Specialised treatment

In the case of some couple it may be necessary to use the advanced methods of treatment, including in vitro fertilisation and associated additional procedures.
INVICTA is the leader as regards the efficacy of IVF programs. The medical team works under the lead of Professor Krzysztof Łukaszuk, following the principles of the Proprietary Infertility Treatment Model – Fertility Excellence. The INVICTA Clinics provide the Patients with access to all methods and therapeutic procedures with recognised efficacy. In addition, they implement their own solutions tailored to the individual needs of the couples undergoing treatment.

In vitro fertilization is a method applied in case of existing fallopian tube obstruction or adhesions, endometriosis, diminished ovarian reserve, failure of previous treatments and long-term idiopathic infertility. It is also suggested in the case of premature ovarian failure where the procedure can be performed with donor eggs.

The method consists in the fertilisation of ova outside of the woman’s body (in vitro). At the first stage the woman takes medicines which stimulate ovaries and induce ovulation. When the follicles containing oocytes are already mature, the procedure aiming at their retrieval is performed (so-called ovum pick-up or OPU). At the same time the male partner provides his semen sample. The material collected from both partners is then prepared and subjected to selection. The egg cells are transferred to a special culture media and placed within an incubator for several hours, and then the embryologists place the sperm cells in the same place. After 8-20 hours the fertilisation or its absence can be confirmed. On day 5 (or sometimes on day 2 or 3) of embryo development, one, two or three embryos (their number depends on the woman’s age and health condition) are transferred to the uterus with the use of a specialised catheter. After the embryo implantation, when the pregnancy is confirmed, the patient should remain under medical supervision. In most cases (mainly due to the advanced age of the patients), prenatal tests are recommended. Currently in the leading fertility centres there is a shift away from the described method of classic in vitro fertilisation due to its definitely lower efficacy as compared with the ICSI technique described further below.

ICSI – Docytoplazmatyczne podanie plemnika do komórki jajowej

This procedure complements the in vitro fertilisation program. It is used in cases where no embryos were obtained in the result of previously applied techniques. This applies in particular to the situations where the semen tests indicate serious disorders in the sperm cell count (single sperm cells in semen), motility or structure.

The initial stages of this procedure are similar to the classic IVF program. The patient is subjected to hormonal stimulation and then to ovarian puncture. Selected oocytes are then placed in culture dishes and examined through a special microscope. The ICSI procedure requires the application of the micromanipulation techniques. A previously selected single sperm is taken up in a fine glass needle and is injected directly into an egg. This technique increases the chances of obtaining the fertilised egg. The ICS procedure is considered safe, i.e. it does not pose the increased risk of abnormal child development. Millions of ICS I procedures have been already performed throughout the world, with no reported significant increase in the risk of congenital defects in children born as a result of this procedure. In particular where the treatment using ICSI technique is performed in the couple where the semen parameters do not show extreme pathology.

Embryo transfer is the procedure of moving one or more embryos (depending on the patient’s individual clinical situation and requirements) to the uterus with the use of a specialised catheter. The procedure is performed under ultrasound control on day 5 (or sometimes 2 or 3) after oocyte collection.

In this case, transfer of embryos to the uterine cavity takes place without the previous hormonal stimulation of the patient. Instead, a special medical protocol is applied which ensures the optimal preparation of the uterine lining for embryo reception (implantation).

IMSI-MSOME – Intracytoplasmic Morphologically Selected Sperm Injection with Motile Sperm Organelle Morphology Examination

The procedure involves injecting an oocyte with a sperm cell with a thoroughly evaluated morphology. The analysis is performed with the use of modern microscopic equipment under high magnification. Prior to its injecting into an oocyte a spermatozoon is evaluated in detail for the number, quality and distribution of vacuoles on its surface and for its shape, which allows to select the best possible spermatozoon as regards its visual inspection.

This procedure is recommended for patients with confirmed teratozoosphermia, abnormal sperm morphology based on the semen analysis performed with the use of HOS (hypo-osmotic swelling) and MSOME technique. IMSI-MSOME compared with the standard ICSI technique significantly reduces the percentage of miscarriages in this patient population; however, it does not exclude the risk of aneuploidy in sperm.

FAMSI – Functional fine, Acrosome activated, Morphologically Selected Sperm Injection

This technique allows to inject an oocyte with a sperm cell with a sperm cell with a thoroughly evaluated morphology (like in IMSI-MSOME technique) and in addition assessed intravitally for the risk of DNA fragmentation. The procedure allows to reduce the risk of selecting a spermatozoon with the presence of aneuploidies.

The FAMSI method was developed in the Research and development laboratory if INVICTA in 2010.

IVM – in vitro maturation – in vitro maturation of oocytes

This method allows maturation of oocytes in vitro – outside of a woman’s body. This reduces the duration of hormonal ovarian stimulation stage which can be even eliminated in total or limited to only 3-6 days. The method is applied successfully primarily in patients with polycystic ovary syndrome (PCOS). However, the percentage of pregnancies after the treatment with the application of IVM technique, as comparted to a standard in vitro fertilisation program is lower and amounts to approximately 25% per cycle. The IVM method, despite its lower efficacy, appears to be safer for a PCOS patient due to the risk of hyperstimulation under standard procedures.

Extended embryo culture to blastocyst stage may significantly increase the chances for achieving the positive results of treatment. In this procedure, embryos are transferred to the uterus on day 5 after ovum pick-up. They are cultured in the specialised media. Blastocyst is the last stage of embryo development available in laboratory conditions.

Embryo culture to blastocyst stage significantly increases the chances for achieving the positive results of treatment:

  • blastocyst stage embryos have higher implantation rate than those consisting of 6-8 cells (blastocyst – 50.5%, embryo on day 2 or 3 of culture – 30.1%, P<0.01),[/fusion_li_item]
  • for the same number of transferred embryos, blastocyst transfer has significantly higher live birth rate (29% – day 3, 36% – blastocysts),
  • with blastocyst transfer doctors are able to select for transfer embryos of better quality,
  • extended culture allows more precise synchronisation between embryo and endometrium at the transfer,
  • where necessary, Pre-implantation Genetic Diagnosis (PGD), i.e. examination of the embryos’ DNA gives more information than in the case of a 2- or 3-day old embryo.
  • Extended embryo culture provides the chance of obtaining blastocyst stage embryo(s), but it doesn’t guarantee that this stage will be reached. Occasionally, it may happen that the transfer will not be possible due to the lack of embryos on day 5 or 6. Moreover, in the case of extended embryo culture, the number of embryos qualified for freezing in a single cycle is slightly lower than in the case of culture to day 2 or 3.

    For some men with the confirmed absence of spermatozoa in semen, for example due to inflammatory conditions or congenital absence of the vas deferens, testicle or epididymis puncture (TESA/PESA) for obtaining sperm (if present there) may be a chance for having offspring). Sperm aspiration is performed in general or local anaesthesia. From the collected material, cells being an early form of sperm or mature spermatozoa are isolated in laboratory settings. In 75% of cases this procedure leads to obtaining healthy sperm eligible for egg fertilisation with the use of the ICSI technique.

    In some patients, even when normally developing embryos are transferred to the uterus, they fail to implant into the uterine lining. In such cases in the next treatment cycle it is possible to apply the so-called „assisted hatching”. This procedure, performed immediately before embryo transfer in in vitro laboratory, helps embryos to get out (“hatch out”) from its shell known as the zona pellucida. In vitro embryo culture may lead to thickening of this layer thus causing difficulties with blastocyst hatching out and in consequence also with embryo implantation in the uterine cavity. Assisted hatching involves breaking the continuity of zona pellucida using mechanical cutting, enzymatic digestion or laser techniques.

    Sperm cells used in IVF techniques require the adequate preparation. With the use of techniques of sperm cell isolation from semen, spermatozoa are separated from the semen plasma, substances inhibiting the ability to fertilise egg cells are removed, processes facilitating the egg cell fertilisation are initiated, sperm cells with proper morphology and motility are selected, bacteria and viruses are eliminated and the sperm cells with a female or male chromosome are selected.

    The following techniques are most commonly applied in the sperm cell isolation:

    • semen flushing
    • Sperm separation in discontinuous gradient medium
    • swim up

    The most commonly used method of sperm separation is density gradient centrifugation (DGC), or the Percoll method, which allows to obtain the homogeneous population of normal sperm cells, separate the sperm cells from other morphotic elements of semen, and poses negligible risk of losing some small amount of spermatozoa when their number in the ejaculate is small.

    Do you know that....

    INVICTA Fertility Clinic was the first in Poland to perform, in 2008, Sperm Separation Test in its own Medical Laboratories!

    Ovarian Tissue Freezing is a novel method which provides the patients facing invasive treatments or aggressive cancer therapy the possibility of recovering their fertility, unavailable with any other previous treatment method.

    Tissue freezing is most useful in some cases including the following:

    • for the purpose of preserving fertility and hormone function in cancer patients, prior to the initiation of chemo- and/or radiotherapy;
    • for young women with Turner Syndrome, as the chance of giving birth to their own baby;
    • or women with oestrogen deficiency, as the method of preserving their hormonal status.
    The first in Poland procedure of ovarian tissue collection and freezing by vitrification was performed in INVICTA Fertility Clinic, on 21 November, 2009. Today it is still the only facility in Poland which offers this medical procedure. With his achievement the Team of INVICTA Fertility Clinics joined the circle of specialist centres from France, Germany and Japan where the procedures of this type have been performed so far.

    INVICTA, as the first in Poland, introduced oocyte cryopreservation by vitrification and has been applying it routinely since September 2003. Oocytes for freezing are obtained after the hormonal stimulation of the patient subjected to the procedure of in vitro fertilisation. Then a part of oocytes is fertilised and the other part is frozen. Under the traditional, formerly used method, all eggs were fertilised. This allowed to obtain up to several dozen embryos; two or three of them were transferred to a woman’s uterus, and the remaining ones were cryopreserved. With the new method, after the failure of the first treatment, the appropriate number of previously frozen eggs is thawed and fertilised, and the developing embryos are transferred to the uterus of a mother-to-be. Vitrification allows to use the entire stock of formerly obtained eggs because it increases their survival rate up to 95%. The percentage of pregnancies achieved with the use of thawed eggs is comparable to that obtained with fresh eggs. After successful treatment and upon the decision on the completion of reproduction, oocytes can be donated to other patients or utilised without ethical concerns.

    Hormonal stimulation conducted for the purpose of IVF and ICSI procedure leads to the development of large amounts of oocytes (from 3 to as many as 20 eggs). Depending on the patient’s wish, some eggs may not be subjected to fertilisation. During embryo transfer, maximum 3 fertilised oocytes may be transferred to the uterus. If more than 3 eggs are fertilised, and other embryos do not present development abnormalities, they may be frozen. Embryos are frozen in a special medium at – 196°C (temperature of liquid nitrogen). They can be stored at this temperature for a very long period of time.