IVF, ICSI, IMSI, IUI, Embryoscope, TEC

Assisted Reproductive Technology (ART): Intrauterine Insemination

Intrauterine insemination (IUI) is an ART technique involving the direct insertion of sperm into the uterine cavity on the day of ovulation. After collecting the partner's sperm, it undergoes a laboratory process called capacitation to select the most motile and resilient sperm. These are then inserted directly into the uterine cavity using a small plastic tube; this is a painless procedure. Note that 3 to 5 days of sexual abstinence are necessary, and the sample is collected after the man urinates to prevent bacterial contamination. This procedure bypasses the cervical mucus barrier, which can hinder sperm travel. IUI is indicated when the partner's sperm have good motility and are present in large numbers, or with mild oligoasthenoteratozoospermia – meaning slight alterations in sperm concentration, motility, and morphology that can be corrected after appropriate sperm sample preparation. IUI can also be applied when couples experience sexual difficulties due to impotence or vaginismus, retrograde ejaculation, or in cases where infertility is secondary to the inability to have complete sexual intercourse.

In Vitro Fertilization (IVF)

In vitro fertilization is the primary assisted reproductive technology. This system has enabled many infertile couples or those with fertility problems to realize their dream of becoming parents.

It's important to distinguish IVF (in vitro fertilization with embryo transfer) from IUI (intrauterine insemination). If IUI proves unsuccessful or is not feasible, couples wishing to have a child must resort to IVF.

With IVF, conception is artificially created outside the woman's body, and then the resulting embryo(s) is/are placed in the uterus. The woman's eggs and the man's sperm (male and female gametes) are collected and fertilized in a laboratory, in a petri dish.

ART Technique: Conventional IVF

Fertilization (Day 0)

After extracting the male and female gametes, in vitro fertilization itself can be performed. The best sperm are washed and selected, those with the greatest motility, and the eggs are isolated. Each egg is then cultured with the selected sperm and kept in a 37-degree incubator. Two days after the woman's egg retrieval, it's possible to know the exact number of embryos formed. When in vitro fertilization is successful, the resulting embryos can be placed in the woman's uterus. In some cases, for better embryo selection, in vitro culture is extended by four additional days.

At the end of this phase, one (maximum two) of the best embryos is chosen to be transferred into the woman's body. A syringe pushes the embryos into the uterus through a thin tube: implantation is painless and very quick.

The Day After Fertilization (Day 1)

The day after fertilization, approximately 17-20 hours later, the oocytes can be observed under a 400x inverted microscope to detect whether fertilization has occurred. A fertilized oocyte has two pronuclei, corresponding to the female and male genetic codes. Specialists and the doctor can observe if the oocytes have been correctly fertilized, unfertilized, and abnormally fertilized.

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ART Technique: ICSI

ICSI (Intracytoplasmic Sperm Injection)

ICSI is a laboratory technique that allows the insertion of a single sperm into a mature oocyte. This is crucial when the sperm sample doesn't meet the criteria required for IVF. IVF and ICSI differ in how fertilization is achieved. IVF involves inoculating a sufficient number of sperm into each culture drop. All other treatment steps, from stimulation and ovarian monitoring to oocyte retrieval, embryo culture, and embryo transfer to the uterus, remain unchanged in both techniques. ICSI is an excellent ART technique in cases of male infertility.

Fertilization (Day 0)

In the ICSI technique, eggs are extracted by follicle aspiration. Once extracted, the eggs are kept in culture for a few hours, and during this time, the sperm is prepared to extract motile sperm. The eggs are then prepared by removing the outer layer of cells, and via intracytoplasmic microinjection, a single sperm is introduced into each oocyte.

The Day After Fertilization (Day 1)

The day after oocyte retrieval, fertilization is checked, and the number of correctly fertilized oocytes is assessed. In the following days, the fertilized oocytes undergo the physiological divisions characteristic of correct embryonic development until, by selecting embryos with the best developmental characteristics, they are transferred to the uterus.

ART Techniques: Embryo Transfer

Vitrification

Currently, embryos and oocytes are frozen by placing them in direct contact with liquid nitrogen; the ability to survive vitrification depends on the degree of cellular dehydration and the thawing rate, rather than the type of cryoprotectant used. Vitrification is the best available strategy for cryopreservation at different stages of development, from the mature oocyte to the embryo up to the blastocyst stage.

Embryo Vitrification

Embryo vitrification involves rapid freezing on the order of -15,000 °C per second. The results of vitrification are measured in survival rates, depending on the embryo's ability to withstand the freezing and thawing process. Therefore, as high-quality embryos are needed, they are not generally all vitrified. Once vitrified, the embryos are stored in liquid nitrogen containers at temperatures close to -196 °C.

Oocyte Vitrification

Once vitrified, the oocytes are placed in straws through a hermetic system that prevents them from coming into contact with the liquid nitrogen in which they are immersed for storage, thus ensuring maximum safety conditions.

The EmbryoScope®

The Embryoscope offers a cutting-edge technique in assisted reproduction, indicated for the best selection of the embryo to be transferred to the mother's uterus during the in vitro fertilization process.

Selection of this embryo is done using this artificial embryo incubator, which allows viewing the embryo's status every 15-20 minutes, 24 hours a day. This allows the specialist to see, almost live, the rate of cell division of the embryo without needing to subject the embryo itself to a stressful situation.

The embryo observation period can be carried out between 3 and 5 days, which helps prevent potential failures in choosing embryos to transfer to the maternal uterus. In this way, the chances of success of all in vitro fertilization treatments are exponentially improved.

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