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Technologies

Basic Assisted Reproductive Technologies

IVF

IVF (In Vitro Fertilisation) involves fertilising egg cells outside the body in laboratory conditions. An embryo is created which is later placed in the woman’s uterus. The complete IVF cycle comprises 5 stages and related technologies:

  • hormonal stimulation
  • egg cells retrieval
  • fertilisation with specially prepared sperm
  • embryo assessment and further culture
  • embryo transfer to the uterus

 

 Who is it for?

  • Women with absent or non-surgically repairable fallopian tubes
  • Women affected by endometriosis and haven’t been able to get pregnant after medical or surgical treatment
  • Women with ovulatory dysfunction who haven’t been able to get pregnant after regular ovulation induction
  • Women with a history of DES (diethylstilbestrol) exposure during pregnancy
  • Couples experiencing unexplained infertility

ICSI

ICSI (Intracytoplasmic Sperm Injection) involves injecting a single sperm directly into an egg in order to fertilise it. This fertilised egg (zygote) is cultured for 2-5 days and then transferred to the patient’s uterus. ICSI is used in cases of severe male factor infertility and couples with a history of poor fertilisation after IVF.

Who is it for?

  • Couples for whom IVF was unsuccessful or had very poor fertilisation following standard IVF treatment
  • Men with abnormal sperm parameters (e.g. low count, poor motility, high percentage of abnormal forms and high levels of antisperm antibodies in the semen) to allow a reasonable chance of success with standard IVF
  • Azoospermic (complete absence of sperm in the ejaculate) men who have their sperm surgically retrieved. This could be due to failed vasectomy reversals or congenital absence of both vas deferens and non-obstructive azoospermia.
  • When frozen sperm is limited in number and quality.
  • ICSI is generally unsuccessful when used to treat fertilisation failure that is primarily due to poor egg quality
  • After an IVM procedure

IMSI

IMSI (Intracytoplasmic morphologically-selected sperm injection) is used to select the healthiest sperm without any morphological changes. It allows embryologists to examine sperm under 6000x magnification so that they can detect subtle defects in the sperm nucleus or morphology that may not be detectable under the 400x magnification of ICSI. Choosing the best sperm increases the chances of successful implantation.


Who is it for?

  • Patients whose sperm samples are unusually highly abnormal
  • Patients who have already undergone several IVF cycles without success
  • Patients whom well qualified embryo cannot be obtained in previous applications unless well ovum quality
  • Those who have miscarriage history in previous pregnancies
  • Ladies with less ova to increase fertilisation ratio. In recent studies, better embryo development, higher pregnancy rates and less pregnancy losses have been detected by using sperms selected by IMSI technique

IUI

IUI (Intrauterine Insemination) involves placing specially prepared sperm inside a woman’s uterus to facilitate fertilisation. IUI enables healthy sperm to reach the fallopian tubes increasing the chance of conception. It is combined with 'sperm washing’ which separates sperm from the seminal fluid.

 Who is it for?

  • Women who do not produce cervical mucus around the time of a natural ovulation or after ovulation induction
  • Women with a history of mild to moderate endometriosis after laparoscopic treatment
  • Couples where the male partner's sperm production has decreased or the motility of the sperm has been compromised
  • Couples experiencing unexplained infertility

Vitrification

Vitrification involves freezing egg cells and embryos. It is a fast cryopreservation technique that offers superior survival compared to slow freezing techniques. This is because it avoids the formation of ice crystals within the cells. It is used in IVF treatments.

Who is it for?

  • Women who wish to postpone motherhood
  • Oncology patients and others who are going to be given gonadotoxic treatments
  • Women who have had repeated ovarian surgery, for example in the case of endometriosis
  • Patients who would prefer to carry out embryo transfer in a cycle other than the one in which follicle stimulation takes place
  • When there is a risk of OHSS (ovarian hiperstimulation syndrome), development of polyps, hydrosalpinx or hydrometra, absence of spermatozoa, etc.
  • Patients who have a poor response to: accumulating oocytes or obtaining a sufficient quantity of oocytes for pre-implantation genetic diagnosis

 

Special techniques

IVM

In vitro maturation of oocytes (IVM) allows egg cells to be collected while they are still immature. They are then matured in the laboratory before being fertilized. This means the woman does not need to take as many drugs before the eggs can be collected compared to conventional IVF.

Who is it for?

  • Women who are at higher risk of ovarian hyperstimulation syndrome (OHSS), including women with polycystic ovarian syndrome (PCOS)
  • Women who are younger and have normal menstrual cycles
  • IVM can be used with regular IVF cycles to obtain many immature eggs from the stimulation procedur

IVC

Intravaginal culture (IVC) enables embryos to develop and reach the more advanced blasyocyst stage. This blastocyst is transferred into the uterus as part of an IVF procedure. IVC involves the fertilisation and early development of egg cells in a closed, air-free environment without the use of CO2.

Who is it for?

  • Patients who develop a larger number of eggs and embryos benefit most from blastocyst transfer.
  • Women who would not consider a multifetal pregnancy reduction procedure or multiple pregnancies is a particular concern. Elective single blastocyst transfer is recommended in such cases.
  • Blastocyst transfer is not advised for patients who develop few eggs or few embryos

AZH

Assisted zona hatching (AZH) increases the chances for embryos to implant that have developed a thickened outer layer (zona pellucida). It involves making a small opening in the outer layer so that the embryo can easily hatch through it. AZH is performed before the embryo transfer using a powerful microscope equipped with a laser.

Who is it for?

  • Women with advanced maternal age (>38 years)
  • Women with repeated failed treatment cycles despite good embryo quality
  • Women having a frozen-thawed embryo transfer cycle

MSOME

Motile Sperm Organelle Morphology Examination (MSOME) is used to assess male fertility by analysing sperm at 6600x magnification. Any major sperm anomalies as well as defects in the head of the sperm (e.g. vacuoles) can be detected. Only mobile spermatozoa are analysed which provides a more realistic assessment with reduced variability.

Who is it for?

  • Patients where severe male infertility is suspected following routine semen analysis and morphology evaluation
  • Couples with repeated ART failures and/or with unexplained infertility

TESE & MESA

Testicular sperm extraction (TESE) and Microsurgical Epididimary Sperm Aspiration (MESA) are used when there is no sperm in male ejaculate. TESE involves taking sperm directly from testicular tissue. The MESA procedure extracts sperm from the epididymis. Both are surgical procedures performed under local anesthesia.

Who is it for?

  • Patients with congenital or acquired (injury, infection) blockages of the reproductive tract duct system near the prostate, or anywhere else outside of the scrotum
  • Men who are unable to ejaculate due to diabetes or spinal cord injury
  • Sperm production must be normal in the testis

EmbryoGlue ®

EmbryoGlue increases the chances of embryos successfully implanting in the uterus by 34% compared to traditional methods. When embryos are transferred to the uterine cavity, a small amount of EmbryoGlue. EmbryoGlue contains high concentrations of a special compound, hyaluronan.

Who is it for?

  • All patients who undergo embryo transfer in the course of assisted reproduction
  • Women over 34 years old who have had three of more previously failed IVF cycles
  • Patients with unexplained causes of infertility

Embryovision

Embryovision is a new system to monitor the development of newly-fertilised embryos using time-lapse imaging. It enables embryologist to more accurately assess the potential of different embryos and select the best ones to transfer.

Who is it for?

Any patient may benefit from culturing their embryos in the Embryovision system and in particular:

  • Younger patients who fall into the single embryo transfer (SET) group, as the embryologists may be able to select the best embryo with greater confidence
  • Those patients who have had multiple failed treatments as the extra information may help to identify embryos showing abnormal development
  • The use of Embryovision may be less useful for those patients with only a few eggs at egg collection where fewer embryos develop

 

PGD & PGS

Pre-implantation genetic diagnosis (PGD) allows newly-fertilised embryos to be screened for genetic disorders before they are transferred to the uterus. PGD involves taking a single cell from the embryo and testing it. This cell biopsy is typically performed three to four days after fertilization. Pre-implantation genetic screening (PGS) helps identify embryos at risk.

Who is it for?

  • Women of advanced maternal age (>38years)
  • Couples with a history of unexplained recurrent miscarriages
  • Couples with a history of a previous pregnancy that was found to be chromosomally abnormal
  • Couples where at least one partner has a known genetic defect (such as cystic fibrosis, myotonic dystrophy, etc) that has been previously identified
  • Couples where at least one partner has a specific chromosomal rearrangement known as a translocation

 

Every time I put on my doctor scrubs, I know that today we’re going to be changing someone’s life – to make it much, much better. I wouldn’t change this feeling for anything else.
robert-gizler-invimed-wroclaw.jpgRobert Gizler, M.D, Ph.D Medical Affairs Director

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