What is in vitro fertilisation IVF?
It all began in 1978 in Bourn Hall, England, where the birth of the first child with In Vitro Fertilization took place, by Patrick Steptoe and Robert Edwards, giving hope to millions of couples around the world. Almost 40 years later, the diagnosis of infertility, the improvements of the method of in vitro fertilization and the increase of its results, combined with the progress of society that has gradually begun to accept it, has led to its widespread dissemination.
More specifically, in vitro fertilization is the fertilization of a mature ovum from a single sperm that happens outside the human body, in a laboratory, in order to produce a fertilized ovum or zygote. The method has proven to be extremely effective, contributing to the birth of thousands of healthy children into the world.
In vitro fertilization is the appropriate solution when one of the following conditions is true:
- There are damaged or blocked fallopian tubes
- There are ovulation disorders
- The woman suffers from endometriosis
- Problems in male sperm (low sperm count, low sperm motility and increased morphological abnormalities)
- Immunological factors related to endometrium and sperm
- Advanced reproductive age
- Cases of unexplained infertility, where despite the exhaustive check-ups of both man and woman, the cause of infertility has not been identified.
Couples who follow the in vitro method, undergo the following examinations:
- Gynaecological exam
- Cultivation of vaginal fluid
- PAP Test
- Hormone tests
- Mammography, if over 35 years of age.
- Sperm cultivation
- Sperm diagram
Depending on the results of the tests and the couple’s history, the physician will decide if more specialized examinations are needed, such as:
- Thrombophilic test
- Immunological test
- Genetic tests (such as karyotype, control for cystic fibrosis, etc.)
After full clinical and laboratory examination of the couple who decided to proceed with in vitro fertilization, the most appropriate ovarian stimulation protocol if followed, according to age, hormonal profile, or results from any previous stimulation of the female partner. Then, prescription drugs are prescribed.
Ovarian stimulation regimens are roughly divided into Long and Short, with the administration of a GnRH analogues and in relation to LH antagonist regimens.
THE STAGES OF IVF
The start date of the treatment, the type and dosage of the drugs to be used and the review day will be agreed. In each examination, the hormone estradiol is measured and an ultrasound test of the endometrium thickness is performed, as well as the number and diameter of follicles growing in the ovaries. From those results, the continuation of treatment is also judged. On average, women are examined 3 to 5 times during a program of IVF, up until egg collection. Ovulation stimulation takes approximately 9 to 12 days.
Eggs are obtained by transvaginal puncture, using a special needle under ultrasound monitoring. Light anesthesia is provided. Shortly after it is over the woman may return to her home.
The eggs which are obtained from the woman, along with the male sperm and after appropriate treatment, are placed together in special culture media and incubated for 24 hours. During the next day, the number of fertilized eggs is determined.
This is a simple, painless process. 2, 3 or 5 days after egg collection. The embryos are transported, with the help of a very fine catheter, into the uterine cavity, which does not require anesthesia. The gestational test by measuring β-chorionic gonadotropin (b-HCG) takes place 14 days after ovulation.
Cryopreservation of embryos
Unused embryos of good quality are cryopreserved in liquid nitrogen (-196º C) in order to be used in a subsequent cycle, if necessary.
IVF in a natural cycle
It is IVF without ovarian stimulation with drugs, but with ultrasound tracking of the woman’s cycle. Monitoring is done until the follicle of the circle reaches the ideal diameter and the hormonal measurement indicates that a mature egg can be obtained.
The method is recommended for women:
- with ovaries that do not respond adequately to drugs to stimulate them
- which have repeatedly failed in previous IVF attempts by taking medicines to stimulate the ovaries
- who do not want stimulation of the ovaries or whose medical history does not allow it
The “pros” of the IVF method in a natural cycle:
- No medication
- The ability of repeating the process each month
- Usually high quality eggs are collected
- The psychological burden on the couple is low
The “cons” of the method
- At the time of scheduled egg sampling, it is possible that ovulation has occurred , so that egg collection is impossible
- The egg may not be mature enough to be fertilized by a sperm
- The egg may not be fertilized for unknown reasons
At Medimall IVF Clinic we have a high level of expertise in IVF in a natural cycle with very satisfactory results. We are pioneers, because at the 1st World Natural Cycle Congress in December 2006, we were the first clinic that published the series of our cases, as well as their success rates.
It is recommended in cases of blocked or damaged fallopian tubes and, possibly, in cases of endometriosis. The most important precondition is that the parameters which characterize the sperm (number, mobility and morphology) are normal. With this method, gametes (egg – sperm) are incubated together in culture medium for 16-18 hours.
It is also called Intracytoplasmic sperm injection. It is appropriate in the case of male infertility, i.e. when sperm parameters (number, motility, morphology) are not normal. According to this method, with the help of a special needle, an immobilized sperm is introduced directly into the egg.
TSES testicular biopsy
It is indicated in case of azoospermia and consists of the following: sperm are taken directly from the testes, followed by the method of ICSI.
It is followed in cases where the membrane surrounding the embryos is harder or thicker than normal. This method makes the membrane thinner, either mechanically or chemically.
Embryo transfer at the blastocyst phase
It applies when:
- no pregnancy is achieved after two IVF attempts, with embryo transfer of good quality embryos
- in cases where there is a sufficient number of high quality embryos but the couple wishes to transfer only one of them
- Under special conditions, which will be decided by the IVF physician
- The transfer of embryos takes place 5-6 days after egg collection.
WHAT YOU SHOULD KNOW
- The success of an IVF cycle, depends on a combination of the woman’s age, the quality of the embryos and the cause of infertility. It is worth mentioning that 90% of the couples starting an IVF program will lead to embryo transfer.
- The law defines the largest number of embryos which can be transferred, in relation to the age of the woman. When the couple wants to avoid possible multiple pregnancies, fewer embryos than permitted may be transferred.
- In women, after egg collection, drugs are administered, mainly by mouth, or some vaginal ointment. In this way, a friendly endometrium is created, which can better accommodate embryo implantation.
- The team of doctors of the IVF clinic and the physician, brief the couple before they decide on the fate of the remaining embryos. The remaining embryos may be cryopreserved for five years, unless this is extended by the National Authority, subject to certain conditions.
- The number of IVF attempts which a couple will undergo in order to achieve pregnancy is not specific. Usually, however, after the 6th attempt, there is little chance of success.
Pursuant to Law 3305/2005, adults who have submitted their written consent and have undergone the appropriate laboratory tests, may undergo an IVF procedure. Also, the legal maximum number of embryos to be transferred is two (2). Women over 50 years of age cannot undergo in vitro fertilization. Finally, the legal framework makes clear the interval for which preservation of frozen eggs, sperm and embryos is permitted, as well as under what conditions cryopreservation can be extended.