In Vitro Fertilization (IVF) refers to the fertilization of a woman’s egg outside of her body. The procedure involves ovarian stimulation, removing a mature egg or eggs from the woman’s ovary, fertilizing it with semen (in vitro: outside the body), incubating the dividing cells in the laboratory and then transferring the developing embryo in the mother’s uterus at the appropriate time. The fertilization of the eggs can be carried out by means of the conventional IVF technique or by Intracytoplasmic Sperm Injection (ICSI).
In Vitro Maturation is an alternative to IVF where the main differences are • there is little or no ovarian stimulation, • the egg/s are obtained from the woman’s ovary before they have completed their growth and final maturation. The collected immature egg/s complete their development in the laboratory before they are fertilized with semen. In IVM the pregnancy rate is lower than conventional IVF, thus it is reserved for carefully selected patients at risk for ovarian hyperstimulation syndrome (OHSS) and for those with contraindications to hormone administration.
PGD (Preimplantation Genetic Diagnosis) for single gene disorders is a genetic test that may be performed during assisted reproduction treatment to screen embryos that are at risk to develop a serious genetic disorder. PGD is performed on a small embryo biopsy and identifies which embryos are not at increased risk of developing the disease. Some genetic diseases only affect one sex rather than the other. In this case, the embryo is tested to find out its sex and only embryos of the non-affected sex are transferred to the mother’s womb. PGD is recommended for • couples at risk of transmitting chromosomal alterations or monogenic diseases, • couples with a medical history of repeated miscarriages, • couples with several cycles of IVF that have not achieved pregnancy, • when are abnormalities in spermatozoa maturation and • women of advanced age.
Preimplantation Genetic Screening 24 (PGS24) is a genetic test that may be performed on embryos during IVF treatment to screen for numerical chromosomal abnormalities and offers comprehensive analysis of all 24 chromosome types. PGS24 is performed on a small embryo biopsy prior to transfer and identifies which embryos are chromosomally normal. Chromosomally normal embryos are the most likely to develop to term and to be born as a healthy baby. PGS24 is recommended for couples with a previous pregnancy with chromosomal abnormality, couples who have experienced several spontaneous miscarriages of unknown cause, couples with several cycles of IVF that have not achieved pregnancy, men with low sperm concentration and for women over 35 years of age.
PICSI – Physiological Intracytoplasmic Sperm Injection is an innovative technique where the single viable sperm to be microinjected into the extracted egg is selected based on its ability to bind to specific molecules that are physiologically surrounding a mature-ready to be fertilized-egg. The use of IMSI for sperm selection significantly improves fertilization rate and embryo quality and thus the IVF outcome. Physiological Intracytoplasmic Sperm Injection (PICSI) is similar to ICSI but differs in the criteria used to select the single viable sperm to be microinjected into the extracted egg. While in ICSI the sperm’s selection criteria are based on the visual observation in the microscope, in PICSI the selection is made by imitating the selection that is made in human biology during fertilization of the sperm with the egg. The mature egg to be fertilized is surrounded by a specific negatively charged polysaccharide called Hyaluronic Acid (HA) or Hyaluronan and for fertilization to occur the sperm must be able to bind to it. During PICSI sperm is placed in dish containing samples of Hyaluronan hydrogel and competent, mature, biochemically active sperm binds to it and is selected and used for ICSI.
Semen sample for the use of any of the Assisted Reproductive Techniques can be provided by the man via normal ejaculation but whenever this is not possible, due to obstructive or nonobstructive azoospermia, sperm can be extracted via the TESE(Testicular/Epididymal Sperm Extraction) technique directly from the anatomical site of its production.
The time-lapse technology allows inspecting the development of their embryos with great frequency but without disturbing them or exposing them to outside air conditions.
Controlled Ovarian Stimulation