In Vitro Fertilisation (IVF) and Intra Cytoplasmic Sperm Injection (ICSI)
In contrast to insemination, IVF (in vitro fertilization) and ICSI (intracytoplasmic sperm injection) combine the oocytes taken from the woman’s ovary with the man’s sperm outside the body in a test tube, in vitro (lat. Vitrum = glass).
The fusion of the genetic material (=fertilization) is just as independent as otherwise. “Artificial” is actually just referring to the place of the fertilization. Therefore I prefer to speak of “test tube”- or “In Vitro”- instead of “artificial” fertilization.
The difference between IVF and ICSI is just the way that the spermatozoon arrives in the egg cell. In IVF one of many spermatozoa enters the egg cell on its own. In ICSI one individual spermatozoa is injected into the egg cell under the microscope with the help of a micropipette (very fine needle).
The sperm can usually be obtained easily by ejaculation. The eggs cells, on the other hand, have to be punctured from the ovaries via a small operation from the vagina shortly before ovulation. Usually the ovaries are stimulated with a hormonal treatment to bring about 10-15 eggs to maturity, instead of just one as in the normal cycle, so that several eggs can be obtained through the intervention.
If several egg cells are fertilized, some of them can be frozen, in the so-called pronucleus stage and later inserted into the uterus in a so-called thawing cycle, without the need of further complicated hormone treatments.
If the ejaculation doesn’t contain any sperm, sperm can sometimes be obtain from a tissue sample of the testicle (= TESE, testicular sperm extraction).
Reasons for an IVF treatment
- Fallopian tubes which are irreparably blocked or restricted in their function by infections, endometriosis or operation (prevention or sometimes after an appendectomy)
- Male fertility disorder
- After an unsuccessful insemination(usually after three trials)
Reasons for an ICSI
- Serious male fertility disorder
- Missing or poor fertilization in IVF
Chances of success
The chances for a pregnancy after an IVF/ICSI depend on one’s age,depending on the age-related decrease in fertility. At the age of 35 there is a 30% chance, at the age of 40 there is a 20% chance and above the age of 40 there is a 10% chance per cycle, with a strong downward tendency. Of course, the chance also depends on individual factors. We will be happy to advise you in this regard.
Procedure
Stimulation
After a protocol adapted to you, hormones are injected which stimulate the ovaries to form ideally 10-15 follicles. You or your partner will be instructed in the administration of the syringes. The growth of the follicles is closely monitored by regular ultrasound and blood tests.
Cryopreservation
If more fertilised eggs (=zygotes, oocytes in the pronuclear stage) are present than required for transfer, they can now be frozen and stored in liquid nitrogen. They can later be inserted into the uterus in a defrosting cycle. According to Swiss legislation, zygotes may be stored for a maximum of 5 years.
Follicle puncture
After ovulation is triggered by the ß-HCG injection, the follicles are punctured from the vagina with a needle and the liquid containing the eggs cells is aspirated. Normally, this takes place under a light narcosis (analgosedation, under control of an anaesthetic team). You will receive an appointment in the IVF laboratory and can go home a few hours after the procedure.
Fertilization
After the puncture, the egg cells and the sperm are combined in special glass bowls. Respectively in the case of ICSI, one sperm cell is microinjected into each egg cell. Further development then takes place in the incubator under optimal environmental conditions (temperature, nutrient solution, pH-value etc.).
24 hours later, the embryologist can see if and how many eggs have been effectively fertilized.
Embryo transfer
2-3 days after the puncture, again in the laboratory, usually one embryo is put back into the uterine cavity. This is done via a very thin catheter from the vagina and is painless
Pregnancy test
14 days after the transfer, or 16 days after the puncture, the pregnancy hormone in the blood is determined. If the result is positive, an ultrasound 2-3 weeks later will show whether the pregnancy develops normally. If so, your gynaecologist or your family doctor will carry out further pregnancy checks.
Thawing cycle
If egg cells could previously be frozen, a thawing cycle can be carried out if a pregnancy does not occur or if a new child is desired. For this purpose, either the lining of the uterus is specifically built up with hormone tablets or hormone patches or the ideal time for implantation is determined in a natural or stimulated cycle with ultrasound and blood controls.
After thawing of the eggs and the first cell divisions, usually one embryo can be placed in the uterine cavity.