally it takes 3-4 reviews during stimulation.
Unfortunately, at this stage there is an option of suspension of the cycle unless there is an adequate response, and that the new stimulation starts, usually at a different protocol in one of the next cycle.
At a specific time, usually 35-36 hours after stop ampoules, it is necessary to carry out the extraction of egg cells. The procedure is performed under ultrasound guidance through the vagina, with thin needles used for entering in ovarian follicles.
The procedure can be performed when awake, but women often prefer to perform the procedure in the short-term anesthesia (intravenous opiate without intubation), which is standard practice in our institution. The procedure lasts on average 5-10 minutes, the patient awakens from anesthesia, rests in hospital for another 1-2 h, and then can return to its duties.
Aspirated egg cells are then taken to the embryologist in the laboratory, as well as a sample of partners' semen (this is a stage that usually requires the presence of both partners, if it is not the use of frozen partners semen) who continues to further work with the obtained gametes.
This phase represents the In vitro fertilization.
After obtaining gametes, embryologist, based on the characteristics of semen, as well as the number of egg cells, their quality, condition and other factors, selects the technique of fertilization (conventional IVF, ICSI, PICSI and other options), and performs fertilization of the egg cell by well-defined protocols and the highest standards of contemporary practice in IVF laboratories.
By merging of gametes, a fetus or embryo is created, which continues to cultivate. It is grown and kept in a sophisticated and highly-controlled incubator for the development of human embryos.
This phase usually lasts 3-5 days.
The proper development of the embryo in the body of a women or in laboratory (in vitro) conditions, implies certain dynamics of the division of the fertilized egg, in which the third day after fertilization we usually get an eight-cell embryo, which by further cultivation progresses to blastocyst stage, on the fifth day after fertilization. Blastocyst is the stage in development of embryos that occurs the 5th or 6th day, which generally indicates a greater chance of achieving pregnancy.
Modern laboratory conditions, high standards, trained staff and the use of the most modern and highest quality media in our clinic, allow unrestricted cultivation of almost all embryos up to blastocyst stage. Not all embryos come to this stage, since the embryos with chromosomal abnormalities often stop development at an early stage. Blastocyst cultivation is used as a method of selecting the best embryo with the highest potential for pregnancy, and offers the option of returning even the small number of embryos and achieving pregnancy.
Blastocyst transfer is performed on the fifth day after aspiration of of egg cells, and there are indications that this term carries a better receptivity of the uterus, because imitates the natural cycle (even in spontaneous conception, the embryo reaches the uterus only on the fifth day after ovulation, in the stage blastocyst).
The classic IVF represents embryonic fertilization technique - fertilization of the egg cell, in which the embryologist, in an appropriate container, and the presence of a suitable medium, leaves the egg with its surrounding and concentrate of semen, which then spontaneously fertilizes the egg cell. This technique is commonly used in situations where there is no significant disruption of semen, and its advantages are allowing "natural selection" - it is left to the most potent spermatozoid from the group to fertilize egg cell in these special conditions.
ICSI - intracytoplasmic sperm injection, is the technique of fertilization of the egg cell from the group of micro-manipulation techniques, where a single spermatozoid is injected directly into the cytoplasm of the egg cell...
In some individuals, spermatozoa may not be present in the ejaculate. This condition is called Azoospermia. This can be either due to problems in sperm production itself or due to obstruction to the flow of semen during ejaculation. Congenital anomalies may be relatively uncommon in the general population, but can occur in up to 2 percent of infertile men. The newest of the aspiration techniques is testicular sperm retrieval (TESA – TESE).
Intrauterine insemination is a method of medically assisted reproduction, which does not involve In vitro fertilization, but helps a couple in spontaneous achieving of pregnancy. The procedure is simple, safe and often successful in helping the infertile couple.Learn more
The failed attempts of In vitro fertilization is a source of huge frustration for both patients and for the entire IVF team. Although the chance of success of IVF cycles is good and reaches over 50% in certain situations, this procedure is still not a "magic wand" and a certain percentage of patients will fail the first or even several attempts.Learn more
Multiple pregnancies represent the presence of more than one fetus in the cavum of the uterus, most often it comes to twin pregnancy, but also to triple pregnancy - triplets, while the higher-order multiple births are rare.Learn more
In certain situations when the number or quality of remaining egg cells is lower, the best and sometimes the only form of successful treatment of infertility represents a cycle with donated egg cells.Learn more
Ovarian hyper stimulation syndrome - OHSS represents one of the biggest complications of treatments of infertility and in vitro fertilization.
This condition may end fatally, and it is estimated that this tragic outcome occurs in 3/100 000 initiated cycles of in vitro fertilization, as a result of OHSS.