IVF
  • IVF
  • To whom IVF is advised?
  • For whom ICSI is advised?
  • The ICSI procedure
  • Treatment outcome
  • IUI

    • IVF

      IVF means fertilization outside the body in a test tube. Since the birth of Louise Brown, the first test-tube baby in 1978, IVF has resulted in over 1,000,000 babies worldwide. Pregnancy rates and live birth rates have improved over the past few years, leading to a steady increase in the number of IVF treatment cycles performed worldwide.

      To whom IVF is advised?

      There are several groups to whom IVF treatment may be advised that include:

      • Women with blocked, damaged Fallopian tubes or inoperable tubes or whose tubes
        have been removed after ectopic pregnancies.
      • Women with endometriosis.
      • Women with cervical mucus problems.
      • Men with infertility problems.
      • Men or women with immunological infertility problems.
      • Couples with unexplained infertility.
      • Women  with anovulatory problems not resolved by other treatment methods



       

      Conventional or standard IVF treatment involves the administration of fertility drugs, monitoring of the cycle, collection of eggs, mixing eggs and sperm together outside the woman's body in a culture dish or test-tube. Any resulting embryos are left to grow and the best 2-3 embryos are then transferred into the woman's womb. Any remaining embryos of good quality may then be frozen for future use.

      IVF cycle consists of several steps over an interval of 4-6 weeks and start when a woman begins taking drugs to stimulate her ovaries to produce eggs, monitoring progress by ultrasound scan and blood tests, collecting eggs, collecting man’s sperm, fertilizing the eggs, transferring the embryo and end by the pregnancy test.
      For whom ICSI is advised?
       There are selected groups of patients to whom intracytoplasmic sperm injection (ICSI)
       is recommended:
      • Couples who have failed to achieve fertilization or had very poor fertilization following
        standard IVF treatment.
      • Men with abnormal sperm parameters (e.g. low count, poor motility, high percentage of
       abnormal forms and high levels of antisperm antibodies in the semen) to allow a
       reasonable chance of success with standard IVF.
      • Azoospermic (complete absence of sperm in the ejaculate) men who have their sperm
       surgically retrieved. This could be due to failed vasectomy reversals or congenital
       absence of both vas differences and non-obstructive azoospermia.
      • When frozen sperm is limited in number and quality.
      The ICSI procedure

      The early stages of ICSI are the same as for standard IVF. The woman takes fertility drugs to stimulate her ovaries with the aim to grow several mature follicles. The eggs are usually collected by vaginal ultrasound scan into a specially prepared culture medium. Once the eggs are collected, they are examined under the microscope to assess their quality. The eggs are then placed in the incubator for a period of time usually between 3-6 hours. Thereafter the eggs are removed from the incubator and the cells that surround the egg are stripped off to assess the maturity of the egg. Because ICSI can only be performed on mature eggs, immature eggs can be kept in the culture medium and injected the following day if they show signs of maturation.

      Sperm collection from ejaculates or aspirate from the epididymis (PESA) or testis (TESA or TESE) is prepared using special cultured medium. Sperm preparation may also be obtained from frozen semen sample or testicular tissues.

      Once the eggs have been selected, a chosen sperm is rendered immotile, then sucked into the tip of a very fine glass needle and injected directly into the egg. The egg is held in place by gentle suction on the opposite side using a holding pipette. This is a very delicate procedure and involves using a micromanipulator.

      This process is repeated for each egg. The elastic nature of the egg membrane means that the tiny hole made by the needle closes very quickly. About 5% of the injected eggs may be damage by the procedure.

      The eggs are examined the next morning for signs of fertilization. The developing embryos are allowed to grow and cleave (divide) for a further 24-48 hours. Not all fertilized eggs will divide and some embryos may arrest (stop growing) at an early stage of development.

      Treatment outcome

      ICSI has now been in use for over 19 years and there are over one million babies already born as a result of ICSI worldwide. Fertilization rates are in the range of 60-70% of the injected eggs and cleavage rates of about 80% are expected after ICSI. The risk of complete failure of fertilization is less than 5%. The overall live birth rate per embryo transfer is about 23.1% (HFEA 2000) and 28.7% (SART 2002). This represents an increases of 1-2% compared with last years results. There is wide variability in results between centers. The success rates of ICSI treatment are dependent on the skill and experience of the practitioners. Other factors, which also affect ICSI success rates, include the woman's age, duration of infertility and the number of embryos transferred.

      IUI

      Intrauterine insemination, or IUI, is a common form of artificial insemination (AI). {AI refers to techniques used to introduce sperm into a woman's body through means other than sexual intercourse.} IUI is relatively less invasive than some other assisted reproductive technology (ART), which is one of the reasons that physicians often offer IUI as a treatment before IVF and other techniques.

       IUI is performed in a series of steps:
      • A woman's cycle is, with or without medication, monitored so that her time of ovulation is
        apparent.

      • A sperm sample is obtained from the male partner. The sample has optimally been
        through a process referred to 
      as "sperm washing".
      • Sperm sample is then inserted into woman's uterus via a catheter through her cervix.

      The goal is to place as many active, well-formed sperm as close to the ovulated egg as possible, thereby increasing their chances of meeting.