Things to know about in vitro fertilization

Since its inception, in vitro fertilization (IVF) has always been the last clue for infertile couples who want to give birth to babies, when all other support solutions bow.

What is in vitro fertilization?

In vitro fertilization is a method of fertilization in which eggs are fertilized by sperm outside the body, in vitro. This is a method that is applied after the fertility support technique has failed, applied to those who are of reproductive age or women, for whatever reason. Therefore, sperm cannot fertilize eggs by natural methods. Ovulation is controlled by hormones and fertilized eggs are inserted into the uterus.

The method, considered to be the solution for these infertile couples, is named in vitro fertilization by its biological father, Dr. Robert G. Edwards, who conducted all studies in conventional test tubes. Achieving success in 1978, this method was called with its true nature at the time.

In vitro fertilization is a method of fertilization in which eggs are fertilized by sperm outside the body, in vitro.

Currently, fertilization is no longer carried out in vitro, instead, this process takes place on Petri dishes . However, this method is still called in vitro fertilization in the traditional way of calling because in essence, not so many things are changed.

Studies show that conducting in vitro fertilization from frozen embryos has a higher likelihood of success with greater safety for embryos compared to fresh embryos taken directly from parents. Even using frozen embryos helps to reduce the risk of bleeding during pregnancy, limiting premature births and ensuring a healthy weight for the fetus.

In fact, in vitro fertilization is considered a cure for inferior couples by the superior ability it possesses. Specifically, all problems related to childbirth, including problems in female reproductive organs as well as low sperm quality in men are easily overcome.

In order to increase the success rate of in vitro fertilization, most doctors usually implant 2-4 embryos simultaneously into the mother's body at the same time. This means that people who perform in vitro fertilization often have a much higher rate of twins, triplets or life. However, having multiple pregnancies causes the mother's body to be overloaded, causing an adverse effect on the success of in vitro fertilization. Therefore, doctors are the ones who give the most reasonable advice to parents who wish to have children.

In fact, the successful birth rate for in vitro fertilization is not absolute. In particular, the successful birth rate among young couples is much higher than for older people who want to give birth by this method. Specifically, the success rate in the group of people under 21 years old is up to 35.3% while the success rate among people over 37 is only 27.4%. In particular, no in vitro fertilization has been successful for people over 48 years old.

Process of in vitro fertilization

1. Examination and assessment of fertility

Test wife

1. Endocrine testing

The endocrine test is to quantify the concentration of blood hormonal hormones such as FSH, LH, estradiol, testosterone, and SHBG to assess the endocrine status of the ovaries and organs involved in birth activity. product. This is one of the tests that contributes to the diagnosis of the number of ovaries remaining in the ovary as well as the prognosis of the ovary's response to stimulants in the case of in vitro fertilization or pumping sperm into the uterus. .

Recently, AMH (anti-Mullerian hormone) is considered to be a more accurate endocrine test and can replace FSH, LH and estradiol in ovarian reserve assessment. If FSH, LH and estradiol need to be tested in the first days of the menstrual cycle - from day 1 to day 5, AMH can be carried out at any time of the menstrual cycle.

1. Test of sexually transmitted diseases

Normally, all patients who go to infertility examination are given blood tests for HIV, hepatitis B, syphilis and Chlamydia trachomatis.

Chlamydia trachomatis is a bacterium that can be transmitted sexually. For the majority of women, Chlamydia trachomatis leaves itself and does not leave sequelae. However, in some other cases, the infection may spread to the uterus and two ovaries, increasing the risk of infertility due to ovarian injury. Therefore, Chlamydia screening tests are often combined with other tests in the diagnosis of ovarian lesions.

1. Gynecological ultrasound, counting follicles on ovaries

Gynecological ultrasound through vaginal recurrence helps detect gynecological abnormalities such as uterine fibroids, ovarian cysts, congenital abnormalities of the genital tract (double uterus, double-horn uterus, uterus with septum, no uterus, .), polycystic ovary.

In infertility examination, gynecological ultrasound should also be conducted in the early days of the menstrual cycle, not only to diagnose the above abnormalities but also to count the number of follicles on the ovary. Ovarian follicle counting is also a subclinical factor that helps assess the number of eggs remaining in the ovary and prognosis of ovarian response to ovarian stimulants.

Husband test

1. Semen

Map semen is a simple, cost-effective test, and provides important information in diagnosis and treatment. Semen samples are taken by masturbation after 2-7 days of abstinence from sex. Taking semen during abstinence for less than 2 days usually results in low sperm count. On the contrary, abstinence from sex for too long will result in a decrease in the percentage of mobile sperm. Semen samples must be contained in a special device, made of non-toxic material for sperm.

Through the results of semen, the doctor will assess the quality of the semen sample tested: low sperm, weak sperm, abnormal sperm or no sperm. Except for non-sperm, semen sperm does not help confirm the fertility of the patient, only suggestive. Sperm quality can vary between different semen making.

In 2010, the World Health Organization standardized and introduced the minimum standard of a normal semen:

1. Volume ≥ 1,5 ml.
2. Sperm density ≥ 15 million / ml.
3. Total sperm count trùng 39 million.
4. The ratio of mobile sperm reached ≥ 32%.
5. Normal shape of sperm trùng 4%.

Other tests

Husbands are also tested for sexually transmitted diseases such as hepatitis, HIV, and syphilis. In the absence of sperm, patients may be assigned to carry out other specialized tests such as blood hormone endocrine assay (FSH, LH, Testosterone), scrotal ultrasound, transvaginal ultrasound. rectal. In some cases, the patient may have a testicular biopsy before a treatment decision is made.

Currently, fertilization usually takes place on Petri dishes.

2. Pre-anesthesia test

The patient was tested for blood, urine, electrocardiogram, chest X-ray to help evaluate the condition before performing a procedure to suck the ovum and get pregnant.

3. Stimulate the ovary

Ovarian stimulation is performed on a case-by-case basis. The duration of ovarian stimulation may vary from 2 weeks to 4 weeks, depending on whether the patient is given a short or long-term regimen.

1. Ultrasound follicles and endocrine quantification

The number of follicles and the rate of follicular growth in cycles of ovarian stimulation depends on the drug and ovarian stimulation regimen used. Ultrasound helps assess the number and development of follicular follicles, thereby helping to adjust the dose promptly to achieve optimal ovarian response and minimize possible complications. In the process of stimulating the ovary, the patient will receive an ultrasound of the follicle 2 to 3 times. When the follicle reaches 18-20 mm in size, the patient will receive hCG, the ovule to mature and cause ovulation.

Parallel to the ultrasound process of follicular follicles, endocrine quantification is also necessary in the process of monitoring the development of follicular follicles. Quantification of estradiol (E2) is often used in the monitoring of follicular growth due to the correlation between E2 concentration in the blood and the development of oocyte follicles. Normally, the concentration of E2 will increase by half or twice the previous day, and it is expected that the follicle will grow well.

In addition, quantifying LH and progesterone levels will also help predict the quality of eggs. Normally, the concentration of these two substances in the blood is usually low during the ovarian stimulation process. If elevated levels of LH and progesterone can reduce oocyte quality and embryo quality.

4. Prick the ovum

Patients will receive ovarian aspiration around 36-40 hours after hCG injection. The ovary aspiration is performed through vaginal contraction and the patient will receive local anesthesia and general anesthesia. Patients who did not eat or drink before sucked eggs for 4 hours. After being sucked, the ovum will be transferred to the laboratory room to process and combine with the husband's sperm to form the embryo. After combining eggs and sperm into embryos, the embryo will be cultured in vitro 2 to 3 days or 5 days before transferring into the womb of the wife.

5. Transfer the workpiece

Embryos after being in vitro for 2-3 days (or 5 days) will be transferred to the womb of the wife. The number of embryos depends on the age of the wife, the cause of infertility, the number of previous cycles as well as the current quality of the embryo. The doctor will decide the number of embryos to transfer to achieve the highest pregnancy rate and minimize the risk of multiple pregnancies.

Normally, about 2-3 embryos are transferred on average with a pregnancy rate of about 35-40%. After embryo transfer, patients only need to rest in place for 1-2 hours, then can return to normal. After embryo transfer, if there are excess embryos and good patients will be consulted to store cold embryos to be able to use for later cycles. The patient was given medication to support the nesting process of the embryo 2 weeks before the pregnancy test.

6. Pregnancy test

Performed after 2 weeks of embryo transfer. Patients will be evaluated for beta-hCG in the blood. If the pregnancy test is positive, the patient has an ultrasound appointment to confirm the pregnancy 3 weeks later. The higher the beta-hCG value, the higher the chance of multiple pregnancies.

7. Fetal ultrasound

Ultrasound is performed after 3 weeks if beta-hCG is positive. Ultrasound is used to determine the exact pregnancy or not, the number of pregnancies and the state of pregnancy.

Things should and should not be done when in vitro fertilization

1. Nutrition

Patients eat normally, no need to abstain from any food during ovarian stimulation and after embryo transfer. Patients at risk of ovarian hyperstimulation should eat a lot of protein (meat, fish) and drink plenty of water can help reduce ovarian hyperstimulation quickly.

1. Life style

The husband should not smoke because it can affect sperm quality, thereby affecting the quality of the embryo and the outcome of pregnancy. The wife does not do heavy work nor does she practice heavy sports during ovarian stimulation and after embryo transfer. Husband and wife relationship should be avoided during ovarian stimulation and after embryo transfer.