IN VITRO FERTILIZATION
What is in vitro?
In vitro fertilization (IVF) is a procedure involving the collection of women and men reproductive cells (and consequently the oocytes and sperm), and then their fertilization in laboratory. The embryos are grown up to 2, 3, 4 or 5 day of their development, and then passed over into the woman’s uterus.
This method has been used in the world for over 37 years. Its originator, Robert Geoffrey Edwards, in 2010 won the Nobel Prize for its development . Louise Brown is the world’s first baby born on 12 November 1978 in the UK, with the help of in vitro methods. In Poland, the first successful in vitro fertilization treatment was made by Marian Szamatowicz in 1987. Worldwide, more than 600 000 in vitro procedures are performed. It is estimated that since 1978 about 5 million children have been born using this method.
How does the in vitro treatment proceeds?
1. Hormonal stimulation of the ovaries
The stimulation protocol is chosen for each patient individually (short or long protocol), according to:
- the patient’s age,
- of course treatment,
- results of hormone tests (AMH, FSH)
- the image of the ovaries by ultrasound.
The main task of stimulation is an incitement of follicular growth in the ovaries to obtain mature oocytes. While taking medicines it is extremely important to control the growth of follicles every few days, using the USG. When the follicles reach the suitable size, the patient receives a drug inducing ovulation. 36 hours afterwards the puncture procedure is performed during which the ova are taken. Most often from a few to several mature oocytes are obtained. While natural ovulation usually only one ovum matures.
|Question||Long protocol with
a GnRH agonist (GnRH)
|Short protocol with
a GnRH antagonist
|What is it?||For a minimum of 15 days from the beginning of the cycle the patient takes contraceptives, then drugs that inhibit the pituitary i.e. analogs of the GnRH hormone (gonapeptyl), whose task is to prevent premature cracking graffian follicles and release of oocytes. These drugs also inhibit the release FSH and LH. After 14 days the level of Estradiol is checked (confirmation of block of the pituitary gland at a concentration <50 pg / ml). Successively gonadotropin is administered (Menopur, Puregon, Gonal F), which are intended to cause the growth of follicles.||. The patient from the second day of the cycle takes gonadotropins, and after a few days gonadotropin-antagonist (if one of the follicles exceeds 14 mm, and / or estradiol level is <400pg / ml). An alternative is to start administering of the antagonist routinely in the 6 day of the stimulated cycle.|
|How long does it take?||a minimum of 24 days||days about 8-10 days|
|The number of injections||higher (daily injections with GnRH analogues)||less|
|The risk of ovarian hyperstimulation syndrome *||higher||smaller (by calling the peak of ovulation using a single administration of a GnRH antagonist)|
|The risk of the formation of functional cysts||smaller (by taking contraceptive drugs, prior to administration of GnRH antagonist)||higher|
* Ovarian hyperstimulation syndrome – a condition of excessive stimulation of ovulation using hormonal preparations, which is a complication of the preparations to a treatment in vitro. This leads to an increase of the size of the ovary, in which there are several dozen follicles.
2. Oocytes and spematozoa collection
In the table below you can find detailed information on the procedure of collection of oocytes in women and description of the procedure of sperm donation by men.
|On puncture, the patient should be on an empty stomach. Oocytes collection involves puncturing of the ovary through the vaginal vault, under USG. The procedure is performed under general anesthesia and lasts for 15 minutes. Obtained fluid with oocytes is delivered to the embryological laboratory, where the oocytes are separated from the follicular fluid and placed in a special medium for culture. After the puncture, the patient rests in a postoperative room in peace. In the event of severe abdominal pain and / or bleeding, a few days after the puncture we recommend you go to the hospital immediately and inform the clinic by phone!||At the same time, the man gives semen through masturbation into a sterile container, signed by his name and with the time of delivery of the ejaculate (if the partner has a different name on the container a name of the partner should also appear). Collection of the semen should be made after sexual abstinence of from 2 to 7 days. If you have difficulty with semen collection, it is possible to collect it previously and freeze the sperm sample or material taken during testicle biopsy or epididymis. Couples can also benefit from a sperm bank. The semen is subject to the appropriate preparation depending on the individual parameters.|
3. Fertilization in the laboratory (cIVF or ICSI)
The following table provides information on the differences between the classical method of in vitro fertilization and sperm injection into the oocyte.
|Classical in vitro fertilization (cIVF.)||Microinjection of spermatozoon into oocyte (ICSI)|
The selection of spermatozoon for ICSI procedure may be made using pICSI and MACS techniques. These techniques significantly increase the efficiency of the treatment.
4. Embryo culture
After 16-18 hours, one can already tell how many cells had been properly fertilized. After 25 hours properly fertilized oocyte should be divided into two blastomeres – then a zygote becomes an embryo. In the next time there are successive cell divisions. In the development of the embryo it is important both the pace of development and uniformity of the division, which testify to the quality of the embryo. Embryos developing unevenly or slower have less development potential. The below picture shows the stages of embryo development.
Embryo transfer (ET) is a painless procedure involving the transfer of the embryo or embryos, with a plastic catheter, into the uterine cavity. The procedure is performed under USG. It is important that the patient during the procedure had filled bladder. After the surgery, the patient stays for 15-20 minutes in the treatment room. Over the next few days, it is recommended not to use the sauna, solarium, avoid tanning, intense exercise and stress.
What is next?
2 weeks after the puncture the patient checks the level of beta-HCG. It is a blood test that can be performed in any laboratory, near the place of residence.
|The value above 30-50mIU / ml is considered as raised level of beta-HCG.|
The state in which the observed raised level of beta-HCG in the blood is called biochemical pregnancy. This is the signal to continue taking hormone medication to facilitate the implantation of the embryo in the uterus and the maintenance of pregnancy. On the other hand, the clinical pregnancy has to be confirmed by ultrasound, where the fetus is visible with the action of the heart.
What is the efficiency of in vitro?
The efficiency of IVF treatment ranges from 25-40%. With a single procedure, the chance of pregnancy is more than 20%, and in the case of three procedures it reaches 40-50%. The number of in vitro procedures performed in one woman is individual. It is assumed that the optimal number of treatments ranges from three to six. A larger number of treatments can lead to excessive burden on both physical and mental health of both partners.
Are there any consequences of the procedure in vitro fertilization?
In vitro fertilization, like any other medical procedure is affected with the possibility of complications. They appear relatively rarely.
- Complications of the puncture:
- vaginal bleeding (3%),
- bleeding into the peritoneal cavity (1.3%)
- Pelvic inflammation (0.5%). Taking hormone medication is associated with the risk of health problems such as ovarian hyperstimulation syndrome (women with polycystic ovary syndrome are at risk) and is in the group of 0.5% of women who are given hormonal stimulation.
- Stimulating medicines cause the raise of the level of estrogen and progesterone, which in turn is associated with symptoms such as water retention, weight gain, nausea, diarrhea, and discomfort in the lower abdomen, sore breasts, mood swings, headaches, fatigue.
- The procedure of anesthesia is related, happening at different frequencies, with the following consequences, side effects and complications: extended somnolence, nausea and vomiting, respiratory disorders (from shortness of breath, hypoxia after aspiration pneumonia), cardiovascular disorders (from pressure drop to disruption of the heart), sore throat, muscle pain, tooth damage, allergic reactions and others. Severe, life-threatening or fatal complications are extremely rare.
- In the case of assisted fertilization, slightly more than in the case of natural conception, it comes to pregnancy complications such as placenta previa or an ectopic pregnancy.
- Multiple pregnancy – during in vitro fertilization deliberately to increase the chances of conception, more than one embryo can be placed in the uterus. It increases the risk of multiple pregnancy.