Assisted Reproductive Treatments In Vitro Fertilization

Since the birth of the first test-tube baby using the In Vitro Fertilization technique (1978), a lot of scientific progress was made in the domain of human reproduction.

The In Vitro Fertilization is an assisted reproduction treatment during which the eggs obtained by ovulation stimulation are fertilized in the laboratory (“in Vitro”) by sperms. The obtained embryos are then transferred to the uterus of the patient.

The In Vitro Fertilization enables us to analyze “what happens” during the embryo formation. The In Vitro Fertilization results vary and depend on various factors. In our laboratory, the success rate is between 30-60%.

The In-Vitro Fertilization is a safe technique requiring periodic checks during the process. In our assisted reproduction laboratory, we can systematically use the ICSI or IMSI technique to perform the In Vitro Fertilization.

The conditions required to perform the In Vitro Fertilization are as follows:

  • For the woman: gynecological report, blood analysis.
  • For the man: blood analysis and sperm sample with sperm analysis or a testicular biopsy to find one.
  • Consent to the In Vitro Fertilization treatment, after making an informed decision.

The In Vitro Fertilization treatment is prescribed in the following cases:

  • Male factor: moderate/severe alteration of the number or the mobility of sperms.
  • Failed Conjugal Artificial Insemination treatment.
  • Failed Artificial Insemination treatment with a Donor.
  • Moderate or serious endometriosis.
  • Bilateral tubal occlusion.
  • HIV or CHV positive patients.
  • Pre-implantation genetic diagnosis of the embryo.

We do not perform the In Vitro Fertilization treatment in the following cases:

  • Ovary dysfunction or close to menopause: in this case, the functional ovary reserve is not high enough to respond to controlled ovary hyper-stimulation. An Oocyte donation program is therefore prescribed in this case.

The In Vitro Fertilization technique

Ovulation induction: controlled ovary hyper-stimulation.

The objective consists of creating an appropriate follicle development to obtain a high enough number of pre-egg follicles which will produce ready oocytes, that can be fertilized and transformed into embryos, which will then be transferred to the uterus of the patient. Gonadotropin (subcutaneous injection) is required to stimulate the growth and maturation of follicles. An additional treatment is also prescribed to inhibit a possible spontaneous ovulation at the pituitary level (antagonists or agonists of the released gonadotropin hormone GnRH).

In all In Vitro Fertilization cycles, we perform ultrasound and analytic controls (œstradiol) to evaluate the growth and maturation of follicles. After 9-12 days of stimulation, when the follicles reach a size of 17-18 mm, we trigger the ovulation with the help of the HCG hormone and we plan the follicle insertion.

Follicle insertion oocyte retrieval (ovary).

This is an ambulatory process performed surgically and under local anesthesia and/or slight sedation. It is therefore important to come in a sober condition. The average time of the process is 20 minutes. By means of an ultrasound localization of follicles and an insertion through the vagina, we extract the follicular liquid that we keep in test-tubes which we then send to the laboratory.

The biologists immediately analyze the follicular liquid to find and isolate the oocytes. In the case of an In Vitro Fertilization treatment with the sperm of the couple, it’s at this time that we collect the seminal sample. One hour after the insertion, the patient can leave the clinic. She is recommended to rest the entire day. From the first night onwards, we will start the vaginal Progesterone administration.

In Vitro Fertilization Laboratory.

The oocytes are first sorted in the laboratory according to their maturity degree, they are then incubated in a culture medium.

The methods used to fertilize (inseminate) the egg are as follows:

  • “Classic” In Vitro Fertilization:
    The insemination of oocytes is done with around 100,000 mobile sperms by oocyte. We keep the combination of oocytes and sperms until the next day to check whether the fertilization has taken place.
  • In Vitro Fertilization with Micro-injection of sperm or ICSI:
    The ICSI consists of inserting a sperm by using a micro-needle in the egg cytoplasm.
  • In Vitro Fertilization with Micro-injection of morphologically selected sperms (IMSI):
    In order to select sperms that should be micro-injected, we use an Advanced Micromanipulation Station enabling us to view the sperms by zooming in up to 16000 times (for the ICSI, we can only zoom up to 400 times). Thanks to this technology, which multiplies the vision of the biologist by 40 times, we can see the alterations of sperms and select, at the time of the treatment, the sperms that will most likely form the best quality embryos (IMSI), and thus increase the success rate and reduce the risk of abortion to half.
    The day after the insertion is made, we will contact the patient to inform her about the number of embryos and plan for the embryo transfer which generally takes place 2 to 3 days after the follicle insertion.
  • Transfer of embryos:
    This operation is carried out in the cabinet and does not require any anesthesia. We use an ultrasound to monitor the procedure, and we introduce the embryos with the help of a catheter via the cervix and deposit them at approximately 1.5 cm at the back of the uterus. The number of embryos to transfer depends on the age of the patient, the quality of embryos and the previous attempts. The remaining embryos are frozen, if they can be. After the transfer, we recommend the patient to rest at home for 24-48 hours. The Progesterone vaginal administration is done until the pregnancy test (after 13 days).
  • Assisted Hatching (“embryo hatching”):
    It is a laboratory technique that we use in our assisted reproduction center to improve the embryo implantation. Via a laser, we open a small window in the pellucid membrane (which covers the embryo) to facilitate the embryo hatching.

In Vitro Fertilization Complications:

  • Multiple Pregnancy
  • Severe Ovary Hyper-stimulation Syndrome (less than 1%)
  • Ectopic pregnancy
  • During the ovary insertion: hemorrhage, infection and risks derived from the anesthesia
Last Update: 05/09/2014
References:
Manual Práctico de Esterilidad y Reproducción Humana. Laboratorio de Reproducción Asistida (Tercera Edición). J. Remohí, A.Cobo, J.Romero, M.J. de los Santos, A. Pellicer McGraw-Hill Madrid 2008.
– Ruiz A, Remohi J, Minguez Y, Guanes P, Simon C., Pellicer.A. The role of in vitro fertilization and intracy- toplasmatic sperm injection in couples with unex- plained infertility after failed intrauterine insemination. Fertil Steril 1997; 68: 171-3.
– Berkovitz A, Eltes F, Paul M, Adrian E, Benjamin B. The chance of having a healthy normal child following intracytoplasmic morphologically-selected sperm injection (IMSI) treatment is higher compared to conventional IVF-ICSI treatment. Fertil Steril 2007; 88: S20.