In vitro IVF / ICSI fertilization

In Vitro Fertilization (IVF)

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It is an assisted reproduction technique in which fertilization takes place outside the mother’s body.

The oocytes are taken by ovarian puncture and fertilized in the laboratory with sperm. Own or donor reproductive cells can be used.

The embryos obtained are cultured and evaluated, in order to appreciate their chance of implantation.

An embryo is transferred to the uterus, and additional embryos can be frozen for variable periods.

Stages
  • Ovarian stimulation with hormonal treatment
  • Puncture of oocytes
  • Laboratory fertilization of sperm oocytes
  • Embryo culture in the incubator
  • Transfer of the embryo to the uterus
What are the chances of success?

The success rate depends on a multitude of factors, the most important being:

  • Age of patients, especially women
  • Number of oocytes collected (Ovarian reserve)
  • Number and quality of embryos obtained

The average success rate is 35% for a test

  • Under 35 years, the pregnancy is obtained in over 50% of cases on the first attempt
  • After 40 years, the chances of success fall below 10%

As a matter of course, some embryos are aborted (20%), others may be implanted ectopically (2%).

When is IVF recommended?
  • Obstruction, absence or bilateral damage to the fallopian tubes
  • Severe male infertility
  • Advanced endometriosis
  • Unidentified infertility
  • Failure of conventional treatments
  • Special programs:
    • Donation of oocytes or embryos
    • The carrier mother
    • Preimplantation genetic testing (PGT)
What are the risks?

The risks are extremely rare, but still possible:

  • Infections
  • Prostaglandin reaction – cramps, nausea
  • Pain
  • Bleeding

How a IVF cycle goes

Stimularea Ovariană

Purpose:

  • Obtaining more oocytes (ideally over 8-10)
  • Oocyte maturation
  • Prevention of spontaneous ovulation and other risks
  • Preparation of the endometrium to support embryo implantation

Duration: 2-3 weeks

Daily administration, usually in subcutaneous injections

Ultrasound and hormonal monitoring

Risks:

  • Ovarian hyperstimulation syndrome (an exaggerated reaction of the ovaries to stimulation treatment, expressed by excessive production of estrogen hormones and increased vascular permeability). It is manifested by bloating, abdominal pain, difficulty breathing, accumulation of fluid in the abdomen.
  • Headache
  • Abdominal or injection discomfort
  • Alergic reactions
  • Nausea
  • Difficulty breathing
  • Rare severe complications: thrombosis (veins in the veins), ovarian torsion

Oocyte and Sperm Collection

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Oocyte harvesting
  • Ultrasound-guided transvaginal ovarian puncture
  • Local or intravenous anesthesia
  • Duration: 15-30 minutes
  • Method: with special needle connected to the suction system with controlled pressure
  • Possible complications: bleeding, urinary retention or genital inflammation
  • Normal symptoms: abdominal tension, mild cramps or reduced vaginal bleeding
  • Restrictions after puncture: the car cannot be driven after sedation
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Sperm collection
  • By masturbation, usually
  • Other possibilities of sampling: surgical or postejacular urine
  • Pre-frozen semen

It can be possible:

  • no viable oocytes are found in the aspirated follicular fluid
  • oocytes do not fertilize or
  • there are no viable sperm in the collected sperm
  • the embryos develop abnormally and are not viable

In vitro fertilization and embryo culture

Standard in vitro fertilization

The oocytes are put in contact with the sperm obtained after preparation and the fertilization is done spontaneously, without the help of the specialist.

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Micromanipulation techniques
  • ICSI (Intracytoplasmic Sperm Injection)
  • The embryologist chooses a sperm and injects it into an oocyte
  • P-ICSI is an ICSI variant in which sperm selection is done with special media
  • Assisted hatching
  • Embryonic biopsy
Embryo culture
  • The evolution of embryos is a continuous process of natural selection
  • Cultivation over 72 hours, provides additional information and allows more efficient selection
  • On average, 40% of embryos reach blastocyst stage on day 5-6 (the stage that an embryo must reach in order to implant in the uterus).
  • Only embryos considered viable can be used in assisted reproduction.
  • Unfertilized cells and non-viable embryos are removed or can be used in research.
24 h - 2PN fertilized egg
48 h - Embryo 4 cells
72 h - Embryo 8 cells
Morula - Blastocyst day 5

Intrauterine Transfer of Embryos

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  • It is usually a painless procedure.
  • The embryos are inserted into the uterus with a special fine catheter, under ultrasound control.
  • After storage in the uterus, the chances of implantation and the evolution of embryos can no longer be influenced.
  • The patient can resume normal activities starting the next day
  • It is recommended to avoid excessive physical effort, hot baths or saunas.
  • Taking a progesterone supplement to prepare the uterus and promote implantation.
  • Normal symptoms after transfer: abdominal tension, cramps or reduced vaginal bleeding.
Outcome of the procedure and alternatives

10-14 days after the embryo is transferred to the uterus, a blood pregnancy test is scheduled.

If the chances of IVF with own oocytes are too low (age over 42 years, repeated implantation failure) or the risks of treatment are not assumed, other options can be considered: IVF with donated oocytes, adoption, renunciation.

In the case of severe male pathology, there is an alternative to using sperm from the donor, for insemination or IVF.

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IVF pregnancy

The evolution of pregnancy obtained through IVF is similar to the natural one.

There is a risk of complications:

  • Multiple (twin) pregnancy, with an increased risk of miscarriage or premature birth.
  • The risk of miscarriage is 20% – 25%, slightly higher than natural pregnancies (15 – 20%)
  • Extrauterine pregnancy occurs in 1-2% of cases
  • Obstetric complications – maternal hypertension, placental abruption, gestational diabetes. The risks are lower for pregnancies in frozen embryos.
  • Risk of malformations or genetic abnormalities in IVF children very slightly increased (2-3% of pregnancies). The risk increases with age even when there are severe sperm changes.

From existing data, cryopreservation does not appear to increase this risk.

Couples who resort to assisted reproduction may have difficulty coping with the emotional challenges of the procedures.

It is important to seek the help of relatives, psychologists or support groups; talking to someone who understands these experiences can be very helpful.

Most couples manage to become parents, although not always from the first attempt. There is a chance for success for everyone, for whom it is worth seeking specialized support.

The formula for success is to ask for the help of specialists in time, perseverance and sometimes acceptance of alternative solutions.

Frequent questions

Can hormone treatment have long-term risks?

Women who do not have children generally have an increased risk of genital cancers compared to the general population, even if they do not have hormonal treatments. Long-term studies do not show an increase in this risk if you perform hormonal stimuli.

Will I get through menopause sooner if I do a lot of ovarian stimulation?

In a natural cycle, several dozen follicles (formations containing oocytes in different stages) are recruited and lost in the ovary. One follicle grows and ovulates, the others will degenerate, a process called follicular atresia. Stimulating medication does not increase the number of follicles that are lost in a month, but matures those already recruited. Ovarian stimulation does not consume the eggs faster, but, on the contrary, saves eggs that would have been lost in that cycle, allows them to grow and be used.

What does low ovarian reserve mean?

When the reserve of oocytes left in the ovaries is small, it does not mean that a pregnancy can no longer be obtained, but that there is no more time to wait.

For IVF, reduced ovarian reserve is associated with lower success rates because fewer embryos are obtained. The possibility of embryo selection decreases, as does the probability of having additional embryos for freezing.

How to determine if the eggs are of poor quality?

The most important factor that determines the quality of the eggs is AGE. Even if in the laboratory the oocytes look the same, the older they are, the less embryos they will generate. Even in young people there may be problems with oocyte quality, from birth or after inflammation, endometriosis or certain treatments. There is no specific test, but the poor quality is seen in the unfavorable evolution of embryos in the laboratory or after implantation.

When is genetic testing of embryos done in the laboratory before implantation?

Genetic analysis of embryos in the laboratory is possible, but not routine, due to limitations and risks: it is invasive (requiring the extraction of cells from the embryo) and can generate false or inconclusive results. It is recommended in particular situations, with high genetic risk.

Why do the chances of success of an IVF cycle depend?

The success rate depends on a multitude of factors, the most important being:

  • Age of patients, especially women
  • Number of oocytes collected (Ovarian reserve)
  • Number and quality of embryos obtained

The cause of infertility is important, as it influences the above factors. There can be a high chance of success in infertility with severe causes if the age is young. In cases without identified causes, the chances may be low if the age is advanced or the ovarian reserve is reduced.

Clinical protocols, experience, technological methods used are also important.

Can I travel during assisted reproduction procedures?

Lifestyle should not change radically during treatment. Travel by car, train or plane is allowed at all stages, after a discussion with the doctor, in case certain additional measures are needed.

Is IVF pregnancy different from natural pregnancy?

The probability of having a multiple pregnancy is higher if more than one embryo is transferred to the uterus. Transfer of a single embryo is recommended to reduce the increased risk of complications associated with twin pregnancies.

And in the case of single fetal pregnancy, there was a slight reduction in fetal weight at birth. This effect does not occur in the case of frozen embryo transfers.

The risks of miscarriage, ectopic pregnancy or fetal abnormalities also exist in the case of pregnancies after IVF, as well as in the case of pregnancies that occur spontaneously. The IVF procedure does not exclude, but neither does it significantly increase the risks.

Are the injections painful?

The vast majority of injections are given subcutaneously and are not painful.

Is it dangerous if many follicles develop as a result of ovarian stimulation for IVF?

If over 15-20 follicles develop as a result of ovarian stimulation, the chances of success increase, but complications can occur – ovarian hyperstimulation syndrome. There are ways to avoid or reduce the risks if appropriate measures are taken during treatment.

Are the procedures painful?

Oocyte sampling is the only minimally invasive procedure, as it involves puncturing the ovaries. It can be performed without anesthesia, with local anesthesia or with intravenous sedatives or anesthetics for a short time. The other procedures are not painful.

How is the quality of embryos evaluated?

The quality of embryos is assessed according to certain criteria: the appearance and number of cells in each day, the evolution or stagnation in evolution from one day to another, the degree of fragmentation.

The morphological evaluation of the embryos in the laboratory allows the estimation of the implantation chances and the selection of the embryos with better potential.

The morphological criteria do not show whether the embryo has a genetic defect or whether it will have a malformation during its subsequent development in the uterus.

How can we be sure that sperm, oocytes or embryos are not confused in the laboratory?

In the Gynera Clinic such an error cannot happen, because in our work protocols are provided rigorous safety measures and verification by three concomitant methods.

In addition to checking the unique number of patients assigned by the electronic database, patients are asked to verbally confirm their own and partner’s name. In addition, the unique MatcherTM system in Romania scans, records and verifies all barcodes on patients’ cards and labels of organic products. For frozen samples, a color-based identification system is also used, making it easier to identify samples in cell and embryo banks.

Is the chance of getting pregnant higher in case of blastocyst transfer?

Embryos that evolve in the laboratory for 5-6 days can reach the blastocyst stage, the stage in which the embryo implants. Most embryos formed in the laboratory (and naturally) do not reach this stage, they stop evolving after 3-4 days. If an embryo exceeds this critical stage and reaches the blastocyst stage, it will have a higher chance of implantation.

Do children born with IVF have an increased risk of birth defects?

The risk of developing a congenital anomaly in the general population is about 2-3% of births and can be affected by age, lifestyle or certain conditions that occur during pregnancy.

IVF does not significantly increase these risks, but does not eliminate them, as they are dependent on various factors, sometimes occurring after implantation.

In the case of severe male genetic pathology, the IVF / ICSI procedure may increase the risk of transmitting genetic abnormalities to the fetus.

If I live in another locality, how long will I have to stay in Bucharest?

In the Gynera Clinic many patients come for treatment from other localities or from other countries. Communication and some monitoring can be done remotely or through collaborations. No procedure requires staying overnight in Bucharest. If you live in another country, consider a period of at least 2 weeks, provided that the treatment plan is organized in advance.