Types of female infertility treatment
At the moment of revealing the cause of infertility we can start with treatment. We always proceed from simple methods to the more complicated ones. If it is required, we can also carry out necessary surgeries.
INTRAUTERINE INSEMINATION (IUI)
IUI is a non-invasive method which can be used only in case of minimum one patent fallopian tube and normal or slightly lower count of a seminogram. Use of a donor sperm is also possible. Although the probability to conceive by this method is lower than the in vitro fertilization method.
This method tries to circumvent the immunological factor of infertility (the presence of antibodies against sperm). The modified limited sperm is introduced into the uterine cavity by a thin cannula during the ovulation period.
It is an outpatient intervention which is painless and does not require anaesthesia. A patient goes home one hour after the application. No special mode is required at home.
IN VITRO FERTILIZATION (IVF)
The method, which has been used since 1978, presents a successful solution for many childless couples. Insemination, which normally takes place in the fallopian tubes, is done artificially in a laboratory in strictly given conditions. The whole process from the egg insemination, cultivation of embryos to the transfer of a suitable embryo to the uterine cavity takes 48 - 120 hours.
The intervention is preceded by serving hormonal medication which stimulates the ovaries to increased activity. The aim is to gain more than one mature egg (oocyte) and increase the probability of conception.
We collect the egg at the time of its highest fertility (i. e. at the time of the ability to be inseminated) by the method of transvaginal ovum retrieval which is carried out under the direct ultrasound guidance under short general anaesthesia.
A human egg is located in the aspirated follicular fluid (it is necessary to mention that not every follicle contains an egg). We transfer it to the culture medium in the test tube which is kept in similar conditions like in the mother´s body (at the temperature of 37 ºC and 5% concentration of CO2).
While the egg cell is being kept to mature (maturation) in the cultivation chamber, it is important to get the sample of ejaculate (the quality sample of sperm contains more than 20 million sperms in one mililitre and more than 50 % of them are well motile). Only one sperm penetrates into the egg.
The first stage of embryogenesis starts. During 48 hours the fertilized egg splits twice so the developing embryo will consist of four cells (blastomeres). The natural selection asserts even here as only some of the fertilized oocytes develop further.
Then the embryos are carefully transfered back to the uterus by a special cannula. The correct positioning of the embryos is supervised by ultrasound. Embryotransfer is painless so it does not usually require anaesthesia. A nowadays trend is to introduce only one most perspective embryo and avoid a multiple pregnancy. After the individual consultation of a patient and an embryologist we can introduce even two embryos and increase the chance that at least one will embed in the uterus. As well as during the natural fertilization even here the nature chooses which embryo will develop in a foetus.
IN WHICH CASES THE IVF METHOD IS INEVITABLE?
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damaged function of ovaries
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blocked fallopian tubes
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insufficient amount of motile sperm in the partner´s ejaculate
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immunologic factor
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genetic indication
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ICSI: ADVANCED METHOD OF IN VITRO FERTILIZATION
A micromanipulation technique which consists in inserting the sperm in the egg cytoplasm by a glass needle (under the big magnification of a microscope).
It is mainly suitable for couples where the partner´s sperm has significatly low count and it is the only solution in case of microsurgical sperm retrieval (TESE).
The ICSI method is also carried out in couples where the oocyte fertilization and cleavage failed previously. It is recommended in case of a low gain of oocytes and donor sperm fertilization.
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PICSI: SELECTION OF MATURE SPERM DESIGNED FOR ICSI
This modern method uses the natural bond of mature sperm with cumulus oophorus of the egg in the process of in vitro fertilization. For the fertilization there are chosen only sperms which would ideally inseminate the egg naturally.
The initial mechanism of the selection is a bond of the sperm to the hyaluronan substance which is located in the cells surrounding the egg. This bond is possible only for the sperm with a receptor for this substance which is located on the surface of only mature sperm.
The method is recommended for low fertilization after the ICSI method, after repeated abortions or repeated unsuccessful embryotransfer. It can be the option for the serious condition teratozoospermia.
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The method where the most perspective embryos suitable for the transfer are cultivated in special media for 96 - 120 hours. Its advantage is that it enables to select the most perspective embryo for embryotransfer (the longer time of cultivation helps the selection of embryos with lower growth potential). The embryos at the stage of blastocyst after the prolonged cultivation are statistically more likely to develop a flourishing pregnancy.
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This method is mostly used in older patients when the egg coat (zona pellucida) is so strong that it prevents the embryo from releasing and embedding in the endometrium.
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PRE-IMPLANTATION GENETIC DIAGNOSIS (PGD)
The state of the art method which enables a detailed genetic examination of the embryo before it is transferred to the uterus.
From the embryo 1 - 2 cells are taken by a special glass capilary tube and examined in a genetic laboratory. Embryos with a genetically normal finding are transfered to the uterus. This method often excludes the necessity of interrupting the pregnancy due to the incidence of birth defects.
The results of the genetic examination are known within 48 hours from the retrieval when ideally the embryo is sufficiently repaired and ready to be implanted.
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Cryopreservation is the process of in-depth freezing of cells or tissues and their use subsequently after the thaw in the process of assisted reproduction. For freezing we either use special devices which provide slow computer-conducted cooling of the sample or are frozen by the process of so called vitrification (converted into glass) when on the contrary the sample in the cryoprotectant is quickly dipped straight into liquid nitrogen at the temperature of -196 °C. An embryologist decides when the particular methods are suitable for particular cases.
Currently, we routinely freeze:
EMBRYOS
Each emryo can be frozen up to –196 ºC and kept in liquid nitrogen for a long time. Freezing enables the later use of embryos in case of a negative result of previous IVF without the necessity of another hormonal stimulation and retrieval of amniotic eggs.
SPERMS
They are frozen and kept in liquid nitrogen as well. Sperm freezing can be used before oncological treatment, with an increasing count of seminogram or when a partner is absent at the time of oocyte retrieval.
OOCYTES
Currently, it is also possible to keep egg cells in liquid nitrogen but this technique still has its stumbling blocks so a good development potential is not guaranteed. This method is used e. g. before oncological treatment.