In Vitro Fertilisation refers to the Fertilization that occurs outside the human body.this method was invented initially for providing fertility solutions in females who suffer from blocked or dysfunctional fallopian tubes. currently, IVF is prescribed to patients who are unable to conceive due to other reasons as well. o.
If you are diagnosed with male fertility issues, such as a low sperm count, previous history of vasectomy in the male partner, continuous IVF failure then standard IVF is not likely to result in fertilization. It is also done when semen has low sperm count and they need to be taken surgically from testicles. In this condition, Intracytoplasmic Sperm Injection (ICSI treatment) is suggested. It is similar to the process of IVF, the only difference being the technique that is used to accomplish fertilization. .
In the process of ICSI, a single sperm is injected into each ovum or egg with the help of fine micro-manipulation equipment. the human egg is one-tenth of a millimetre in diameter and the sperm is approximately 100 times smaller than the egg, this is a very sensitive method that is performed by highly skilled embryologist using a micro-manipulator.
Along with IVF, ICSI is one of the most common techniques that is used extensively in Assisted reproductive technology. Since its advent, this technique has led to the birth of thousands of children worldwide.
Which method is used depends on the nature of the problem in the male partner, which needs to be explored carefully first.
A man who has no sperm in his semen is said to have azoospermia. This occurs due to the blockage in any of the tubes carrying sperm from the testes where they are produced, towards the penis during ejaculation. Obstructive azoospermia could be a result of testicular cancer, as the tumour presses against the vas deferens. This cancer commonly occurs in young men and can be treated successfully. Unfortunately, it can lead to male infertility, thus surgical sperm retrieval is necessary to store some sperm before starting the treatment.
Other reasons that can cause non-obstructive azoospermia, includes an abnormal cystic fibrosis gene. Men suffering from this condition fail to exhibit all the symptoms, but they often suffer a lack of vas deferens. Surgical sperm retrieval is possible but there is an equal chance that the embryos produced further by the process of ICSI and IVF will carry the similar genetic abnormality. The options that are then left are using a sperm donor and the use of intrauterine insemination (IUI) or even IVF. Pre-implantation genetic diagnosis (PGD) can also be carried out on the embryos for selecting the one that carries the normal gene.
When the release of sperm is prevented by a blockage in the vas deferens, or by a vasectomy, several techniques can be used to retrieve the large numbers of sperm that remain inside the testes. The first three involve aspirating sperm using needles or tubes placed through the skin of the testis and are carried out under local anaesthetic. The fourth requires open surgical sperm retrieval and is usually carried out under general anaesthetic.
Certain studies have been conducted for comparing the success rates after doing the different types of sperm retrieval through surgery. MESA is thus known to give the highest number of sperm, recovered when compared with procedures like TESA and perc biopsy.
MESA produced sperms, which were better swimmers and thus more effective for infertility treatments, including IVF and ICSI..
Men who lack any sperm in their semen, even after having clear tubes in their testicles, have an underlying problem with the process of sperm production. It is very less likely that sperm are present in large numbers, so the sperm retrieval through surgical techniques required are more invasive.
As these infertility treatments methods are still quite new therefore much evidences are still to be collected. However, one of the most accomplished combinations are MESA followed by ICSI, that has given great results with fertilisation and pregnancy rates between 45 % and 52 %
During the process of IVF, the embryos are cultured for around six days and during that period they receive quality grades everyday.
Fertilization can be seen clearly after 16 to 22 hours after the process of insemination. Normal fertilization can be seen by exactly two pronuclei in the center of a one celled zygote. Fertilization is not abnormal when there is a single pronucleus and when there are more than two pronuclei present.
On day two the single cell zygote should divide into an embryo (approx. two to four cells). On day three the embryo should continue to divide (four to eight cells).
On the 4th day, the transition of embryos begin from a multi cell embryo to a highly advanced developmental stage. Embryos then start compacting and forming morulae. Cells of a morula-stage embryo are not quite distinct like the previous days; and hence these embryos fail to receive quality grades.
A blastocyst is developed embryo that comprises of two different cell types: one group of cells is referred as the inner cell mass, that forms the fetal tissue and another group of cells, known as the trophectoderm, helps in the formation of placenta. Blastocysts are graded on the basis of their expansion (early, expanding, expanded, and hatching) as well as on the basis of the quality of these two different cell types (graded on a good-fair-poor scale). Blastocysts that are are good or even fair in quality can be freezed.
How we decide on which day to transfer your embryos
Embryo transfer is the last stage of the IVF treatment and is often referred to climax of the IVF treatment cycle. How is it decided on which day to transfer your embryos ? Day 1 ? Day 2 or 3 ? or even 5 ? What is better ? and why ?
Unfortunately, human reproduction is not a very efficient process as most of the embryos fail to become babies. This is due to the genetic error that many embryos contains ( which is often random) and will not lead to implantation, as nature prevents them from doing so. This is the reason, the implantation rate even for high quality embryos is only around 40%.
We are quite flexible on the day embryo is to be transferred for increasing the chances of success.
Usually embryos are transferred on Day 2, Day 3 and Day 5 after ICSI / IVF. it must be noted that day of egg collection is considered Day 0.
There are various factors which we consider while deciding when the transfer of your embryos is placed back to your uterus.