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In Vitro Fertilization (IVF) or Test Tube Baby (High Complexity)

Home » IPGO Inglês » In Vitro Fertilization (IVF) or Test Tube Baby (High Complexity)
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IVF is the most sophisticated and advanced of all Assisted Fertilization techniques. To perform this technique (or program), the woman receives, in the same manner as the previous techniques, some hormones, but in larger dosages, to obtain a large number of eggs. Also in this procedure, the growth of the eggs is monitored by ultrasound until they reach a diameter of approximately 18 mm, and the endometrium, a thickness above 7 mm. The patient receives a final injection (HCG) to complete the maturation of the eggs, which are retrieved after 35 hours, by a special needle. Afterwards, they are placed in contact with the spermatozoa (in vitro), allowing for the fertilization to occur outside of the mother’s body. When the quantity of spermatozoa is small, ICSI (Intracytoplasmic Sperm Injection) is performed, in which the spermatozoon is injected into the egg. The embryos are initially developed in the laboratory, and then returned into the uterus where they continue to grow until the day of birth. The rate of success for this technique can reach up to 55% in patients who are less than 35 years of age.
Indications

  • Women with peritoneal abnormalities (adhesions).
  • Obstruction in the tubes.
  • Sterility without Apparent Cause (SWAC) or Unexplained Infertility.
  • Serious immunological factors.
  • Endometriosis.
  • Repeated failures in less complex treatments.
  • Advanced age.
  • Male factor (low sperm count, serious abnormalities in morphology or motility of the spermatozoa).

Procedure

The procedure is relatively complex and the process consists of six phases:
1st Phase – Blocking the hormones in the body.
2nd Phase – Growth stimulation of the eggs.
3rd Phase – Aspiration and retrieval of the eggs.
4th Phase – Fertilization of the eggs.
5th Phase – Transferring the embryo(s) into the uterus.
6th Phase – Regulating the hormones until the pregnancy test.

Details about each phase:

1st Phase – Blocking the hormones in the body

It is a partial blocking of the ovarian function with the appropriate medication. In this manner, it is possible to control the ovarian function and not to ovulate outside the scheduled time.

2nd Phase – Growth stimulation of the eggs

Various medication protocols exist to stimulate the growth of a large number of eggs. With a large quantity, there are more embryos to possibly select the best from and, as a result, it increases the chances of pregnancy. This phase lasts eight to twelve days and is accompanied by transvaginal ultrasound and hormone dosages.

 

 

 

 

3rd Phase – Aspiration and retrieval of the eggs

In a surgical environment and with deep sedation, the eggs are aspired by a needle connected to an ultrasound. This process is practically painless and lasts a few minutes. On this day, the husband’s semen is collected.

 

 

 

 

 

4th Phase – Fertilization of the eggs

In the laboratory, an experienced embryologist performs the fertilization of the eggs, which can be spontaneous, by ICSI (Intracytoplasmic Sperm Injection) or IMSI (Intracytoplasmic Morfologically Select Sperm Injection – Hight Magnification Morfological Selection). The decision will depend on the quantity and morphology of the spermatozoa and on the number of eggs.

 

 

 

 

 

5th Phase – Embryo Transfer

Two to five days after fertilization, the embryos are placed in the uterus. On this day, it is known which embryos are the best quality and thus the doctor and the couple will decide together how many of them will be transferred. This number can vary from one to four. The transfer is performed with a flexible catheter, without anesthesia, through the vagina. It is painless and similar to the discomfort of a gynecological exam.

 

 

 

 

*** IMPORTANT:

1) EXCESS EMBRYOS ARE NOT DISCARDED. IF THERE ARE MORE EMBRYOS THAN EXPECTED, THE EXCESS CAN BE FROZEN FOR LATER USE. IF THE COUPLE DO NOT WISH TO HAVE MORE CHILDREN, THEY CAN DONATE THEM TO ANOTHER COUPLE OR TO SCIENTIFIC RESEARCH.

2. THE COUPLES WHO, IN ANY CIRCUMSTANCES, DO NOT AGREE WITH FREEZING THE EMBRYOS, CAN LIMIT THE NUMBER OF EGGS FERTILIZED. THEREFORE, THEY AVOID THE EXCESS AND THE NECESSITY OF FREEZING.

6th Phase – Hormone Support

In this phase, blood exams are done to check the hormone balance. If necessary, the doses may be modified. The pregnancy test is done eleven days after the embryo transfer.

IMPORTANT:

The probability of a miscarriage or a baby with malformation occurring is the same, whether by ovulation induction or by natural conception. The existing risks depend on the age of the mother and genetic factors. If the patient becomes pregnant after this treatment, it will not be necessary to take any special measures; the pregnancy will be treated exactly like any other and the prenatal is exactly the same as a spontaneous pregnancy. The task of childbirth and nursing will not be affected in any manner.

Embryo Freezing (Vitrification)

At the beginning of an in vitro fertilization treatment, a very important question which concerns doctors and couples is the number of eggs that will potentially be produced during the cycle. This information initially seemed to have been of little relevance, but it has become important. The number of eggs produced is directly related to the number of embryos that will be obtained. A large number of embryos produced offer the medical team a better selection of embryos for the transfer, increasing the success rate. It also offers better conditions for longer cultivation, blastocyst culture, minimizing the chance of embryonic loss during the cultivation.

Nevertheless, high numbers of eggs can produce a large number of excess embryos in the cycle. According to the Federal Council of Medicine, nowadays the excess embryos in the in vitro fertilization cycle can have three destinations: freezing, donating to another couple, or donating to scientific research. There exists a certain resistance from couples to the last two options that relate to donation. Therefore, freezing becomes the evident choice.

Embryo freezing has a long history within reproductive medicine, originating in the mid- 80’s, and today, it is a proven procedure already widely diffused in the human reproduction centers throughout the world. In this field, a variety of laws exists which generally changes in accordance with the country. However, in general, embryo freezing is accepted by the majority. This allows couples who produce high number of eggs and, therefore, embryos to have another chance to conceive. In the same manner, couples who succeed on the first attempt and freeze the excess embryos can return after a couple of years and use these same embryos for a second attempt.

Embryos to be frozen must go through a dehydration process, in order for some water to leave the cells. This prevents the embryos from bursting during the process. After this stage, they are submitted to computerized freezing, starting at 37ºC and within a period of two hours, reaching -30ºC, and later being stored in liquid nitrogen at -196 º C. The length of time in the liquid nitrogen seems to have little affected on the embryonic viability. Cases of pregnancy already exist after a period of 8 years of freezing. The loss of viability during storage seems to be small; however, uncertainty still exists as to the maximum period of time in which the embryos can endure.

Similar to questions related to the freezing process, the current number of procedures performed and the success rate per attempt demonstrate that this procedure offers good success rates and should be used when necessary, such as in those couples who produce a high number of embryos. Another approach would be the storage of embryos by couples who, on the contrary, produce a small number of embryos. These couples could do various cycles with small quantities of embryos and freeze them. After a few months, this “stock” of embryos could be used at one time to maximize their chances. It is a common procedure in spontaneous cycles; that is, it only occurs in the production of one egg, or in some women with very low egg production.

In general, this procedure should always be considered when starting an in vitro fertilization treatment, for chances of using it are relatively high.

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