In Vitro Fertilization
In vitro fertilization (IVF) is the most common method of Assisted Reproductive Technology. It was successfully applied to humans for the first time in 1978.
As the term suggests, in vitro fertilization involves fertilization outside the body: instead of the egg being fertilized by sperm in its natural environment, which is the woman’s fallopian tube, it takes place in the laboratory. Essentially, it is the bypassing of a specific human function when, for various reasons, it cannot occur naturally within the body.
Stimulation Protocols
The medications administered fall into two categories: one that prevents ovulation and one that stimulates the development of follicles.
The main difference lies in the duration of administration of the medication that prevents ovulation.
The choice of the best protocol and the ideal dosage is personalized for each patient, depending on her age, hormonal profile, the response of her ovaries in previous attempts, as well as the number and course of past efforts. During stimulation, close monitoring is conducted through transvaginal ultrasound and estradiol measurement. Once the follicles reach the appropriate size, a final injection (Ovitrelle or Triptoreline) is administered to trigger their maturation and ovulation.
The Procedure on
Egg Retrieval Day:
Egg Retrieval
Once the stimulation process is complete and it is determined that the follicles have reached the final stage of maturation, the egg retrieval is scheduled. The procedure is performed through transvaginal aspiration of the follicles under continuous ultrasound guidance. The gynecologist uses a needle to puncture each follicle and aspirate its follicular fluid. The follicular fluid is quickly handed to the embryologists, who search for the eggs with the aid of a microscope. At the end of the procedure, the embryologists inform the patient about the number of eggs retrieved.
Although egg retrieval is a short procedure, it is performed under light sedation (analgesia-sedation). Therefore, for safety reasons, women undergoing egg retrieval must fast completely from midnight of the previous day.
Sperm Collection and Processing
On the day of egg retrieval, sperm collection and processing take place. For better sperm quality, a 3-4 day abstinence period is recommended before egg retrieval. The sperm then undergoes special processing to isolate the most motile spermatozoa in a small volume. This process activates the sperm, making them capable of fertilizing the eggs.
It should be noted that sperm collection on the scheduled day often causes stress for men, which may lead to difficulties in providing the sample. To avoid such a situation, the husband can bring the sample from home or freeze his sperm a few days before the egg retrieval. In cases of azoospermia (absence of sperm in the ejaculate), sperm can be retrieved directly from the testes through biopsy (Testicular Sperm Extraction TESE or Testicular Sperm Aspiration TESA) on the day of egg retrieval, or donor sperm can be used.
Fertilization
A few hours after egg retrieval and the appropriate processing of the sperm, the eggs and sperm come into contact. This can happen in two ways. In standard in vitro fertilization (IVF), the eggs are simply placed in a high concentration of sperm, and one of the sperm will fertilize the egg by penetrating its outer membrane. In cases where sperm quality is poor, intracytoplasmic sperm injection (ICSI) is performed. During ICSI, a single sperm is injected directly into an egg using a micropipette under a microscope. The eggs are then placed in special dishes inside incubators.
The next morning, fertilization is checked by the embryologists. The presence of two pronuclei (small round formations) in the center of the egg indicates successful fertilization. The fertilization rate in the laboratory ranges from 50% to 100%. The variation in this percentage depends on several factors, such as the condition of the eggs (degree of maturity, cytoplasm quality), the fertilizing ability of the sperm, and the method of handling and cultivation in the laboratory.
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