IN VITRO FERTILIZATION (IVF)
In Vitro Fertilization (IVF) is a technique whereby egg fertilization takes place outside the woman’s body. Embryos are created in the laboratory and then placed in the woman’s uterus to stimulate development and achieve pregnancy.
This process involves several steps, which need to be adequately coordinated. Designing made-to-measure treatment for the patient's needs, team quality and the clinic's technology are key to success.
WHO NEEDS IN VITRO FERTILISATION (IVF)?
Couples may benefit from in vitro fertilization (IVF) treatment if the any one of the following factors are present:
- Damaged or blocked fallopian tubes, including past tubal ligation
- Ovaries are unresponsive to fertility medications
- Immunological factors
- Endometriosis related infertility
- "Unexplained” infertility
- Poor sperm motility (sperm does not move well)
- Poor sperm morphology (misshapen sperm)
- Low sperm count
- Lack of sperm in the semen (Azoospermia)
- "Unexplained” infertility
STEP-BY-STEP IVF PROCESS
Study and preparation of the patients
Every patient is a unique individual for Vita Altera. For this reason, our treatments at Vita Altera are tailored to every one of our patients. Our goal is to locate the source of infertility among couples and select the most effective treatment. The male’s sperm and hormone levels are analyzed and, if necessary, a urological assessment is performed.
In the case of women, their cervical canal and endometrial cavity are examined, as well as possible alterations in their fallopian tubes and their menstrual cycle patterns. These are accompanied by detailed assessments of the couple’s sexual health. This process ensures that IVF is the correct solution to the patients’ infertility problems and that they are physically and psychologically ready to begin the cycle. If this is not the case, the patients are offered other treatment options.
In order to maximize the possibility of pregnancy, we need to obtain more than one oocyte, which is the number a woman’s ovary normally produces. In order to stimulate the production of several oocytes and guarantee their quality, we provide a combination of medicines whose response is monitored with vaginal ultrasound scans and occasionally blood tests.
The whole process lasts approximately between 8 and 12 days, depending on each case.
Egg retrieval / Sperm capacitation
Unless using donated ova, approximately 36 hours after the ovulation injection, the ovum pick-up procedure takes place. The mature oocytes are retrieved with the guidance of a fine, hollow needle guided by ultrasound. This process only takes 10-15 minutes. Sedation and local anesthesia are provided to remove any discomfort that you might experience during your egg-retrieval procedure.
The male partner will need to provide a semen sample, on the same day as the egg collection.
In order to obtain the best quality possible, ejaculation through masturbation should be performed 3 days ago.
If you are using donor sperm or previously frozen sample of your partner’s sperm, it will be thawed and prepared.
Depending on the concentration, motility and morphology of spermatozoa, classical IVF or ICSI is employed.
With the Classical IVF as soon as the eggs are extracted from the ovaries, they are placed into an "embryo culture" medium with the sperm and then placed in an incubator overnight. After insemination, eggs are incubated for a period of 24 hours, after which fertilization rate and a number of pronuclear stage (PN) embryos are determined. At this stage, an egg is successfully fertilized and two pronuclei are seen in the cell, representing chromosomes from the mother and the father. Over the next day, the embryos will be left to develop. Meanwhile, it is best to have as little contact with the embryos as possible, because when the embryos are removed from the incubator, crucial conditions, such as: humidity, concentration of gases and temperature change can affect their development.
On the third day post egg collection, one of our embryologists will call to inform you about the progress of fertilization, quality of day 3 embryos (comprised of 6-8 cells) as well as advantages and eligibility criteria of culturing embryos till day 5 for a blastocyst transfer. The embryonic genome is activated after the 6-8 cell stage, therefore, if the conditions allow, extended culture will highlight embryonic arrest and help identify healthy embryos for transfer, though not all embryos that develop until day 5 will be chromosomally normal.
If a guarantee of healthy embryos is needed then we must perform pre-implantation genetic diagnosis (PGD).
We will weigh up the pros and cons of each option and decide together whether we will proceed with a transfer of day 3 embryos or day 5 blastocysts.
Embryo biopsy is the technique applied by the embryologist within an IVF treatment in order to remove a cell or cells from the pre-implantation embryos. These cells will be then further examined by a genetic/molecular laboratory in order to receive information on the genetic status of the embryos. Briefly, this technique is utilized in order to select the healthy embryos prior to their transfer into the uterus. Embryos that are carrying genetic disorders or chromosomal aberrations will be excluded from the final selection.
ICSI (Intracytoplasmic Sperm Injection)
ICSI is performed on oocytes when the reproduction biologist in charge deems it necessary or when it has been previously agreed upon. The Intracytoplasmic Sperm Injection (ICSI) consists in the introduction of a single spermatozoid inside a mature egg to achieved fecundation.
ICSI proved to be a revolution in assisted reproduction techniques, as it overcomes most male infertility problems. This technique is used in fertilization when sperm suffers from low count, an abnormal morphology, poor motility or when the sperm is unable to fertilize through IVF. It can also be used with patients suffering from a blocked sperm duct. In this case, a puncture is made in order to extract sperm directly from the testicles. This procedure is performed using a microscope. Micromanipulation equipment is also used, allowing us to stabilize the egg softly and subsequently place the sperm inside it.
Embryo transfer is normally scheduled between two and five days after fertilization (i.e. at the peak of the treatment). The goal is to move the embryo from the laboratory to its final destination for development: the future mother’s uterus.
It is carried out with the help of an abdominal ultrasound in order to find the perfect spot for implantation. Please note that we need your bladder to be full as this will provide a better view of your uterus during the process. In order to achieve this, you should empty your bladder about one hour before your appointment and then drink a small bottle of water before the procedure. Please do not wear any perfumes on the day of the transfer A thin catheter is introduced through the neck of the uterus, and a drop taken from the culturing environment where the embryo is floating is poured into the uterus.
Sedation is not necessary, it is not painful and, as a matter of fact, it is very similar to a regular gynecological checkup. The procedure is performed at a temperature of 36ºC in a dimly lit, sterilized room located next to the laboratory to make it as unintrusive as possible.
In case there are any supernumerary embryos, cryopreservation may be done for future use. There is an extra charge for the vitrification, which includes one year of free storage. From then on, there is a small fee to pay monthly or yearly for keeping frozen embryos at our cryobank.
Afterwards, you will be transported back to your private bedroom on a bed and you will need to remain in bed for 30-60 minutes after the transfer. On the evening of your embryo transfer you should relax and have as much rest as possible. From the following day onwards, you can continue your normal routine, although you must adhere to the “Dos and Don’ts” information that you will be given on the day of embryo transfer.
In case the results of the preparation are not satisfactory (e.g. the progesterone level is high or lining of the uterus is not thick enough), transfer is not performed and the embryos are kept frozen to be transferred during another cycle.
Positive Pregnancy Test
As it is still too early to get an accurate result with a urine test, we perform a βhCG blood test 11 days after your embryo transfer; then again 2 days later, and we repeat it once more 7 days after. If the βhCG blood test is positive and rising:
+ It is important to continue the medication exactly as prescribed for the first trimester. Your hormones are already artificially raised and so you must maintain that level until the placenta is strong enough to support the baby on its own.
+ At week 6 of gestation, you can have an ultrasound scan to confirm how many embryos have implanted and to check for the fetal heartbeat.