Dr. Edgar Mocanu
Dr. Edgar V. Mocanu

Introduction to Assisted Reproductive Technology (ART)

Intrauterine Insemination (IUI)
Intrauterine insemination also called artificial insemination (AI) is a procedure where “laboratory prepared” semen is passed through the vagina and the neck of the womb into your womb. It is indicated where intercourse cannot occur, erection or ejaculation is not happening or as a last treatment before IVF. The semen must be of a certain quality in order for this procedure to be successful.  The female partner will have ultrasound monitoring (follicle tracking) to ensure egg development and also allow accurate timing of the insemination. Ovulation induction with tablets or FSH injections will be used. The likelihood of pregnancy is female age dependant and can be as high as 17-18% per cycle of treatment. In women over 40 the likelihood to conceive is less than 6% per cycle. 

In Vitro Fertilisation (IVF)
It is a laboratory procedure in which your eggs (recovered from your ovaries after stimulation) and your partner semen are combined in a test tube (used to be made of glass thus the “in vitro” term), kept at warm temperature and constant environment in an incubator and allowed to interact in a process called fertilisation. Following fertilisation, the development of newly formed embryos is monitored for two, three or five days before one or more are selected for transfer. This is a procedure during which your embryos are placed, using a very fine tube, through the neck of the womb into your womb. Over the next 14 days your embryos and your body will negotiate the establishment of a pregnancy.

Intra Cytoplasmic Sperm Injection (ICSI)
ICSI is used mainly for cases where the semen quality is so low that the interaction between your sperm and eggs, as described in IVF, is very unlikely to occur. As such, to avoid fertilisation failure, ICSI is used. Each “mature” egg that has been recovered from your ovary is injected with a sperm, under high magnification and using specific laboratory skills. Following injection and fertilisation the monitoring of embryo development, selection and transfer of embryos occurs as in IVF. It is only the process of facilitating sperm and egg interaction that is different between IVF and ICSI, one happens naturally, in the other the sperm is "injected" into the egg.

Ovarian stimulation, ultrasound monitoring and egg retrieval
It is a medical intervention during which some of your eggs (present in the ovaries) are stimulated to grow using a hormone called Follicle Stimulating Hormone (FSH). You will be injecting underneath your tummy skin, once daily and have ultrasound monitoring to count the number and measure the size of follicles that develop. The follicles are small cysts that contain the eggs. In order to ensure the eggs do not get released inside your tummy, as they grow, a second medication I used. This can be a nasal spray (agonist) or an injection called an antagonist. I will discuss this in more details with you at the time of the consultation. When the follicles reach a certain size, the eggs inside are ready to be “picked-up” from the follicles. This involves a surgical procedure during which you will receive an anaesthetic and a fine needle will be passed through the vagina directly into your ovaries. The fluid from the follicles will be aspirated, the eggs identified by a scientist and stored safely in preparation for IVF or ICSI.

Egg freezing
If egg freezing is the procedure you are embarking upon, the process will involve stimulation, ultrasound monitoring and egg retrieval. Following retrieval, the eggs are instantaneously plunged to -196 degrees Celsius in order to cryopreserve (freeze) them. This process is called vitrification and has increased likelihood of egg surviving after thaw (region of 95%). Pregnancy rates after thaw are female age dependant.

Embryo freezing
In women younger than 40, I recommend the transfer of one or maximum two embryos, quality depending. You should avail of embryo freeze for any other embryos remaining after transfer as they will offer you a second opportunity to conceive, without having to undergo a full treatment again.

Pregnancy rates
Pregnancy rates after IVF and ICSI are similar. In general, the likelihood of conception after one transfer is 50% for women under 30, 40% between 30 and 35, 33% between 35 and 40 and 20% in women over 40 years of age.

Risks
Main risks with IVF/ ICSI are reaction to medication, under response or over response to stimulation, infection or bleeding after egg retrieval, no eggs fertilising, no embryo to transfer and OHSS (Ovarian Hyperstimulation Syndrome) occurring in 1 in 100 treatments. I will discuss all these in detail with you.
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