SECOND LEVEL TECHNIQUES
All second-level MAP techniques (the most used are Fivet, Icsi) include a series of preliminary tests to exclude diseases that may interfere: among others, blood group, karyotype, cystic fibrosis screening, hepatitis B and C, HIV ; for her also pelvic and breast ultrasound, hormonal assays, pap tests, vaginal swabs for the detection of chlamydia, mycoplasma and trichomonas, antibodies to rubella, toxoplasmosis, cytomegalovirus, herpes; for him spermiogram and urethral swab.
The woman may also be prescribed more invasive tests, such as laparoscopy and hysteroscopy. In Vitro Fertilization with Embryo Transfer (IVF)
For who. IVF is a very widespread technique, which allows to treat various dysfunctions both female and male: for example, endometriosis, bilateral tubal occlusion, lack or altered spermatozoa (low number, poor motility, morphological damage) or male genital alterations that prevent the sperm being emitted with the ejaculate; it is also indicated for idiopathic infertility that has not had results with first level MAP techniques.
An IVF is a complex procedure that lasts about four weeks, in various stages (some may vary according to the therapy established by the doctor.
Ovarian stimulation. Almost always the treatment begins with the intake of drugs (GnRh analogues or GnRh antagonists) that 'rest' the pituitary gland to prevent it from triggering ovulation at a certain point in the cycle, dispersing the follicles before collection.
The ovaries are stimulated (usually with gonadotropins) to produce more follicles at the same time to retrieve more eggs to fertilize. The drug and dose vary depending on how the patient is expected to react to treatment.
The development of the follicles is controlled by means of ultrasound scans and dosages of estradiol (the hormone that increases with the development of the follicles), also to avoid the danger of ovarian hyperstimulation (fortunately a very rare risk that causes enlargement of the ovaries, accumulation of fluid in the abdomen, and possible respiratory, cardiac, liver and kidney complications).
When the follicles are sufficiently developed, a dose of Hcg or Lh is administered to complete their maturation. After about 36 hours there is ovulation and then the egg retrieval.
In cases of azoospermia it is possible to recover the spermatozoa directly from the testicles through surgery (Mesa, Tesa, Tese). The seminal fluid is also examined and subjected to a preparation to recover the most mobile and morphologically normal spermatozoa.
If the law allows it, the frozen embryos can be used if the IVF cycle fails and the woman does not need to undergo further hormonal stimulation. Intracytoplasmic sperm injection (ICSI)
For who. Icsi is indicated in cases of severe male infertility, because it gives the possibility of obtaining fertilization with only one sperm for each oocyte (in IVF it takes at least 200 thousand): oligospermia (sperm concentration less than 5 million / ml), teratospermia ( with a percentage of spermatozoa with normal shape lower than 7-8 percent) and asthenospermia (sperm motility lower than 10 percent), and even if there are no spermatozoa in the seminal fluid and it is necessary to take them directly from the epididymis or the testicle (with called Mesa, Tesa and Tesi, see).
ICSI is also used when there are few oocytes or if IVF has not been successful. How. ICSI is identical to IVF, except in the way fertilization occurs: while in IVF the oocyte and the spermatozoa are brought into contact in the culture fluid and left to "do it all by themselves", in ICSI a single sperm is injected with a microinjection carried out with the help of a high-magnification microscope inside each oocyte.
How. In IVF there is ovarian stimulation, the use of mature oocytes and the preparation of seminal fluid before fertilization, to which only the morphologically best spermatozoa are destined.
(Scientific advice by, gynecologist and endocrinologist of the Maugeri Foundation -)
To know everything about fertilization go to our special: Fertility and conception, from natural fertilization to assisted reproduction
- assisted fertilization
- first level techniques
- second level techniques