Methods used in IVF
When nature seems to fail, we at GYNCARE are able to help you. We use state-of-the-art treatment procedures and take advantage of the most efficient instruments to achieve the much desired and belated result.
How we can help
- IVF with latest ART methods (IMSI/PICSI/MACS, EmbryoScope,
Laser Assisted Hatching, EmbryoGlue/EmbryoGen)
- Donation programs (eggs, sperm, embryos) without waiting time
- PGD/PGS for selection of eupolid (genetically normal) embryos
Micromanipulation techniques for sperm selection and fertilisation
ICSI – Intracytoplasmic sperm injection
ICSI represents application of a sperm cell directly inside the egg (into the cytoplasm). During a standard ICSI, the embryologist selects the sperm depending on its motility and morphology; however, special methods of selecting the right sperm also exist.
When should this method be used?
- In the case of insufficient sperm count in ejaculate or insufficient sperm motility
- In severe semen analysis pathology
- After surgical collection of sperm
- If a female patient is older than 37
- If we are unable to obtain enough eggs
- If the women suffers from endometriosis
- If sperm antibodies are present in the ejaculate
- If sperm DNA is fragmented
IMSI – Intracytoplasmic Morphologically Selected Sperm Injection
Sperm selection method in ICSI, which is based on maximum microscopic enlargement of the sperm. This is a modification of the ICSI method, when the embryologist can assess the minimum defects of sperm morphology and select the optimum sperm for egg fertilisation. The IMSI method cannot be used in the case of a very low sperm count in the ejaculate.
PICSI – Physiological Intracytoplasmic Sperm Injection
Sperm selection method in ICSI, which is based on selection of a mature sperm cell. Before the actual ICSI, sperm cells are layered over a dish, which is similar in composition to the egg cell coating. Only sperm cells that have adequate genetic characteristics and would stand the best chance of actually fertilising the egg should then become bound firmly to this plate.
When should this method be used?
- In patients with pathologic semen analysis parameters
- In non-optimal development of embryos in preceding IVF cycles, if we anticipate sperm-related problems
- In repeated unsuccessful IVF cycles with embryotransfer of quality embryos
Oosight spindle view
Oosight spindle view
A special microscopic technique, which enables imaging of the egg spindle, which then enables better evaluation of egg quality. It is recommended in females aged over 37 with low AMH levels, in females who have had inadequate embryo development in the preceding IVF cycle despite the standard semen analysis parameters, in eggs which have non-optimal microscopic image, in applying frozen eggs and in women with a low percentage of fertilised eggs in the preceding IVF-ICSI cycle.
Sperm separation techniques
MACS – Magnetic-Activated Cell Sorting
A sperm-sorting method, which uses the influence of a magnetic field. It results in separation of sperm cells with a good genotype (undamaged DNA), which stand the best chance of fertilising the egg. Apart from IMSI and PICSI, sperm cells separated in this manner can be used in all methods of assisted reproduction – insemination, IVF, ICSI or this sperm can even be frozen for further usage in the future.
Embryo culture methods
Gyncare – Miracle of life
- Balstocyst transfer
- Multi-chamber incubator
(up to day 5 of embryo development)
Embryo culture in laboratory conditions up to the stage of the expanded blastocyst, which develops on day 5 after fertilisation. IVF results following the blastocyst transfer are better compared to embryo transfer at earlier stages of development, as the development of a major part of embryos stops right after day 3 following fertilisation. If the embryo development reaches day 5, there is a greater chance of implantation in the uterus.
A special culturing device for embryos, which maintains stable conditions in the incubator and provides output in the form of a video recording of embryonic cell division (the device takes photos of the embryo every 20 minutes). The embryologist can thus precisely state the regularity of embryonic cell division. The result of this culturing is then the possibility of optimal selection of the embryo to be transferred into uterus (i.e. the embryo with the most regular cell division), without disrupting the conditions for cell division.
When embryos are cultured in a multichamber incubator, each patient has a tiny incubator chamber dedicated only to her embryos. Compared to classic culturing, it is therefore not necessary to disrupt the optimum atmosphere, which is essential for correct embryonic cell division, every time the embryologist needs to control the embryos of another patient. The stable atmosphere in the incubator improves early embryonic development, thus increasing the chance for implantation in the uterus and further development.
A special culturing medium designed for patients who have suffered repeated miscarriages in the past (pregnancy losses). It contains specific growth factors, which increase the percentage of embryos with optimal cell division. Besides patients with repeated pregnancy loss, it is also recommended for patients who have suffered from repeated failure of embryo implantation following the transfer, as well as patients with idiopathic infertility.
Laser-assisted hatching (AH)
Disrupting the embryo shell with a laser beam. Up to day 6 following fertilisation, the embryo is protected by a special shell – the zona pellucida. It needs to leave this coat to be able to implant itself in the uterus. An embryo shell which is too firm can be the reason why the embryo cannot leave and is therefore unable to implant itself in the uterus. Cutting the zona pellucida with a laser beam is safe and poses no risk to further embryonic development.
Embryo glue is a lay term for a specific medium (solution) in which the embryo is transferred into the uterus. The chemical composition of this medium is very similar to the liquid that is normally found in the uterus and has a greater density compared to the standard media used for embryo transfer. This should provide not only optimal conditions for further development and embryonic cell division but should also minimise the risk of embryo shift within the genital tract of the woman following the embryo transfer.
The process of freezing reproductive cells and embryos has become an integral part of assisted reproduction methods. This is a procedure in which reproductive cells or embryos which are not directly used for fertilisation or injection into the uterus are frozen at temperatures as low as -196 °C. This enables their preservation for a practically unlimited time.
Under this method, oocytes (eggs) are frozen; it is applied in women who are awaiting oncological treatment or in women who do not plan pregnancy at the given moment and wish to keep their eggs preserved for the future (so called social freezing). Cryopreservation of eggs is preceded by hormonal stimulation of ovaries, which takes approximately 12 days. Sampling of mature eggs is conducted under total anaesthesia, and the collected eggs are immediately frozen and kept in liquid nitrogen. Cryopreservation is carried out by way of vitrification – ultrafast cryopreservation of eggs in special straws (capillaries).
If multiple embryos are obtained in the IVF cycle, we transfer only one or a maximum of two embryos with optimum development into the uterus. The remaining embryos are recommended to be frozen and preserved for the couple for the future. The survival rate of embryos after thawing is high, and the couple thus stands a good chance in the case of failure to get pregnant during transfer of the fresh embryo to go through the procedure of cryoembryotransfer (CET), which is preceded only by preparation of uterine mucous membrane to adopt the inserted embryo. The woman does not need to again undergo the whole stimulation process followed by egg collection. In the case of good embryo quality after thawing, chances are good for pregnancy after a cryoembryotransfer similar to the transfer of fresh embryos.
Cryopreservation of sperm is used in patients before initiating oncological treatment as well as in a sperm donor program. Sperm survival rate after thawing is highly individual, but in general, the process of freezing and thawing is survived by approximately 50% of sperm cells. Depending on the parameters of semen analysis, sperm cells can be used after thawing either for intrauterine insemination, when the insemination dose should contain at least 15 million sperm cells. In the case of worse semen analysis parameters, eggs are fertilised using micromanipulation techniques within the IVF program.
Egg (oocyte) donation
Oocyte donation belongs among the most successful methods of infertility treatment. Treatment with donated eggs represents a set of therapeutic procedures, when the eggs of an anonymous donor are fertilised by sperm of the partner or a donor.
Reasons for treatment with donated oocytes:
- Early failure of ovarian function
- Genetic disorders
- Low quality of eggs in previous IVF cycles
- Previous oncological treatment
- Repeated unsuccessful embryo transfers with own eggs
In as many as 50% of oocyte recipients the reason is the premature ovarian insufficiency, ovarian function failure before reaching the age of 40.
Egg (oocyte) donation principle
Who are egg donors?
Our egg donors are healthy, young women 18 – 34 years old. To become an egg donor, each donor has to go through detailed examination with reproductive gynaecologist, general practitioner and geneticist to ensure excellent ovarian reserve and exclude infectious, sexual and genetically transmitted diseases.
When selecting an oocyte donor, phenotype characteristics (eye color, hair color, height, weight) of the recipient are taken into account. We also try to match the blood group and Rh factor of the donor with blood group of the recipient.
How does the process go?
The oocyte donor undergoes ovarian stimulation, which results with egg retrieval under total anaesthesia. On the day of collection, retrieved eggs are fertilised by the partner’s sperm and after several days of culturing (typically 3 to 5 days), based on agreement with the recipient, 1 or 2 embryos are transferred into the uterus of the recipient, future mother. Transfer of embryo(s) is done in fresh synchronized cycle with the egg recipient. If you are travelling from abroad, please expect stay around 7 days.
In some cases, transfer of fresh embryo(s) is not performed, but all embryos are cryopreserved (via vitrification). Frozen embryo transfer can then be done without synchronization with the donor, with HRT (hormonal replacement therapy) or in the natural cycle on a specific day after ovulation is confirmed. If you are travelling from abroad, this can make your stay shorter.
Oocyte donation is strictly anonymous, voluntary and unpaid. However, every donor is compensated for her time and the costs she may have incurred in relation to the donation of eggs. According to Slovak legislation, the mother of the child is the woman who gives birth to the child.
Sperm donation is recommended to couples where the male partner has a continuing problem with fertility. This can mean an absence of sperm in ejaculate (azoospermia) or cases when the male partner carries a genetic disorder.
Treatment of single women with using donor sperm is not allowed.
Sperm donation principle
Sperm donors are man 18 to 34 years old who meet the required criteria in terms of semen analysis parameters and that the results of initial examinations and tests rule out infectious, sexually and genetically transmitted diseases. Sperm is frozen and stored in quarantine for 180 days; tests for infectious and sexually transmitted diseases are then conducted again. Only when negative results are confirmed can the sperm actually be used in donor programs.
Embryo donation is a form of infertility treatment suitable for couples in which both partners suffer from significant disruption of developing their own reproductive cells (eggs and sperm). Donated embryos are created using donor eggs and donor sperm. When planning embryo transfer, it can be done in fresh synchronized cycle or with frozen embryos. Both egg and sperm donors are selected to match recipient’s phenotype and blood groups.