A sequence of treatments is necessary to be able to carry out in vitro fertilisation (FIVET), such as: ovulation induction, sampling of the oocytes, in vitro fertilisation according to various procedures, the development of the embryo under culture and its transfer to the uterus.
During ovulation stimulation, medicines are utilized to stimulate the ovaries to produce more mature ovocytes. More fertilised eggs (zygotes) can be obtained and therefore a greater possibility of pregnancy by repeating the embryo transfer several times.
For about 10 year, we have also been offering a mild hormonal stimulation, especially for patients where a stronger hormonal impact is contraindicated; for women who want more “natural” treatments, young women with a risk of excessive ovarian responses or women who are older than 40 years where a higher dose of hormones would probably not result in more oocytes.
This mild stimulation only involves a light hormonal impact and less injections, but also lower overall costs of the treatment.
The timing of the treatment is a crucial element in carrying out assisted fertilisation. Also in this case, LH and Estradiol plasmatic level,in combination with ecographic controls establish when the follicular maturation process has occurred (approximately 12/24 hours before ovulation). At this point, an HCG injection is given, simulating the ovulatory peak of the LH, and bringing the eggs to final maturity after 34/36 hours.
The ovocytes are taken from the follicles, under ecographic guide, via aspiration with a special needle. The aspiration of the eggs from the ovary occurs under local anaesthetic (under general anaesthesia on medical advice, or at the request of the patient) and lasts some minutes. The eggs obtained are taken to the laboratory for the successive fertilisation by the male sperm. In the IVF procedure, (In vitro Fertilisation and Embryo Transfer), the partner’s or donor’s seminal liquid, depending on the analysis, is treated to select the spermatozoa with greatest mobility. The gametes (eggs and spermatozoa) are then cultivated on culture medium and the fertilisation spontaneously occurs in vitro.
The ICSI procedure (Intracytoplasmic Sperm Injection) can be carried out as an alternative to the IVF procedure; this technique consists of injecting a single spermatozoa inside the egg. It is a treatment advised in the cases of important male sterility factors. After approximately 16/20 hours it is possible to verify if fertilisation has occurred by noting the formation of fertilised oocytes.
Two fertilised eggs are maintained under culture for 48/72 hours and then transferred to the uterus at the embryo stage (4/8 cells). The remaining fertilised eggs are cryopreserved for possible other transfer to the uterus.
The Transfer procedure is the insertion into the uterus of embryos (maximum of three under the law: preferably two to reduce the risk of multiple pregnancy) that are adequately developed in vitro. The transfer occurs via the vaginal tract utilizing a fine catheter, it’s a painless procedure that lasts just few minutes.
The transfer normally occurs when the embryo has reached the stage of 4-8 cells or 48/72 hours after the sampling of the eggs.
In the case of transfer of cryopreserved fertilised eggs, the eggs are thawed and maintained under culture for 1 or 2 days before the transfer.
In certain cases where there is a lack of spermatozoa in the seminal liquid, it is opportune to search for them at epididymal or testicle level. Therefore, surgical sperm recovery techniques are practiced, such as MESA (Microsurgical Epididymal Sperm Aspiration) or TESE (Testicular Sperm Extraction). Both operations are carried out in the operating room under general anaesthetic in the Day Hospital.