Assisted reproduction technologies (ART) encompass all procedures that consist of direct extraction of egg cells from the ovary.

Although the number of said procedures is on the rise, the most frequent ones are still:
– IUI ( Intra uterine insemination) – sperm being processed in a specialized medium, and introduced into the uterus.
– IVF (In Vitro fertilization) – extraction of an egg cell, laboratory fertilization, and subsequent placement of fertilized egg cell in the uterus.
– ICSI (Intracytoplasmic sperm microinjection) – introducing the spermatozoid directly into the egg cell.

After completing the diagnosis, examinations and tests, patient can start with the procedure which revolves around three key elements: male gamete (spermatozoid) , female gamete (oocyte) and uterus.
The technique consists of several successive phases:
– Stimulation of follicular growth and development
– Ultrasound monitoring of follicular growth and endometrial thickness.
– Follicular puncture, aspiration, and egg cell selection.
– Male sample analysis
– Embryo culture
– Transfer of embryo into the uterus.

Ultrasound monitoring of follicular growth and endometrium thickness

Ultrasound examination is used for monitoring follicular growth in stimulated cycles in order to diagnose ovulation, measure daily follicular growth and determine the time for STOP injection administration.

Embryo culture

Development and quality assessment of an embryo is monitored by the team of biologists during the period from aspiration to embryotransfer.

Embryo analysis is preformed again just before the embryotransfer. Based on quality criteria, embryos are selected for transfer or cryopreservation.

Embryotransfer

Embryotransfer is the final step following the laboratory phase, and it consists of embryo placement in uterus using specialized catheter.
Further development occurs naturally in the uterus until the childbirth.

Although the method of insemination is chosen according to the spermatogram parameters and other relevant couple details, the difference in efficacy among various different techniques is minimal.

Most frequent modification of insemination is Intrauterine Insemination (IUI) with unprocessed or processed semen.

Insemination may be homologous (using partners semen) or heterologous (using donor semen).

The most frequent  indication for insemination is reduced male fertility, low sperm mobility , quality of cervical mucus or presence of antispermatozoidal antibodies.

It can be preformed in natural or stimulated cycle.

Cryopreservation is process of controlled cell or tissue freezing to temperature below -80 °C and preservation at liquid nitrogen temperature of -196°C.

Low temperature stops all biologic activity including biochemical reactions leading to cell death.

Cryopreservation is also used in sterility treatment, mainly for sperm freezing, testicular tissue freezing, and excess embryo freezing (during the course of IVF treatment).

During the process of freezing, the freezing medium is enriched with cryoprotectants.

Cryoprotectants are substances with low freezing point which disable creation of ice crystals that could damage the cells. Different kinds of cryoprotectants are used for different stages of embryo development. Embryos can be frozen from the stadium of pronucleus until the blastocyst stadium (5-7 days after fertilization)

During the IVF treatment, there is a possibility of obtaining multiple vital embryos of good quality. The number of embryos can be higher than the couples requirement, in which case a cryopreservation is offered.

Cryopreservation can be preformed using method of slow freezing or rapid freezing (vitrification). The advantage of vitrification is that it provides better embryo quality , higher rate of embryo survival – and therefore higher percentage of pregnancies.

Our clinic uses the process of vitrification – rapid freezing at the temperature of -196 ˚C. Frozen embryos are stored in specialized liquid nitrogen capsules. Embryos are stored until the patient requires the use , for the maximum period of 5 years.

Sperm and testicular tissue can also be stored and kept for the future use in insemination and IVF program.

It is important to remember that every patient has different reaction to the therapy and treatment, and that every cycle is special in its own way.
This means that every patient will respond differently to the therapy when compared to others. Moreover, every individual patient may have different response in different treatment cycles. For this reason, patient may discover the difference between ones own treatment and treatments of others.

Please do not attempt to compare your treatment with other patients. Even though patients feel they can relate to one another, it is important to remember that IVF fertilization is very private issue.
Infertility is not rare. Estimates show that 10% of couples experience low to high difficulty in creation of offspring.
In-Vitro fertilization is preformed only when no other simpler method of sterility treatment is applicable, ant it is preformed in laboratory.
Pregnancies achieved through IVF are completely same as natural pregnancies, and therefore complications may arise regardless of the procedure.

The process does not guarantee pregnancy. It is sometimes necessary to go through the process of IVF fertilization several times before success.
The success rate of this method is dependant on many factors and couple related specificities, and its estimated at between 25% and 40%.

Microfertilization (ICSI) is technologically significantly more complicate. The method of merging egg cells and spermatozoid is done through micromanipulation – sperm cell is introduced directly into the egg cell using specialized equipment.

This procedure is indicated for the patients of older age with low number of egg cells, and in cases of low sperm count and/or mobility .
Finally, the procedure is used in cases of repulsion between the sex cells, exemplified by spermatozoid inability to find a way to the egg cell under the classical IVF conditions.
Microfertilization is sometimes complemented with testicular aspiration biopsy (TESA) or surgical biopsy. This is preformed with cases with insufficient sperm cells in ejaculate.

Decision about the method selection depends on number of factors, the most important ones being:

• Age of female patient and length of infertile period
• Number and quality of egg cells.
• Number and quality of spermatozoids.
• History of unsuccessful attempts

Definitive decision is made through patient-doctor consultation, and with patients informed approval. It is therefore crucial that the patient is properly informed about all the relevant elements of the procedure.