In vitro Fertilisation (IVF) with sperm bank
In case of unsuccessful results after DAI for those women which this treatment was not recommended at first because of a lower chance of pregnancy, In vitro Fertilisation with sperm bank would be recommended. It is exactly the same treatment as in couples with sterility problems, nevertheless, fecundation is performed with sperm donor. This assisted reproduction technique consists in the fertilisation “in vitro”, that is, in the laboratory, of the couples’ gametes (oocytes and spermatozoids) and transfer the embryos, which are the result of this fertilisation, into the woman’s uterus.
What are the phases of this process?
Ovarian stimulation treatment:
It is a hormone stimulation treatment to provoke the growth of several follicles at once. When the oocytes that are conained in the follicles mature, they are extracted so as to create embryos to transfer into the uterus. These treatments usually last 12 to 15 days. Generally, they are preceded by a treatment with a hormone preparation, which avoids the interference of the spontaneous functioning of the ovary with the stimulant treatment.
Each treatment is individualized according to the patient and requires controls during the stimulation (echographies and hormone blood tests). We try to simplify this process so as to make it easier so it does not interfere in the couple’s daily life.
When most of the follicles have an optimum size, they are ready to be aspirated. Then, the follicular puncenture is programmed to obtain the ovules within.
Punció fol·licular i recuperació dels oòcits:
The follicles puncture implies a very simple surgical intervention, which does not require hospital admission. It is carried out via vaginal and under sedation by anesthesia.
During the puncture, the follicles developed thanks to stimulation are aspirated. The fluid obtained is collected in tubes, which are taken to the laboratory where the oocytes will be isolated. The oocytes collected are placed on a plate with the appropriate medium within an incubator, which maintains optimum conditions for culture until the time of in vitro fertilisation. After the puncture, a hormone treatment with oral progesterone is begun. If pregnancy is achieved, the treatment has to be maintained during several weeks. On the contrary, it has to be followed until the appearance of the menstruation.
In vitro fertilisation and intracytoplasmatic spermatozoid injection (ICSI):
The oocytes fertilisation in the laboratory may be performed through a standard in vitro technique or by intracytoplasmatic spermatozoid injection.
Standard in vitro fertilisation consists in adding a determined quantity of spermatozoids to the culture plate, which contains the oocytes.
Intracytoplasmatic spermatozoid injection (ICSI) is used when the semen sample is within the limit of normality or is clearly pathologic. It consists in the introduction of a spermatozoid in each of the “mature” oocytes with a micropipette, that is, in the oocytes that are in conditions for being fertilised.
In both cases, around 70 % of the oocytes are fertilised.
Observation of the fertilisation:
17 to 20 hours after the above mentioned process -generally the next day- the oocytes are observed to determine whether they have been fertilised and if any of them has to be ruled out due to any abnormality.
The patents are informed of the report of the fertilisation result by telephone and they are given an appointment to complete the information and to perform the embryos transfer -usually within a period of 48 to 72 hours.
The embryos transfer consists of placing the selected embryos into the woman’s uterus.
The number of embryos transferred is variable and depends on different factors. The decision is made together and by common agreement between the professionals of the center and the couple. Factors such as the age, causes and length of sterility, previous pregnancies and, specially, the embryo number and quality are considered. Three is the maximum legal limit of embryos that are allowed to be transferred.
While the doctor prepares the patient for the process, the biologist places a catheter joining a syringe with a small quantity of culture medium with the selected embryos. With the aid of the ultrasound scanner, the physician introduces another catheter into the uterus. This catheter will be used as a guide to introduce the embryos carefuly in the most appropiate place.
After the transfer, the patient remains resting for approximately 30 minutes. Before leaving, the patient is informed of the protocol to be followed during the following days until the results of the pregnancy test, which are known two weeks after the follicular puncture.
Embryo cryopreservation (“freezing”):
Embryo cryopreservation is a technique that allows preservation of the embryos remaining after an IVF cycle by freezing for posterior use.
This increases the possibilities of success of the cycle in the cases in which gestation has not been achieved after the “fresh” transfer or facilitates another gestation in the case that this has been achieved in the previous embryo transfer. This process represents a simple way for the patient to have another embryo transfer without the need for repeating hormone stimulation and the controls required by a complete IVF cycle. It also allows preservation of the embryos in case of unforeseen contraindications for embryo transfer into the uterus.
Nonetheless, this is a very delicate process in which the embryos must go through different mediums to achieve total dehydratation of the cells. A medium that acts as a cryoprotector during the decrease in temperature is later incorporated and allows the embryo to remain submerged in liquid nitrogen and in a latent situation with no type of activity.
Not all the embryos obtained are valid for cryopreservation. Cryopreservation is only undertaken if the embryo quality demonstrates its viability.
How are cryopreserved embryos thawed and transferred?
When previously frozen embryos are to be transferred, a medication regimen is provided to the patient (estrogen and progesterone pills or patches) to prepare the uterus. At around day 12-14 of the cycle, an echography is carried out so as to evaluate the appropriate date of the transfer. The couple decide the number of embryos that are going to be transferred.
Before the embryos transfer, the thaw process has to be carried out in order to evaluate its viability. Despite the existence of a high variability, around 70 % of the thawed embryos are viable for transfer. This process is opposite to freezing, in the sense that a correct rehydratation of the embryo must be achieved after eliminating the cryoprotector. Thereafter the embryos are left in culture medium until the time of the transfer is performed as previously described. The embryos transfer process is done in the same way as in “fresh” embryos.
How can IVF with sperm bank treatment be arranged if I do not live in Barcelona?
Living away from Barcelona is not a problem at all. However, it is essential to arrange a first appointment in our center in order to evaluate the medical history and indicate the appropriate treatment. Once it starts, the monitoring visits can be done anywhere else -as long as they are done by an experienced doctor in the assisted reproduction field. The results from the external visits will have to be sent so our medical team can evaluate them and, consequently, adapt the medication patterns. The follicular puncture and the embryo transfer will take place in our center at an agreed date.