35. Assisted reproduction: IVF, ICSI.

IVF

In Vitro Fertilization (IVF) is a type of assisted reproductive technology (ART) that involves fertilizing an egg with sperm outside the human body. IVF has been successfully used since 1978 to help individuals and couples conceive.

• Ovarian Stimulation (Superovulation):

  • The process begins with stimulating the ovaries to produce multiple eggs. This is achieved through hormonal treatments, such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) analogs, which encourage the development of several follicles within the ovaries.

  • During this period, the woman undergoes regular transvaginal ultrasounds to monitor the growth of the ovarian follicles and blood tests to measure hormone levels.

• Egg Retrieval (Oocyte Retrieval):

  • Once the follicles have reached the appropriate size, a minor surgical procedure called follicular aspiration is performed to retrieve the eggs.

  • The procedure is typically done on an outpatient basis under mild sedation or anesthesia. Using ultrasound guidance, a thin needle is inserted through the vaginal wall into the ovarian follicles. The needle is attached to a suction device, which aspirates the eggs and follicular fluid from each follicle, one at a time.

• Insemination and Fertilization:

  • The retrieved eggs are then placed in a culture dish containing a nutrient-rich medium. Sperm, collected from a partner or donor, is added to the dish to allow natural fertilization to occur. This step is called insemination.

  • If the sperm quality or quantity is low, or if previous IVF cycles have failed, a procedure called Intracytoplasmic Sperm Injection (ICSI) may be used. In ICSI, a single sperm is directly injected into the cytoplasm of an egg using a fine glass needle. This method increases the chances of fertilization by bypassing the natural penetration process.

• Embryo Culture:

  • After fertilization, the fertilized eggs (now called embryos) are cultured in a special incubator that mimics the conditions of the human body. The embryos are monitored for several days to assess their development and quality.

• Embryo Transfer:

  • A selected number of high-quality embryos are then transferred into the woman's uterus through a thin catheter. The number of embryos transferred typically depends on the woman's age, embryo quality, and specific fertility circumstances.

  • The goal is for one or more embryos to implant in the uterine lining and develop into a successful pregnancy.

• Pregnancy Test:

  • About two weeks after the embryo transfer, a blood test is performed to determine if pregnancy has been achieved. If successful, the woman is closely monitored for the early stages of pregnancy.

ICSI

ICSI is a specialized form of IVF that is often used when there are issues with sperm quality or quantity, such as low sperm count, poor motility, or abnormal morphology. It is also used in cases of unexplained infertility or if previous IVF attempts have not resulted in fertilization.

• In the ICSI procedure:

  • A single healthy sperm is selected and injected directly into the cytoplasm of a mature egg using a microscopic needle.

  • This technique bypasses several natural barriers to fertilization, making it an effective option for many couples facing male factor infertility.

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