1 - Couples with unexplained failure of conception
2 - Patients with blocked tubes (the sperm cannot reach the oocytes to fertilize them)
3 - Patients with poor semen analysis.
4 - Patients with severe polycystic ovarian syndrome and dysfunctional ovulation
5 - Patients with endometriosis
6 - Patients with anti-sperm antibodies (both male and female)
Literally it means fertilization in a glass test-tube. It is laboratory assisted fertilization of the mature oocytes with sperms (after activation of the sperm in the laboratory). Once fertilised, the resultant embryos are transferred to the mother. The laboratory stage of the treatment takes 3-5 days. The chances of a pregnancy in a cycle of treatment are enhanced because more than one embryo can be transferred to the uterus of the mother.
Pregnancy is a natural phenomenon. It can take healthy couples up to 1 year to conceive a child. The age of the wife is very important to determining the urgency of seeking specialist treatment. If the wife is between 20 –29 years, she can wait a whole year, but if she is between 35 – 39 years, it is better to consult a specialist after 6 months, because women have greater difficulty achieving conception with advancing years.
IVF treatment has minimal discomfort and few complications. It has a relatively high success rate. If the cause of the infertility is male factor (poor semen analysis), and the wife is young and healthy, the success rate with IVF is very high. On the other hand, if the wife is older, overweight, with irregular periods and endometriosis, the success rate with IVF is lower.
Deciding on the best management of the problem is based on doing blood tests on the wife, giving her medications to stimulate her ovaries to produce eggs, and then collecting the eggs via a vaginal approach. Routine egg collection takes 15-30 minutes, and does not involve any major surgery. The mother can go home immediately afterwards, as long as there is someone at home to stay with her.
The eggs are fertilised with the husband’s sperm in the laboratory, and the resultant embryos are put in complex incubators to complete the fertilization process to a stage where the embryos are ready to be returned to the mother's uterus.
Embryo transfer takes 5 - 10 minutes, and is done through the cervix (again via the vagina). The mother can go home immediately afterwards.
This varies from case to case, depending on the cause of infertility. Sometimes embryo transfer is done after 24 hours, and sometimes after 3 to 5 days. But in the majority of cases, it is done after 72 hours.
The best embryos are chosen on the observation that the embryonic cells are dividing at an appropriate rate. The success rate is highest when first class embryos are transferred in a young mother (20 –30 years). Recently, aneuploidy screening allows selection of embryos with normal chromosomes. This new technique relies on removing a sample from the dividing embryo for genetic screening and analysis. It has doubled the success rate of IVF in certain cases.
There are 2 types:
This involves stimulating the ovary, collecting the oocytes, fertilization of the oocytes with activated semen, and then transfer of the embryos back to the mother.
This is the most modern technique for the treatment of infertility, particularly for couples where there is male factor infertility. With this procedure, the embryologist identifies the collected eggs and injects a single sperm into each egg directly with the sharp tip of a micropipette (7 times smaller than a hair) using a microscope.
This technique is particularly appropriate for:
1-Patients with very poor semen analysis
2-Couples who have had failure with Standard I.V.F. treatment
3-Patients with no sperm in the ejaculate, but who do have sperm in the testes. In these cases, the sperm are aspirated from the epididymis or extracted directly from the testes prior to ICSI treatment.
For these patients, ICSI is very successful.
PGD (Preimplantation Genetic Diagnosis) has become a powerful tool in assisted reproductive technology. It is the procedure by which the sex of the baby can be selected. It is possible to correctly identify male and female embryos in 95% of cases. One cell is removed from the embryo after the 3rd day (before transfer of the embryo into the uterus); this cell is genetically analysed so that the nucleus is classified as carrying either XX (female) or XY (male) chromosomes. Once identified and separated, only embryos of the desired sex (male or female) are returned to the mother. Sex selection by couples is only allowed in the UAE under certain strict situations, including management of hereditary diseases, and gender balance in families.