Assisted reproductive technologies and methods

IVF (in vitro fertilisation)

In vitro fertilisation is a process of fertilisation where an egg is combined with sperm in vitro, and then allowing them to incubate. The sperm fertilises the egg. Embryologists do not interfere with the fertilisation process and only observe it. Later, an embryo is transferred to the uterus. This method is used when the quality of sperm is appropriate. However, before the procedure, in addition to the standard spermogram, it is advisable to perform sperm function testing to determine the capacity of sperm to fertilise an egg.

ICSI (intracytoplasmic sperm injection or micromanipulation-assisted fertilisation)

This method of fertilisation is also called micromanipulation-assisted fertilisation (injection of a single sperm into the cytoplasm of an egg) using special equipment. This technique is used to treat severe cases of male factor infertility when the capacity of sperm to fertilise an egg is low as well as in cases of female factor infertility when the egg count is low or, in case of poor response to ovarian stimulation, to increase the number of fertilised eggs and the number of embryos. When this technique is used, an embryologist injects a single sperm into a mature egg using a special needle. Micromanipulation-assisted fertilisation is the only possibility to use sperm if it is not contained in the seminal fluid because in this case sperm is obtained from testicular tissues using the TESA technique.

PICSI (physiological intracytoplasmic sperm injection)

PICSI is an additional method of selecting sperm. This method allows selecting not only morphologically appropriate but also functionally mature, viable sperm. When the PICSI technique is used, prior to ICSI, sperm is placed in a culture dish with a special medium containing hyaluronic acid. Only mature sperm are capable to bind with it and lose their motility whereas immature ones continue to float freely. Only physiologically mature sperm are selected for fertilisation. 

Preimplantation genetic testing (PGT) of embryos for aneuploidy

(PGT-A, also known as PGS (preimplantation genetic screening)). Preimplantation genetic screening is used to identify numerical and certain structural chromosomal abnormalities of embryos obtained in the course of IVF; the screening is performing right before embryo transfer. This screening enables verifying the normal/appropriate number of chromosomes, which is the main difference of this method from preimplantation genetic diagnosis (PGD) that is aimed at testing for specific genetic defects.

The appropriate number of chromosomes is a guarantee of a healthy embryo. A healthy embryo must have 46 chromosomes. Any changes in the quantity may show certain abnormalities and be a cause of early miscarriages, for instance, in case of Down syndrome, Edwards syndrome and Patau syndrome.

Various chromosomal abnormalities are one of the main causes of unsuccessful embryo implantation during IVF treatment. Chromosomal abnormalities also cause approximately 70% of early miscarriages.

This method is aimed to test embryos for the normal number of chromosomes, which enables implanting a healthy embryo free from any aberrations.

IUI (intrauterine insemination)

It is an artificial insemination technique that is recommended in case of minor changes in the spermogram and in the absence of issues with tubal blockage and in the presence of ovulation because the process of egg fertilisation takes place naturally. The insemination is performed on the day of ovulation. Sperm of your partner (or a donor) that have been washed and concentrated are placed directly in the uterus.

Egg vitrification (egg freezing)

Egg vitrification is one of the most demanded techniques among modern women, which provides a unique opportunity to postpone childbirth and in this manner create a “guarantee” to those who need to plan their life and time carefully. This technique is also recommended to those who have cancer or is to undergo radiation therapy or chemotherapy or ovarian surgery.

The social factor and the absence of a sexual partner as well as genetic tendency to premature ovarian failure are also indications to have eggs vitrified.

AVA Clinic also provides an opportunity to perform egg vitrification when a patient undergoes artificial insemination treatment, namely in cases where no partner sperm is available or the quantity of sperm is insufficient on the day of ovarian drilling.

This technique is recommended to women up to 38 years of age, although every patient may discuss her situation with her doctor. Thanks to the modern vitrification technology, the threat of damaging eggs is minimised. The rate of egg survival after thawing at AVA Clinic is 93%.

TESA (testicular sperm aspiration or testicular biopsy)

TESA is performed to obtain sperm from testicular tissues or seminiferous tubules. This procedure is performed in cases such as ejaculatory duct obstruction or congenital absence of the vas deferens, absence of sperm in the ejaculate or after vasectomy/male sterilisation. In exceptional cases, the obtained sperm may be vitrified.

Embryo cultivation in an incubator with time-lapse monitoring (EmbryoScope and Geri incubators)

These time-lapse incubators enable the ongoing embryo monitoring in real time without disrupting the controlled culture environment, until the moment of embryo transfer to the uterus. Thanks to the integrated microprocessor that ensures the optimal temperature and gas content in the time-lapse incubators, conditions for embryo development similar to those in case of natural conception are ensured. All this ensures embryo development in a safe and stringently controlled environment and excludes the risk of stress factors related to the development.

Embryo cultivation until the blastocyst stage

This technique of embryo growth in incubators provides for their prolonged cultivation outside of the woman’s body for up 120 hours. This method allows selecting the strongest and best embryos for embryo transfer, with the highest potential to be successfully attached to the uterine wall. To ensure the development and viability of embryos in incubators, conditions that are as close as possible to the natural environment are provided.

EmbryoGen/BlastGen

These two media are used for embryo cultivation from the moment of fertilisation to the blastocyst stage and for embryo transfer. Thanks to the content of the media, the woman’s organism does not view an embryo as a foreign body. When EmbryoGen and BlastGen are used, the interaction of the embryo and endometrium is improved, which provides an opportunity to implant and to guarantee successful pregnancy. The use of EmbryoGen/BlastGen is recommended after recurrent unsuccessful implantations whereby, when good quality embryos are transferred, implantation does not occur, or in case of recurrent spontaneous pregnancy loss. 

Assisted hatching (opening of the zona pellucida)

Assisted hatching is a procedure in which a small hole is made in the zona pellucida to facilitate the attachment of the embryo to the uterine wall. The procedure is performed right before embryo transfer. In case where the zona pellucida is thicker than normal, it will not break and the embryo will not be able to attach to the uterine wall. An embryologist uses a laser to make small holes in the zona pellucida to facilitate implantation and maximise the chances of pregnancy. 

Fertile Plus

Fertile Plus is a method of selection of the best sperm based on their morphological and DNA fragmentation parameters. In this case, a special membrane is used to select mature sperm with the appropriate morphological structure. This technique allows avoiding any additional sperm processing and reduce the oxidative stress of sperm during fertilisation. This technique not only increases the viability of sperm but also their motility compared to unprocessed material.

Embryo Glue

It is a special medium that is used during embryo transfer to increase the chances of successful embryo implantation. This medium is rich in hyaluronic acid, carbohydrates and amino acids that act as binding components during embryo implantation in the uterus. Scientific research has revealed that, at the time of embryo implantation in the uterus, the level of hyaluronic acid that helps embryos to be implanted/to attach increases. Right before embryo transfer, the embryo is placed in Embryo Glue that is rich in hyaluronic acid to increase the embryo’s capacity to securely attach to the uterine wall.

ERA (endometrial receptivity analysis).

This analysis enables determining the optimal time for embryo transfer and synchronising the time of embryo transfer and the implantation window. This analysis is recommended to couples with repeated implantation failure (RIF). RIF is diagnosed when good-quality embryos repeatedly fail to implant, and there are no other evident causes of failed pregnancy. In these cases, the need to perform the analysis is discussed with your doctor.