IVF (MEDICINE USE)

For many couples with fertility problems, in vitro fertilisation (in vitro fertilization – IVF) is the best solution for achieving a pregnancy. It can be used to treat a range of causes of infertility, such as mild sperm problems, endometriosis, damage to the fallopian tubes or unexplained infertility. In conventional IVF, the eggs are fertilised by the sperm in the laboratory (instead of in the woman's fallopian tubes). Fertilisation can be achieved either by conventional in vitro fertilisation (IVF) or by intracytoplasmic sperm injection (Intra-cytoplasmic sperm injection – ICSI).

The history of IVF

Robert G. Edwards was to become the most famous biologist of his time when, on 25 July 1978, he announced the birth in England of Louise Brown, the first "test-tube baby", together with the obstetric surgeon Patrick Steptoe and the midwife Jean Purdy. Since then, developments have been rapid: a revolution came with the announcement of successful intracytoplasmic sperm injection (ICSI) in 1992 (Palermo) and its variants, MESA (Silber & Asch, 1992) and TESE (Schoysman, 1993). Male factor infertility is considered to have been practically overcome. In Greece, the first child conceived by IVF was born on 20 January 1982 and was the 13th test-tube baby in the world.

The stages of IVF – The process

An IVF treatment cycle includes the following stages:

Investigation and diagnosis of infertility

Preliminary tests

Ovarian stimulation with medication (12-14 days), with the aim of developing multiple follicles. We choose the type of protocol based on the particular features of each woman's cycle, her age, previous attempts and other factors we assess

Monitoring with a series of ultrasound scans and hormone measurements. Monitoring takes place every two to three days in order to optimise the daily medication dose and achieve the best possible outcome for your attempt

Triggering final egg maturation (a single evening injection). On the day the follicles have matured sufficiently, the final injection is given, which times the final maturation of the eggs and ovulation

Egg retrieval (collection of the eggs). The eggs are retrieved from the ovaries transvaginally by needle aspiration under continuous ultrasound guidance. Egg retrieval is short (10-30 minutes) and practically painless because it is performed under sedation

Sperm collection. In cases of azoospermia, testicular biopsy (TESE) is recommended

Fertilisation of the eggs by the sperm. In this laboratory stage, the eggs are brought into contact with the sperm. When the semen parameters are normal, conventional IVF is chosen as the method of fertilisation. In the conventional method no intervention is made. For many couples with poor sperm quality, where the sperm cannot fertilise the egg on its own, intracytoplasmic sperm injection (ICSI – Intracytoplasmic Sperm Injection) is chosen, which allows the eggs to be fertilised successfully even in difficult cases of severe oligoasthenoteratozoospermia. The next day the embryologist checks and records the proportion of normally fertilised eggs

Embryo culture. After fertilisation, the embryos are cultured in the laboratory for 2 – 6 days, up to the blastocyst stage. Proper cell division is a key criterion of their quality

Embryo transfer. The best embryos are selected and transferred into the uterine cavity. The embryos are transferred to the uterus two to six days after egg retrieval. It is a painless procedure that does not require sedation. Using a thin catheter, the embryos are placed in the endometrial cavity

Pregnancy test (13 days after embryo transfer, with a blood test to measure the hormone beta-hCG)

Confirmation of clinical pregnancy by transvaginal ultrasound (4 weeks after embryo transfer).

Confirmation of an ongoing pregnancy at the 12th week of pregnancy, i.e. 10 weeks after embryo transfer.

Optional procedures (depending on the history)

Embryo or egg freezing. Freezing allows eggs, sperm and embryos to be preserved for an extended period (five years or even longer). With the new freezing method, vitrification, survival and pregnancy rates appear to be higher than with slow controlled freezing

Assisted hatching is a technique performed in the laboratory that helps the embryo to hatch. It is recommended when the zona pellucida of the embryos is thick or hard, for cryopreserved embryos, and for women with previous unsuccessful attempts

Preimplantation genetic diagnosis (PGD) to detect genetic abnormalities, and preimplantation genetic screening (PGS) with the new array CGH method, in patients for whom it is considered necessary.