IVF – In Vitro Fertilization:
In Vitro Fertilization is probably the best known and most widely used ART procedure. For well over a decade, IVF has allowed infertile couples the chance to conceive and bear children. The best candidates for IVF are women with damaged fallopian tubes.
IVF is a four-stage procedure. The beginning of this process involves ovarian stimulation to produce several mature eggs that can be harvested from the ovary before they have been released from the follicles, and the monitoring and collection of eggs. Multiple eggs are removed from the woman and placed in a special medium for two to three hours. The male semen is processed, using different techniques to obtain a vigorous motile sperm. The prepared sperm is then introduced into the medium containing the egg(s).
In Vitro Fertilization with Embryo Transfer (IVF – ET)
In the fourth stage of IVF, many of these eggs will fertilize and develop into embryos, which are then transferred back into the woman’s uterus through a simple procedure that requires no anesthesia. In most cases, egg recovery is preceded by a period during which the woman receives daily hormone medications to stimulate the growth of multiple eggs. In some instances, however, it may be possible to accomplish IVF without the use of these ovulation induction medications.
ICSI:
Intracytoplasmic sperm injection (ICSI) is a highly sophisticated technique for injecting one single sperm into an egg using microscopic and micromanipulation instruments. In men with low sperm count, low motility or a high number of abnormal sperm, this technique has proven to be a highly successful remedy.
Combined with IVF or ZIFT, the procedure of ICSI is able to achieve a high rate of fertilization and normal embryo development. ICSI has even been successful in cases where sperm must be taken directly from the testes (testicular biopsy) due to the absence of sperm in the ejaculate or a previous vasectomy. ICSI is also the best choice when other andrology tests identify a possible problem with sperm function.
ICSI & IVF
ICSI is a more aggressive approach compared to traditional IVF. During a traditional cycle of IVF, the sperm and eggs are introduced together in a cultured medium, while the ICSI procedure takes an individual egg and microscopically inseminates it with an individual sperm. The successfully fertilized eggs are observed, graded for quality and reintroduced to the mother’s uterus.
Blastocyst Transfer:
This is a procedure that allows a longer time for the embryo to develop in the laboratory (five days instead of two to three). This enables the embryo to reach the Blastocyst stage, which is the natural embryonic stage for implantation in the uterus.
Many couples undergoing In Vitro Fertilization accept the risk of multiple gestation as an integral part of the treatment process. They want to maximize their chances of achieving a pregnancy and will transfer three or more embryos to achieve their goal. After all, the chance of taking home a baby is not 100%, and the cost of an IVF cycle can be quite significant. Sometimes, the financial resources of a particular couple may only allow them to undergo an IVF cycle once in their lifetime. The end result of transferring 3 or more embryos has been a significant increase in the rate of triplet and higher order multiple pregnancies. There are enormous medical, social, and financial consequences of this increase in multiple birth rate.
One solution to this problem may be to culture the embryos for 5 or 6 days, to the blastocyst stage. Embryos developing to the blastocyst stage (blastocysts), have a higher implantation rate than embryos grown only three days, and are more likely to succeed in initiating a pregnancy. As result, only two blastocysts need to be transferred to have the same pregnancy rate usually seen when 3 or more embryos that have been grown for only 2 or 3 days are transferred into the uterus. In other words, fewer embryos are needed to achieve the same or higher pregnancy rate, resulting in a lower incidence of multiple gestation.
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