Assisted reproductive techniques

Assisted reproductive techniques involve the laboratory preparation of sperms, ovum or both and artificially bringing them together to raise the fertility rates. It is used in cases of tubal occlusion or severe endometriosis or adhesions in the pelvis or low sperm motility or prolonged unexplained infertility. It is also used in cases of high semen viscosity or male sub fertility like low count or motility. It is also used in cases of severe endometriosis or polycystic ovaries.

Artificial insemination

It is a technique used for problems with husbands (erection problems, low count or motility of sperms) or sperm antibodies or unexplained infertility. Intra uterine injection of sperms after preparing them with special material that increases their motility. They are injected by a special catheter at ovulation time in the uterus.

In Vitro Fertilization IVF or Intracytoplasmic Sperm Injection ICSI

  • Ovulation induction: In case of IVF or ICSI we need more than one egg. Ovulation induction is performed by giving a preparatory drug (GnRh agonist or antagonist) then giving (HMG/FSH) which helps eggs to reach the correct size and maturity for fertilization. During induction the woman should be monitored well by ultrasound measurement till the eggs reach the best size and then other drugs are given which induces ovulation within 36 hours from taking them after which eggs are collected.
  • Egg collection: Eggs are collected through the vagina with the aid of vaginal ultrasound with a special aspiration needle attached.
  • Egg fertilization : Eggs are inspected by the embryologist then the best eggs are chosen and placed into plates with nutrient and enrichment media which are kept into incubators at certain temperature with enough oxygen then fertilization occurs by either of 2 methods:
    • In Vitro Fertilization: Some sperms are placed into a special plate with media containing aspirated eggs.
    • Intra cytoplasmic sperm injection: A sperm is injected into the egg under microscopy.
  • Embryo transfer: After about 3 days 2-5 embryos of the best quality are transferred into the endometrial cavity using a special embryo transfer catheter which does not harm the embryos or endometirum. Before the transfer the doctor measures the cervical and endometrial length by ultrasonography then injects the syringe with embryos inside them through the catheter and into the uterus.
  • Follow-up: The woman is given hormonal support drugs that help the embryos to implant inside the endometirum. After 14 days the woman is tested for pregnancy by checking her HCG levels and if found pregnant she would return for checking her pregnancy by ultrasound and during that time she would be under good medical care.

New technologies

Pre implantation genetic diagnosis

It is a method to check for genetic problems in the embryos before transferring them to the uterus. It is done by extracting a cell from the embryo with special instruments and then studying these cells. Sometimes it is used to choose the gender of the baby by studying the gender chromosomes of the embryos.

Assisted hatching

The embryo is surrounded by a thin shell which breaks and the cells come out to be implanted in the uterus. Assisted hatching assists the breaking of this shell and improves implantation rates.

Blastocyst transfer

A Blastocyst is an embryo that is left in special culturing media till the fifth or sixth day. After that it is transferred to the uterine cavity. The concept is that the embryo which reaches the 5th day safely has a 50% chance of implantation in the uterus. It is advised for people who have repeated failure of Invitro fertilization process with transfer done on the 3rd day, pregnancy without fear of twins because only the best one will be transferred. The only problem is that about 40% of embryos could not survive to the 5th day leaving no embryos at the end for transfer.

Cryopreservation of embryos

In cases of too many embryos being fertilized, some of them can be cryo persevered in any stage of division if they are good quality. The embryo is mixed with a cryo preservant that protects the embryo when frozen. The mixture is put into straws that are stored in nitroglycerin incubators at 196 degrees below zero centigrade. Thawing the embryos consist of removing the cryo preservant material after removing the straw from the nitroglycerin incubator then it is left in another special incubator ready for transfer inside the uterus. This technique is used for a woman who might be of risk of ovarian hyper stimulation, weak endometrium or a woman who will get cancer radio therapy. It can also be used for a couple who have failed cycle or successful one and want to more kids.

Author: DrAshrafSabry

Fertility, Obstetrics & Gynecology Consultant.