In Vitro Fertilization (IVH)

Fertilization, is a natural process, that consists of the crossing of two gametes into the woman's fallopian tube. Namely, the oocyte for woman and the spermatozoon for man. It is from this meeting that within a week an embryo is formed,. This process is called in vivo procreation. Whereas the artificial procreation process is called In vitro fertilization. The In vitro process takes place in a laboratory and follows all stages of natural procreation. We are talking about Medically Assisted Reproduction or MAR. In vitro fertilization is a laboratory technique that allows you to fertilize an egg with a spermatozoon, outside the uterus.

This IVF technique aims to recreate in the laboratory the various stages of natural fertilization while maximizing the chances through collecting several oocytes and optimizing them by selecting sperm and embryos. This implementation is carried out by a multidisciplinary team. Furthermore, there are four possibilities of IVF: IVF with own eggs and sperm of the spouse, IVF with own eggs and donor sperm, IVF with donor eggs and sperm of spouse, and IVF with donor eggs and donor sperm in case of definitive sterility in both members of the couple.

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Ideal Candidates:

The IVF procedure is advised in the following cases: Patients who have failed during previous treatments such as artificial insemination. A tubal anomaly: the causes of these tubal anomalies related to the fallopian tubes, are varied. In fact, it can be the aftermath of genital infections, adhesions after surgery, or ectopic pregnancies. In a third of cases, an alteration of the spouse’s sperm is associated.

In vitro is recommended for women with no fallopian tubes or with damaged ones, since these tubes are essential element for natural fertilization or insemination. Women with advanced endometriosis that probably impacted the fallopian tubes and oocyte quality can rely on the IVF technique. Endometriosis is a disease characterized by the abnormal presence of uterine lining on the peritoneum of the small pelvis and in the ovaries essentially, which causes a decrease in fertility. In case of unexplained infertility, the use of in vitro fertilization usually occurs after several unsuccessful attempts at simple stimulation of ovulation and intrauterine insemination.

In Vitro Fertilization Preparations

The IVF treatment procedure requires many appointments with specialists, who prepare the couple for the technique. Indeed, the decision to enter into an in vitro fertilization protocol is taken by the gynecologist after the necessary clinical and biological examinations of both spouses. First, a certain number of medical analyses are essential to develop the pre-FIV file such as spermogram, hormonal assay, serological tests such as hepatitis B, C, HIV etc. Then, once the examinations have been carried out, the specialist will suggest the appropriate medically assisted reproduction, depending on the spermogram and sperm survival test in culture medium: conventional IVF, IVF with microinjection: ICSI or IMSI.

The couple should be informed about complex steps such as the injection of hormonal medications, as well as the risks and side effects, along with the waiting time required.

In Vitro Fertilizationstep step by step

In vitro fertilization process involves several steps that are important to know. Indeed, it has 7 phases:

Ovary stimulation:

Obtaining a large number of oocytes is done on the basis of a woman's hormonal treatment, which consists of administering a number of daily injections for the ovaries to produce several oocytes - instead of producing only one as is the natural case. This treatment is intended to prevent the brain from acting on the normal production of the ovaries. It is therefore necessary to stimulate them medically and, in this way to ensure the growth of the follicles.

Ovary monitoring:

During the IVF cycle, 2 or 3 vaginal ultrasounds take place to measure the response of the ovaries to hormone therapy. The follicles are counted and their diameter is measured. Their size should increase steadily until the egg retrieval. Once the follicles have reached maturity, fertilization is initiated at a specific time during which the egg retrieval is performed.

Spermatozoa collection and preparations:

The sperm gathering is performed in the morning of the egg retrieval by masturbation in a sterile container. The spermatozoa are then frozen and defrosted later to keep the spermatozoa still mobile.

Egg retrieval:

Approximately 35 hours after the ovulation activation, the egg retrieval is performed in the operating room under general or local anesthesia. It lasts about 15 minutes. The doctor aspirates each follicle visualized on ultrasound using a thin needle and removes the fluid from the follicles.

Gametes preparation:

It consists of preparing both oocytes and spermatozoa. Once the follicular fluid is obtained after its aspiration, it must be transmitted to the laboratory to obtain fertilizable oocytes.

Fertilization:

Once the oocytes obtained after the egg retrieval, they will be inseminated with spermatozoa generally obtained from a sperm sample produced by the male partner.

This process can be achieved by following the classical IVF technique of placing an oocyte surrounded by sperm on a culture slide, or following the ICSI technique which consists in introducing a living spermatozoon into the oocyte by exerting a puncture on the latter by means of a pipette. The ICSI technique is indicated in some cases, when a sperm moves slowly or if it has a defect in morphology that would have difficulties to achieve it naturally or via the classical technique of IVF.

To perform this technique, the man will have to provide a sample of his sperm or he will have to undergo a testicular biopsy if necessary, to extract and select the best spermatozoa that will be used to fertilize the oocytes.

Embryo development:

The gametes are put together in a culture dish and placed in an incubator to obtain embryos.

We can notice the next day the oocytes fertilization by their nuclei. After 48 hours of incubation, the appearance of the fertilized egg will be quite different. Indeed, it consists of several cells and surrounded by an envelope called zona pellucida. This is 2 pronuclei. A female pronucleus and a male pronucleus. These are the zygotes. at this stage is becomes an embryo that can be transferred to the maternal uterus. The endometrium (lining of the uterus) should be ready to receive a possible embryo.

Embryo transfer:

After 2 to 5 days, the embryo transfer is performed in the woman's uterus usually under ultrasound. The process is not painful. The embryo will be introduced to the uterus vaginally. With the help of a catheter, the embryo is placed in the uterus where it develops until implantation.

Embryo cryopreservation:

Once the embryo transfer is complete, the doctor proceeds to cryopreserve the non-implanted and in good quality embryos, so that they can be used in a next cycle without having to repeat the ovary stimulation method. The embryo cryopreservation technique has the main advantage of avoiding the ice crystals formation that damage the oocyte and allows 97% of them to survive the freezing process.

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