What Are the Different Kinds of IVF Procedures?

People in our country often call "in vitro fertilization and embryo transfer" (IVF-ET) "test tube baby". In fact, in vitro fertilization is a special technology. It takes the eggs and sperm out of the body, allows them to complete the fertilization process in an artificially controlled environment in vitro, and then transfers the early embryo into the woman's uterus, Become a child. Babies produced using in vitro fertilization techniques are called test-tube babies, and these children also develop in the mother's womb. It can be said that "IVF" is equivalent to "in vitro fertilization".

Basic Information

Chinese name

IVF technology

Foreign name

test-tubebaby technique

nickname

In vitro fertilization

Visiting department

Department of Reproductive Medicine

Common causes

Infertility

IVF Technology Indications

1. Patients with tubal obstruction;

2. Unexplained infertility patients who have not been pregnant through IUI and other treatments;

3. The man has severe weak and weak spermatozoa, or the man has azoospermia, and needs sperm to be obtained through puncture of the testis or epididymis;

4. Women with endometriosis and infertility can use IVF to assist pregnancy as appropriate;

5. Patients with ovulation disorder have no mature follicle growth after general ovulation promotion treatment.

IVF Technical Classification

1. Conventional IVF and embryo transfer techniques;

2. Intracytoplasmic sperm injection technique;

3. Preimplantation embryo genetic diagnosis technology.

IVF technique process

Ovulation promotion treatment

Since not every egg can be fertilized, and not every fertilized egg can develop into a viable embryo, it is necessary to obtain multiple eggs from a female body to ensure that there are embryos that can be transplanted. This requires female ovulation promotion .

2. Egg retrieval

Under the guidance of the B-ultrasound, the doctor uses a special retrieval needle to puncture mature follicles through the vagina and suck out the eggs. Egg retrieval is usually performed under intravenous anesthesia, so women do not feel the pain caused by the puncture process.

3. In vitro fertilization

Sperm harvesting: When women retrieve eggs, men perform sperm retrieval. After the sperm undergoes a special washing process, the sperm and eggs are placed in a special culture medium in order to naturally combine. This is the so-called conventional fertilization method.

4. Embryo transfer

A few days after fertilization, a very thin embryo transfer tube is used to transfer the best embryo through the cervix into the mother's uterus. The number of embryos to be transferred is determined based on age, embryo quality and previous IVF outcomes, usually 2 to 3 Embryo. In recent years, in order to reduce the rate of multiple pregnancies, some centers have opted for single embryo transfer, or a maximum of 2 embryos.

Because the embryo transfer tube is thin and the doctor moves gently, the patient usually does not experience any pain.

5. Corpus luteum support

Due to the use of GnRH agonists / antagonists and ovulation-promoting drugs, as well as the loss of follicular granulosa cells caused by egg retrieval, women often have luteal insufficiency during the egg retrieval cycle, which requires the use of progesterone and / or chorionic gonadotropin for corpus luteum. Added / supported. If you are not pregnant, stop progesterone and wait for menstrual cramps. If you are pregnant, continue to use progesterone, usually 3 weeks after the B-ultrasound.

6. Determination of pregnancy

Serum HCG was measured 14 days after embryo transfer to determine if pregnancy. Serum HCG was measured again 21 days after embryo transfer to understand embryo development. Transvaginal ultrasonography was performed 30 days after embryo transfer to determine whether intrauterine pregnancy and fetal heartbeat were present.

IVF technical success rate

The success rate of IVF-ET technology is generally judged by the clinical pregnancy rate, that is, the ratio of the clinical pregnancy cycle to the embryo transfer cycle. Clinical pregnancy refers to the intrauterine pregnancy sac observed by vaginal ultrasound 28 to 30 days after embryo transfer. Different IVF centers have different success rates. Most centers have a success rate of 30% to 50% per transplant cycle. Some centers report a success rate of 60% to 70% per transplant cycle. The success rate of clinical treatment is affected by many factors. Impact, such as patient selection, clinical treatment methods, laboratory techniques, etc.

IVF Factors affecting IVF success rate with IVF technology

There are many factors that affect the success rate of IVF. Female age, the cause of infertility, and the quality of the IVF central laboratory are all factors that affect the success rate.

Age

It is an important factor affecting the success rate of IVF. With the increase of age, the number of eggs decreases, the quality decreases, the fertilization rate decreases, the pregnancy rate decreases significantly, and the abortion rate increases. The pregnancy rate of IVF for women aged 41 to 42 is 12%, the live birth rate per embryo transferred is only 5.9% for women over 42 years old, and the abortion rate for women over 43 years old is 50%.

2. Hydrosalpinx

Significantly reduced embryo implantation rate and pregnancy rate, reducing pregnancy rate by 50%. Therefore, women with hydrosalpinx should remove hydrosalpinx before IVF.

3. Uterine abnormalities

Endometrial damage, such as endometrial polyps, endometritis, previous surgery or inflammation (most common in tuberculosis), can affect embryo implantation.

IVF technical complications

In general, IVF technology is safe, but there may be some complications.

1. Ovarian Hyperstimulation Syndrome (OHSS)

Due to the growth of multiple follicles, some factors in the body change, causing fluid in the blood vessels to leak into the abdominal cavity and even the chest cavity, causing pleural and ascites fluid. The incidence is about 10%. Most people have mild symptoms, such as abdominal distension, abdominal discomfort, and mild nausea, which can be left untreated; however, a few people experience severe abdominal distension, oliguria, abdominal pain, poor appetite, and even chest tightness and shortness of breath. Intravenous fluids are even admitted to hospital for treatment. Less than 1% of people may develop thrombosis or renal failure.

2. Para-damage caused by egg retrieval

Bladder injury, patients may develop hematuria, usually by indwelling the urinary catheter and flushing the bladder, the purpose of hemostasis can be achieved. Occasionally puncture the blood vessels in the intestine or pelvis. Ovarian hemorrhage: In a few cases, the punctured ovaries will continue to bleed, and sometimes even an open abdomen is required to stop bleeding. pelvic infection

3. Ovarian torsion

Ovulation-promoting treatment results in the growth of multiple follicles, or the formation of multiple corpus luteum cysts after egg retrieval, which significantly increases the ovaries. At this time, when women are overactive or change their posture too quickly, they can cause ovarian torsion. Patients will experience sudden and severe abdominal pain, which may be accompanied by nausea and vomiting. If the twisted ovaries cannot be reset in time, surgery may be required. In severe cases, the necrotic ovaries need to be removed.

4. Multiple pregnancy

Because multiple embryos are transferred to the uterus, the rate of multiple pregnancy caused by IVF technology is significantly higher than that of natural pregnancy, about 25-30%. The risk of miscarriage and preterm birth in multiple pregnancy is significantly higher than that in single pregnancy, and the mother's risk of gestational diabetes, pregnancy-induced hypertension, dystocia and postpartum bleeding is significantly increased. Therefore, multiple pregnancy is not good for both mother and child. At present, many IVF centers are beginning to reduce the number of embryos transferred, or to perform single embryo transfers, in order to reduce the rate of multiple pregnancies. For three or more pregnancies, it is necessary to reduce the number of births. For twins, it is recommended that the patient reduce the number of births.

5. Ectopic pregnancy

The incidence of ectopic pregnancy in the general population is 1% to 2.5%. Although IVF transfers embryos into the uterus, due to the effects of fallopian tube chemokines on the embryos, the embryos will migrate into the fallopian tubes, implant and develop in the fallopian tubes, causing ectopic pregnancy. Sometimes embryos are also planted in the cervix and other parts. Therefore, receiving IVF treatment does not prevent the occurrence of ectopic pregnancy. On the contrary, the incidence of ectopic pregnancy in women receiving IVF treatment is higher than the general population, which is 2% to 4%.

The safety of offspring generated by IVF technology.

Test tube baby technology specific methods

1. Intracytoplasmic sperm injection

Monosperm intracytoplasmic injection (ICSI) is a special fertilization method that accompanies IVF. It is a technique for injecting a single sperm directly into an egg cell to assist in fertilization. The English abbreviation is ICSI. But even if sperm are injected directly into the egg cell, there is still no guarantee of fertilization. For those who need this technology, pregnancy rates will increase.

Indications include: those who need sperm or epididymal sperm extraction, men with severe and weak sperm usually require ICSI for fertilization; those who have failed conventional IVF fertilization may need to fertilize through ICSI (not absolute); Infertile couples can also consider using ICSI for fertilization; People with a history of abnormal fertilization, such as polyfertilization.

2. Preimplantation genetic diagnosis technology

Preimplantation genetic diagnosis (PGD) is an early prenatal diagnosis method that analyzes the genetic material of gametes or embryos before implantation to detect whether there is abnormality in the genetic material of gametes or embryos; through PGD, the selection of test items is normal Embryos for transplantation.

Indications include: sex-linked genetic disease; single-gene-associated genetic disease; chromosomal disease: abnormal number and structure of chromosomes; high-risk groups of children with possible fertility disorders.

3. Embryo freezing and freeze-thaw embryo transfer

Freezing excess embryos for later transplantation can increase the cumulative pregnancy rate of IVF and greatly reduce costs. Sometimes all embryos are frozen when there is a serious risk of OHSS, or when embryo transfer is not appropriate for other reasons. Therefore, embryo freezing and thawing embryo transfer has become an indispensable method in IVF treatment.

4.IVF repeated embryo implantation failure

There are many reasons why embryos fail to implant repeatedly. Some reasons are not clear. Treatments that may help include:

Check the chromosome karyotypes of both couples; Hysteroscopy, except for uterine abnormalities, such as the presence of endometrial polyps; Endometrial biopsy, to check for endometritis (pathology); Some literatures have reported that the pregnancy rate of people with endometrial blood loss is reduced, but some studies have not obtained such results; if there is hydrosalpinx, the hydrosalpinx must be removed; in some patients, embryo assisted hatching may increase Chance of implantation; Blastocyst transfer: The pregnancy rate of blastocyst transfer is higher than cleavage stage embryo transfer.

5. Embryo assisted hatching

Human fertilized eggs are early in the zona pellucida, and embryos must be hatched from the zona pellucida before implantation. When the zona pellucida is too hard, too thick, or other reasons cause the zona pellucida to dissolve, the embryos cannot hatch, which can cause implantation failure.

The specific methods of embryo assisted incubation include: cutting of zona pellucida; etching of acidic liquids; laser drilling method: applying laser to make holes or thinning zona pellucida.

Older women are prone to hardening of the zona pellucida. For women aged 38 years, with too thick zona pellucida and repeated IVF failures, embryo assisted hatching can be considered to improve embryo implantation rate.

6. Blastocyst culture

In IVF, the blastocyst is the end stage of the in vitro culture of the embryo. It usually forms 5 to 7 days after the egg is fertilized. In its natural state, human embryos are implanted into the mother's body in the form of a blastocyst. Therefore, it is not difficult to understand that blastocyst transfer can achieve a higher embryo implantation rate.

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