In Vitro Fertilisation (IVF) is currently the treatment with the best results.For this, once the eggs and the semen sample (if applicable) have been extracted, fertilisation is carried out in the laboratory, followed by selecting the embryos with the greatest potential for transfer to the uterus with the aim of achieving a successful pregnancy.
IVF can be performed with two different procedures: the conventional one, leaving the egg and sperm to unite spontaneously; or by sperm microinjection or ICSI, when the sperm is of reduced quality and fertilisation is performed by injecting a single sperm into each egg.
What are the steps involved IVF?
Ovarian stimulation: to stimulate the ovaries, a medication regimen is administered according to the needs of each patient. Firstly, exogenous menstrual cycle hormones (FSH and LH) are used to stimulate follicular development. Then, the patient injects the hCG hormone about 36 hours before the follicular puncture, or egg retrieval, to induce ovulation.
Follicular puncture (egg retrieval): This is a simple, painless and quick procedure to extract the follicular fluid where the eggs are located. Our gynaecologists schedule the retrieval in the operating theatre when the ovaries have good-sized ovarian follicles. The procedure does not require hospitalisation and is performed under sedation. Egg retrieval takes between 15 and 30 minutes, depending on the number of follicles, and the collection is controlled by vaginal ultrasound. Once the process is complete, the patient rests for an hour or so in our intra-hospital facilities and once discharged, we recommend rest for the rest of the day, so we recommend you bring someone to the clinic with you.
Egg count in the laboratory: : The follicular fluid is transferred to the laboratory so that the embryologists can identify the eggs obtained from the retrieval under the microscope, after which they are isolated and classified according to their stage of maturity.
Sperm capacitation: While the eggs are being classified, the semen sample is collected from the partner or from a donor for capacitation, selecting the spermatozoa with the greatest fertilisation potential. Our Andrology laboratory prepares the sperm sample, discarding non-viable, weak, or slow sperm; if donor sperm is required, all the samples in our bank are of legal age and anonymous. They are selected according to the blood group and physiological characteristics of the person requesting it and are perfectly studied to rule out any congenital or genetic pathology or sexually transmitted disease.
Fertilisation: Once the eggs and sperm with the best chances of achieving fertilisation have been selected, the union of both gametes is carried out by conventional in vitro fertilisation. The insemination of the egg can also be carried out by sperm microinjection or ICSI, by introducing a single sperm, previously selected, into the egg with an intracytoplasmic injection.
Culture in a Time Lapse incubator: Our embryologists monitor the cellular development of the embryos for a maximum of 5 days, and select those with the highest quality and evolutionary potential so that, after their transfer to the uterus, pregnancy can be achieved; from the 4th day onwards, the embryos are in the blastocyst stage and have already compacted their cells, and movement can even be seen. The 5th day is the longed-for day of transfer, and Time Lapse technology allows the development of the embryos to be monitored minute by minute by taking photographs, which means that this material is available on video for future mothers.
Embryo transfer: This procedure does not require sedation, it is a painless process in which our gynaecologists transfer the embryo or embryos, using a fine catheter and under ultrasound control, which allows us to see the most appropriate area of the uterus to deposit them.
Prognosis: 12 to 14 days after the transfer, a pregnancy test should be carried out. A blood test will guide us on the prognosis of the pregnancy, as well as the possibility of twin pregnancy.
Vitrification: This is the process of freezing the surplus embryos at an ultra-fast speed with cryoprotective substances, going from a culture temperature of 37º to a cryopreservation temperature of -196º, preserving them in liquid nitrogen for as long as desired and keeping the cells intact for later use. The greater the number of eggs, the greater the probability of obtaining viable embryos and, therefore, of achieving reproductive success; however, the most important thing is their quality, if they are not of good quality they will not achieve conception, even if many are extracted during the retrieval. Moreover, not all the eggs obtained are able to fertilise correctly. For this reason, it is important to obtain a good number of quality eggs and viable embryos that can be frozen for use in subsequent cycles if patients wish to have more children, and thus avoid repeating the whole process.
How effective is In Vitro Fertilisation?
The success of in vitro fertilisation depends largely on the age of the woman, the number and quality of the eggs obtained, the semen sample and the development of the embryos. In general, the pregnancy rate per cycle is between 40% and 65%, although in patients under 32 years of age this figure can reach 90% in three cycles.
