In vitro – indications, methods. How does IVF work? [WE EXPLAIN]

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The problem of infertility concerns about one million couples in Poland. The in vitro method is for them a chance for the desired offspring, which is why it is becoming more and more popular. Due to the problem of infertility, more and more couples decide to try in vitro fertilization.

Whole in vitro fertilization procedure consists of four phases:

1. hormonal stimulation to stimulate the eggs to grow intensively,
2. collection of mature eggs,
3. carrying out in vitro fertilization,
4. transfer of a fertilized egg, i.e. its transfer to the patient’s uterus.

In vitro fertilization treatments in Poland has been carried out since 1987. The provisions concerning in vitro fertilization are regulated by the Act on infertility treatment. For patients trying to conceive, one of the most important provisions of the Act is the prohibition of in vitro fertilization of more than 6 reproductive cells, unless the increase of the limit is justified by circumstances (patient’s age, medical indications).

How to check ovulation during the menstrual cycle? Check: Sterility. How to check if the cycles are ovulatory?

Indications for in vitro fertilization

In vitro is one of the methods of infertility treatment. In vitro fertilization it is usually offered to those couples who have been diagnosed with the following problems:

1. obstruction of the fallopian tubes;
2. inability to induce ovulation;
3. endometriosis;
4. hormonal disorders in the menstrual cycle;
5. disturbance in the functioning of the ovaries;
6. low quality of sperm in a man;
7. idiopathic infertility in both of them – despite good research results, the couple still fail to conceive a child;
8. infertility, when using other treatments that have not worked so far.

Often, the in vitro method is treated as a last resort, especially in cases where a couple has been trying to conceive for a long time and all the methods of treatment used so far have failed. Before a decision is made to undergo in vitro surgery, a thorough diagnosis must be made, which excludes the possibility of pregnancy with pharmacological support or surgical intervention. Only after ruling out all possibilities, a couple may decide to undergo in vitro fertilization.

What factors can help you get pregnant faster? Read: How To Get Pregnant Quickly? Fertile days, sex, well-being

In vitro and the causes of infertility

The in vitro method always comes with the problem of infertility. In what cases can infertility be suspected? From the medical point of view, infertility may be confirmed by a situation in which, despite regular unprotected intercourse, a woman does not get pregnant within a year. Infertility affects women as often as men. Doctors point out that usually about 30% of the causes of infertility are on the side of the woman and the same on the side of the man. Another 30% concerns marital infertility, where the problem occurs in both partners. However, in 10-15% of cases it is impossible to explain the causes of infertility at all.

Among the causes of infertility in women the most frequently indicated are:

1. ovulation disorders or anovulation, most often caused by an endocrine disruption. Common causes of infertility are problems with the thyroid gland or polycystic ovary syndrome;
2. obstruction of the fallopian tubes – in many cases it is enough to open the fallopian tubes for a woman to get pregnant without any problems;
3. endometriosis;
4. congenital or acquired defects of the reproductive organ – the cause of infertility in this case may be intrauterine adhesions or fibroids;
5. immune-related disorders – an example is the cervical mucus, which reacts negatively to sperm. In addition, there may be antibodies in the mucus that will hinder fertilization as well as implantation of the embryo;
6. embryo hostile endometrium,
7. taking medications that disrupt the menstrual cycle;
8. woman’s age – fertility in women decreases with age, which is associated with more and more frequent non-ovulatory cycles.

Among causes of male infertility while the most frequently indicated are:

1. varicose veins of the spermatic cord;
2. reproductive and systemic infections – an example may be mumps in childhood;
3. cryptorchidism, that is, the lack of testicles in the scrotum;
4. torsion of the testicle around the spermatic cord;
5. injuries of the testicles or overheating of the scrotum;
6. obstruction of the sperm discharge pathway;
7. hormonal disorders;
8. chemotherapy and radiation therapy, as well as taking certain medications that reduce fertility;
9. male age – male fertility decreases with age, which is associated with deteriorating sperm condition. According to the findings of the World Health Organization, as the years progress, a man has less and less sperm in his ejaculate. In addition, they are less mobile, less viable, have construction defects and are of much lower quality.

If you want to know more about infertility read: Infertility: Causes, Diagnosis and Treatment

In vitro — a step-by-step procedure

In vitro fertilization procedure it follows strictly defined stages. It looks the same every time, no matter what clinic the couple decides to go through this infertility treatment method.

1. Qualification, which consists of: the first visit to the clinic and the so-called qualifying visit. During the first visit, the doctor gets acquainted with the medical documentation on the current infertility treatment. The doctor conducts a medical survey, and the woman undergoes a gynecological examination extended with an ultrasound. The necessary laboratory tests are also ordered. In the case of a woman, these are: AMH, FSH, TSH, E2, prolactin and cytology, and in the next stage of qualification: blood group test, APTT, sodium, potassium and blood count. The man must perform a semen analysis and see an andrologist or urologist. Both partners must also perform the following virological tests: HBS AG, HCV, HIV, WR.
2. Hormonal stimulationduring which the woman takes pharmacological hormones to stimulate the maturation of the eggs. This process takes 7 to 12 days and is associated with cycle monitoring. For this reason, during hormonal stimulation, the patient has 2 to 4 follow-up visits with ultrasound examination. At the end of this stage of the IVF procedure, the doctor determines the exact date of collection of the eggs for in vitro fertilization. Hormonal stimulation can be divided into several stages. At the very beginning, the patient receives a stimulation monitoring card in which the doctor writes down individually selected doses of drugs. Medicines are administered in the form of subcutaneous injections, which, after training, the patient can also perform alone at home. It is important that the medicines are taken at the same time each day, the doctor will usually tell you the time of day. It is worth remembering that various side effects may occur while taking medications, most often spotting or bleeding. This should not worry the patient as it is the body’s natural reaction to the changes taking place in it. Follicle growth is monitored every 2-3 days, and your doctor may also decide to measure your hormone levels. 
3. Collection of eggs – on the agreed date, the patient comes to the clinic on an empty stomach. Under general anesthesia, ovarian puncture is performed to collect the follicular fluid with the eggs. The procedure takes about 15-20 minutes. However, the patient and her partner should appear at the clinic one hour before the procedure. Due to general anesthesia, one should be on an empty stomach for the procedure. On the day of egg collection, the patient and her partner stay at the clinic for about 4-6 hours. Immediately after the procedure, a doctor’s visit usually takes place, during which the doctor informs the couple about the number of cells taken and recommendations after the puncture.
4. Collection of semen – while the eggs are collected from the woman, the partner donates sperm.
5. In vitro fertilization – the next stage is the actual process of in vitro fertilization. In the embryology laboratory, the best 6 eggs are selected from all the collected eggs and combined with sperm. 16-20 hours after insemination, it is assessed whether the cells have been fertilized.
6. Embryo transfer – within 2 to 5 days after fertilization, the embryos (one or two) are inserted into the uterine cavity. The procedure is performed under ultrasound control and lasts 10-15 minutes. The embryos are transferred into the uterus by the vaginal route using a thin catheter. From the moment of collecting the mature eggs, a woman takes medications that increase the chance of embryos implantation. If more embryos were created in the fertilization process, the rest are frozen – they can be used in a possible next in vitro procedure.
7. Confirmation of pregnancy – 11 days after the transfer, a blood pregnancy test (beta-HCG test) can be performed. If the test shows a biochemical pregnancy, an ultrasound scan is performed after another 3 weeks to confirm the pregnancy. If the test is negative, the doctor will suggest a frozen embryo transfer if, of course, you managed to get it. Your doctor may also suggest another consultation to discuss further treatment options.

What tests should be performed in case of suspicion of infertility? Check: Diagnosis of infertility in women – what tests should be performed?

In vitro fertilization methods

Depending on the individual situation of the couple, the doctor may suggest different in vitro techniques. Currently, in vitro methods are used:

1. classic IVF fertilization – is the first successfully developed method of in vitro fertilization. In this method, sperm cells are placed and incubated with the eggs. In such an environment, sperm independently penetrate the egg within a few hours, which triggers all natural physiological reactions. This method is used in cases of infertility caused by obstruction or lack of fallopian tubes. Classic IVF fertilization is possible when the man’s sperm is of good quality, which means that its parameters are close to the norm;
2. fertilization by ICSI – this method consists in introducing the previously selected sperm directly into the egg. This type of sperm injection is especially recommended for those couples whose infertility is due to the male factor. ICSI fertilization is also effective in female infertility, especially in cases of endometriosis, premature ovarian failure or immunological problems. The effectiveness of ICSI fertilization can be compared to “classic” in vitro fertilization. With the observation that the effectiveness of this method depends, inter alia, on the patient’s age and the quality of her eggs;
3. fertilization by IMSI method – this method uses advanced digital-optical technology, which is helpful in selecting a sperm for intracytoplasmic cell injection. The technology used allows to obtain a sperm image magnified 12 times. This magnification allows the detection of morphological changes in sperm organelles that are imperceptible in the standard ICSI method, where the image magnifies up to 000 times. The indication for the use of the IMSI method is an abnormal MSOME test result, which showed a significantly reduced percentage of morphologically normal sperm;
4. fertilization by PICSI – this technique uses the physiological properties of mature and properly built sperm to bind with hyaluronic acid. In this case, sperm are selected on the basis of morphological criteria and the positive binding reaction of the sperm to hyaluronan. Sperm that are normal and mobile react with hyaluronan through receptors on their head. The sperm that will be selected during the PICSI procedure significantly increase the probability of fertilization of the egg and subsequent proper development of the embryo.

What is fertilization? Read on: Fertilization – symptoms, course, when is it possible?

1. Physical preparation of the organism for in vitro – before the in vitro procedure, the patient should take care of her diet, which should include proteins, calcium and folic acid. Protein affects the production of healthier eggs, so it is worth enriching the menu with lean meat, fish or lentils. Calcium, on the other hand, provides nutrients that are extremely important for fertilization. The sources of calcium are yoghurts, green vegetables and nuts. Folic acid, in turn, is found in cereals, beans and peas. Before the IVF procedure, the patient should also hydrate the body and refrain from drinking alcohol and coffee. If a patient smokes cigarettes, she should also say goodbye to this addiction. Physical activity is also important, as it will improve blood flow, so it is worth doing light exercise or at least taking regular and long walks.
2. Mental preparation of the organism for IVF – mutual support of partners and a positive attitude towards the procedure itself is very important. It is worth spending more time honestly talking about your feelings during this specific time. In many cases, visits to a psychologist’s office are invaluable support. 

When is it worth using psychological advice? Check: Psychological consultations – when is it worth using them?

1. the age of the woman and her ovarian reserve – with age, the number and quality of egg cells decrease. This has a direct impact on a woman’s fertility;
2. semen quality – semen parameters can be checked by appropriate tests. The conclusion is simple, the smaller the number of motile and normal sperm cells, the lower the chances of successful fertilization;
3. the occurrence of diseases that cause infertility – depending on the type of disease and the stage of its advancement, the chances of conception may be lower;
4. the occurrence of diseases accompanying infertility – diabetes, infectious or autoimmune diseases significantly reduce the chances of successful fertilization;
5. genetic issues – they can affect the success of fertilization, therefore preimplantation tests of embryos are often performed during the in vitro procedure;
6. BMI index – problems with weight, obesity, but also underweight significantly reduce the chance of getting pregnant. Normal BMI should be between 18,5 and 24,99.
7. smoking tobacco and cigarettes – toxic substances from tobacco smoke significantly reduce the chances of conception. Smoking cigarettes also reduces the quality of semen;
8. structure of reproductive organs – anatomical defects may cause problems with implantation of the embryo and make fertilization much more difficult;
9. mental state of patients – negative attitude, severe stress, depression, general poor mental state are not conducive to embryo implantation, and in the later stages of pregnancy;
10. diet and lifestyle – improper diet and unhealthy lifestyle affect the quality of reproductive cells. These aspects of everyday life are also important in the process of embryo implantation and during pregnancy.

Do you want to know the cause of infertility? We recommend the KIR mail order genetic test for infertility diagnostics available on Medonet Market.

If you want to know how to prepare for pregnancy, read on: How to prepare for pregnancy? Psychological handbook

In vitro dinner

IVF is not the cheapest procedure, and not every pair can easily pay for it on their own. In cities where local governments do not run in vitro funding programs for couples, people applying for a child must take into account the costs of about PLN 7 to even a dozen or so. The price of the in vitro procedure itself also includes additional costs, e.g. of all follow-up visits, as well as of the couple’s diagnostics before the procedure itself. A lot also depends on the location of the selected clinic – usually those located in smaller cities have lower prices compared to, for example, Warsaw.

How much do Poles spend on treatment on average? Check: The Pole is not expected to see a doctor

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