In Vitro Fertilisation (IVF) is an assisted reproduction treatment that consists of fertilising the egg cells outside the maternal uterus to –once the fertilised embryos have been obtained- transfer these to the uterus with the aim of achieving pregnancy. Using this technique, whereby the fertilisation of the egg cell is done in the lab –in vitro- high pregnancy rates are accomplished.
At Amnios in Vitro Project, thanks to the latest medical technologies and our professional medical team, we are able to offer our patients the highest possible success rates, always with a humane relationship which is 100% personalised and where your well-being and the success of your treatment are the only important matter.
In Vitro Fertilisation, always after studying the results of the fertility study, is indicated in the following cases:
- For women whose Fallopian tubes do not work correctly or are obstructed.
- In those cases where the man has a small amount of useful sperm cells. Even if no sperm cells exist in the semen, these can be obtained straight from the testicle.
- For women with no success in previous IVF cycles.
- For women suffering from endometriosis.
- For women over 40.
These are the stages of the IVF treatment we offer at AMNIOS In Vitro Project:
In this phase of IVF, medication to stimulate the growth of the ovarian follicles is used. This medication is completely natural. These are the same substances (FSH, LH) which are produced by the pituitary gland to stimulate the follicles. Follicles are a type of small cysts which are formed in the ovaries, in which we find the egg cell. The aim of this treatment is obtaining these egg cells and take them out of the woman’s body. This medication is applied through subcutaneous injection. These are injections, but so simple and not painful at all, that they can be administered without any risks after a short course.
During a normal ovulation cycle, the ovaries produce just one follicle, and therefore, just one egg cell. If the ovaries would not be stimulated, we would only obtain one egg cell to be fertilised in each cycle, which would lower the chances of pregnancy substantially.
In the beginning, IVF was executed in a natural cycle. Afterwards, when the ovary stimulating hormones were discovered, hyperstimulation was applied.
Ovarian hyperstimulation commences when a woman has her period. On the second or third day, an ultrasound is done (and sometimes a blood test to check on some hormone levels such as LH, progesterone and estradiol). If the ovaries are resting, we start to inject the medication. On the fourth or the fifth day, the first ultrasound is done to check how the ovaries are responding.
The development of the hyperstimulation is followed through these ultrasound checks. The number of follicles is counted and their sizes are measured. This way, the doses of medication for the following days are adjusted. From here, there are checks every 2 to 3 days. At times it is also necessary to do a blood test to check on the hormone levels (estradiol, LH).
Ovarian hyperstimulation in IVF normally takes approximately 9 to 10 days, until the main follicles reach a size of more than 18 mm. When this is the case, another type of medication will be injected (hCG), to complete maturation of the egg cell inside the follicles. And then everything is ready for the next phase (ovarian puncture, or oocyte retrieval).
This phase in IVF is carried out using a puncture through the vagina, guided by ultrasound. A low level of sedation is applied, so the woman does not feel any pain.
The egg cells are too small to be seen on the ultrasound. What we see are the follicles (the egg cells are inside).
To retrieve the egg cells, the follicles are located in the ovaries and these are punctured. When the follicle is punctured, the content is sucked up (in the sucked up liquid is the egg cell) with a pump and the obtained liquid is immediately handed over to the biologists in the IVF lab, which is right next to the puncture room. The biologists then search for the egg cells, using a microscope.
Once the egg cells are obtained, there are two techniques to fertilise them: In Vitro Fertilisation or intracytoplasmic sperm injection (IVF or ICSI). If IVF is the technique of choice, the egg cells are placed in a dish with the culture medium, alongside a high amount of sperm cells (about 100,000 per egg cell) and they are left to fertilise on their own.
In the case of ICSI, one sperm cell is directly injected in each egg cell. This technique is used when the number of sperm cells or the mobility of the cells is very low. To fertilise egg cells through conventional IVF the quality of the semen needs to be adequate: recuperation of more than 5 million sperm cells, with a minimum of 30% progressive mobility and 30% of normal morphology. In case the conditions are not met, the chances of failure (failure of fertilisation) are high, therefore it is preferred to directly use ICSI.
Whichever technique is used to fertilise the egg cells, the next day the number of fertilised egg cells is checked. Normally, about 80% of the egg cells are fertilised (either through IVF or ICSI). The embryos are kept in incubators at all times, under strict cultivation conditions (controlling the temperature, CO2 concentration, oxygen pressure, etc.).
On the second day, the already fertilised embryos with a normal evolution have already divided, and have between 2 and 4 cells. On the third day, they have between 6 and 8 cells.
The embryo transfer in an IVF process normally takes place on the second or third day after the ovarian puncture. To transfer the embryos, these are introduced in a catheter (a very fine tube), and controlled by ultrasound, they are placed in the uterus. The embryo transfer is not painful. It is as uncomfortable as any other gynaecological examination and no sedation or anaesthetics are needed. Once the catheter is pulled back, the biologist checks that it is empty (which means that all embryos have entered the womb correctly).
During the next 14 days, the woman undergoes a treatment with progesterone pills (and sometimes with oestrogens, too) which are introduced in the vagina, to help with the implantation of the embryos. 14 days after the transfer, a pregnancy test can be taken.
In some IVF cycles, instead of transferring the embryos on the second or third day, the embryos remain in the lab until the fifth day. This process is called blastocyst transfers.
INTRACYTOPLASMIC SPERM INJECTION (ICSI)
Intracytoplasmic Sperm Injection (or ICSI) is a fertilisation technique for egg cells that are obtained after ovarian hyperstimulation.
Once the patient has undergone ovarian hyperstimulation and we have retrieved the egg cells through ovarian puncture, the same day the man is asked for a semen sample. In the lab the first thing that is done, is to “peel” the egg cells, to get rid of the granule cells, that is a thick layer of cells wrapped around the egg cell. Once the egg cell is clean, it is tested how many are “mature”. This means we check how many are in Metaphase II, i.e. the state that the egg cell should be in, to be fertile.
De sperm cells are introduced in a very thick medium, so the ones with the best mobility and morphology can be selected. The get injected one by one into each egg cell to force fertilisation.
The percentage of IVF cycles using ICSI increases all the time. However, in principle this is indicated mainly for those cases where the sperm count is very low, including those that are obtained straight from the testicle. This should also be used when the membranes of the egg cell are thicker and obstruct the fertilisation, when there is a problem with classic IVF or in general whenever there are doubts about the results that classic IVF may offer.
To carry out a blastocyst transfer we use a lab technique called sequential growth. This consists of keeping the embryos in the lab until they get to the blastocyst stage. This can happen on the 5th or 6th day of their development.
The metabolic needs of the embryo change over the first days of development, and therefore a specific culture medium is needed, which contain the nutrients that the embryo needs in its first stages.
The maximum time that the embryos can remain in the lab is 6 days. The majority of the embryos reach the blastocyst stage on the 5th day, although some may take 6 days. When it is decided to use a sequential growth process, the moment of the transfer is when the embryo reaches the blastocyst stage (either on the 5th or 6th day).
The freezing or vitrification of embryos is an assisted reproduction technique which allows a woman to conserve her fertility by keeping the embryos frozen. This technique offers a survival rate of the frozen embryos of 80% and high pregnancy rates (although these are 10 lower than the pregnancy rates with fresh embryos).
After an IVF cycle the recommendation to resort to the vitrification of embryos is not uncommon. The current technology allows us to freeze human embryos and keep them for years. The reasons why embryos are frozen are:
- Because a high number of high quality embryos was obtained. The Assisted Reproduction Law obligates couples to freeze the “remaining” embryos of an IVF cycle, i.e. the embryos that were not transferred.
- Because a woman had a very strong reaction to an egg cell inducement treatment and she has a high risk of developing Ovarian hyperstimulation syndrome. In these cases it is necessary to freeze all embryos (i.e. the patient does not receive transferred embryos in the cycle), to reduce the risk of this syndrome occurring.
At Amnios In Vitro Project the cost for vitrification of embryos is included in the actual IVF cycle.
Si ya te has sometido a un ciclo de Fecundación in Vitro y no has conseguido el éxito esperado, no te desanimes. Ese primer ciclo nos puede dar mucha información sobre cómo está el funcionamiento de tus ovarios, de tus óvulos y sobre qué pasa cuando se juntan óvulos y espermatozoides. Toda esa experiencia nos puede servir de muchísima ayuda para mejorar los procedimientos de siguientes ciclos y mejorar las probabilidades de embarazo.
Acude a una consulta gratuita en AMNIOS, donde valoraremos cómo mejorar tu tratamiento y sus probabilidades.