Assisted reproductive technologies
One way of treating infertility is an assisted reproductive technology.This is a general term referring to a wide range of procedures.
Your personal treatment depends on the cause of infertility and your personal specifics.
Below we describe the procedures that we use in our clinic with great success.
1. Cycle monitoring
2. Luteal support
If the tests do not discover any sperm abnormalities, serious fallopian tube problems (blocks on both sides), nor critical hormone values then we choose artificial insemination as the preferred treatment. With a minimal amount of hormones we stimulate ovulation and check the maturation of the dominant follicle by an ultrasound scan. At the optimal time we trigger ovulation. After preparation we inject the freshly taken sperm sample into the uterine cavity through a thin catheter. This procedure is painless and causes no strain on the body, so it is performed without anaesthetic (?) . The sperm can come from the male partner, or if there is no sperm of appropriate quality then it can come from a donor. The success rate of the procedure is 15-20%, which is higher than the rate of spontaneous pregnancy (10-15%).
Artificial insemination by donor
The procedure is basically the same as classic insemination. We use this method for those couples where the male partner cannot produce appropriate sperm and in the case of those single women who meet the legal requirements. We can obtain the necessary sperm from a sperm bank after signing an agreement.
4. In vitro fertilization (IVF)
The first step is to use a minimal amount of hormonal stimulation to make the ovaries produce more follicles. On the right days of the cycle we check the maturation of the follicles. If maturation is regular – under anaesthesia – a small needle is inserted through the vagina and guided via ultrasound in order to collect the fluid that contains the eggs. Then our well-trained embryologists look for and evaluate the eggs in the fluid with the help of a stereomicroscope. The extracted eggs are put into a special culture medium that provides the optimal environment for the development of gametes and the embryo. Then the extracted eggs are fertilized with the help of the sperm given by the male partner. Fertilization happens 3-4 hours after the (?) for which sperms are well prepared.
On the days after fertilization our embryologists check the procedure of cell division under a microscope to be able to choose those embryos with the best capacity to develop, and later they can freeze those that are not placed into the uterus. The fertilized and properly dividing embryos are placed into the uterus either 48-72 or 120 hours after the egg extraction. First the embryos are stored in a modern solution that helps their implantation then they are transferred into the uterus through a thin catheter guided via ultrasound. This procedure is painless so we perform it without anaesthesia.
During the transfer we try to avoid multiple pregnancies. To do this we try to use the minimal number of embryos that will be sufficient for pregnancy.
Intracytoplasmic sperm injection is a type of IVF procedure. If the reason for infertility is a weak sperm sample then the sperm can be artificially inserted into the egg with a micro-manipulation technique. During this procedure the egg is fixed by a very precise device, then we inject the sperm into the egg directly with a thin and delicate needle. The greatest advantage of Intracytoplasmic sperm injection is that even if the ejaculation does not contain sperm (azoospermia), ICSI can still be carried out with the help of sperm extracted from the testicles or the epididymis by surgery.
Assisted hatching procedure can increase the success of the implantation of the embryo, and thus the IVF treatment. During AHA (assisted hatching) we make a small incision on the zona pellucida, allowing the embryo to discard the surrounding zona pellucida and to be implanted into the endometrium more easily. The zona pellucida, the membrane surrounding the embryo originally, plays an important role in the fertilization of the egg, as it only allows one sperm to enter. It also protects the eggs from mechanical and immunological damage when they move in the fallopian tubes. But embryos need to leave this membrane eventually to be implanted in the endometrium. The name of this procedure is hatching. It usually happens five days after fertilization. As the embryo grows it breaks this membrane. If it cannot discard the zona pellucida then it won’t be able to be implanted and it will die. Assisted hatching (AHA) done by mechanic, chemical or laser treatment, increases the chances of success.
Cyropreservation – Embryo freezing
Embryos are stored in liqu ified nitrogen at -196 ºC. This very low temperature is reached by a special freezing device controlled by a computer that cools the embryos gradually by a special program for maximum safety. In an optimal case the survival of embryos with good structure can be around 75-80%.
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