IN VITRO FERTILIZATION
IMPORTANT MESSAGE : MEDICAL COUNCIL DECISION CONCERNING PATIENTS OF AGED OVER 43 YEARS OLD - data analysis of IVF cycles carried out at the ovo clinic demonstrate that the chance of obtaining a live birth in patients of 43 years of age or older are minimal. As of August 20th 2010, the ovo clinic Medical Council has decided to no longer propose IVF for patients after 43 years of age. At the ovo clinic the only alternative treatment that will be offered is egg donation.
IMPORTANT MESSAGE : MEDICAL COUNCIL DECISION CONCERNING PATIENTS WITH A BODY MASS INDEX GREATER THAN 35 - Over a certain weight, the chances of pregnancy are reduced and the chance of a miscarriage as well as obstetrical problems during the pregnancy are increased. Your BMI must be under 35 in order to start a cycle of in vitro fertilisation.
You can calculate your BMI by going to this link.
The idea is to reproduce the natural process of fertilisation in a test tube as well as the first steps of the embryo’s development.
The woman’s ovaries are stimulated using hormone injections to produce several oocytes (or eggs). The process of stimulation lasts between 2 and 5 weeks. The idea behind the stimulation is that if there are several eggs obtained, the number of embryos will be greater and it is easier to select the best embryo for the transfer.
During this period, the growth of the follicles is monitored by ultrasound. It may take between 2 and 4 ultrasounds as needed.
Once the stimulation is completed , we proceed to the collection of the eggs from the follicles. We collect the maximum number of oocytes as possible to keep them in the laboratory where they are put into contact with the spermatozoa that were produced the same day. The egg retrieval is carried out under local anaesthesia and sedation.
Approximately 48 to 72 hours after the egg retrieval, the embryo transfer is carried out to the patients uterus so that it can implant. Additional embryos can be cryopreserved (frozen). Certain medication is necessary after the embryo transfer in order to help with the implantation. Two weeks after the egg retrieval, a pregnancy test will be carried out to verify if an implantation has taken place.
Natural cycle IVF (nIVF) was used for the very first test-tube baby born in England over 30 years ago, but this technique fell out of favour as the introduction of IVF with ovarian stimulation developed; the principle to produce several eggs with the help of medication.
In nIVF, the egg that has been naturally selected during the course of the menstrual cycle is collected with minimum medical intervention. The egg is then fertilised in the laboratory before being transferred into the uterus once it develops into an embryo. This method is gentler than classic IVF treatment since it removes the use of medication to stimulate the ovaries, it eliminates secondary effects related to the ovarian stimulation as well as removing the risk of multiple pregnancy with the exception of monozygotic pregnancy (identical twins).
The risk of ovarian hyper-stimulation syndrome is removed also without stimulation of the ovaries. Another benefit is the possibility to carry out cycles in consecutive months.
Indications for nIVF
Generally, nIVF is offered to patients with regular cycles, who have a normal ovarian reserve and who are less than 37 years old.
nIVF appears to be a interesting alternative for certain populations of patients who have a poor prognosis. Also it can be an option in cases of repeated implantation failure defined by the absence of pregnancy despite the transfer of several good quality embryos from stimulated cycles. Sometimes the ovarian stimulation creates a significant increase in circulating levels of estradiol which may reduce the chance of implantation.
Young patients with abnormally low ovarian reserve of follicles are also good candidates as it is more appealing to obtain an embryo from a natural cycle rather than having a small number of embryos obtained after stimulation with maximum doses of medications. The implantation rates (the chance for an embryo to establish itself in the uterus after the transfer) in nIVF are higher than those obtained after stimulation.
Of course, nIVF may also be offered to couples with a good prognosis. Thus, many couples after a vasovasostomie failure qualify for this treatment. In this case the nIVF is associated with a sperm micro-injection technique (ICSI) after the sperm is obtained from the epididymis. It is often a situation where the man may already have children from a previous relationship and wants to avoid ovarian stimulation and possibly a twin pregnancy with his new partner who is often young and without any fertility problems.
nIVF may also be a sensible alternative for women who have a history of cancer linked to hormones where it is essential to avoid ovarian stimulation.
The advantages of this minimally invasive treatment are indisputable and should be used more often. However, IVF with stimulation remains an indispensable tool for many infertile couples, especially when a woman's age exceeds 35 years.
The medical team at ovo fertility has been responsible for two medical advancements that open new horizons for couples suffering from infertility:
Disadvantages of nIVF
The detractors of nIVF list the daily monitoring, the risk of premature ovulation, an increased risk of cycle cancellation, the requirement for staff to be available during the day and night, the risk of failing to obtain the oocyte and the chance of cancelling the embryo transfer as major negative points for nIVF. Due to these reasons, the proportion of cycles that complete from egg collection to embryo transfer is around 50%. If there is an embryo transfer a pregnancy will be obtained in 36% of cycles.
assisted reproduction techniques- gamete donation >>