Who needs IVF
In many situations in which a couple is experiencing infertility, AH fertility doctors can treat the problem with first-line fertility treatments such as ovulation induction or intrauterine insemination (IUI). In other cases, the condition causing infertility is treatable with surgery for the male or the female.
For women in whom first-line fertility treatments have been unsuccessful or who have other situations or conditions, in vitro fertilization (IVF) may be the treatment of choice. IVF was originally developed for women with tubal factor infertility (non-functioning fallopian tubes); however, because of major advances in in vitro fertilization, IVF is not always the treatment of last resort. In fact, it is often the first-line treatment.
Some common female infertility indications for IVF treatment include:
- Fallopian tube damage
- Unexplained infertility
- Age-related infertility
Being at risk of genetic disease such as cystic fibrosis (IVF with pre-implantation genetic diagnosis — PGD may be indicated)
Infertility or recurrent pregnancy loss related to chromosomal abnormalities — IVF with PGD or pre-implantation genetic screening may be indicated
In Vitro Fertilization
This treatment consists of extracting and fertilizing the egg with donor sperm or sperm from the partner in the laboratory. The embryo culture in the laboratory requires constant surveillance and control of multiple parameters; for this reason, the in vitro fertilization greatly depends on the quality of the laboratory as well as on the applied assisted reproduction techniques.
This method was initially developed for treating tubal infertility (closed Fallopian tubes). However, nowadays it is used for treating both male and female infertility.
It is performed by means of personalized and controlled ovarian stimulation, using next-gen protocols in order to obtain an adequate number of eggs.
Fertilisation of the egg by the sperm involves a complex sequence of events, initially controlled by the sperm.
Classical IVF and intra-cytoplasmic sperm injection (ICSI) are the two most popular assisted reproductive technologies used for successful fertilisation. The only difference between the two is the way the egg is fertilised. IVF allows the sperm to penetrate the egg of its own accord whereas ICSI directly inserts the sperm into the egg.
ICSI (Intracytoplasmic Sperm Injection) bypasses the work the sperm otherwise has to do during fertilisation. The eggs are placed in a shallow dish in microdroplets of culture medium under oil, arranged around a central drop containing sperm. The embryologist captures sperm one at a time using fine glass needles attached to manipulators mounted on a microscope. The embryologist then moves to a drop containing an egg, holds the egg with another fine pipette, and injects the sperm deep into the egg.
As part of the ICSI procedure, the embryologist breaks the egg’s membrane to trick the egg into thinking it has been fertilised in the normal way. The embryologist also breaks the sperm’s tail before injection to allow chemicals to escape from the sperm into the egg, and so signal that the sperm is present and ready to be ‘unpackaged’.
ICSI can work because in most men the genetic make-up of sperm is normal even though the sperm might be abnormally shaped, unable to move very well, or unable to undertake the steps of normal fertilisation.