Assisted reproductive technologies
Insemination (IUI) is the simplest technique of assisted reproduction which is also the least stressful for a woman. During the procedure, the doctor introduces specially selected sperm cells into the uterine cavity. This method allows to select from the partner’s semen specimen the most fit and valuable sperm cells, and to eliminate the factors which prevent the fertilization at the stage of vagina or the cervical canal. In addition, the sperm cells are subjected to activation which facilitates or – in the case of some couples – enables the egg fertilization. In order to carry out this procedure, we should have the possibility to prepare at least several million sperm cells. In the first phase of treatment, the woman is given medications which stimulate ovaries and then induce ovulation. In this phase, regular ultrasound examinations are indispensable as the whole process has to be thoroughly monitored. When ovulation occurs, a special catheter is introduced to the uterus and then semen prepared by the laboratory staff member in sterile laboratory settings is introduced via this catheter.
Indications for inseminations include confirmed difficulties with the sperm getting through the cervical mucus, irrespective of their cause, and long-lasting efforts using other techniques in couples who refuse to undergo in vitro fertilization. Insemination is performed also in cases of endometriosis. Sometimes – when the cause of infertility is attributable to the male partner (poor semen parameters) or when partners do not want to undergo in vitro fertilization – insemination is performed with donor sperm.
In vitro fertilization
In vitro fertilization (or IVF) is a technique used in case of obstruction or adhesions in fallopian tubes, endometriosis, decreased ovarian reserve, ineffective previous treatments and long-lasting unexplained infertility. It is proposed also in case of premature ovarian failure, when donor’s eggs can be used.
The technique consists in fertilizing an egg outside a woman’s body (in vitro). In the first place, the woman takes medications which stimulate ovaries and induce ovulation. Then – when the follicles with eggs are mature – the procedure of egg collection (so-called ovum pick-up) is carried out. At the same time, the male partner collects semen. The material collected from both partners is then analyzed and sorted. After the eggs have spent a few to less than twenty hours on a special culture media in the incubator, embryologists introduce sperm into the eggs. After 8-20 hours, it can be confirmed whether the fertilization occurred. On the second or third day of embryo development, two or three embryos (depending on the woman’s age and health condition) are placed into the uterus with the help of a special catheter. After the embryo has implanted in the uterus and the pregnancy has been confirmed, the woman should stay under the medical supervision. In most cases (mainly due to the advanced age of the patients), prenatal tests are recommended. Currently, the leading infertility treatment centers gradually abandon the described classical in vitro fertilization technique, as its effectiveness is definitely lower than the ICSI technique described below.
ICSI – in vitro fertilization procedure supported with microsurgical manipulations
This solution increases the chances for success of every IVF program, in particular when the partner’s sperm cells are not able to fuse together with the egg cell on their own. The beginning of the procedure (patient’s stimulation and ovum pick-up) in this case proceeds just like in the standard IVF program. Following collection and selection, the chosen eggs are placed in culture dishes and examined visually under a special microscope. Here, the egg is punctured with a special microneedle and a previously chosen, single sperm is introduced into its inner part.
What if the assisted reproduction fails?
In case of failure, the physician decides on further proceedings depending on the results obtained during the conducted procedure. Based on the analysis of every stage in the applied treatment, the decision is taken whether the treatment will be modified at the next attempt or repeated in the similar way, or the approach to the treatment will be changed.
Usually, after three unsuccessful inseminations, patients are advised to use other therapeutic actions, including in vitro fertilization. Here, more attempts are possible (at intervals of several months), depending on the patients’ health conditions and determination.
At every stage of treatment, the couple, together with the physician, should consciously examine various options of solving the problem with getting pregnant. In some cases, it is worth using sperm, eggs or embryos from the bank, or consider adoption or resignation from parenthood.