A large number of infertile couples were able to become parents of long-awaited babies thanks to the introduction of assisted reproductive technologies. Artificial in vitro fertilization (IVF) is the most progressive method. Indications for its use are various types of infertility, both female and male. Depending on the pathology, the effectiveness of the procedure can reach 50% and higher. ICSI fertilization is a highly effective option for IVF.
A bit of history
The in vitro fertilization method was first applied in England in 1976. But, unfortunately, this pregnancy was ectopic (ectopic). But already in 1978 in the same clinic Born Hall was born - the first child "from the test tube." His mother, Louise Brown, had his fallopian tubes removed. And in 1993 in Belgium the first ICSI fertilization. Reviews of the procedure, for the most part, indicate the high efficiency of this method. But each case is unique, and of course, there can be no solid confidence in either a positive or a negative result.
How is in vitro fertilization performed?
First of all, you need to undergo a thorough medical examination. Since the procedure is carried out “in vitro”, germ cells are extracted from the body of a woman and a man. To do this, with the help of drugs, the expectant mother stimulates the maturation of eggs and prepares the endometrium for pregnancy. After reaching the required indicators, eggs are extracted from the ovary by puncture. In order for fertilization to occur, they are placed in a test tube with seminal fluid, where the conditions are similar to natural. After three to five days, viable embryos are transported to the uterine cavity. As a rule, three or four embryos are transferred, since some can be rejected by the female body and only one of them will develop. But as a result of IVF, a multiple pregnancy can occur.
What is the difference between IVF and IVF + ICSI?
In traditional IVF, an egg is placed with a sperm in a special environment, where it is subsequently fertilized naturally (an independent introduction of the sperm into the cytoplasm of the egg takes place). ICSI procedure involves the introduction of a sperm into the egg by injection with a microneedle. Pregnancy and the frequency of its onset, as a rule, do not depend on the quality of sperm. The procedure requires the presence of at least one high-quality sperm.
How is the ICSI procedure going?
After completing all the preparatory stages (as with conventional IVF): stimulation of the ovaries, puncture, collection and processing of sperm, the preparation of the egg for fertilization begins. For this, the embryologist using a special reagent removes its protective layers. Under the microscope, the most active sperm is selected. Both cells are placed in a special sterile medium with the required temperature. Then, with the help of a special micropipette, the egg is fixed, the tail is separated from the sperm and placed in the microneedle. With the help of manipulators, the embryologist is extremely careful, observing what is happening in the microscope and controlling his every movement, introducing a sperm into the egg. The ICSI procedure is now complete. Now you need to wait until fertilization and the first cell division occurs. What is the difference between IVF and IVF + ICSI besides the conception procedure? As a matter of fact, this is where the differences end. After successful fertilization, the woman will be under constant medical supervision as well as after the IVF program.
In what situations is the ICSI procedure indicated?
ICSI fertilization carried out with the most severe forms of male infertility that are not treatable. For instance:
Azoospermia - the complete absence of sperm in the ejaculate.
Teratozoospermia - the presence of sperm with a normal configuration in an amount of less than 14%.
Oligozoospermia - insufficient sperm count.
Congenital absence of the vas deferens.
- Condition after vasectomy.
In addition, the ICSI method it is used for poor indicators of the qualitative and quantitative composition of sperm, low quality of thawed sperm, unsuccessful attempts of previous IVF, infertility of uncertain origin.
How to prepare for the procedure?
Before the ICSI procedure, a woman and a man must pass a series of tests:
blood type, Rh factor;
syphilis;
AIDS;
hepatitis C, B.
The test results are valid for the next three months.
A woman should conduct such studies as:
blood test for hormones (FSH, LH, prolactin, estradiol, testosterone, progesterone, TSH, DGA-S);
genital swab for hidden infections and STDs;
biochemical and clinical blood analysis;
general urine analysis;
smear on the flora;
blood coagulation analysis.
Also, preparation for ICSI involves a mandatory consultation with a gynecologist, to find out possible contraindications.
For men, the most important study in preparation for the fertilization procedure is a spermogram. It is with the help of this analysis that the ability of a man to conceive is determined. A spermogram reveals quantitative and qualitative characteristics of sperm, and also consists of the following studies:
On the day of the puncture of the egg, a woman is forbidden to eat, drink only after the permission of the doctor. A man should refrain from sexual intercourse for three to four days before the procedure, do not drink alcohol for several days.
Procedure Efficiency
ICSI fertilization leads to conception in 30-60% of cases. This depends on the state of the germ cells of both women and men (perhaps one of them carries genetic abnormalities), as well as on the qualifications of the embryologist who performed the procedure (the egg can be damaged during the procedure). If fertilization has occurred, the likelihood that a healthy embryo will develop from a newly formed cell is 90-95%. It should be noted that positive results with multiple pregnancy are lower than with ordinary. If as a result of the procedure several nuclei are obtained, they can be conserved using liquid nitrogen. Such embryos will not lose their qualities even after a few years.
What can affect the result of the procedure?
Successful ICSI fertilization depends on various factors:
age of partners;
causes of infertility;
clinics;
doctor's experience;
the state of the egg.
For a positive result of the procedure, active sperm obtained from the ejaculate of a man and high-quality female oocytes are necessary. If a man has no active sperm, the likelihood of fertilization is reduced.
Physiologically Mature Sperm Selection
The male factor has a major effect on the development of the embryo. Often the cause of male infertility is a large number of immature sperm in the ejaculate. Mature sperm are able to bind to hyaluronic acid. It is on this that the method of choosing the necessary cell is based. The embryologist selects biochemically competent sperm associated with hyalorunan. It is these physiologically mature cells that will be used for the ICSI procedure.
ICSI fertilization: the cost of the procedure
Every day, dozens of women are interested in the effectiveness, cost of this procedure, and are looking for the best clinic for the procedure. In Russia, the approximate price of one attempt at ICSI-fertilization is 150-200 thousand rubles. Abroad, the cost of such a procedure is higher. In Israel - about 2 times. In the USA, Germany, Switzerland - 3-4 times.
Possible risks
Despite the many advantages, ICSI fertilization has one serious drawback - the factor of natural selection does not work here. This is especially true for males with genetic diseases (for example, Kleinfelter syndrome and others) who are not able to conceive without the use of auxiliary methods. Similar pathologies can be inherited and manifest after many years. Genetic failures in unborn children do not develop due to the IVF procedure itself. However, infertility of parents can affect the health of offspring. In order to identify possible chromosomal and genetic abnormalities in a particular embryo, it is recommended to perform preimplantation diagnostics. This can be done at the stage of more than six blastomeres.
What other in vitro fertilization methods exist?
GIFT - oocytes and sperm (gametes) are transferred to the fallopian tubes, if at least one of them is full.
ZIFT - fertilized oocytes (zygotes) are transported into the fallopian tubes.
OD - IVF of donor oocytes followed by transportation of the embryo into the uterus of the recipient. This method is used in the absence of a woman's ovaries or a violation of their functions, genetic disorders in the mother, natural menopause.
The “surrogacy” program - embryos of genetic parents for bearing a pregnancy are transferred to the uterus of another woman. The reason for this may be the absence or inferiority of the uterus of the patient, but with the preservation of ovarian function.
The IVF procedure, of course, is expensive and time-consuming, the equipment necessary for the implementation of fertilization is not available in all clinics, and finding a qualified doctor is also quite difficult. However, such a program allows many childless couples to experience the greatest joy of motherhood and fatherhood.