One of the modern methods of increasing the chances of a successful outcome of an in vitro fertilization procedure is ICSI, which involves the introduction of a spermatozoon directly into the egg cell. Fertilization in this case occurs under the complete control of the fertility specialist, however, the correct preparation for ICSI for women and men is recommended, on which the success of the procedure largely depends.
- ICSI is nothing but one of the methods of artificial insemination, therefore its main stages are similar to those of IVF. However, at the same time there are some differences.
- Examination of both partners to clarify the causes of infertility, identify comorbidities, eliminate infections and other factors that may interfere with fertilization.
- Stimulation of ovulation with hormonal drugs to increase the chances of pregnancy. At the discretion of the physician, a short or long protocol can be used (drug administration regimen). At the same time, the doctor monitors the reaction of the ovaries and adjusts the dose of drugs. If the woman is healthy, the procedure can be carried out in the natural cycle, but in the case of ICSI, this technique is applied much less frequently than during traditional IVF.
- Puncture. Mature eggs punctured under ultrasound control. At the same time there is a collection of sperm for fertilization, while it is possible to extract sperm from the testes, if they are absent in the ejaculate.
- Preparation of the egg for the process of fertilization. This stage of the ICSI procedure is somewhat different from the standard IVF. When preparing oocytes, the embryologist frees them from the protective layers (cumulus cells) and assesses the degree of maturity. If it is insufficient, the egg remains in the incubator for maturation.
- Sperm preparation. Sperm cells are treated in a special environment, and then the most viable and with good morphology are selected.
- The introduction of the sperm directly into the egg is the most important difference between ICSI and standard IVF. The oocyte is fixed with a special micropipette, the sperm is sucked into the needle, and then introduced into the egg.
- The transfer of the egg into the uterus, as in the usual artificial insemination.
The preparation for ICSI for a woman is almost identical to the preparation for standard IVF. It begins with a detailed examination, which includes expert advice, ultrasound, hormone tests, smear examinations and other procedures in order to eliminate foci of infection. In addition, the following measures are recommended:
- Preparation for ICSI for older women (after 38 years of age) begins with an assessment of the ovarian reserve, that is, the number of eggs that can be fertilized. This is necessary for proper selection of hormonal drugs and assessment of the possibility of conception in principle (if it is not possible, the patient is invited to use donor oocytes).
- Minimizing the risk of hyperstimulation syndrome due to the consumption of protein foods and large amounts of water (at least 2.5 liters per day).
- Quitting smoking and alcohol.
- Normalization of hormonal levels prior to entry into the protocol.
- The exclusion of significant physical exertion.
Women who do not have problems with the sexual sphere are limited to the measures listed. If the patient has endometriosis, cysts in the ovaries, and fibroids, you will have to spend some time to eliminate these problems, since they can also become an obstacle to conception.
Preparation for ICSI man
One of the main indications for using ICSI is the male factor of infertility due to the low quality of sperm. These can be diseases such as:
- asthenozoospermia, reduced sperm motility,
- oligozoospermia, reduced sperm count,
- necrozoospermia, a large number of non-viable sperm,
- a large number of antisperm antibodies.
In all these cases, it will not be possible to drastically improve the quality of sperm, however, some actions need to be taken:
- Undergo a complete examination, take the spermogram and tests for infection, to establish the exact cause, which prevents conception.
- Eliminate infections and inflammatory diseases that can prevent conception - for example, prostatitis.
- High temperatures have a negative effect on the quality of sperm, so you should refuse to visit saunas and baths for 1-2 months before the start of treatment.
- Viral and bacterial infections can have a negative impact. ICSI is performed on the background of complete health and no earlier than one month after the infection.
- It is necessary to exclude smoking, alcohol intake for at least one month prior to the procedure. Beer and wine increase estrogen levels, which can also reduce the chances of conception.
- It is recommended to include in the diet of fruits and vegetables containing ascorbic and folic acid. According to research findings, if improving the quality of sperm is possible in principle, daily consumption of vitamin C helps to achieve this in part.
- In order for the doctor to be able to get more sperm, it is recommended not to have sex for 3-5 days before the sperm is delivered.
Features of the ICSI method
Moral training is equally important for both partners. Doctors recommend to hope for success, but do not forget that the failure rate is high enough, so it is possible that repeated attempts will be required.
Popular Questions on Reproductive Technologies
The first thing that a couple encounters after confirming the diagnosis and finding out possible ways to influence the source of the disease is the need to train both partners.
What is the preparation for ICSI man? This is a series of measures aimed at examining the body, firstly, and the greatest possible improvement in the quality of sperm, secondly. To improve the quality of genetic material, you can use the course of special preparations.
Preparing for ICSI for women in IVF does not differ from the standard for artificial insemination programs. A woman passes a series of tests and examinations confirming the possibility of gestation.
The ICSI procedure, the stages of which is preliminarily calculated by the reproduction specialist, is one of the most complex and requires maximum attentiveness and concentration. Many families are interested in what the ICSI success rate is, in general, it is comparable to the performance of standard extracorporal fertilization programs.
IVF / ICSI from the first time is not always effective, even if all medical recommendations are taken into account. Negative external factors can also affect the course of the procedure. Even the occasional cold can cause unsuccessful fertilization.
If a patient is diagnosed with teratozoospermia, ICSI will most likely require additional manipulations or the use of donor genetic material to accomplish the task.
Remember that reproductive technologies, despite the rapid development of this direction in medicine, have certain limitations. What are the consequences of ICSI for women, and whether they include malicious ones, it is worth knowing in advance. For example, puncture of the follicles ICSI / IVF, which in theory should not bring any damage to the expectant mother, does not imply a negative effect on the body and strong pain, but under the influence of stress can be transferred by a woman in a bad way. Therefore, it is necessary to clarify in advance how ICSI occurs in order to be ready for any medical actions.
Learning more about the IVF / ICSI program, many couples are convinced that treatment can save them from infertility, but they have to make more than one attempt to achieve pregnancy and the birth of a healthy baby.
To the question, what is more effective than IVF or ICSI, no doctor can answer without tests and examinations that can show what is the cause of reproductive dysfunction. Based on the data obtained, the reproductologist will be able to offer the most effective procedure, taking into account the characteristics of the patients. Sometimes it happens that even 3 ICSI do not bring the desired result, and it takes time to select the most effective treatment regimen.
There are several methods of ART, which can be offered to the patient, this is IVF and ICSI, IMSI. Each program has its own characteristics. Formation of prices for treatment takes into account all the details. What is more expensive, IVF or ICSI - in vitro fertilization using ICSI is more expensive because it is a more laborious procedure.
Before treatment, tests are performed for ICSI, IVF. Some of them can be reappointed to track changes in the state of the body during preparation. Additional examinations may also be prescribed. Patients are advised on how ICSI is performed.
One of the important points is the possibility of getting pregnant with several children during artificial insemination. Having received several germ cells of high quality, embryologists can use them for fertilization. And after ICSI there can be twins.
Despite the possibility of deviations that may appear during the treatment of reproductive dysfunction, the effectiveness of ICSI / IVF, the results of which are obvious, is very high. Today, the use of such techniques allows thousands of infertile couples to become parents. The ICSI technology is often more productive than IVF, egg fertilization occurs in 95% of cases. But the frequency of pregnancy after ICSI is about the same as the result of the standard in vitro fertilization program.
What questions most often concern patients of reproductive clinics?
Large amounts of information provided at the consultations are not always immediately well perceived by patients, and they often require additional explanations. That is why doctors explain how ICSI is done in stages to make sure that patients understand the need to follow the recommendations and the reasons for the appointment of certain procedures. In addition, detailed explanations are often able to stabilize the psychological state of the patient and relieve stress, because to possess information means to control the process. Those who gave birth after ICSI, describing their impressions, say that often many assumptions and fears are exaggerated, while in reality there is nothing to be afraid of.
To improve the effectiveness of the treatment in some cases, fertility specialists advise to combine ICSI and IVF. When do ICSI? (Without IVF this procedure is impossible, it is part of the program) If the cause of infertility is recognized as poor quality or a small number of male germ cells. This information is given by the spermogram, after analyzing which, the doctor decides on the need for ICSI.
Indications for ICSI in women include repeated attempts at conception through in vitro fertilization, which were unsuccessful, a small number of oocytes obtained. A change in treatment tactics may be suggested by the attending physician if he suggests possible failures in the following IVF.
Knowing how the IVF / ICSI procedure is carried out, potential parents will be able to make an objective choice and save money, preferring not a second unsuccessful treatment, but a more effective method. Having learned what the difference between the procedures and what differences they have, it will be easier for you to decide on ICSI IVF.
Doctors warn future parents in advance about how to behave after embryo transfer, to allow embryos to gain a foothold in the uterus. About its occurrence after ICSI hCG test shows better than any other tests. The increase in human chorionic gonadotropin begins several days after embryo replanting, and within two weeks reproductologists can give an accurate answer to the question of whether intracytoplasmic sperm injection into the oocyte helped to become parents.
According to official statistics, the ICSI technique with poor sperm morphology is the most appropriate method of artificial conception.
One of the popular questions that women ask is “Does ICSI hurt?” Also, as with IVF, oocytes suitable for fertilization should be obtained by puncture. This manipulation is performed under anesthesia. ART programs, such as IVF, ICSI, imply monitoring of the state of the body after embryo transfer. The expectant mother should be extremely attentive to her own well-being and inform the doctor about the negative symptoms that arise.
The spermogram conducted before ICSI clarifies the need for this procedure. In order not to carry out treatment to no avail, doing three ICSI, one should prepare the body for the procedures. If the sperm of the partner is absolutely not suitable for use, it makes sense to seek the assistance of donors to avoid unsuccessful ICSI.
Among the popular questions that parents ask reproductologists: “Is it possible to know in advance the sex of the child ICSI?” You can only determine the gender of the future baby using the PGD procedure. It is carried out exclusively for medical reasons, with the risk of inheriting the disease, sex-linked. At the request of "order" the sex of the child can not be.
Even if a successful ICSI was performed at the clinic of reproductive medicine, the expectant mother should not neglect the instructions given by the doctors to save the pregnancy and produce a healthy baby.
Patients ask if it happens that the eggs do not fertilize with ICSI. This happens very rarely, since the sperm is injected directly into the cytoplasm of the oocyte for fertilization. Embryo development may stop in later stages.
Analyzes in front of ICSI, which are given by both representatives of a married couple, make it possible to understand which points to pay attention to when considering therapy. IVF Clinic IVF does not guarantee 100% recovery, but can offer effective methods of influence on the reproductive system to achieve conception. It is worth noting that ICSI pathologies can take place, this largely depends on the quality of the genetic material used in the program. TESA with ICSI is necessary when seed has to be obtained directly from testicular tissue.
At the forum on IVF and ICSI, you can ask real people how relevant the risks of ICSI are, which are described by doctors. Often, not only patients of reproductive medicine clinics take part in the forum discussions, but also physicians who are ready to answer any questions. It is worth remembering that each specific infertility situation is individual. Before you decide on a method of treatment, it is necessary to clarify whether you have contraindications ICSI. Special attention is required for those patients who choose ICI cryoprotocol, since the obtained genetic material requires compliance with certain storage conditions.
What are the chances of having ICSI getting pregnant? About 35-45% of the programs end with a successful pregnancy, in the final of which a long-awaited healthy baby is born. The success of the sperm injection is somewhat higher than the effectiveness of IVF, but only when used in a suitable situation. ICSI stimulation for each specific diagnosis is also selected individually.
Clinic "Center IVF" has everything you need to effectively treat patients for infertility. Operation ICSI is carried out in accordance with international standards. If you are interested in the likelihood of ICSI pregnancy, the procedure of the procedure and its prospects, contact the Center for IVF in the Crimea and visit the first consultation.
Indications for fertilization by ICSI method
To conduct fertilization by ICSI apply in the following cases:
- A history of unsuccessful IVF attempts: an unsatisfactory fertilization rate in previous protocols (less than 50%).
- Various variants of violations in the structure and motility of sperm (male factor).
- Lack of sperm in the ejaculate or lack thereof.
- Use of thawed sperm with a decrease in quality and quantity.
- Woman over 39 years old.
- The need for pre-implantation diagnosis - with an increased risk of the development of genetic mutations.
- A significant amount of ejaculate (according to the results of the MAR test) antisperm antibodies (more than 50%) is the so-called immunological sterility.
- Combined semen disorders.
- As a result of stimulation, few oocytes (female germ cells) were obtained.
- The use of donor cryopreserved egg in the program.
As you can see from the list, basically ICSI do in cases of violation of spermatogenesis and the use of cryopreservation. В случаях, когда нужно провести анализ ПГД методом CGH обязательно прибегают к этой технике.
Эффективность метода ИКСИ
Вероятность оплодотворения варьирует от 60 до 100% случаев. Из которых в 90–95% развиваются полноценные и здоровые эмбрионы. Такие показатели эффективности ИКСИ primarily due to the fact that the program selects sperm cells with the best morphological characteristics. To date, there are two more techniques that improve the selection of sperm - PIKSI and IMSI.
How does ICSI occur and what is the difference from IVF?
All stages until fertilization are identical to IVF. The difference is that fertilization does not occur independently, but with the help of micromanipulation under a microscope of multiple magnification. The selected sperm is injected into the egg, after making a puncture with a special tool - the capillary. The principal difference ICSI from IVF - The embryologist does not give nature a chance to choose the best spermatozoon, but does it for it.
ICSI occurs in four stages:
- Evaluation of the quality characteristics of the eggs obtained (after puncture). An embryologist, studying an oocyte, cannot look inside the cell, but according to the qualitative characteristics - in appearance and form of the membrane, presence / absence of inclusions, vacuoles are oriented, is it worth taking such a cell into work.
- Putting Petri dishes with eggs in a special CO² incubator. This is a heat chamber with a temperature of 37 ° C and a carbon dioxide concentration of 5%. Such conditions mimic the internal environment of the female body. Cells "rest" for several hours.
- Sperm preparation. Choose the best and highest quality for morphological features.
Spermatozoa occupy only 3% of the ejaculate, therefore it is necessary to thoroughly clean the sperm sample from seminal fluid, inclusions and select the most promising, strong, mobile spermatozoa. For this purpose, liquid filters are used (aqueous solution of polyvinyl-pyrolidone granules of different density) and centrifugation.
At the bottom of the tube lay down a solution of more dense granules, then on top of it - a less dense layer. Semen is placed on top of the layers of liquid filters and centrifuged. That allows to obtain fractions of seminal plasma and cryopreservatives (when cryopreservation of sperm) in the upper layer, and the sperm will descend. And both layers are able to pass only moving cells, which will be used for fertilization.
To effectively perform ICSI an embryologist must have deep experience. Among the large number of cells, the doctor must find the sperm with the correct shape of the head, tail and straight-line movement (at a speed equal to or greater than 25 microns per second).
A disproportionately large head suggests that there are chromosomal abnormalities, because all the genetic material is in it. This sperm is not suitable for fertilization.
Selection of a spermatozoon for fertilization is a very crucial stage. An experienced embryologist will often not be able to explain with words why he does not like a certain sperm cell. But experience suggests that this sperm will give a good embryo, and this one will be a bad one.
The work is carried out with the help of special devices - micromanipulators. Such equipment allows you to make very precise movements (in hundredths of microns). Large hand movements are translated into subtle movements of the manipulators. All manipulations are carried out on an anti-vibration table. If ICSI carried out on a regular table, even steps in the next room could damage cells and microtools.
- Fertilization of the egg. On the sample table is placed a cup with an egg cell and sperm, which are in different drops of the solution. The hands of the embryologist are the instruments - a micropipette and a capillary - a glass tube that converges at the end into an invisible thread and is sharpened in a special way.
The capillary catches the sperm, preliminarily cutting off its tail, and injected under the shell of the egg. Cutting off the tail increases the chances of successful fertilization. Under natural conditions, when the baby is conceived, the tail does not fall under the shell of the egg. During ICSI, conditions of natural conception are modeled. The presence of a tail can lead to the formation of undesirable inclusions and complexes in the embryo.
The egg cell is fixed with a micropipette, creating a negative pressure in it, piercing and injecting the spermatozoon. Fertilization is completed at this stage.
The fertilized egg is returned to the incubator and culture is observed for 3–5 days.
Despite the fact that fertilization with ICSI - an expensive procedure, it is widely used in reproductive clinics in Ukraine, Russia and around the world. The method is promising, reliable and effective.
What it is?
This technique is a component of the in vitro conception. It involves entering a high-quality sperm directly into the egg. This allows you to overcome the most frequent factors of infertility on the part of women or men. This method began to be put into practice in 1992 in Belgium. Today it is very effective, because even after the first attempt at conception, the probability of a positive result is from 32 to 50%. During the re-ICSI the probability becomes even greater.
Indications for ICSI
Before we begin to study the features of ICSI, reviews of which you will find in this article, you should consider the indications for the procedure. So, it is prescribed in the event that:
- The patient has pronounced oligozoospermia.
- After the examination, the doctor discovered asthenozoospermia, which is combined with oligozoospermia of various degrees.
- The doctor found out that after defrosting the quality of cryopreserved spermatozoa is low.
- The man has been diagnosed with azoospermia, as a result of which there are no mature sperm in his ejaculate. At the same time, active sperm cells were detected after puncture of the testicle or its appendage.
- There was a need for a genetic pre-implantation study.
- The couple had several unsuccessful IVF attempts.
In addition, it is necessary to mention the relative indications. These include sperm morphology below 4%, as well as the presence of antibodies that reject sperm.
Benefits of the procedure
According to reviews, ICSI has the following advantages:
- In order for the egg to be fertilized, only one sperm cell is used, which makes it possible to achieve a successful conception even if the partner’s semen quality is not very good.
- The described method is effective even if the patient has defects in the vas deferens.
- This technology will be the ideal solution for couples who have been diagnosed with infertility of unknown etiology.
- When using the described method, fertilization of the egg occurs in 60% of cases. The probability of developing a healthy embryo is 95%.
- Children conceived in this way are no different from those conceived naturally.
- When conducting ICSI donor biomaterial can be used.
Preparation for ICSI for men
If a man has low sperm quality, then this is the main indication for using the ICSI method. So, it is necessary to undergo the procedure if a man has the following diseases:
- reduced sperm motility
- asthenozoospermia or oligozoospermia,
- reducing the number of sperm,
- a large number of sperm that are unviable,
In all the cases described, it will not be possible to dramatically improve the quality of seminal fluid, but it is recommended to take the following actions:
- do a full examination and take a spermogram,
- check for infection
- eliminate infection and inflammation if they are found.
It should be remembered that the high temperature affects the quality characteristics of sperm. Therefore, approximately two months before the start of treatment, it is necessary to stop visiting the bath and sauna. Also adversely affect viral diseases.
The ICSI procedure is performed only when the patient is completely healthy, but not earlier than one month after recovery. A man should also stop smoking and drink alcohol, as beer and wine increase the level of estrogen, which reduces the chances of successful conception. It is necessary to include in the diet of vegetables and fruits, which contain in its composition ascorbic and folic acid. Studies have shown that sperm quality can be improved if you take vitamin C daily. For better diagnosis, it is recommended to abstain from sexual intercourse for 3 or 5 days before taking spermograms.
Many couples ask themselves the question: “ICSI - what is it and how is it done?”. Reviews suggest that the procedure involves several steps.
First of all, doctors prepare a woman for the necessary manipulations. She is prescribed drugs that stimulate the growth of the egg. The doctor controls the maturation of the follicles with an ultrasound machine. It is very important not to miss the moment when the egg is ready for release. During this period, the doctor makes a puncture of the ovaries to collect the egg, which will participate in the subsequent fertilization.
As for the men, they after the preparation pass sperm samples. Experts place them in a special viscous medium. Then the embryologist with the help of special tools immobilizes the sperm. After that, it is placed in a very small needle for insertion into the cytoplasm of the female cell.
The whole procedure is done with the help of special automatic manipulators under the microscope. At the end of the needle is removed. From this point on, the entire fertilization process is similar to conventional IVF.
The ovum fertilized by the sperm cell is transferred to a test tube in which cell division occurs. After a few more days, the embryo is placed in the uterus. Its further development depends on the quality of the material and the body of a woman.
As the reviews say, ICSI does not help everyone from the first time. After all, the process is influenced by many factors. Some women have to do several procedures. And the lady who decided on ECO ICSI, reviews of the procedure should study to be ready for anything.
The probability of conception from the first time
Every woman is planning to get a positive result the first time IVF ICSI. Reviews say that this is possible. Moreover, the probability of a successful pregnancy is quite high. Especially if the reproductive system of a woman is without disturbance. It is very important that there are no inflammatory processes, and the menstrual cycle is regular.
So the success of ICSI from the first time is real. Reviews showed it. But many women who become pregnant after such a procedure fear that a sudden interruption will occur. But this is not supported by statistical data. Those who did ICSI, leave positive feedback and say that they were able to make a healthy baby.
Most of the reviews indicate that with the support of pregnancy in the early stages, as well as the observation of the doctor, pregnancy after the procedure ends with a successful delivery.
ICSI in the natural cycle
Reviews of this procedure indicate that this method of fertilization in the IVF protocol does not include hormonal therapy. This procedure is suitable only for women who have fully preserved reproductive function. As a rule, ICSI in the natural cycle is carried out when the presence of antisperm antibodies in a woman or when infertility is caused by a male factor.
It should be said that if the procedure is performed without hormonal stimulation of the ovaries, the chances of success are reduced. Indeed, in this case only one egg is fertilized, but not several.
Are children born healthy after the procedure?
Women who have passed ICSI, positive reviews about children. Crumbs are no different from their peers in both physical and mental development.
It should also be said that the treatment of infertility in men with the help of the described method is distinguished by features. Here we should not miss the factor that a man can pass on some genetic defects to his child. To exclude such a possibility, it is necessary to make a genetic screening before the procedure, which allows to determine whether there is a pathology.
But the procedure itself does not affect the health of children and does not entail any genetic failures. It all depends on the health of future parents. Thanks to a special pre-implantation diagnosis, you can analyze a specific embryo for the presence of various deviations of chromosomal or gene genesis.
ECO IKSI, PIKSI - reviews and differences
The main difference is that with the usual ICSI, the doctor chooses the appropriate sperm cell subjectively. He draws attention to the appearance, mobility, and other morphological characteristics.
If we talk about the PIXY method, then it is based on molecular analysis, thanks to which it is possible to assess not only how correct the structure of the sperm cell is, but also how much it is able to overcome the natural barrier. Only a mature sperm cell can pass through the shell of the egg. The level of maturity is confirmed by laboratory research. An embryologist assesses sperm's ability to interact with hyaluronic acid.
What do women say?
At the ECO IKSI thematic forums, ladies reviews are mostly positive. They note that they got pregnant the first time exactly when they did IVF together with ICSI. Normal IVF does not give such a result.
Helps method and ovarian failure. The future mother will have to take progesterone and microfollin. But embryo transfer in many cases is successful.
The described method of conceiving a child is complex and painstaking. Therefore, the cost of the procedure is high. Depending on the medical institution, the need for concomitant treatment and procedures carried out at the preparation stage, the cost of the service without IVF varies between 15-17 thousand rubles. The entire complex often costs about 200,000 rubles. In addition, the freezing of the biomaterial is additionally paid.
What is it and how does IVF differ with ICSI / IMSI: what is the difference between procedures and how are each of them done?
IVF is in vitro fertilization. Literally, this term can be decoded as fertilization outside (extra) of the body (corpus) of a woman. The essence of the technique is that a suspension of prepared, motile sperm is added to the resulting egg cell. Then begins the natural process of fertilization - the strongest of the sperm penetrates into the egg, resulting in the formation of the embryo. After successful fertilization and the beginning of the development of the embryo, it is placed in the woman’s uterus and awaiting pregnancy.
What if fertilization does not occur naturally? In such cases, embryologists are involved in the work and microsurgical fertilization methods are applied - ICSI or IMSI.
First, let's look at the reasons for the lack of natural fertilization.
They may be as follows:
- In the semen reduced sperm count,
- In sperm in sperm motility is reduced,
- Many sperm have pathology
- Sperm contains anti-sperm antibodies (ASAT).
Now back to the essence of the ICSI methodology. So, ICSI is an intracytoplasmic sperm injection. A specialist embryologist chooses one with the best morphological characteristics from among the many spermatozoids obtained. To do this, use a microscope, which allows you to achieve a 400-fold increase in the image. Then, with the help of a special microneedle, this sperm cell moves into the egg cavity. Fertilization should occur within 24 hours after this manipulation. Further actions using the ICSI conception method are the same as with conventional IVF: embryo cultivation, its transfer to the uterus and the expectation of pregnancy. With poor female biomaterial indicators, ICSI can be performed and fertilized with a donor egg cell.
With reduced sperm parameters (low sperm motility, increased sperm DNA fragmentation, abnormal sperm morphology), the ICSI method is used to obtain the embryo, namely IMSI. To do this, you need to use a special opto-electronic device that will allow you to study the resulting material (sperm) with the image magnification 6000-6600 times. Such an increase makes it possible to see the smallest changes in the structure of spermatozoa and exclude from the selection those whose morphological characteristics even slightly differ from the ideal ones.
Treatment of infertility and fertilization with IVF, ICSI / IMSI in St. Petersburg: an experiment or a reliable way to combat infertility?
Whatever myths IVF has overgrown, it is this method that has already given life to more than 5 million people. Of course, it is not resorted to when it is possible to conceive a child in a natural way. No one is trying to prove that children from “the tube” are better, stronger, smarter and healthier than those who were born without the intervention of modern medical technologies. However, if for some reason a woman cannot become pregnant on her own, IVF for her is a real chance to become a mother.
Процедура ЭКO (а также проводимые дополнительные манипуляции в рамках этой процедуры – ИКСИ/ ИМСИ) будет наиболее эффективной и безопасной, если:
- Перед процедурой будут проведены все необходимые исследования и анализы. Specialists investigate the biological material of women and men, estimate the predisposition to various diseases (including genetic), study the causes of miscarriages, termination of pregnancy, if this has already happened in a woman’s life. There are enough studies at the preparatory stage - future parents need to be patient and follow all instructions of the doctors.
- Before the procedure will be considered all possible contraindications. By the way, there are quite a few of them, but not all of them are absolute. To postpone, temporarily postpone the procedure of IVF can cause diseases such as hepatitis, tuberculosis, infectious, inflammatory processes. In such cases, to begin with, it is necessary to carry out therapy aimed at eliminating precisely these pathologies, and then - to address the problem of infertility. The absolute contraindications to IVF are serious blood diseases, mental disorders, severe pathologies of the liver and kidneys.
- The procedure will be held in a modern center, where experienced reproduction specialists, gynecologists, embryologists, and so on work. The technological equipment of the center is also important (for example, for the IMSI procedure, as mentioned above, special equipment is needed, which is not in every clinic).
Successful fertilization, embryo transfer and even its proper attachment and implantation in the uterus is only the first step on the path to a happy parenthood. Pregnancy resulting from IVF should be monitored as well (perhaps even more carefully), as well as the one that occurred naturally - to perform periodic screening examinations, ultrasound, CTG, and so on.
How to prepare a woman and a man for the procedure ECO-ICSI?
Before starting the IVF-ICSI program, a specialist reproductive specialist, after talking with patients (male and female) and studying their medical history, will appoint a series of examinations for both of them to prepare. The list of examinations is regulated by the order of the Ministry of Health of the Russian Federation No. 107n "On the procedure for using assisted reproductive technologies, contraindications and restrictions on their use."
Analyzes for men
Analyzes with a shelf life of 12 months:
- blood per group and Rh factor
- microscopic examination of smear from the urethra,
- PCR diagnostics for chlamydia, mycoplasma, ureaplasma, herpes, cytomegalovirus (sexually transmitted diseases - STDs),
- blood for antibodies to herpes simplex virus type 2.
Analyzes with a shelf life of 6 months:
Analyzes with a shelf life of 3 months:
- Blood test for antibodies to syphilis, HIV 1,2 (IgG and IgM), hepatitis B, C.
Before these examinations require sexual rest for 3-5 days, as well as abstaining from alcohol, sauna bath for 1 week.
Tests for women
Analyzes with a shelf life of 12 months (or given once in a lifetime, such as, for example, the Rh factor):
- blood per group and Rh factor
- blood for antibodies to herpes simplex virus type 2,
- Ultrasound of the heart (ECHO),
- Thyroid ultrasound followed by an endocrinologist consultation,
- Breast ultrasound on the 5-11 day of the monthly cycle for women under 35 years old, women over 35 need to undergo a mammogram, followed by consultation with a specialist mammologist,
- blood for rubella, cytomegalovirus, toxoplasmosis.
Analyzes with a shelf life of 6 months:
- cytological examination of cervical smear, cervical canal,
- PCR diagnostics for chlamydia, mycoplasma, ureaplasma, herpes, cytomegalovirus, HPV type 16.18.
Analyzes with a shelf life of 3 months:
- Blood test for antibodies to syphilis, HIV 1,2 (IgG and IgM), hepatitis B, C.
After passing through the above procedures, the woman needs to obtain a therapist's opinion on her general health condition and the possibility of infertility treatment, as well as on further pregnancy. Be sure to write down the conclusion: "Conducting assisted reproductive technologies and surgical interventions, gestation of pregnancy are not contraindicated." Shelf life of such a conclusion - 6 months.
All of these examinations and analyzes can be done in our center. In addition, other studies can be assigned based on the individual picture of health.
How does the procedure of fertilization of the egg with the method of ECO-ICSI and how much time it is spent?
ICSI is a microsurgical manipulation in the framework of IVF, which becomes necessary when fertility (conception) is impossible even in artificially created ideal conditions. ICSI is used if the male sperm have poor performance - low sperm speed, their small number and morphological structure pathology. Also, the use of the ICSI method is justified in cases when IVF has already been done before, but fertilization did not take place or happened, but the embryo was not viable.
Consider in stages how IVF-ICSI fertilization occurs.
- For IVF (including using ICSI), one egg is small - 5-10 eggs are needed. In this case, the chances of getting a healthy embryo increase significantly. In this regard, IVF begins with the stimulation of superovulation. In order for the eggs to mature in the follicles, at the end of the stimulation, the patient is prescribed hCG preparations that trigger the maturation of the eggs. As a result, instead of a single egg cell in a woman's body, several mature. In some cases, the procedure ICSI-ECO is carried out in the natural cycle, that is, without stimulation of the ovaries. This option is suitable for women who have not disturbed physiological processes in the ovaries. In other words, they have regular menstrual periods with normal ovulation, confirmed by research results, or women with reduced ovarian reserve, when stimulation is contraindicated, and the use of donor oocytes is premature or the woman is not morally ready for this. The duration of the menstrual cycle should not go beyond the average values - 26-32 days.
- After the eggs have matured, the following manipulation is performed - transvaginal puncture. For this purpose, a special needle is used, which is performed through the posterior and lateral vaginal vaults. By vacuum aspiration under ultrasound control, the matured eggs are removed from the follicles and placed in test tubes.
- The resulting eggs get to the laboratory. Embryologists examine them under a microscope and evaluate common external parameters: size, structure, and so on. Then the oocytes suitable for fertilization are transferred to the nutrient medium, in which they must be kept for several hours in a special CO2-incubator. We can say that this way the eggs “rest” and adapt, because they were removed from the usual environment.
- While the egg cell adapts to new conditions, embryologists work with male germ cells - spermatozoa. The biomaterial is placed on the stage of the microscope, and its study begins. An embryologist should select the most viable with normal morphological characteristics from the total mass of sperm. A sperm cell should have the correct shape of the head and tail. A disproportionately large head can mean that there are chromosomal abnormalities — such an instance of a male cell is not suitable for fertilization. In addition, the sperm must move rectilinearly, at a speed of at least 25 microns / sec. After the embryologist has chosen the best spermatozoon, he pulls it into the cavity of a special glass needle.
- The next stage is artificial insemination. A cup with an egg cell is placed on the microscope stage. Using a special microscopic sucker, the egg is fixed. Then, the needle containing the prepared sperm cell pierces the outer layer of the egg. Next, the sperm is injected into the cavity of the egg. The needle is removed, the egg is dropped from the sucker. This completes the fertilization process.
- A fertilized egg for 3-5 days is placed in a CO2 incubator. On each of these days, experts monitor the development of embryos and can already preliminarily assess which of them will be viable and which one will not. Viable embryos for indications are subjected to additional examination - the pre-implantation genetic diagnosis of PGD - it is necessary to determine whether there are cell mutations. The likelihood of developing a child with a chromosomal pathology or other genetic abnormalities is identified.
- At 3-5 days of development, the highest quality of embryos is transferred to the uterus. This is a critical period, since after it the embryo-covering membrane is torn, and it must attach to the wall of the uterus. Naturally, this should happen in the body of a woman.
How is embryo replanting done during the ECO-ICSI program, where does the procedure take place and how long does it take?
Our specialists are inclined to think that only one is the right way to sit down, because this is the nature of nature, and therefore more naturally, besides, multiple pregnancies that can develop when transferring more embryos are fraught with negative consequences and IVF is a complication.
Embryo transfer should be carried out in a strictly defined period of the cycle. There is such a concept for the uterus, as a "window of receptivity". At this time, the endometrium lining the internal cavity of the uterus is ready to receive an embryo inside. The difficulty lies in the fact that the period of receptivity does not last long - approximately 2 days.
The procedure of grafting is painless for a woman, it is technically simple and takes no more than 15-20 minutes in duration. A replanting is carried out under sterile conditions of the operating unit under ultrasound control on a gynecological chair. Previously, a woman is given a sedative medication, which will help with some ease and without anxiety to endure a few unpleasant sensations from medical manipulations.
It is possible to determine the result of embryo replanting, that is, whether a pregnancy has occurred, in about 12-14 days. To do this, a woman can do the usual pregnancy test. Also, to confirm the result, blood is taken for analysis of hCG.
What can affect the effectiveness of ECO-ICSI?
1. The first factor affecting the efficiency of in vitro fertilization is the age of the woman. It is the health of the future mother and her reproductive age that are decisive, since she will have to not only pass the biomaterial, but also go through the replanting procedure and then, with a successful outcome, endure the pregnancy. Women under the age of 38 are more likely to become pregnant with IVF.
2. The second factor is the particular genetics of future parents. Those couples who do not have serious health problems have more chances for successful IVF - there are no hereditary pathologies and hormonal disorders.
3. The third factor is the readiness of the female body to accept an artificially obtained embryo. It often happens that everything is going great until the moment of replanting: there are a lot of eggs, a lot of healthy, motile spermatozoa, fertilization occurs quickly and even several healthy embryos are obtained. However, after planting a long-awaited pregnancy does not occur.
This can happen for the following reasons:
- too thin or fat endometrium in the uterus,
- inflammatory diseases of the female reproductive system,
- the presence of scars on the uterus or polyps in its cavity.
It is possible to avoid such difficulties during implantation only after carrying out thorough preparation and preliminary examinations in front of IVF-ICSI. It is possible that if you identify any problems of an inflammatory nature or other in vitro fertilization, you will have to postpone. The patient will need to undergo a course of treatment, eliminate the diseases and only then proceed to the solution of the problem of infertility. In such cases, it is very important to be patient, which is quite difficult, especially for couples who have long dreamed of a child.
4. Another factor affecting the success of in vitro fertilization by intracytoplasmic sperm injection (ICSI) is a properly selected period for replanting. Here it is important to correlate the most successful period of embryo cultivation with the most successful period in the woman's cycle, when the endometrium is most ready for implantation of the embryo. Let us examine this question in more detail. Cultivation is the process of artificially growing an embryo. Its maximum duration is 5-6 days, but replanting can be done on the second or third day of cultivation. Everything is very individual here and it is rather difficult to call specific terms for replanting - the decision is made jointly by reproduction specialists and embryologists, who mainly rely on practical experience.
Now about the readiness of the endometrium. Unfortunately, the window of implantation, the period when the endometrium is most ready for embryo adoption, is very narrow - on average, this is only two days. What happens in these two days:
- Endometrium thickens and loosens. Due to this, the embryo seems to sink in its villi, firmly fixed on the wall of the uterus.
- Endometrial cells are stored nutrients that the embryo needs.
- In the endometrium, the number of blood vessels increases, thereby providing enhanced nutrition with oxygen and beneficial substances.
So, the task of fertility specialists and embryologists is to correlate the most successful period of maturity of the endometrium with the most successful period of development of the embryo, and it is during this period that the infusion is carried out.
5. Of course, the qualification and experience of embryological specialists have a great influence on the success of the IVF-ICSI procedure, because they must choose the best spermatozoon for fertilization. Often, embryologists cannot even explain why they choose one or another spermatozoon - just experience tells them which of them can correctly and fully transfer the DNA of the female egg. It is also important how skillfully the embryologist captures the sperm with a microscopic instrument and then implants it into the egg cell. This work can not be called even jewelry - it is much more difficult and responsible. And the specialists of the Genesis Reproduction Center successfully cope with it.
IVF or ICSI / IMSI: where is the greater chance of success and the likelihood of pregnancy after the first attempt?
Perhaps a phased description of the ECO-ICSI process seems very complicated and the question arises as to how often the effectiveness of this procedure is achieved. The statistics of the protocols of conventional IVF suggests that the proportion of successful procedures is approximately 30-38%. We are talking about those cases where not only cultivation, but also replanting, and then pregnancy and childbirth, is successfully underway.
As for ICSI, after it, the probability of embryo survival and fertilization of eggs from the first time (if done with a good sperm) varies from 60 to 100 percent of cases (which% depends on many other factors). These are very high indicators that prove the effectiveness of this technique. Such performance indicators are primarily due to the fact that the program selects sperm with the best morphological characteristics. In other words, what nature had to do (the natural selection of sperm, their delivery to the egg and so on) is done by the hands of specialists and with the help of equipment.
These statistics figures do not unequivocally indicate that ICSI (or its complicated version of IMSI) is better and more effective than IVF, although the probability of a positive result in the first procedure is greater. Statistics indicate the chances of pregnancy, and which of the methods of fertilization is suitable in each particular case, experts must determine. If male germ cells are able to fertilize an egg independently, why interfere with this process using ICSI? If they are not able to do this, why try to re-simple IVF, knowing in advance that it will not end with pregnancy?
How much does IVF cost using the ICSI / IMSI method in St. Petersburg: factors affecting price
The cost of the in vitro fertilization procedure will depend on the specificity of the problem of infertility that exists in one or another pair.
In order to understand how much an in vitro fertilization procedure will cost in the Genesis Reproduction Center, you need to sign up and come to the initial consultation with our specialists and learn more about our capabilities and special offers. Specialists of the clinic will tell you what specific procedures may be needed in your particular case. They will study your medical history, analyze the diagnoses concerning infertility, and then draw certain conclusions.
What determines the cost
When it comes to the cost of IVF by ICSI or IMSI, it should immediately be noted that this procedure requires significant financial investments. В процессе искусственного оплодотворения задействовано много специалистов, используется дорогостоящее оборудование, специфические медикаменты, и это, разумеется, требует соответствующей оплаты. Также всем будущим родителям, подыскивающим клинику, где они пройдут ЭКО, нужно помнить, что это не та процедура, на которой стоит экономить. Искать в первую очередь нужно высококлассных специалистов, а не супердешевые предложения.
Однако не всё так печально. Today, various social programs are being developed for couples, and it is possible to undergo ECO-ICSI / IMSI at the expense of the state (if there is an OMS policy). Turning to the center of reproduction "Genesis", you can take advantage of this chance.
Our in vitro fertilization prices are affordable for many categories of the population. They are lower than the average European, and the total cost of a set of procedures does not exceed the insurance limit, if we are talking about the possibilities of a medical policy.
We are always focused on results and make every effort to give the joy of motherhood and paternity as more couples as possible.