In Vitro Fertilization (IVF) and ICSI

Classic IVF

In vitro fertilization (IVF) is an assisted reproductive technology (ART) that involves collecting male and female gametes so that fertilization takes place in a controlled laboratory environment. The resulting embryo is then transferred to the uterus of the future mother.

IVF is indicated for couples experiencing difficulties conceiving, such as problems with sperm reaching the egg. This can be due to various factors, including advanced maternal age, male sperm production issues, blocked fallopian tubes, and endometriosis.

IVF is also indicated for women who have difficulty producing eggs. Through this treatment, they can receive donor eggs, which are fertilized with male gametes and implanted in their own uterus.

To undergo IVF, the future mother should follow recommended guidelines, receive the fertilized gametes from the laboratory, and prioritize her health by:

• Maintaining a balanced diet;
• Avoiding smoking;
• Reducing alcohol consumption;
• Taking folic acid supplements

The IVF process is relatively straightforward. The male partner provides a sperm sample, collected in the laboratory through masturbation or, if no gametes are present in the semen, through a small testicular puncture.

The woman undergoes ovulation induction using medication to facilitate the collection of female gametes. Then, selected sperm are placed in a Petri dish with a female egg.

Approximately 200,000 sperm are selected to attempt fertilization of a single egg. This process mimics the natural fertilization process within the human body.

After fertilization, the embryo is placed into the woman's uterus using a process similar to a pap smear. After 14 days, a follow-up examination confirms the success of the procedure.

The entire process, from gamete collection to fertilization, uterine implantation, and final examination, takes approximately 25 days.

Success rates are linked to the age of the egg donor, as older women may experience more difficulty with fertilization:

Success rates can reach 60% per attempt.

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IVF-ICSI

In vitro fertilization with intracytoplasmic sperm injection (ICSI) is indicated in cases of male infertility. This combined technique allows for fertilization of eggs even when sperm count is low, motility is insufficient, or morphology is abnormal.

IVF treatment with ICSI involves five stages:

• Ovulation Stimulation: This involves administering hormones, usually subcutaneously, to stimulate the growth of a larger number of follicles, resulting in a greater retrieval of eggs for fertilization.

This phase begins on the second or third day of the menstrual cycle and lasts an average of 9 to 12 days. During this period, the patient monitors the growth of ovarian follicles (containing the eggs) using transvaginal ultrasound and possibly blood tests.

Once most follicles reach an average volume of 18 millimeters, a final medication (HCG) is administered to trigger final egg maturation and retrieval within 34 to 36 hours. Egg and Sperm Retrieval

Egg retrieval involves removing eggs from the ovarian follicles using a needle guided by transvaginal ultrasound. Short-term sedation is administered for the procedure.

The aspirated fluid is placed in a tube and given to the embryologist for examination and egg collection. Sperm collection usually takes place on the same day as egg retrieval, typically through masturbation. In specific cases, sperm retrieval may also be performed surgically, as medically indicated;

• In Vitro Fertilization: 3 to 4 hours after egg retrieval, the gametes undergo in vitro fertilization, which may be performed using intracytoplasmic sperm injection (ICSI).

A single sperm is captured using a needle and injected into the egg. This technique, first reported in 1992, revolutionized assisted reproductive treatments;

• Embryo Culture: After 18 to 20 hours of incubation, fertilization is checked to verify the number of eggs fertilized. Successful fertilization is confirmed by the appearance of two pronuclei (male and female) in the egg's cytoplasm.

On days 2 and 3 of embryonic development, we check embryo development for cell count and fragmentation percentage. On day 5, we check and classify embryos at the blastocyst stage, evaluating the degree of expansion, the inner cell mass (ICM), and the trophectoderm;

• Embryo Transfer: After fertilization, embryos develop in the laboratory for 3 to 5 days. Embryo transfer is a generally painless procedure performed using an ultrasound-guided catheter, which delivers the embryo into the uterine cavity (endometrium).

A pregnancy test (quantitative β-hCG) is performed via blood sample and analysis 12 days after embryo transfer. Any extra embryos obtained during the IVF procedure are frozen for future use;

ICSI can achieve a success rate of 40%, primarily dependent on the woman's age and sperm quality. In some cases, poor sperm quality affects the chances of success.