In vitro fertilization (IVF)

If you’re reading this, chances are you’re already acquainted with the basics of in vitro fertilisation (IVF). Even so, let’s cover all the bases. IVF, as it is commonly known, is a form of assisted reproductive technology (ART) in which fertilisation takes place outside the female body, in the laboratory.

Here, egg and sperm, taken from the treated couple, are brought together to form an embryo, which is subsequently transferred to the female’s uterus with the ultimate aim of pregnancy.

If you have viable eggs and are responsive to ovarian stimulation, but are still having trouble conceiving naturally, IVF may be your answer.

In Vitro fertilisation (IVF) consists of 3 main steps:

Ovarian stimulation + gynaecological tests

Donor egg collection + sperm sample
In Vitro fertilisation and embryo culture

Embryo transfer

IVF is recommended in the following cases:

• Obstruction of the fallopian tubes
• Male factor that cannot be resolved with artificial insemination
• Low ovarian reserve
• Genetic diseases that require preimplantation evaluation
• Aged 38 or over
• Previous insemination failure

Long-term sterility

The most important risks of In Vitro fertilisation (IVF) originates from:

• Ovarian stimulation:

Hyperstimulation syndrome may occur due to the excessive response of the ovaries to the medication. This risk is currently minimal since individualised protocols are performed.

• Ovarian puncture:

Bleeding can occur, which is generally self-limited. In rare occasions surgery will be required to solve this.

• Multiple pregnancy

The single embryo transfer policy is helping to considerably reduce considerably the number of multiple pregnancies.

To perform IVF with good chances of success, a sufficient number of eggs need to be collected. This will be achieved by subjecting the woman to controlled ovarian stimulation through the administration of subcutaneous hormone injections. The stimulation regimen will be individually adjusted according to the woman’s ovarian reserve. During stimulation, ovarian response should be monitored by serial ultrasounds until there are the correct number of appropriately sized follicles. At this point, ovulation will be triggered for collecting the eggs 36 hours later.

IVF within a natural cycle is indicated in cases of women with previous treatments and very low response, who seek the collection of a single egg that has been naturally selected. This option has low success rates and is reserved for cases where the patient does not accept egg donation.

Conventional fertilisation consists of connecting the eggs with more than 100,000 sperm so that fertilisation occurs.

When is conventional fertilisation recommended?

Conventional fertilisation has been the technique used for IVF until the appearance of ICSI. Currently its use is limited to those rare cases in which fertilisation can be performed with both techniques if there is a high number of eggs.

What is ICSI?
ICSI consists of the intracytoplasmic sperm injection technique. One sperm is injected into each egg through microinjection. Sperm selection is performed at 400x magnification.

When is the ICSI treatment recommended?
ICSI is the most common In Vitro fertilisation technique of choice for the majority of cases, especially if there has been a history of fertilisation failure or very poor sperm quality.

What is IMSI?
IMSI consists of the intracytoplasmic injection of morphologically selected sperm. It differs from ICSI in that sperm selection is performed under 8000x, which allows the best sperm to be chosen, significantly improving the reproductive prognosis.
In order to perform it, a microscope with high image quality combined with complex computer software is needed, which allows the handling of the microscope from their computer.
When is the IMSI method recommended?
Applying IMSI is recommended in cases of poor sperm quality, to improve the selection of the sperm that will be used when fertilising the egg:

• Severe teratospermia
• High levels of sperm DNA fragmentation