Assisted reproductive technologies
One way of treating infertility is an assisted reproductive technology.This is a general term referring to a wide range of procedures.
Your personal treatment depends on the cause of infertility and your personal specifics.
Below we describe the procedures that we use in our clinic with great success.
1. Cycle monitoring
- If we do not find significant problems during the tests, then we do not suggest artificial fertilization techniques. In order to put less strain on the body we only use a minimal amount of stimulating medication. During cycle monitoring we check if the ovaries work properly according to the cycle, and in order to make the female conceive as soon as possible, we suggest an optimal time for sexual intercourse.
The tests can be more easily evaluated if you use the TervezettBaba.hu site to register the events of your cycle and here you can get a really precise prediction for the time of your ovulation.
2. Luteal support
- Luteal support means the supplement of progesterone produced by the yellow body (corpus luteum). The yellow body is formed in the second half of the cycle after ovulation, at the follicles. This is the organ producing hormones that maintain pregnancy hormonally, because the progesterone hormone produced by it prepares the endometrium to receive the embryo. If the yellow body does not work properly and the amount of progesterone is not sufficient then the menstrual cycle becomes irregular, making pregnancy harder and it can also cause miscarriage. Luteal support is the supplementation of this missing hormone.
- Artificial insemination is the least invasive intervention to treat infertility.
If the tests do not discover any sperm abnormalities, serious fallopian tube problems (blocks on both sides), nor critical hormone values then we choose artificial insemination as the preferred treatment. With a minimal amount of hormones we stimulate ovulation and check the maturation of the dominant follicle by an ultrasound scan. At the optimal time we trigger ovulation. After preparation we inject the freshly taken sperm sample into the uterine cavity through a thin catheter. This procedure is painless and causes no strain on the body, so it is performed without anaesthetic (?) . The sperm can come from the male partner, or if there is no sperm of appropriate quality then it can come from a donor. The success rate of the procedure is 15-20%, which is higher than the rate of spontaneous pregnancy (10-15%).
Artificial insemination by donor
The procedure is basically the same as classic insemination. We use this method for those couples where the male partner cannot produce appropriate sperm and in the case of those single women who meet the legal requirements. We can obtain the necessary sperm from a sperm bank after signing an agreement.
4. In vitro fertilization (IVF)
- The essence of IVF is that the meeting of the male and female gametes necessary for conception happens outside the uterus then the fertilized embryo that has already started to develop is placed into the uterus. In other words, the female ovum is fertilized by the males’s sperm in a laboratory then it is placed into the uterus.
The first step is to use a minimal amount of hormonal stimulation to make the ovaries produce more follicles. On the right days of the cycle we check the maturation of the follicles. If maturation is regular – under anaesthesia – a small needle is inserted through the vagina and guided via ultrasound in order to collect the fluid that contains the eggs. Then our well-trained embryologists look for and evaluate the eggs in the fluid with the help of a stereomicroscope. The extracted eggs are put into a special culture medium that provides the optimal environment for the development of gametes and the embryo. Then the extracted eggs are fertilized with the help of the sperm given by the male partner. Fertilization happens 3-4 hours after the (?) for which sperms are well prepared.
On the days after fertilization our embryologists check the procedure of cell division under a microscope to be able to choose those embryos with the best capacity to develop, and later they can freeze those that are not placed into the uterus. The fertilized and properly dividing embryos are placed into the uterus either 48-72 or 120 hours after the egg extraction. First the embryos are stored in a modern solution that helps their implantation then they are transferred into the uterus through a thin catheter guided via ultrasound. This procedure is painless so we perform it without anaesthesia.
During the transfer we try to avoid multiple pregnancies. To do this we try to use the minimal number of embryos that will be sufficient for pregnancy.
- IVF can be the solution for the following cases of infertility:
- if both fallopian tubes are blocked,
- if advanced endometriosis damaged the function of the fallopian tubes,
- if the patient has significant hormonal problems,
- if the sperm-count is low,
- if the mother is older than the norm ,
- if previous inseminations were unsuccessful.
- IVF can be the solution for the following cases of infertility:
Intracytoplasmic sperm injection is a type of IVF procedure. If the reason for infertility is a weak sperm sample then the sperm can be artificially inserted into the egg with a micro-manipulation technique. During this procedure the egg is fixed by a very precise device, then we inject the sperm into the egg directly with a thin and delicate needle. The greatest advantage of Intracytoplasmic sperm injection is that even if the ejaculation does not contain sperm (azoospermia), ICSI can still be carried out with the help of sperm extracted from the testicles or the epididymis by surgery.
- ICSI procedure is carried out if
- the sperm-count is very low,
- the rate of mobile sperm is less than 20%,
- there is a great number of abnormal sperm (more than 95%),
- the rate of progressive sperm is low,
- the spontaneous fertilization capacity of the sperm sample was low or insufficient (less than 20%) during previous IVF treatments,
- there were many unsuccessful previous IVS treatments.
Assisted hatching procedure can increase the success of the implantation of the embryo, and thus the IVF treatment. During AHA (assisted hatching) we make a small incision on the zona pellucida, allowing the embryo to discard the surrounding zona pellucida and to be implanted into the endometrium more easily. The zona pellucida, the membrane surrounding the embryo originally, plays an important role in the fertilization of the egg, as it only allows one sperm to enter. It also protects the eggs from mechanical and immunological damage when they move in the fallopian tubes. But embryos need to leave this membrane eventually to be implanted in the endometrium. The name of this procedure is hatching. It usually happens five days after fertilization. As the embryo grows it breaks this membrane. If it cannot discard the zona pellucida then it won’t be able to be implanted and it will die. Assisted hatching (AHA) done by mechanic, chemical or laser treatment, increases the chances of success.
- AHA procedure is recommended if
- the mother is over 35,
- two previous IVF treatments were not successful,
- a microscopic scan shows that the zona pellucida is thick
Cyropreservation – Embryo freezing
- The fertilized embryos that are not placed into the uterus, if they divided properly and are of good quality, can be frozen and stored. Frozen embryos can be stored indefinitely in liquified nitrogen and can be used if the couple plan pregnancy in the future. Frozen embryo transfer (FET) has less impact for the patient than the extraction of the eggs (IVF) because we use a mild stimulation for it and it does not involve any surgical procedures. During the freezing and thawing procedures a few embryos die, even with the most cautious methods. Apart from the materials and techniques used, personal characteristics can also determine whether some embryos can deal with the changes during freezing and thawing and some cannot.
Embryos are stored in liqu ified nitrogen at -196 ºC. This very low temperature is reached by a special freezing device controlled by a computer that cools the embryos gradually by a special program for maximum safety. In an optimal case the survival of embryos with good structure can be around 75-80%.
- Under certain conditions the need might arise to freeze the male partner’s sperm . The procedure is much simpler than freezing embryos because we can use many more sperm cells and these cells are not so delicate. Sperm can also be stored frozen for a longer time. Our clinic offers the possibility to store frozen sperm for the patients’ own later use.
- During the IVF procedure, after the embryo transfer the fertilized embryos that are not placed into the uterus, if they divide properly and are of good quality, can be frozen and stored. We use the most modern procedures to treat infertility. Freezing eggs is one of the most modern procedures. But the rate of pregnancies from frozen eggs is still lower than that from the frozen embryos. The main reason for this is that eggs are quite volatile during the freezing procedure.
- With the advancement of age the ovaries work slower or they stop working, which means they do not produce eggs in appropriate number and quality. For patients diagnosed with early ovary deficiency or in whom an egg with appropriate chromosomes could not be found during previous IVF procedures, we recommend using donated eggs. In this procedure, which is regulated by law, we extract the potentially viable eggs of a healthy patient then donate them to the couple in need. After they are fertilized by the sperm of the father, the embryos are transferred into the uterus of the "recipient" mother. This procedure requires careful preparations which our clinic is set up to provide.