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| In-vitro fertilisation (IVF) treatment and ICSI |
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Indications
Indications for in-vitro fertilisation (IVF) treatment may include: - blocked fallopian tubes, - male factor infertility: gross male subfertility (<10 mln/ml, < 30% a+b motion) - endometriosis - Luteinized Unruptured Follicle Syndrome (LUF) - unexplained infertility Tests
Before IVF attempting protocol the patient is required to have certain tests:
- blood type - hormone levels (FSH, LH, Estradiol on the 1st – 2nd day of cycle) - bacteriology for Ureaplasma, Mycoplasma, Chlamydia - Pap smear - Ultrasound scanning - Seminogram While controlled hyperstymulation you will be advised to do other tests: - morphology, EKG, urine tests – up to 3 weeks before IVF - aPTT, Na+, K+, albumin, creatinine – 36 hours before IVF and estradiol with progesterone (depending on doctors decision)
Assisted conception procedures IVF
In-vitro fertilization literally means fertilization "in glass". Following stimulation of the ovaries, eggs are collected (harvested) and placed in a dish (not a test tube!) with washed and prepared sperm. Embryos resulting from this can be transferred to the woman’s uterus (womb) and any surplus suitable embryos may be frozen and stored for the couple for future use in a frozen embryo transfer treatment. Regulation Patients are prescribed combinations of drugs to stimulate the ovaries to produce eggs. There are different treatment regimes which can be used for this. Your treatment cycle is entirely individual and the drug dosage and number of visits to the Clinic are dependent on how your body responds to the drugs you receive. Monitoring of the treatment cycle To make us sure that drugs are effective your treatment cycle will be monitored by means of vaginal ultrasound scanning to reveal the dimensions and the number of follicles and endometrial thickness. There will be blood tests taken to evaluate oestriol. Ovarian stimulation Gonadotrophins stimulates the ovaries to produce multiple follicles, the majority of which will contain eggs. Gonadotrophins depending on protocol consist of FSH only or FSH and LH together. Those hormones are natural substances which stimulates growth of a follicle. Gonadotrophins treatment last for 1 to 2 weeks and during that time you will be asked to self administer it subcutaneously. The time of cycle depends on ovaries respond. Your treatment cycle will be monitored by means of vaginal ultrasound scanning and oestrogen blood tests. Near the end of the treatment cycle, you will be asked to self administer a one-off dose of recombinant choriogonadotrophin alfa. This is also called the "HCG injection". This is used to induce the final maturation of the eggs in the follicles and is again administered subcutaneously by self injection. Egg collection and embryo transfer When you are nearly ready to ovulate you will be given instructions on when to have your HCG injection. This HCG injection determines the time of ovulation. You will also be informed of the date and time of your egg recovery, and when to be at the Clinic. On the day of egg recovery you will also start progesterone support. 36 hours after HCG injection the eggs are collected. Ultrasound directed vaginal egg collection is carried out in the operating theatre. You will be under intravenous sedation or general anesthesia for this procedure. You are advised to stay in the Clinic for about 1-2 hours after the collection. Embryo transfer is a simpler procedure, usually done without any sedation. 
Egg collection
Semen collection
The male partner is required to produce a specimen of semen in the Collection Room within the Clinic. Abstinence from ejaculation of 3-7 days is usually recommended prior to egg recovery. In case of difficulties the male partner may produce the specimen earlier, and we can use a frozen one.
Fertilization
Depending on indication, different fertilization procedure is done: - in vitro insemination: About 2-4 hours after egg collation each oocyte will be transferred into a drop of medium under paraffin containing motile sperm at a concentration of approximately 100,000 per ml. Afterwards the result of insemination is being checked. If fertilization is confirmed the embryos are being incubated for 2 more days. - Micromanipulation (ICSI): 2 hour after retrieval oocytes are being gently dissected away from adherent clots and cells. The technique involves injecting a single sperm into the centre of each egg. The treated eggs are checked after the ICSI procedure to see if fertilization has occurred. If fertilization is confirmed the embryos are being incubated for 2 more days. When is ICSI used? ICSI is used when there are problems with the sperm that would make it unlikely to achieve fertilization with conventional IVF or when sperm parameters appear normal but previous failure or poor fertilization rates have been observed. ICSI may be appropriate in the following cases: - Patients with very low numbers of sperm. - Patients with very low sperm motility (movement). - Patients with very high numbers of abnormal sperm. - When sperm have been taken directly from the epididymis or testicles by a small operation. - When there are high levels of antibodies in the semen. - When there has been previous failure to achieve fertilization in conventional IVF, or when very few eggs have fertilized following IVF. - Where sperm function tests have shown that sperm would not be able to achieve fertilization. 
In-vitro fertilisation (IVF) treatment and ICSI
Embryotransfer After 3 days of incubation, the embryos consist of 6-8 cells. They are being scored and divided in 4 groups from A to D. “A” group has the strongest potential development, ”D” has the poorest one. We usually transfer up to 3 embryos. Embryo transfer is a simpler procedure, done under USG control, with full bladder usually without any sedation. Following transfer you have to rest for a about 20 minutes before you leave the Clinic. You will be prescribed a progesterone supplement to help support the embryos after transfer to your uterus. 
Embryotransfer
After 2 weeks since embriotransfer to the uterus the pregnancy test is being done, if positive we decide about further treatment and tests. |
