What are the cons of IVF
IVF (in vitro fertilization)
In in vitro fertilization (Latin for fertilization in a jar), the egg cell (ovum) and sperm are brought together in a bowl. A sperm fertilizes the egg and so a child is created through artificial insemination.
For IVF, egg cells and sperm cells are needed outside the body. Obtaining sperm is easy, while egg collection can be a little more complicated.
The first successful IVF treatment was performed in 1978. At that time, no hormonal stimulation could be carried out; instead, egg retrieval took place in a natural cycle. Only one egg could be obtained in this way.
The chances of success with IVF without stimulation would be very sobering, especially for older women.
How does IVF treatment work?
The course of treatment is divided into the following stages:
- Hormonal stimulation of the ovaries,
- Triggering ovulation,
- Egg retrieval,
- Fertilization of the egg in the laboratory,
- Embryo transfer,
- Support for the second half of the cycle.
1. Hormonal stimulation
The start of IVF is ovarian stimulation. In the natural cycle, usually only one ovarian follicle matures with one egg cell. To increase the chances of success of the treatment, the woman's ovaries are stimulated by injecting natural hormones - usually a combination of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). In this way, as many egg cells as possible mature in the ovary and premature ovulation is also prevented.
Egg maturation is monitored by ultrasound and blood sampling.
2. Induction of ovulation
Once the egg cells have matured, usually between day 10 and 12, ovulation is triggered by another hormone injection. Here the human chorionic gonadotropin is mostly used as a preparation.
3. Egg retrieval
The egg retrieval takes place around 48 hours later in a small surgical procedure. The removal can be carried out in the practice by the attending physician and is carried out with sleep anesthesia or a brief general anesthetic.
An ultrasound machine with a special, thin needle is inserted into the vagina. With the needle, the egg cells are sucked out by puncturing the follicle together with the follicular fluid.
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If you start with examinations in the field of fertility medicine, you quickly notice that you have to make decisions about diagnostics, fertility treatment yourself and additional optional services.
Up to 20 egg cells can be obtained in this way, but usually only 5 to 10. The amount depends heavily on the age of the patient. There is not always an egg in every ovarian follicle, so the number can differ from the number of follicles seen on the ultrasound.
The egg cells are then placed in nutrient fluid in the laboratory and carefully examined. It can happen that not all the eggs that are removed are fertile eggs.
On the day of the egg retrieval, the partner's sperm is required. The semen can be obtained at home or in the practice. It is then processed so that only the most motile sperm are ultimately used for artificial insemination.
4. Fertilization of the egg
For fertilization, one egg is placed in each shell in the IVF laboratory and around 100,000 sperm cells are added. The bowls are placed in a special heating cabinet. After about 24 hours, a check is made to see whether fertilization has taken place. In IVF, just like in the body, it is purely random which sperm fertilizes the egg.
Over the next few days, the development of the fertilized egg cells will be checked in the embryological laboratory. The embryo grows into a multicellular stage and becomes a blastocyst. It can happen that some embryos do not develop any further and can therefore no longer be used. This is completely natural and would happen in the body as well.
5. Embryo transfer
Once the fertilized egg cells have turned into a blastocyst - usually on day 5 of treatment - the embryo transfer can take place. To do this, one or more blastocysts are placed on a thin plastic tube and placed in the uterus. This medical procedure is almost always painless and is therefore carried out by the doctor without anesthesia or anesthesia.
In Germany, a maximum of three, more likely only two, blastocysts are normally placed in the uterus. If several embryos are used during in vitro fertilization, this has the advantage that the chance of pregnancy increases. If one embryo is not viable, there is another.
Using too many embryos can be dangerous. Because if all embryos implant and grow, the risks of malformations, premature and miscarriages and other complications are very high. A healthy center must therefore be found, which is around two to three embryos.
Surplus embryos, i.e. blastocysts that are left over after assisted reproduction, can be frozen in liquid nitrogen if desired. They are then used in the next cycle of artificial insemination if it fails, or in the case of in vitro fertilization for another child even after several years.
6. Support for the second half of the cycle
In the last step, the second half of the cycle - the corpus luteum phase - is supported by taking the hormone progesterone. This allows the lining of the uterus to build up well and the chances of the embryo implanting are increased.
What are the advantages of IVF?
Conventional IVF treatment bypasses many disruptive factors that can stand in the way of a natural pregnancy. The biggest advantage is that the sperm don't have to travel the long way from the vagina to the ovary.
In some women, the vaginal mucus kills the sperm, in some the fallopian tubes are blocked, in other couples the sperm are too slow, or there are simply too few. These are just a few examples of complications that no longer play a role in assisted fertilization by IVF.
What are the risks of in vitro fertilization?
The drugs and hormones used in the treatment are mostly natural, not artificial. However, they can still cause side effects.
In rare cases, the medication can overstimulate the ovaries. Then too many egg cells mature from taking the hormones. That sounds good at first, because a lot of egg cells mean a lot of chances of having a baby.
However, due to the large number of follicles, there is a large accumulation of fluid in the abdomen, which can lead to weak to very severe pain, nausea and vomiting.
In addition, unprotected sexual intercourse must be avoided in the event of overstimulation. Because the large number of egg cells present can lead to extreme multiple pregnancies even after removal, which can be very dangerous for the mother.
Egg retrieval is just a puncture, but is considered a surgical procedure and is performed under anesthesia. Every anesthetic always carries a certain risk.
What are the chances of treatment?
Even under optimal conditions, not every in-vitro fertilization is successful. The chances of getting pregnant depend on many factors, such as age, and can be very individual.
In young couples with no known fertility problems, the chance of success with artificial insemination is much higher than in older couples, in whom the sperm quality is poor and the ovarian reserve is almost exhausted.
From a global perspective, there is a 20-30% chance of success with IVF per embryo transfer. That doesn't sound like much, but it is actually slightly higher than the probability of pregnancy naturally per cycle.
Couples who are undergoing fertility treatment have already made many attempts in the first step to become pregnant naturally. Fertility disorders are common. With this in mind, 20-30% per IVF treatment is not a bad chance of success.
According to the German IVF register, 20,000 children were born after artificial insemination in Germany in 2015, and 65,000 couples opted for fertility treatment.
What other options are there in reproductive medicine?
If IVF does not work, or if other fertility disorders are known, for example with regard to the quality of sperm, the desire to have children can still be fulfilled. In reproductive medicine, more and more methods are being developed with which in vitro fertilization can be supported or continued.
The further method to IVF is the Intracytoplasmic Sperm Injection (ICSI). The process of ICSI hardly differs from that of in vitro fertilization, but here a sperm is selected that is injected into an egg at a time.
In addition to IVF and ICSI, there are many other therapies to support assisted reproduction, such as assisted hatching, in-vitro maturation or TESE.
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ICSI - procedure, treatment and opportunities
Intracytoplasmic sperm injection (ICSI) is a method of artificial insemination for couples who want to have children. During the treatment, a single sperm cell is injected directly into an egg cell with a fine needle so that an embryo can develop. As with IVF, eggs and sperm are brought together outside of the body.
Blastocyst and Blastocyst Transfer - Process and Chances
In the case of a blastocyst transfer, embryos are only transferred at an advanced stage of development in the context of artificial insemination. This stage is usually reached five days after the follicular puncture. The method can significantly increase the chances of getting pregnant during IVF / ICSI.
Assisted hatching - method, opportunities and risks
Assisted hatching is a relatively new procedure that is used in the course of artificial insemination. In this method, the shell of an egg cell is thinned with a laser in order to increase the likelihood of an embryo implanting. The method is only used for IVF or ICSI. Egg cells and sperm can also come from cryopreservation.
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