Additional methods of treatment IVF

Micromanipulation techniques of egg fertilization by sperm

ICSI – Intracytoplasmic Sperm Injection

Intracytoplasmic Sperm Injection (ICSI) is an egg fertilization procedure using direct injection of a sperm inside a mature egg. The sperm is selected on the basis of its morphology and motility. Alternatively, one of the sperm selection methods may be added before performing the ICSI itself.

 We recommend ICSI:

• in case of disorders detected by semen analysis,
• in idiopathic infertility,
• in female patients over the age of 37,
• in endometriosis
• if the previous IVF did not result in adequate fertilization of the eggs during standard fertilization.

IMSI – Intracytoplasmic Morphologically Selected Sperm Injection

The method of sperm selection in ICSI, which is based on the maximum microscopic magnification of a single sperm. This is a modification of the ICSI method, in which the embryologist can assess even the smallest sperm morphology defects and thus select the sperm with optimal morphology for fertilizing the egg. The IMSI method cannot be applied in case of a very low sperm count in the ejaculate.

Oosight spindle view

A special microscopic technique that enables the imaging of the mitotic spindle of the egg, thus allowing the correct timing of egg fertilization using the ICSI method. We recommend this procedure in patients over the age of 37, in women with low egg yield, in patients who had inadequate embryo development in the previous IVF cycle despite normal semen analysis parameters (of their partner), in eggs that do not have an optimal microscopic image, when using cryopreserved eggs and in low percentage of fertilized eggs in the previous IVF-ICSI cycle.

Sperm separation techniques

Selection of sperm by hyaluronic acid binding (ICSI of preselected sperm)

The sperm selection method for ICSI is based on the quality of the sperm surface membrane. Only mature sperm has binding sites for hyaluronic acid on its surface. Before the ICSI itself, the sperm is either layered over a plate that resembles an egg envelope (PICSI dish) or cultured in a solution that contains hyaluronic acid (SpermSlow). Only the sperm showing the signs of binding to hyaluronic acid shall subsequently be used for egg fertilization. It is assumed that the sperm thus obtained is genetically healthier and should stand the highest chance of fertilizing the egg. At the same time, several studies have confirmed lower risk of miscarriage when using this method.

When is this method used?

• in patients with pathological parameters of the sperm analysis,
• in case of sub-optimal embryo development in previous IVF cycles, if we assume a problem on the part of sperm,
• in repeated unsuccessful IVF cycles with embryo transfer of quality embryos,
• in couples with a prior history of spontaneous miscarriage,
• in patients at higher age.

MACS – Magnetically Activated Sperm Selection

A method of sperm selection that is able to separate the damaged (apoptotic) sperms with a high percentage of fragmentation of genetic information from other sperms. The result is the separation of sperms with good genetic make-up (undamaged DNA), which stand the highest chance of fertilizing the egg. Unlike IMSI and PICSI, sperms separated under this protocol can be used for all methods of assisted reproduction – insemination, IVF, ICSI and it is even possible to cryopreserve the obtained sperms for further use in the future.

MSS (Microfluidic sperm sorting)

Sperm selection method based on changes in sperm motility depending on their quality. The separation is performed on a special plate with microchannels, which function as a filter and select the sperm with optimal motility and good fertilization abilities. Unlike IMSI and PICSI, sperm separated under this protocol can be used for all methods of assisted reproduction – insemination, IVF, ICSI and it is even possible to cryopreserve the obtained sperm for further use in the future.

Embryo culture methods:

Prolonged embryo culture (until day 5 of embryo development)

Embryo culture in laboratory conditions up to the stage of expanded blastocyst, 5-6 days after fertilization. The success of blastocyst transfer is higher compared to transfers of embryos in lower developmental stages, because in a large number of embryos, the division stops between the day 3 and 4 of their development. The transfer of blastocysts prevents the transfer of those embryos which would stop developing in this period under laboratory conditions. The suitability of prolonged embryo culture is assessed by the number of fertilized oocytes and also depends on a multitude of other factors and should be discussed with the embryologist.

Embryo culture using Time-lapse System

Special embryo culturing device based on the principle of individual culture (each embryo is cultured in a special dedicated microwell). The device takes a photo of each embryo every 20-30 minutes and then processes these photos into a video loop. The advantage of such culturing procedure is that not only it is unnecessary to take the embryo out from the incubator during the whole culture process (resulting in constant conditions for the embryo) but also the embryologist has the possibility to assess the regularity and time sequence of cell division of each embryo and then select the embryo with the highest implant potential for transfer.

Embryo culture in a chamber incubator

When culturing embryos in a multi-chamber incubator, each patient has a tiny incubator chamber dedicated to her own embryos only. In contrast to conventional culture, it is not necessary to disturb the optimal atmosphere, which is essential for the correct cell division of embryos whenever the embryologist needs to check the embryos of a different patient. The permanent atmosphere in the incubator thus improves the early embryonic development thus improving the chances of embryo implantation in the uterus and its further development.

EmbryoGen – culture medium

A special culture medium for patients who have suffered recurrent miscarriages (pregnancy losses) in the past. It contains special growth factors (GM-CSM) that increase the percentage of embryos with optimal cell division. In addition to patients with recurrent pregnancy losses, it is also recommended in patients who suffered from repeated failure of embryo implantation following the transfer as well as to patients with idiopathic infertility. Embryos can be cultured in the medium 3 days after fertilization.

EmbryoGen/BlastGen

A special culture medium for patients who have suffered recurrent miscarriages (pregnancy losses) in the past. It contains special growth factors (GM-CSM) that increase the percentage of embryos with optimal cell division. In addition to patients with recurrent pregnancy losses, it is also recommended in patients who suffered from repeated failure of embryo implantation following the transfer as well as to patients with idiopathic infertility. Embryos can be cultured in the medium for 6 days after fertilization.

Additional methods for embryo transfer:

Laser Assisted Hatching (AH)

Disruption of the embryo shell with a laser beam. Up to the day 6 following fertilization, the embryo is protected by a special coat – zona pellucida. It needs to leave this coat to be able to implant itself in the uterus. An envelope that is too strong may be the reason why the embryo cannot leave the shell and is therefore not able to implant itself in the uterus. Cutting the zona pellucida with a laser beam is safe and poses no risk to further embryonic development.

Laser-Assisted Zona Thinning (LAZT)

Disruption of the embryo shell with a laser beam. Up to the day 6 following fertilization, the embryo is protected by a special coat – zona pellucida. It needs to leave this coat to be able to implant itself in the uterus. An envelope that is too strong may be the reason why the embryo cannot leave the shell and is therefore not able to implant itself in the uterus. Thinning of the zona pellucida on a certain area with a laser beam is safe and poses no risk of endangering the further development of the embryo.

Embryo glue

“Embryo glue” is a lay term used for a special medium (solution) in which the embryo is transferred to the uterus. The chemical composition of this medium is very similar to that of the fluid normally found in the uterus and has a higher density compared to conventional embryo transfer media. This should ensure both optimal conditions for further development and cell division of the embryo, as well as minimize the risk of undesired embryo moves within the female genital tract after embryo transfer.