In Vitro Fertilization
In vitro fertilization is one of the most widely used assisted reproduction techniques in the world. Since 1978, when the first baby was born through this treatment, many couples try to achieve pregnancy through this technique that has revolutionized the world of science and human reproduction.
In vitro fertilization (IVF) is a medical treatment consisting of medical and biological procedures aimed at facilitating the union of ova (oocytes) and sperm in the laboratory, so as to obtain embryos that will be inserted in the uterus for the opportunity for couples or women with fertility problems to conceive.
From fertilization, embryos are obtained, which are the group of cells resulting from the progressive division of the ovum once it is fertilized. The goal is to generate a limited number of embryos in each treatment cycle to have reasonable chances of reproductive success.
A small number (usually 1 to 3) of the embryos obtained will be transferred to the uterus to achieve gestation. The remaining viable embryos, if any, will be retained and stored at very low temperatures (cryopreserved) to be used in the future for the purposes established.
The most common indications are:
- Absence, obstruction or injury to the Fallopian tubes.
- Decreased number and/or mobility of spermatozoa or increased morphological abnormalities.
- Moderate or severe endometriosis.
- Ovulation abnormalities
- Failure of other treatments.
- Advanced age.
- Requirement to receive donated eggs.
- Genetic diagnosis in the embryo(s) before implantation in utero (PGD).
Prior to the IVF process, the following evaluations will be made:
- Evaluation of the partner or husband that may include medical consultation, physical examination and laboratory studies at medical discretion.
- Evaluation of the woman, with her medical history, physical examination and laboratory studies ordered by the specialist.
In Vitro fertilization and sperm microinjection usually begin with stimulation of the ovaries using medications, whose action is like that of certain hormones produced by the woman. The purpose of this treatment is to obtain the development of several follicles, inside which the eggs are found, and to control the moment of ovulation.
Several medications are used to stimulate the ovary, and these can be administered through injection or orally.
The ovarian stimulation process is usually controlled with blood tests of ovarian hormone levels and/or transvaginal ultrasound that report the number and size of developing follicles. If an adequate number of follicles reach development, other medications are administered to achieve the final maturation of the eggs.
Egg retrieval (oocyte retrieval)
The eggs are extracted by the puncture of the ovaries and aspiration of the follicles, by ultrasound guidance and vaginally. This procedure is usually done outpatient under sedation. The woman can go home hours after retrieval with antibiotic treatment and analgesic.
The eggs retrieved are prepared and classified in the laboratory. The number of eggs extracted in the puncture, as well as their maturity and quality, varies according to the woman and cannot be accurately predicted
Sperm Sample Collection
A sample of fresh or previously cryo-preserved and stored sperm (from the partner or donor) must be provided on the day of oocyte collection (it is advisable that this sample be delivered to the laboratory within timeframe of oocyte uptake). The sperm sample is processed in the laboratory to separate and resuspend in the middle of the culture the best quality spermatozoa for insemination of the eggs.
Union of ova and sperm
In vitro fertilization (IVF), ova and spermatozoa are placed together in cultures, and incubated to let fertilization occur. It may be indicated to perform sperm microinjection (ICSI), due to major abnormalities of the sperm analysis or previous failures of egg fertilization, or unexplained infertility with failed intrauterine inseminations. The microinjection of each ovum is performed with a sperm (IVF with ICSI) and the fertilized eggs are incubated to allow development of embryos.
The day after IVF or ICSI the number of fertilized eggs is determined and in successive days of cultivation the number and quality of the embryos that are still in development are assessed. The embryos will be kept in the laboratory for a period of 2 to 6 days after which the transfer will take place.
Embryonic transfer consists of the deposit of embryos in the uterine cavity through the vagina. It is an outpatient procedure that usually does not require anesthesia. The embryos to be transferred are loaded into a thin probe or catheter that is then introduced into the uterus through the vagina to deposit the embryo (s) inside. To promote embryonic implantation, a hormonal treatment is prescribed after transfer.
The number of embryos transferred to the uterus should be limited to one or two and only in cases of older women or exceptional cases will more embryos be transferred. Patients will receive from the biomedical team the necessary information to decide the number of embryos to be transferred to optimize the possibility of pregnancy and avoid multiple gestation as much as possible, understanding that the ultimate and ideal goal of this process is to procure a single pregnancy that results in the birth of a child. After embryo transfer, the woman should be on embryonic rest, (usually for one hour) and then be discharged with hormonal medical treatment.
If there are good quality embryos not transferred from an in vitro fertilization cycle, they can be cryopreserved and stored in liquid nitrogen.
In some cases, the usual IVF and ICSI techniques may be supplemented by other procedures on gametes or embryos intended to improve embryonic implantation capacity (assisted retrieval, fragment extraction, Preimplantation Genetic Diagnosis (PGD), etc.).
The pregnancy test is done 15 days after the transfer. During this time, the woman may need to perform hormonal blood measurements to adjust the dosage of the hormone replacement medication.
The factors that condition the probability of gestation in an in vitro fertilization are the cause of the infertility, the woman’s age, the number of eggs obtained and embryos of good quality.
However, it should be considered that not all patients initiating the treatment achieve follicular development suitable for being punctured, and not all patients with ovarian puncture have embryo transfer, because in some cases the egg collection, fertilization or embryonic development fails. Therefore, the result of the treatment can be expressed as percentage of gestations on the total of cycles initiated, on cycles with follicular puncture or on cycles with transference.
80% of the gestations are obtained in the first three cycles of IVF/ICSI with successful embryo transfer, failure makes it necessary to discuss with the team the desirability of undertaking other treatments.
Between 40 and 60% of the patients obtain enough embryos to allow the preservation by vitrification of the untransferred supernumerary embryos (cryopreservation) considering that they will only be cryopreserved those with biological characteristics of viability.
When pregnancy does not occur, it is important to discuss the outcome of the cycle with the treating physician to evaluate each of the factors involved in the treatment process and define options for future improvement.
The probability of achieving a pregnancy with an IVF cycle is greater than 45% in women under 35 years of age. It may vary according to factors such as the woman’s age, the duration of infertility and its cause. The cumulative total of the pregnancy rate after three treatment cycles may be 70 to 80%. For women, age may be the most influential factor because the number and quality of eggs in the ovaries decreases dramatically as of 35 years of age.
Inser developed the comprehensive four-cycle program as a very beneficial alternative to the physical and emotional level for couples, because by increasing the number of attempts (4 fertilization and embryo cultures), the success rate for achieving pregnancy can increase to 80%, something that reassures and excites the people involved in a highly complex fertility treatment.
One of the advantages of the comprehensive program of four cycles in vitro is that patients know that from the beginning, all possible changes that the specialist suggests to achieve pregnancy such as: embryo transfer, cryopreservation of ova and sperm, fertilization by means of donors, etc. are covered. This means the couple does not have to worry about extra disbursements that were not included at the beginning of the treatment.
In addition, Inser’s comprehensive four-cycle program can become an opportunity for emotional empowerment that is very important for the couple, since the proper management of the process’s own situations allows the development of trust and nourishes perseverance in a common goal. In addition, it fosters personal and partner growth, improves emotional coping and effective response to unanticipated outcomes, strengthens hope, life project and decision-making conjointly.
If you need more information about this treatment.
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