In Vitro Fertilization
In Vitro Fertilization is a High Complexity Assisted Reproduction Procedure designed to facilitate the union of ovules (oocytes) and sperm in the laboratory. As well to obtain embryos that will be transferred into the uterus to achieve a pregnancy. In Vitro Fertilization can be done through two different procedures: conventional in vitro fertilization (IVF), in which the ovum and sperm are placed together to join spontaneously in the laboratory; and the Sperm Microinjection (ICSI), in which fertilization is facilitated by microinjecting a spermatozoon in each ovule.
The most frequent indications for IVF are:
- Significant decrease in the number and / or mobility of the sperm or increase in the morphological alterations of the same.
- Endometriosis grade III or IV.
- Alterations of ovulation, low ovarian reserve.
- Failure of other treatments.
- Advanced age.
- Heritable genetic diseases that require preimplantation genetic diagnosis.
In Vitro Fertilization and Spermatic Microinjection are carried out in several stages:
- Controlled Ovarian Stimulation: This is done through the use of medication in supraphysiological doses, whose action is similar to that of certain hormones produced by the woman’s pituitary gland. The purpose of this treatment is to obtain the development of several follicles, inside which you can find the ovules. The process of ovarian stimulation is usually controlled by blood tests of the levels of certain ovarian hormones and / or by vaginal ultrasounds that inform the amount and size of developing follicles. If the proper development is obtained, other medications will be administered to achieve the final maturation of the ovules.
- Follicular Puncture / Aspiration: The ovules are extracted through the puncture of the ovaries and the aspiration of the follicles is performed under ultrasound vision and through the vagina. This intervention is performed in an ambulatory regime and requires anesthesia and subsequent observation for a variable period.
- Preparation of the seminal sample: Once the ovules have been obtained, they go to the laboratory available for the sperm of the couple, or an anonymous donor in case this applies. The semen is prepared in the laboratory in order to select the most suitable sperm for fertilization.
- Procedures of the Embryology Laboratory: If In Vitro Fertilization (IVF) is performed, the ovules and sperm will be cultivated in the laboratory under favorable conditions for their spontaneous union (fertilization). If Sperm Microinjection (ICSI) is performed, a spermatozoon will be injected into each of the mature eggs that have been recovered.
The following day of the IVF or ICSI treatment, the number of fertilized ovules will be determined and the success of cultivation of the number and the quality of the pre-embryos that continue their development. Pre-embryos will be kept in the laboratory for a period of 3 to 5 days, after those who already come to the transfer. Embryonic transfer involves the deposit of the embryos in the uterine cavity through the vagina. It is an outpatient procedure that usually does not require anesthesia or admission. In order to promote embryonic implantation, a hormonal treatment is also prescribed. The number of preloads transferred into the uterus will be decided in conjunction with the treating physician, the biologist and the patients. Generally the amount is not higher than two in a cycle in order to avoid multiple gestations. After the transfer, drugs for luteal support (Micronized Natural Progesterone) are indicated and successive controls of serum Progesterone, serum estradiol for 10 to 12 days after the transfer are performed, qualitative and quantitative Beta – HCG (Pregnancy Test).
Nowadays, thanks to the techniques of assisted reproduction, many couples achieve their dream of motherhood. But in the cases in which the woman has a problem in her ovaries (advanced age, early menopause) or suffers from a genetic disease that could be transmitted to her children, the success of reproduction techniques depends on the donation program of oocytes. In Vitro Fertilization with donated ovules has been carried out successfully in the world since 1984. In the oocyte donation program, young women undergo an ovarian stimulation treatment with the objective of donating their eggs to those women who need them to be able to get pregnant.
The treatment with donated ovules is recommended in the following cases:
- Primary ovarian failure due to a numerical or structural alteration of the chromosomes (Turner Syndrome, Swyer Syndrome).
- Resistant Ovarian Syndrome (Savage Syndrome).
- Premature ovarian failure (Menopause before 40 years).
- Advanced ovarian age.
- Repeated failures in In Vitro Fertilization.
- Patients whose ovaries have been removed for different reasons (tumors, severe endometriosis (grade III, or IV), cancer, chemotherapy.