What does it entail?
In Vitro Fertilization is the technique most commonly used in assisted reproduction centres. It is a more complex procedure than intrauterine insemination and consists of fertilising eggs with sperm in the laboratory with the aim of generating an embryo. The embryos are cultivated for a few days and then transferred to the woman’s uterus so that they can continue their natural development.
Fertilization can be performed using two techniques:
- a technique called ICSI (Intracytoplasmic Sperm Injection). In this way, our embryologists select the best sperm and inject them one by one directly into each egg. This is an extremely accurate technique that increases the chances of fertilization of the eggs.
- a technique called IVFET (In Vitro Fertilisation and Embryo Transfer). The oocytes collected are placed in a culture plate along with prepared partner/donor sperm to achieve fertilization. After about 20 hours the development of the zygotes is ascertained (pre-embryonic phase).
In addition, depending on where the sperm come from, in vitro fertilization can be:
- IVFET with sperm from the couple (homologous IVFET). The sperm comes from a sample provided by the patient’s partner.
- IVFET-D with donor sperm (heterologous IVFET). The sperm comes from a gamete bank.
Who is it indicated for?
IVFET is recommended in the following cases:
- Lesion or absence of the Fallopian tube
- Severe alterations in sperm quality
- Use of sperm of testicular origin (TESE and MicroTESE)
- Multiple failures of previous treatments
- Hereditary genetic disease
- Need for Preimplantation Genetic Diagnosis (PGT-A, PGT-M)
- Use of vitrified oocytes after oocyte cryopreservation treatment
Control of follicular development
Oocyte collection (Pick-up)
Egg collection is a very simple procedure performed in the operating room, using a thin needle. The operation is performed by transvaginal ultrasound for aspiration of the follicles. The process does not take more than 15/20 minutes and is carried out under sedation for the comfort and well-being of the patient.
It does not require hospitalization, only a few hours rest in our clinic room is advised. Once this time has elapsed, the patient can resume her usual activities.
Preparation of the sperm sample
The sperm sample needs to be prepared so as to be able to fertilize the egg and to obtain an optimal concentration of motile sperm.
The sperm sample is obtained from the man by masturbation, in our centre, on the same day of the oocyte collection or it can be previously cryopreserved. In cases where the use of donor sperm is recommended, it too will be cryopreserved. In both cases, our biologists will treat it in the lab with a process known as sperm capacitation, in order to select sperm with the best motility.
Fertilisation and culture of the embryo
Our embryologists carry out the fertilization by means of a technique called IVFET (In Vitro Fertilization and Embryo Transfer), in which the oocytes collected are placed in a culture plate together with the sperm of the partner/donor prepared to achieve fertilization. After about 20 hours the development of the zygotes is ascertained (pre-embryonic phase). The zygotes destined for transfer to the uterus are left in culture to become actual embryos/blastocysts over the next few days.
Our embryologists carry out fertilization by means of a technique called ICSI (Intracytoplasmic Sperm Injection), which consists of selecting a single sperm for each egg and then microinjecting it into the egg. It is a very accurate method which facilitates the fusion of the nuclei of the male gamete with the female gamete. The fertilized zygotes must be kept in culture for the next few days, becoming actual embryos/blastocysts in the following days.
During embryo transfer the embryo is placed inside the uterine cavity; this can be done with a “fresh” or “thawed” embryo.
The transferred embryo is at the embryo/blastocyst stage (approximately 3-5 days of embryonic life).
It is defined as “fresh” when the embryo/blastocyst obtained during the same cycle of ovarian stimulation and follicle collection is used. Thawing is defined as transferring a previously cryopreserved embryo/blastocyst from an earlier treatment.
A “thawed” embryo is transferred when: a) there is a risk of “Ovarian Hyperstimulation Syndrome”, b) endometrial conditions are not suitable for embryo implantation, c) embryonic genetic diagnosis techniques (screening and pre-implantation diagnosis) are necessary, d) there is some reason that does not recommend gestation in the same cycle as IVFET/ICSI.
In both cases, the transfer is done with a thin transfer catheter. It is a completely painless procedure and requires no hospitalization.
After the “beta wait” period (9-14 days after embryo transfer), a blood pregnancy test will be conducted. This tests for presence of the hormone β-hCG (Human Chorionic Gonadotropin), which is the hormone that the embryo produces after its implantation in the endometrium.
If the beta result is positive, we will perform an ultrasound scan in the following weeks to confirm the presence of the “gestational sac” inside the uterus and observe the heartbeat of the future baby.