IVF and Assisted Reproduction
Fertilization outside the body, i.e. in vitro fertilisation and embryotransfer (IVF+ET) is a method thanks to which thousands of healthy children were born all over the world.
This method is the only treatment option for bilateral fallopian tube obstruction and andrology infertility (low sperm quality). Additional indications are the ovarian, immunologic and idiopathic type of infertility and endometriosis.
Basic principle: the egg is aspirated from the ovary, fertilized by sperm in laboratory and the resulting embryo is then transferred into the uterus.
How does it work? The entire process takes place during one menstrual cycle. Using hormonal drugs in the first half of the cycle we stimulate the function of the ovaries in order to have more eggs maturing at the same time. The aim of hormonal stimulation is that we want to get more eggs to choose from. From experience we know that some eggs are incapable of being fertilized and furthermore after fertilization only some embryos develop and are viable.
This controlled hormonal stimulation starts on the 2nd or 3rd day of the cycle, where despite the menstruation we usually perform ultrasound examination to make sure that everything is all right. If it is, a nurse administers the first injection dose and because these drugs are intended for self-administration, she explains everything to the patient and gives her necessary drugs till the next check-up. We monitor the ovarian response through repeated ultrasound examination - about 2- 4 times during 10-15 days. At the last check-up we plan the date for egg retrieval.
Egg retrieval (oocyte pick-up [OPU]) or also follicular puncture takes place in a short general anaesthesia. Therefore, it is necessary to have preoperative examination done by your practitioner. We aspirate the eggs with a needle inserted through the vaginal wall while checking the process with ultrasound; we insert the eggs into a special culture media and then they are under the care of an embryologist. The woman then rests for about two hours in bed.
About at the same time her partner hands in the sperm to be used to fertilize the eggs. The couple then talks with the embryologist about the number of eggs retrieved and is informed on further procedure. Depending on the situation we issue a sick leave note for the woman. The embryos are further cultured and after two to five days we insert the embryo or embryos through the vagina and cervix into the uterus, using a thin catheter. This is called the embryotransfer (ET).
Before embryotransfer the couple or just the woman is informed about the course of embryo culture procedure by an embryologist and then the embryotransfer itself takes the place; after this, there is about one hour rest in bed. We do not require a full bladder for embryotransfer. After ET we recommend to refrain from heavy physical activity. Since the egg retrieval the woman has taken progestogens, mostly in the form of vaginal capsules which should be taken at least until a pregnancy test. If she gets pregnant, she needs to take progestogens until approximately the 8th week of pregnancy.
All medical treatments are performed on an outpatient basis, without hospitalization. It is necessary to have an identity card to have the OPU and ET performed.
If we obtain more embryos than those transferred into the uterus, other embryos can be frozen and transferred after thawing in one of the next cycles, ideally after successful IVF, i.e. postpartum. This procedure is called FET – frozenembryotransfer. The woman thus no longer has to undergo ovarian stimulation or puncture.
The proof of pregnancy is performed after 14 to 16 days after ET through a reliable urinal test. Until then the woman should not discontinue using drugs, even if bleeding occurs!
Currently, the IVF method is covered by health insurance to women up to 39 years (39th birthday) by all health insurance companies. They pay three or four IVF cycles according to the number of transferred embryos. If only one embryo is transferred into the uterus in each of the first two cycles, the insurance company covers four IVF cycles. In case of transferring two or more embryos, only three cycles are covered.