In vitro fertilization (IVF) – everything you wanted to know about
It is IVF the last treatment to be applied after a series of frustrating fertility treatments, when the couple is broken and discouraged?
The in vitro fertilization process has two purposes, one diagnostic and the other therapeutic. For some couples, the diagnostic in vitro fertilization will be the beginning of the treatments journey, others will be treated with IVF following a diagnosis such as fallopian tube obstruction or very low sperm quality.
What is IVF ?
We know the term in vitro fertilization as a test tube baby. The female partner eggs are picked up from the overstimulated ovaries and the fertilization process takes place in the laboratory instead of the fallopian tubes. The fertilized eggs begin to divide in the laboratory and the resulting embryos are transferred to the womb 3 or 5 days later.
This technique was developed in the UK in the 1980s. and quickly has spread all over the world. Initially, the treatment was designed for patients with obstructed fallopian tubes. Subsequently, egg fertilization techniques have been developed for sperm unable to fertilize on its own. Now is possible to test the future embryo genome and avoid a variety of genetic diseases to be inherited or prevent spontaneous abortion at the beginning of pregnancy. In the foreseeable future, damaged genes will be repaired ensuring genetic disease-free lives for future generations.
Almost 3% of all births in the Western world are by IVF. Due to the success and effectiveness of the method, many are applying for IVF, give birth to a baby of their own avoiding the need for adoption or surrogacy.
In vitro fertilization is now used even when there is no fertility problem, as a diagnostic tool such as the need to prevent the transmission of genetic diseases to the fetus, choice of newborn sex or fertility preservation.
Hyper-ovulation towards the Eggs pick-up.
The purpose of this treatment is to create about 10-15 mature follicles, in both ovaries, containing 10-15 eggs (unlike a natural ovulation cycle in which only one follicle develops in one ovary).
During hyper-ovulation treatment, the female partner will be required to inject artificial hormones similar to those secreted by the hypophyseal gland to induce follicular development and ovulation (gonadotropins): one type is designed to induce hyperovulation and the other type is for the final maturation of the eggs and timing of the ovulation.
During this treatment, the ovarian response is monitored by blood tests to determine hormone levels and transvaginal ultrasound scans of the small pelvis, to determine the number and size of the ovarian follicles, and endometrial thickness. When this monitor indicates that the follicles are mature, the ovulation hormone is administrated. 36 hours later the ovulation follicular rupture and egg expulsion) is expected. 34 hours after ovulation hormone administration, the eggs will be picked up by transvaginal guided follicular fluid aspiration, under general anesthesia. The content of the follicles is transferred to the laboratory for the identification of the oocytes.
Fertilization phase: The normal and moving sperm are isolated from the male partner ejaculate, by a laboratory process, in parallel with the oocytes pick up. Later, the eggs and sperm are brought together for fertilization, which is a pairing of one set of 23 chromosomes from the egg with a parallel set from the sperm cell. The fertilized egg now contains 46 chromosomes (two pairs of 23, one from each parent). The fertilized egg will undergo cell division process: on day 3 after fertilization, the embryo will have 6-8 identic cells; by day five after fertilization, the embryo will containing 150-250 cells differentiated in three kinds, and ready for implantation in the womb.
When the sperm is unable to fertilize by himself the eggs (due to sperm cell anomaly), injecting the genetic material of the sperm into the egg is performed Intracytoplasmic Sperm Injection (ICSI): using a micromanipulator, under the microscope, a single sperm is aspirated into a needle and injected directly into the egg.
Embryo Transfer is performed on the third day or the fifth day after the oocyte pick-up and fertilization; Using a very thin plastic tube,1-2 embryos are transferred to the womb, through the uterine cervix, without anesthesia (no pain or discomfort is involved in this procedure)
Freezing of embryos and cryopreservation
When, after embryo transfer, one or more embryos are left, they can be frozen in a special process and kept at a very low temperature (-196 Celsius degrees below zero). If no pregnancy results in the actual treatment, the frozen embryos can be thawed in the subsequent cycle, without the need to undergo hormonal therapy. If the treatment results in a viable pregnancy, the cryopreserved embryos can be preserved for many years so that a new pregnancy can be created even long after the birth of the baby, even when the advanced maternal age does not permit a new pregnancy. The maternal age of the embryos is the age of the female partner at ovum pick-up time. You may create healthy embryos at age 25 and use them age 40 plus. This is the most effective method of Fertility Preservation.
