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Sex selection, often wrongly termed gender selection, is a process in which doctors and patients (couples/parents-to-be) are legally and ethically permitted to use IVF and associated ART techniques to select an embryo of a certain sex for transfer because of medical reasons. 

The most common medical reason to perform sex selection is to help parents from passing on their sex-linked disorders to their children. A sex-linked disorder is a common genetic disorder caused by or linked to gene(s) located on either of the sex chromosomes (X or Y).

There are hundreds of genes located on the X chromosome, however the Y chromosome is much smaller than the X chromosome and thus, carries relatively far fewer genes.

Disorders on the Y-Chromosome, such as Hypertrichosis of the ears, webbed toes, or porcupine man, can only be transmitted from father to son, since all male children will get the fathers Y chromosome, and all female children will get the fathers X chromosome. So, to avoid a Y-chromosome disorder then the solution is simple sex selection for a female child. 

Inheritance for disorders on the X-chromosome is much more complicated. The inheritance can happen in either a dominant or a recessive manner, dependent upon the disorder and the sex of the child.  

If on the fathers X-chromosome then likely the father will be affected, and that all his male children will be unaffected (they get his Y chromosome) and all female children will be carriers. So, where the father is a carrier on either chromosome X or Y, simple sex selection will remove the disorder (for a boy if the disorder is on the fathers’ X-chromosome, and for a girl if it is on the fathers Y-Chromosome).

If on one of the mother’s X-chromosomes, then;

1. 50% of male children will be affected, and 50% of male children will be unaffected
2. 50% of female children will be unaffected, and 50% of female children will be carriers
3. Further complicated for female carriers, where for some disorders they will be dominant carriers and affected, and for other disorders they will be recessive carriers and unaffected.

In this article, we will walk you through some of the most common X-linked genetic disorders and what you can do to protect your child from inheriting it.

The 5 Most Common X-Linked Genetic Disorders

1. Fragile-X Syndrome

Fragile X syndrome (FXS) is the most common form of inherited intellectual and development disability. The disorder mainly causes intellectual disability or a condition in which there are limits to a person’s ability to learn at an expected level and function in daily life. However, many times it also triggers various behavioral and medical issues including hyperactivity, hand flapping, hand biting, temper tantrums, and autism. 

The disorder is inherited in an X-linked dominant pattern, meaning basically it can affect both males and females (“dominant”) but will affect males more severely than females because females have another X chromosome to offset the damaged X (XX), while males have only one X chromosome (XY) no backup, and the symptom is fully and severely expressed. 

2. Duchenne Muscular Dystrophy

Duchenne muscular dystrophy (DMD) is a rare muscle disorder, but it is one of the most common and most severe genetic conditions in children. Duchene is caused by a mutation in the DMD gene on the X-Chromosome. This mutation prevents the body from producing dystrophin, a protein that muscles needs to work properly. Without dystrophin, almost every muscle cell become damaged and weakened, and will deteriorate over time to the point where children will usually end up needing assisted ventilation and face premature death. The disorder is a multi-systemic condition, meaning if affects many parts of the body, whether it be the skeletal, heart or lung muscles.

The disorder is inherited in an X-linked recessive pattern, meaning basically that it will usually only affect males, with females only a “carrier.” The word “recessive” refers to a situation where a mutation would have to occur in both copies of the gene to cause the disorder, and because it is unlikely that a female will have two altered copies of such a gene, she will usually at worst end up being a carrier.

3. Hemophilia 

Hemophilia is an inherited bleeding disorder in which blood does not clot normally when there is a wound or injury, causing one to bleed longer than other people. The bleeding can occur internally, within joints and muscles, or externally, from minor cuts, dental procedures, or injuries. According to the Centre for Disease Control and Prevention (CDC), “Hemophilia occurs in about 1 out of every 5,000 male births” and “death can occur if the bleeding cannot be stopped or if it occurs in a vital organ such as the brain.”

Like DMD, Hemophilia is inherited in an X-linked recessive pattern, meaning basically that it will usually only affect males, while females are only a “carrier.” 

4. Red-Green Color Blindness

Red-green color blindness, also known as deuteranopia, is the most common type of color deficiency. People with red-green color blindness find it hard to tell the difference between red and green and their whole color spectrum is then often affected. 

Like DMD and Hemophilia, red-green color blindness is inherited in an X-linked recessive pattern, meaning basically that it will usually only affect males, while females are only a “carrier.” 

5. X-Linked Agammaglobulinemia 

X-linked agammaglobulinemia, or XLA, is a genetic immune system disorder. Children born with XLA have very few B cells, which are crucial white blood cells to protect their body against infections. This results in infections taking longer to get cured and often recurring even with antibiotic medications. Individuals with XLA are more susceptible to infections because their body makes very few antibodies. The most common bacterial infections that occur in people with XLA include lung infections (pneumonia and bronchitis), ear infections (otitis), pink eye (conjunctivitis), sinus infections (sinusitis) and chronic diarrhea. Recurrent infections can lead to organ damage.

The disorder is inherited in an X-linked recessive pattern, meaning basically that it will usually only affect males, while females are only a “carrier.” 

Treatment Approaches: IVF, PGT-M, PGT-A for Sex Selection

Most of sex-linked genetic disorders are incurable, but they are certainly preventable. 

For disorders carried by the father, we can use IVF together with Pre-implantation Genetic Testing for aneuploidy (PGT-A), to choose a euploid (correct number of chromosomes) of the right sex. So, where the father is a carrier on either chromosome X or Y, simple sex selection will remove the disorder (for a boy if the disorder is on the fathers’ X-chromosome, and for a girl if it is on the fathers Y-Chromosome).

For disorders carried by the mother, we can use IVF together with Pre-implantation Genetic Testing for monogenetic disorders (PGT-M), to select and transfer only an embryo or embryos that are free or unaffected by your hereditary condition. For X-linked recessive conditions that also allows transfer of female carriers, while for X-linked dominant conditions female carriers cannot be transferred. PGT-M (previously known as PGD) is an early genetic diagnosis test for embryos produced during IVF, prior to their transfer to the uterus. At Superior A.R.T, we use Karyomappping, the latest technology for PGT-M which requires only 1-3 weeks to complete a test workup, unlike other PGT-M tests that usually take months to finish, and has reported higher reliability and accuracy. With Karyomappping, DNA fingerprints of embryos and family members will be compared to determine which embryos are free from the disorder. To learn more about our unique PGT-M and Karyomappping, click here.

References

In a previous article, we have discussed ICSI (Intracytoplasmic Sperm Injection), an adjunct fertilization procedure widely used in the In Vitro Fertilization (IVF) process. We learned how IVF and ICSI has helped millions of couples overcome their infertility issues and discussed what is ICSI, when should ICSI be used, how safe is ICSI, and how ICSI is done (read our introductory article of ICSI here).

In this article, we will walk you through the whole procedure once again, but in more detail to help you understand, and better prepared, for your visit to our clinic. Can’t wait to start? Let’s begin.

A Short Recap: What is ICSI? How Is It Different from Standard IVF Fertilization?

In Vitro Fertilization (IVF) is an assisted reproductive technique used to help couples who cannot conceive through natural reproduction.

In standard IVF, a woman’s eggs and her partner’s sperm are retrieved and mixed together in a laboratory dish to achieve fertilization. Once fertilized, they are known as “embryos”, and are cultured for 5-6 days to become “blastocysts” before being transferred back into the woman’s uterus and hopefully develop into a baby.

The ICSI process follows all the same steps of standard IVF except when it comes to fertilization. Instead of letting a number of sperm combine with an egg in a laboratory dish, in ICSI a single washed and healthy sperm is selected, picked-up and then injected directly into a mature egg. Using a direct injection avoids problems with sperm impaired motility, cervix issues, etc., and results in a higher chance of successful fertilization in couples who had failed to conceive after using standard IVF or have severe infertility issues.

The Process of ICSI

1. Starting Phase

When: Whenever you can get an appointment

How long: 45 – 60 minutes

To begin the process, the female will have to undergo extensive fertility testing, including an examination of your uterus and fallopian tubes, a hormonal assessment, and any other tests that may be required.  In addition, the male will undertake a semen analysis. Having reviewed your test results, your doctor can better understand your health condition and can advise a treatment plan which is right for you.

At this point, you will also be informed about everything you need to know regarding your treatment cycle, including how to administer your daily hormone injections at home, and instructions about any other medications you may be prescribed for your ovarian stimulation.

2. Ovarian Stimulation Phase

When: Day 2 or 3 of your period 

How long: 10 – 12 days

Once you have had your fertility assessment and consult, have learned about your ICSI cycle, and have decided to undergo the ICSI procedure, you will begin the first step of the process, the Ovarian Stimulation Phase.  In this crucial stage, you will stimulate your ovaries to produce as many follicles, egg containing vesicles on your ovary, as possible by administering hormonal drugs starting on day 2 or day 3 of your period and daily for 9-12 days.

There are hundreds of thousands of ovarian follicles on your ovaries, each containing one oocyte (an immature egg). During your normal menstrual cycle, several of these follicles will start to grow and develop, with usually only one proceeding to produce a mature egg. The goal is to have all of the developing follicles proceed to having a mature egg, which can then be retrieved, and give you the highest chance of success

Throughout this phase, your doctor will monitor how your ovaries are responding to the hormonal medications. You will be asked to come into the clinic every few days during the 9 to 12 days of stimulation, for blood tests and ultrasounds. Using these results the doctor may modify your treatment plan and medications. Once the test results show that your eggs have fully matured, your doctor will administer the “trigger injection”, a hormone (usually either human chorionic gonadotropin; hCG, or leuprolide acetate; Lupron) to prepare the eggs for ovulation, allowing your eggs to be released from the wall of the follicles, so that the doctor can do the egg retrieval process.

3. Egg Retrieval and Semen Collection

When: 36 hours after the “trigger injection”

How long: 1 – 2 hours

36 hours after your trigger shot, your eggs will be retrieved through a minor surgical procedure to aspirate your follicles. The doctor will use ultrasound imaging to guide a thin needle through your pelvic cavity to remove or retrieve your eggs. The procedure will be done under general anesthesia to keep the process comfortable and painless. The whole process usually takes only 15-20 minutes.

On the same day that your eggs are being retrieved, your partner’s semen will also be collected. Usually, your physician will prefer your male partner to collect his semen fresh at the clinic, but if he cannot come to the clinic on that day, he may collect the semen sample on a day prior to the egg retrieval and have the washed sperm frozen.

Semen collection by masturbation is recommended to avoid contact with any bodily fluids from the male or the female partner (i.e., saliva, vaginal fluids). These fluids may contain bacteria which could contaminate the fertilization or culture media. After he collects his sample, the male partner will return the sample through a window to a specialist waiting in the Andrology Laboratory which is situated next to the collection room.

The collected semen will be left for about 30 minutes to liquefy, and then washed to remove debris, immobile sperm, and other substances in the semen, before being thoroughly examined for its quality in a process called semen analysis. This semen analysis is important as it will help your physician to best decide if your eggs and your partner’s sperm are to be fertilized by a standard fertilization IVF or an advanced fertilization ICSI method. If the semen sample is normal, the standard fertilization IVF is chosen.  But if the semen analysis results are lower than average, your physician may advise you to choose the second alternative fertilization ICSI technique, as it increases the chance of that fertilization will occur. 

For the IVF technique, the eggs and sperm are mixed together and allowed to fertilize on their own in a laboratory dish, whereas for ICSI technique, a single healthy sperm is specially selected and injected directly into a mature egg to achieve fertilization. ICSI normally takes a longer time and requires an experienced fertility scientist.

Once fertilization occurs, the fertilized eggs are considered as embryos.

4. ICSI Fertilization

1. When: after egg retrieval and semen collection

How long: 24 hours
If it is confirmed and agreed upon by both you and your doctor that ICSI is the best fertilization approach for your case, then, instead of allowing the eggs and sperm to fertilize on their own in a laboratory dish as in standard IVF, in ICSI, your embryologist will use a thin micropipette to specifically select a normal-shaped and fast-moving sperm, and inject that single healthy sperm directly into a selected mature egg. This will be repeated for each individual mature egg.  The next morning, your embryologist will check for signs of normal fertilization. Any normally fertilized eggs are considered embryos.

5. Embryo Culture

When: After fertilization 

How long: 5-6 days

After the eggs and sperm are fertilized and become embryos, they will be cultured in a special incubator for 5 – 6 days until they develop and grow to the blastocyst stage which will be ready to be transferred into and implant in the lining of your uterus. Embryos which cannot grow to blastocyst stage are considered not strong enough and incompetent and will not be transferred into your uterus. The embryo culture process is extremely sensitive and requires embryologists who are well-trained and experienced to manage environmental conditions and operate advanced technical equipment to maintain a stable environment within the laboratory so that the embryos can grow and develop properly. 

At Superior A.R.T., we use the Geri-Time-Lapse Incubator, the newest generation of time lapse incubator technology available, with a single high quality microscope camera system dedicated to each culture chamber, thus allowing detailed tracking of embryo development without the plate or the embryos having to move. Each chamber is independently controlled and monitored, providing individualized, optimal culture conditions. The use of mini incubators increased the pregnancy rates as embryos have more stable conditions in which to develop.

To learn more about our Blastocyst Culture Technology, click here.

6. Embryo Transfer

When: After the culture process

How long: 2 to 4 hours

Finally, your doctor and your embryologist will select one or more blastocysts to be transferred back into your uterus to grow and develop into a baby.

In this procedure, under ultrasound guidance, the experienced embryologist will load your selected blastocyst(s)into a small tube called a catheter, and your doctor will place that catheter through your cervix and into your uterus, then releasing the blastocyst in your uterine cavity wall (endometrium) so it can implant into the wall of the uterus and begin to develop and grow.

Approximately 7-10 days after your embryo transfer you can have a blood pregnancy test to find out if you are pregnant. To confirm your pregnancy, an ultrasound can be done around a further 2 weeks later.

7. Embryo Freezing

When: After the embryo transfer process

How long: 1 to 2 hours

Any good embryos excess to transfer requirements can be frozen using a process called Vitrification, a technique in which your embryos will be frozen ultra-rapidly, so that the water molecules don’t have time to form ice crystals, and then held in deep frozen storage. This results in a long-lasting, high-quality preservation of your embryos indefinitely, if held in a high-quality and well-maintained laboratory with consistent, regular quality control and monitoring of the amount of the liquid nitrogen and the integrity of the equipment.

These frozen embryos can be used at a later time if you wish to get pregnant again.
To learn more about our unique embryo freezing process, click here.

References

Some severe genetic disorders are sex-linked, that is they are due to disorders of either the X or the Y chromosomes. Sex selection, often wrongly termed gender selection, is not only ethical and legal but could also, in many cases, help to avoid having children born with severe genetic disorders. For parents who are carriers of certain X or Y linked disorders and don’t want to pass on that genetic disorder to their children, sex selection may be offered as the most optimal treatment. In this article, we will help you understand how sex selection can help you prevent these genetic disorders running in your family and have a healthy baby.

What is a Genetic Disorder?

Your DNA, found on almost every cell in your body, is the blueprint for the entire functioning of your body. The DNA is broken up into chromosomes, 46 in total, 22 pairs of autosomal chromosomes and 1 pair of sex chromosomes. At intervals along each chromosome are genes, each gene a fundamental functional unit of heredity. These genes code for making different proteins essential to the normal function of your body. They range from making proteins essential to the structure of your body, proteins that generate hormone and enzyme production (eg. Insulin), and genes which decide your characteristics (eye colour, hair colour etc.). Sometimes however, there is a mutation or change in a gene, or multiple genes, which causes the gen to code improperly, and leads to a “genetic disorder”.

The mutation can occur spontaneously before a fertilized egg develops into an embryo, during embryo development, in adulthood, or it can be inherited from parents who are a carrier of a faulty gene and who may or may not have such a disorder themselves.

How Is a Baby’s Sex Connected to a Genetic Disorder?

Usually a female has two X chromosomes, and a male one X and one Y chromosome. A baby inherits one X chromosome from its mother, and either an X or a Y chromosome from the father. If the father contributes a Y chromosome the sex of the baby is male, and if the father contributes an X chromosome, the sex of the baby will be female.

Where the parent’s mutated gene is located on the sex chromosomes, then that has particular effects dependent upon the sex of the baby, as compared to where the mutated gene is on an autosomal chromosome. When the problem is X-linked in the mother, that is the mutated gene is on one of the mothers, the severity of the inheritance is higher in males who have only one X chromosome (they are “XY”), and the X-linked disorder is fully expressed. In contrast, symptoms in females are less severe or even none, because even if one X chromosome has the mutated gene, there is another X (from the pair of sex chromosomes “XX”) which is normal. This means PGT-M can be offered to select unaffected or carrier embryos.

Where the mutated gene is on the father’s X chromosome (assuming it is an X-linked disorder not severe enough to stop him having children), all female children will be carriers, and all male children will be unaffected (males only inherit the father’s Y chromosome). Similarly, where the mutated gene is on the father’s Y chromosome (assuming it is an Y-linked disorder not severe enough to stop him having children), then all males will inherit the disorder, and all females will be unaffected. In all cases where the mutated gene is on the father’s chromosomes then can only offer PGT-A to select the sex of the embryo in order to avoid passing on the disorder.

Examples of common X-linked disorders include red-green color blindness, hemophilia, Duchenne muscular dystrophy, X-linked agammaglobulinemia, Alport syndrome, Charcot-Marie-Tooth, Fabry disease, etc.  

Examples of common Y-linked disorders include Y Chromosome Infertility, Swyer syndrome, Hypertrichosis of the ears, Webbed Toes Syndrome, Porcupine Man, etc.

While for most X-linked diseases males are more affected than females, with Y-linked disorders only males will be affected since females do not have a Y chromosome.

Thanks to the advanced assisted reproductive technologies available today, a couple doesn’t have to wait until the female is pregnant to test for any genetic disorder, and either potentially terminate or have a child with a genetic disorder. We can use Pre-implantation Genetic Testing (PGT), an accurate and reliable technology, to test embryos and detect genetic disorders and/or chromosomal disorders. This testing also reveals the sex of the embryo. We can then select embryos with a healthy chromosome profile for transfer, preventing passing on genetic diseases, and providing higher rates of pregnancy, healthier pregnancies, and healthy babies. The PGT technique requires an IVF/ICSI ovarian stimulation cycle, and the expertise of embryologists and genetic scientists to provide these services.  You can read in more detail about the types of PGT here.

Who Should Be Concerned about Sex-linked Genetic Disorders?

As mentioned above, couples who are aware that, or think that, one or both of them might be carriers of X-linked disorders and/or Y-linked disorders, and are greatly concerned that they might pass such diseases onto their children.

Besides sex-linked diseases, sex selection may also be permitted and used in other common diseases, which have no specific gene known but have significantly higher rates in one sex, such as certain types of diabetes, blindness, sclerosis, dementia, autism etc. The age of the mother is one of the factors where there is an increased risk of many genetic disorders, and therefore may warrant having sex selection. Professor Rasmus Nielsen from the Natural History Museum of Denmark, the University of Copenhagen and the University of California, Berkeley, revealed that, “The older a woman is, the greater number mutations have occurred in her ova, thus increasing the risk of her children being born with various genetic diseases.”

In summary, parents who concerned about passing on a known familial genetic/hereditary disease to their children, are recommended to consult a qualified doctor to see what options are available to help in preventing or minimizing such risks. For some medical conditions, sex selection (sometimes wrongly called gender selection) in conjunction with IVF/ICSI treatment, may be advised. Consulting with the doctor will help you decide which option is most suitable for you.

Where to Start If I Am Concerned?

You can start by scheduling an appointment to visit an experienced fertility clinic and discuss your concerns with the doctor. After assessing all of the details, the doctor can outline and discuss your available options.

Conclusion The sex selection process is permitted and used for medical reasons to prevent sex-linked disorders where a child’s sex is considered to be a direct factor in whether he or she is likely to develop a disease. Medical sex selection can also be more generally used to help prevent parents from passing on other common genetic disorders to their children if it is considered by a doctor to be for medical purposes.

References

There is no joy and delight like expecting a baby and even double the joy when you are pregnant with twins or multiple babies. They look so adorable together and alike that sometimes you may even have a hard time telling them apart. But what exactly are twins or multiple births? How many types of twin are there? Or what are the factors that increase your chance of a multiple pregnancy? Here is everything you need to know about your precious pair. Let’s begin.

1. What Are Twins or Triplets?

If you are pregnant with more than 2 or more fetuses (developing babies), it is called a multiple pregnancy, with two fetuses called “twins”, three called “triplets”, four fetuses called quadruplets, etc. Carrying more than two or three fetuses is often called, “high-order multiples”.

2. How Many Types of Twins Are There?

There are two basic types of twins;

2.1 Fraternal Twins

 “Fraternal twins.” In this twin type, instead of one egg, a woman’s ovaries release two eggs (ova) at the time of ovulation and each is fertilized by a separate sperm. The two embryos implant in the lining of your uterus, and develop into two fetuses in your uterus at the same time.

Because fraternal twins are the result of different eggs and different sperm, they don’t look exactly alike and can be the same or different sexes. Fraternal twins, therefore, sometimes are also called, “non-identical twins” or “dizygotic twins,” which mean “two-cell” or “deriving from two separate ova”

2.2 Identical Twins

The second type, “identical twins” or “monozygotic (one-cell) twins”, are conceived from one fertilized egg that divides into two embryos during the cell division stage. After splitting in two, the self-contained halves then develop into two fetuses with exactly the same genetic information, resulting in twins who are the same sex and identical looking.

3. What Factors Increase the Chance of Having Twins or Multiple Pregnancies?

Some women are more likely than others to give birth to twins. According to the American Society for Reproductive Medicine or ASRM, the most common factors include race, age, heredity, history of prior pregnancy, as well as the use of fertility drugs or Assisted Reproductive Technology.

However, according to ASRM, “your race, age, heredity, or history of prior pregnancy does not increase your chance of having identical twins but does increase your chance of having fraternal twins,” while fertility drugs and assisted reproductive technology can increases your risk of having either type of twins, both identical and fraternal.”

• Race: Studies show that women from South-East Asia, and women of Hispanic origin are substantially less likely to have twins than non-Hispanic Whites and African origin mothers.
• Heredity: Both mother’s and father’s family history play a crucial role in increasing the odds. However, according to ASRM, “The mother’s family history may be more significant than the father’s.” Moreover, a mother will increase her odds of having twins or multiple pregnancy if her sister, her mother, or her mother’s mother had fraternal twins or she herself is one of the fraternal twins.
• Maternal Age: Studies have shown that the likelihood of twins increases with age. In a study of pregnant women who are over 45 years old, 16% of them had multiple pregnancies, with twins being the highest percentage. Moreover women in their 30s or 40s tend to have higher levels of oestrogen which make their ovaries ovulate more than one egg at a time.
• Prior Pregnancy History: The more times a woman has become pregnant, especially pregnant with 2 or more babies, the more likely she is to have twins or multiple pregnancies.
• Fertility Drugs: The use of fertility drugs, particularly ovulation-stimulating medications often used to help stimulate and produce many eggs, can play a role in increasing the odds of having multiple babies.
• Assisted Reproductive Technology: The use of Assisted Reproductive Technology (ART) procedures such as In Vitro Fertilization (IVF) is also generally found to contribute to an increase in multiple birth rates in cases where a higher the number of embryos are transferred back into the woman’s uterus.

4. What Are the Complications and Risks Associated with Multiple Pregnancies?

While expecting twins or multiple births can be a marvelous and exciting time, multiple pregnancies also carry a higher risk of complications. The most common problems include:

4.1 Preterm labor and birth:  60% of twins and almost all high-order multiples are premature babies (born before 37 weeks). The greater the number of fetuses pregnant, the greater the risk of premature delivery. Preterm delivery can cause an infant to need help in breathing, eating, fighting infection, and staying warm, and thus cause him or her to be specially cared for in a neonatal intensive care unit (NICU) until she or he is strong enough to survive on his or her own.

4.2 Gestational hypertension: Referred to as Pregnancy-Induced Hypertension (PIH), gestational hypertension is a condition characterized by high blood pressure during pregnancy that can lead to serious complications for both mom and babies if not treated quickly.

4.3 Anemia: All expecting mothers generally become anemic, but when you are expecting twins, chances are that you will be more anemic and extremely tired compared to mothers with a singleton pregnancy.

4.4 Birth defects: Multiple babies are roughly twice as likely to have difficulties that are present at birth (congenital), such as spina bifida and other neural tube disorders, as well as digestive and cardiovascular issues. Note that even with these increases, the risks are still low.

4.5 Miscarriage: In multiple pregnancies there can be a condition called “Vanishing Twin Syndrome”. In this unfortunate condition, more than one fetus is found after the ultrasound, but during the pregnancy one of the fetuses vanishes (or is miscarried).

4.6 Twin-to-twin transfusion syndrome: Also called “TTTS,” this rare yet severe pregnancy condition refers to a situation where the twins share one placenta and a network of blood vessels that supply oxygen and nutrients essential for development in the womb, but for some unfortunate reasons, the vessel connections within the placenta are not evenly distributed, and the blood exchange between the twins is unbalanced, causing one twin to give away more blood and being put at risk of malnutrition, organ failure and, if not treated quickly and properly, eventual intrauterine death.

5. What Can I Do If I Want to Have Twins?

As discussed in the factors section, a person’s chance of having twins are quite arbitrary and complicated. There’s no perfect or exact recipe for you to try to have twins as each individual’s physical condition and personal history varies. What you can do surely and safely, however, is discuss your health and physical condition with your trusted and reliable doctor or experienced healthcare provider, and assess your odds of having twins Also, if you think that you may have higher  chance of having twins with Assisted Reproductive Technology procedures like ICSI, IUI and IVF, it is important that you carefully select a fertility clinic that is truly ethical and experienced to avoid serious risks and complications commonly found in these advanced procedures.

References

In a previous article, we learned about egg freezing, including how a woman’s eggs are extracted, frozen and stored for future use, who should consider egg freezing, and how safe is egg freezing for women (read our introductory article about egg freezing here).

In this article, we will go into further details on What exactly are the steps of the egg freezing process, When are they done, and how exactly the eggs are frozen?  You will find all the answers here, step by step below.

1. Your First Consultation

When: Whenever you are ready to have an appointment

How long: 45 – 60 minutes

First you will have to meet with a doctor at the fertility clinic. The doctor will review your medical history, guide you through the process, and answer any questions you may have about the procedures.

Here are some tips on what questions to ask:  Does the clinic have experience in freezing eggs and, importantly, thawing eggs? How many eggs may be expected from one retrieval? Is there a chance you may need more than one cycle of egg freezing? What is the cost of the procedure? Or you can just ask the doctor to walk you through all the steps for a better understanding about all the procedures. 

Be aware that the answers to some specific questions, such as how many eggs may be expected from your cycle, or how many cycles you will need to get a sufficient number of eggs, may just be an initial estimation, and your doctor will be able to predict and plan more accurately after doing some initial blood tests and a physical examination.

2. Initial Blood Tests and Examination.

When: Day 2 or 3 of your period

How long: 30 minutes

After discussing everything with your doctor, he or she will make an appointment for you to come to the clinic again on day 2 or day 3 of your period, to have blood tests and an ultrasound scan. As mentioned above, after getting the results of these initial blood tests and examination, your doctor will be able to answer more specific questions about your egg freezing process, such as; the cost per retrieval, number of expected eggs, and your overall chance of success.

Should you decide to proceed to treatment, you can start the same day. The doctor or the nurse will help you prepare for “The Ovarian Stimulation and Monitoring Phase”, the stage at which you will receive fertility medications daily, usually injections, to stimulate your ovary to produce many follicles (small sacs of fluid in the ovaries that contains a developing egg), or more simply, to stimulate your ovary to produce as many eggs as possible.

The fertility medications are usually self-administered. The nurse will teach you how to self-administer the fertility shots

Of course, you may decide to wait and start on day 2 or day 3 of a subsequent menses cycle

3. The Ovarian Stimulation and Monitoring Phase

When: Day 2 or 3 of your period

How long: 10 – 12 days

Once you start having fertility shots, which you will take for about 10 to 12 days, you will be asked to revisit the clinic for more blood tests and ultrasound scans every few days to monitor how your ovaries are responding to the fertility drugs. Once the testing shows that your follicles have grown to a size indicating your eggs are mature, your doctor will administer a “trigger shot” or a hormone (usually either human chorionic gonadotropin; hCG, or leuprolide acetate; Lupron) to help complete the egg maturation process, releasing them from the wall of the follicle so that they can be retrieved.

4. Retrieval and Storage

When: 36 hours after the “trigger shot”

How long: 60 minutes

36 hours after your trigger shot, your eggs will be retrieved (egg retrieval, OPU) through a minor surgical procedure to aspirate your follicles, in which a doctor will use ultrasound imaging to guide a thin needle through your pelvic captivity to remove or retrieve your eggs. The procedure will be done under general anesthesia to keep the process comfortable and painless.

Once your doctor has successfully collected all the eggs, you will be sent to the recovery room to recuperate from the anesthesia. After 1-2 hours you will be discharged and advised to continue resting at home.

Just a few hours after retrieval, all of your eggs which are fully matured will be frozen using a process called Vitrification, a technique in which your eggs will be frozen ultra-rapidly, so that the water molecules don’t have time to form ice crystals, and then held in deep frozen storage. This results in a long-lasting, high-quality preservation of your eggs indefinitely, if held in a high-quality and, well-maintained laboratory with consistent, regular quality control and monitoring of the amount of the liquid nitrogen and the integrity of the equipment. At this point, your egg freezing process is considered complete.

Once you are ready to become a mother, at some time in the future, some of your eggs can be thawed, fertilized with your partners sperm, cultured as an embryo in the laboratory, and then transferred to your uterus to implant, develop and grow into a healthy baby, through processes such as IVF or ICSI.

About Superior A.R.T.

Superior A.R.T. was founded in 2007 by a group of leading Thai Infertility specialists in collaboration with Australian world leading fertility and A.R.T. treatment providers,. Superior A.R.T is a renowned fertility clinic offering comprehensive fertility and genetic services by a team of experienced treatment providers and researchers specifically specializing in Assisted Reproduction Technology – A.R.T. Superior A.R.T. is committed to making your dream of having a healthy baby come true.

อ้างอิง

In a previous article, we learned about IVF (In Vitro Fertilization), the most popular assisted reproduction option, including  what is IVF, when IVF should be used, how safe is IVF, and how it is done (read our introductory article of IVF here). In this article, we will walk you through the whole procedures once again, but with more essential details to help you understand and better prepare for your visit to our clinic. Can’t wait to start? Let’s begin.

1. Starting Phase

When: Whenever you can get an appointment

How long: 45 – 60 minutes

Starting the procedure, you will have to undergo extensive fertility testing, including an evaluation of your uterus and fallopian tubes, a hormonal evaluation, as well as other tests as may be necessary. The check-up will help your physician better understand your overall physical condition and recommend a treatment plan that most suits you.

In this stage, you will also be informed about everything you need to know about your treatment cycle, shown how to administer your daily injections of hormones at home, and be given instructions about any other medications (patches or pills) you may need during your ovarian stimulation phase.

2. Ovarian Stimulation Phase

When: Day 2 or 3 of your period 

How long: 10 – 12 days

After you have learned and understood what you need to do during your whole IVF cycle, and you have decided to proceed, you will begin the first step of IVF, which is to stimulate your ovaries to produce as many follicles as possible through self-administering hormonal drugs starting on day 2 or day 3 of your period, and proceeding for a further 9-12 days.

Your ovaries can have hundreds-of-thousands of ovarian follicles, with each follicle containing an oocyte (an immature egg). During your menstrual cycle, some of these follicles will begin to develop further and the egg in them become a mature egg. The goal, therefore, is for your ovaries to produce as many follicles as possible, since the more follicles, the higher chance you will be able to find and retrieve high-quality mature eggs.

During this phase, you’ll be asked to come into the clinic every few days for around 10 to 12 days, for more blood tests and ultrasound scans, to monitor how your ovaries are responding to the hormonal drugs. Once the testing shows that your eggs have completed their growth and development, your doctor will administer a “trigger shot”, a hormone (usually either human chorionic gonadotropin; hCG, or leuprolide acetate; Lupron) to help complete the egg maturation process, releasing them from the wall of the follicles, so we can begin the egg retrieval process.

3. Egg Retrieval and Semen Collection

When: 36 hours after the “trigger shot”

How long: 1 – 2 hours

36 hours after your trigger shot, your eggs will be retrieved through a minor surgical procedure to aspirate your follicles. The doctor will use ultrasound imaging to guide a thin needle through your pelvic cavity to remove or retrieve your eggs. The procedure will be done under general anesthesia to keep the process comfortable and painless. The whole process usually takes only 15-20 minutes.

On the same day that your eggs are being retrieved, your partner’s semen will also be collected. Usually, your physician will prefer your male partner to collect his semen fresh at the clinic, but if he cannot come to the clinic on that day, he may collect the semen sample on a day prior to the egg retrieval and have the washed sperm frozen.

Semen collection by masturbation is recommended to avoid contact with any body fluid from the male or the female partner (i.e. saliva, vaginal fluids). These fluids may contain bacteria which could contaminate the fertilization or culture media. After he collects his sample, the male partner will return the sample through a window to a specialist waiting in the Andrology Laboratory which is situated next to the collection room.

The collected semen will be left for about 30 minutes to liquefy, and then washed to remove debris, immobile sperm, and other substances in the semen, before being thoroughly examined for its quality in a process called semen analysis. This semen analysis is important as it will help your physician to best decide if your eggs and your partner’s sperm are to be fertilized by a standard fertilization IVF or an advanced fertilization ICSI method. If the semen sample is normal, the standard fertilization IVF is chosen.  But if the semen analysis results are lower than average, your physician may advise you to choose the second alternative fertilization ICSI technique, as it increases the chance that fertilization will occur. 

For the IVF technique, the eggs and sperm are mixed together and allowed to fertilize on their own in a laboratory dish, whereas for ICSI technique, , a single healthy sperm is specially selected and injected directly into a mature egg to achieve fertilization. ICSI normally takes a longer time and requires an experienced fertility scientist.

Once fertilization occurs, the fertilized eggs are considered as embryos.

4. How Embryo Culture 

When: After fertilization (via standard IVF or ICSI)

How long: 5-6 days

After the eggs and sperm are fertilized and become embryos, they will be cultured for 5 – 6 days in the laboratory until they develop and grow to the blastocyst stage, ready to be transferred into and implant in the lining of your uterus. Embryos which cannot reach the blastocyst stage are basically considered too weak and incompetent, and will not be transferred back to your uterine cavity.

The embryo culture process is very sensitive, and requires expertise and experience from embryologists who know how to both manage environmental conditions and operate advanced technical equipment to maintain a stable environment within the laboratory so that the embryos can grow properly. 

At Superior A.R.T., we use the Geri incubator, the newest generation of time lapse incubator technology available, with a single high quality microscope camera system dedicated to each culture chamber, thus allowing detailed tracking of embryo development without the plate or the embryos having to move. Each chamber is independently controlled and monitored, providing individualized, optimal culture conditions. The use of mini incubators increased the pregnancy rates as embryos had more stable conditions in which to develop.

To learn more about our Blastocyst Culture Technology here.

5. Embryo Transfer

When: After the culture process

How long: 2 to 4 hours

Finally, a selected blastocyst(s) can be transferred to your uterus through a simple and painless procedure where your blastocyst(s) will be loaded in a soft catheter, placed through the cervix and into your uterus under ultrasound guidance, and the blastocyst placed in your uterine cavity. The blastocyst(s) will implant into the uterine wall (endometrium) and begin to develop and grow.

About 7-10 days after the embryo transfer, you can take a blood pregnancy test to find out if you are pregnant. An ultrasound can be performed about 2 weeks after to confirm your pregnancy.

6. Embryo Freezing

When: After the embryo transfer process

How long: 1 to 2 hours

Any good embryos excess to transfer requirements can be frozen using a process called Vitrification, a technique in which your embryos will be frozen ultra-rapidly, so that the water molecules don’t have time to form ice crystals, and then held in deep frozen storage. This results in a long-lasting, high-quality preservation of your embryos indefinitely, if held in a high-quality and, well-maintained laboratory with consistent, regular quality control and monitoring of the amount of the liquid nitrogen and the integrity of the equipment.

These frozen embryos can be used at a later time if you wish to get pregnant again.

AAbout Superior A.R.T.

Superior A.R.T. offers comprehensive fertility and genetic services in state-of-the-art Assisted Reproduction Technology (A.R.T.) Laboratories in Bangkok Thailand. Superior A.R.T. was founded in 2007 by a group of leading Thai Infertility specialists in collaboration with Australian world leading fertility and A.R.T. treatment providers, Superior A.R.T is a renowned fertility clinic offering comprehensive fertility and genetic services by a team of experienced treatment providers and researchers specifically specializing in Assisted Reproduction Technology – A.R.T. Superior A.R.T. is committed to making your dream of having a healthy baby come true. 

References

Intracytoplasmic Sperm Injection, more commonly referred as ICSI, is potent fertilization method used in the In Vitro Fertilization (IVF) process. The only difference between standard IVF and ICSI is in the method used to allow the sperm to fertilize the egg. This adjunct procedure has helped millions of couples overcome their infertility issues.

But what exactly is ICSI and who needs it? In this article, you will find all the answers.

What is ICSI? How Is It Different from IVF?

In Vitro Fertilization (IVF) is a technique used to help couples who are unable to conceive through natural reproduction. IVF allows them to be able to have a baby safely through fertilization in the laboratory and transferring a good embryo back to the woman’s uterus.

The ICSI process follows every step of conventional IVF except the fertilization step where, instead of letting the eggs and sperm fertilize on their own in a laboratory dish, using ICSI a single healthy sperm is selected and directly injected into a mature egg to achieve fertilization.

ICSI is usually used when a couple faces male-factor infertility that is too severe to be treated by traditional IVF. ICSI is a technically more advanced form of IVF.

When is ICSI usually used?

ICSI is usually used when patients suffer from one or more following issues:

• High numbers of abnormally shaped sperm
• Poor sperm movement
• Low sperm counts
• An obstruction in the male reproductive system preventing sperm ejaculation
• Poor or no fertilization using conventional IVF, regardless of the condition of the sperm
• Where frozen eggs are used.
• Where the sperm has high DNA fragmentation
• Couple have genetic risks and will use PGT (preimplantation genetic testing)

In all of the above, conditions ‘using PGT’, using conventional IVF will likely have poor outcomes and ICSI treatment is recommended. ICSI is used in PGT to avoid sources of DNA contamination.

How is ICSI done?

ICSI  comprises five steps as follows:

1. Stimulate egg reproduction

Starting on the 2^nd or 3^rd day of a woman’s menstrual cycle, she will meet with her doctor to receive blood tests and an ultrasound. If the results of the tests are positive for potential success, the doctor will prescribe medicines to stimulate the woman’s ovarian follicles. Each follicle contains an egg, so it is basically stimulating egg production. This stimulation is an injection every day for 10-14 days. The woman will have a doctors consult every 3-4 days for further blood tests​ and transvaginal ultrasound to check her ovaries and follicle growth. Once the follicles are of a suitable size, the woman will receive a “trigger shot”, an injectable medication to complete the eggs maturity.  About 36 hours after the trigger shot, the doctor shall perform the egg retrieval.

2. Retrieve and select eggs and sperm

About 36 hours after the trigger shot, the doctor will sedate the woman to keep the process comfortable and painless, and, using ultrasound imaging, will guide a thin needle into the pelvic captivity and retrieve the eggs from the ovarian follicles.

Usually from 1-2 hours before to around the same time as the egg retrieval process, (unless frozen sperm is being used) the male partner will collect semen. The semen is washed and prepared for the ICSI process which is usually done about 2 hours after the egg retrieval process.

3. ICSI, inject a selected sperm into a selected egg

Under a microscope, an embryologist will select a normal shaped fast-moving sperm, using a thin micropipette, and will inject that single healthy sperm directly into a mature egg. This will be repeated individually for each mature egg. The next morning the eggs will be checked for “normal” fertilization. Once fertilization has occurred, the fertilized egg is considered an embryo.

4. Culture the embryo

The embryos will be cultured for 5-6 days in the laboratory until they develop or grow to the blastocyst stage. After embryos reach the blastocyst stage, only healthy and strong blastocysts will be selected for transfer into the woman’s uterus, or for freezing.

5. Transfer the embryo

Following the culture process, a selected blastocyst(s) can be transferred to the woman’s uterus in a simple and painless procedure where a catheter containing the blastocyst(s) is ultrasound guided through the vagina and cervix and the blastocyst(s) deposited in the uterus. The blastocyst(s) will implant into the uterine wall (endometrium) and begin to develop and grow. About 7-10 days after the embryo transfer, the woman should take a blood pregnancy test to find out if she is pregnant. An ultrasound can be performed about 2 weeks after to confirm the pregnancy.

How successful is ICSI?

Fertilization rates for conventional IVF and ICSI are about the same, with generally ~70 % of the eggs getting fertilized. After fertilization, the pregnancy success rate is also the same between standard IVF and ICSI, and is usually in the range of between 40-70% depending on various factors including age, reason for infertility diagnosis, fertility drugs used, and other underlying fertility concerns. Direct consultation with your ICSI doctor will be able to help you get a more precise and accurate assessment of your likely success rate.

What are the risks of ICSI?

ICSI is generally a safe procedure, but like every medical process, it is not without risk. The most common risks of ICSI include:

• Egg damage: Because an egg is quite fragile, during the ICSI procedure the egg may be damaged as a result of the needle insertion. Choosing a good clinic with an excellent laboratory and expert embryologists will reduce the risk of damage to the eggs during the ICSI process.

• Chromosomal abnormalities, autism, intellectual disabilities, and birth defects: Some studies have suggested that ICSI is associated with a slightly increased risk of some disorders as compared to standard IVF and natural pregnancy.

• Multiple pregnancies: Multiple pregnancies may occur at the same rate as in natural pregnancy. However, if more than one embryo is transferred the risk of multiple pregnancies is increased.  The chance of a multiple pregnancy (twins/triplets, etc.)  can be reduced by only transferring a single embryo.

• Ovarian Hyperstimulation Syndrome:  Potential side effects of using fertility drugs to stimulate ovarian follicle growth are bloating, tenderness, and nausea. If not monitored these can become serious. Fortunately, good clinics monitor and adjust your cycle, and OHSS is very rare.

Carefully selecting an ICSI clinic is therefore important. A promising ICSI clinic should be well-equipped with the latest range of medical equipment and technologies, have high-quality, well-maintained laboratories, a team of credentialed experts, and a good track record of ICSI success.

About Superior A.R.T.

Superior A.R.T offers comprehensive fertility and genetic services in state-of-the art Assisted Reproduction Technology (A.R.T.) Laboratories in Bangkok Thailand. Superior A.R.T. was founded in 2007 by a group of leading Thai Infertility specialists in collaboration with Australian world leading fertility and A.R.T. treatment providers, Superior A.R.T is a renowned fertility clinic offering comprehensive fertility and genetic services by a team of experienced treatment providers and researchers specifically specializing in Assisted Reproduction Technology – A.R.T. Superior A.R.T. is committed to making your dream of having a healthy baby come true. 

References

Today, with advances in Assisted Reproductive Technology, we are fortunate to have a variety of proven fertility treatments available. One of the most common fertility treatments is IUI. This relatively simple technique has helped millions of couples finally overcome their fertility issues, and at an affordable price. But what is it exactly, how does it work, and who does it help? Today, Superior A.R.T. has all the answers.

What is IUI?

IUI, or intrauterine insemination, is a fertility treatment where healthy sperm are placed directly into a woman’s uterus, allowing sperm to more easily reach and fertilize an egg(s), increasing the likelihood of fertilization and conception.

Because IUI is relatively simpler, requiring less advanced technology than other fertility treatments such as IVF or ICSI, it is therefore generally less expensive, less time-consuming, and is often recommended as the first treatment before progressing to other treatments if required.

When is IUI usually used?

IUI is usually used and effective in the following scenarios: 

• unexplained infertility
• mild endometriosis
• issues with the cervix or cervical mucus
• mild decreased sperm count
• decreased sperm motility
• issues with ejaculation or erection

The scenarios in which IUI is not commonly effective and used includes:

• women with moderate to severe endometriosis
• women who have had both fallopian tubes removed or have both fallopian tubes blocked
• women with severe fallopian tube disease
• women who have had pelvic infection
• men who have severe decreased sperm count  

All things considered, your doctor will help you determine the best option to help you successfully conceive. Depending on each couple’s condition, sometimes beginning with only IUI is enough, but sometimes one may have to explore more advanced treatments such as IVF or ICSI.

How does IUI work?

At the start of an  IUI cycle, a doctor will prescribe suitable oral or injectable medications to help stimulate your egg production. While on medications, you will receive regular transvaginal ultrasounds and/or blood tests to monitor your egg growth and endometrial thickness. After an egg grows to 18-20 millimeters or more, it will be generally considered as ready or mature, and you will receive an injectable medication known as a “trigger shot” to begin final stages of egg maturation.

36 – 42 hours after your trigger shot, you and your partner will come back to the clinic. If you aren’t using donated sperm, your male partner will provide a semen sample. The sample will immediately be taken to the laboratory and washed to remove debris, immobile sperm, and substances in the semen that can irritate your uterus or kill the egg. It also makes the good sperm more concentrated. After the sperm are ready, a minor surgical procedure for IUI can then begin. Like a routine pelvic exam, you will lie on an exam table, and the sperm will be injected into your uterus through a thin, long flexible soft tube (catheter). Though it may sound painful, the entire process is relatively painless and takes just around 5-10 minutes to complete. After complete IUI procedure, you will take rest 30 minutes before discharged.

About 14 days after the IUI procedure, you can take a pregnancy test at home or at the clinic. The doctor may ask you to come back to the clinic for a blood test to detect the level of the pregnancy hormones.

What are the risks of IUI?

An IUI patient has a very low risk of rare and minor complications including:

• Infection: The low risk of developing an infection from the IUI procedure is very low since the instruments and the room used are sterilized.

• Ovarian Hyperstimulation Syndrome: The use of fertility medications to stimulate egg growth causes a woman’s ovaries to become hyperstimulated and enlarged.  Bloating, tenderness, and nausea may occur, and if excessive may cause more severe side effects requiring hospitalization. Fortunately, good clinics monitor your cycle and OHSS is very rare.

• Multiple pregnancies:  Ovarian stimulation medications increase the likelihood that more than one egg will be released, thereby also increasing the likelihood of having a multiple pregnancy.

Carefully selecting an IUI clinic is therefore important. A prospective IUI clinic should be well-equipped with the latest range of medical equipment and technology, have high-quality, well-maintained laboratories, and be supported by as well a team of credentialed experts. It should also have a good track record of IUI success.

How successful is IUI?

The success rate of IUI can be anywhere between 10 – 15% dependent on various factors including age, underlying fertility concerns, and the treatment plan. Success rates for IUI are likely to decrease significantly in women aged over 40 years old. Direct consultation with your IUI doctor will help you predict your likely IUI success rate and consider whether it is a good option for you.

How many times should one try IUI?

The success rate of IUI tends to increase as more cycles are performed, but it will usually stop increasing, and become typically stable, after the 6th cycle. Generally, most doctors will suggest 3 to 6 cycles of IUI, with the maximum number of 6 cycles.  However, it is up to the patient if they want to try more cycles.

What to do after IUI?

The IUI procedure requires no recovery period or further steps. You don’t have to lie down and can resume normal activities. Doctor may suggest no bathing or swimming for a few days to minimize any risk of infection. The final step is have a pregnancy test.

How much does IUI cost?

The cost of IUI can vary based on your choice of clinic and specific needs, but generally it ranges from ฿10,000 – ฿40,000. This figure is considered low when compared to other more extensive techniques such as IVF or ICSI.

References

In Vitro Fertilization (IVF) is a proven and effective infertility treatment. Because of its long record of success and well-earned reputation, the method is often the first option that comes to mind when a person or a couple is facing any infertility issue. But what is IVF exactly? And what should ‘parents-to-be’ know first about IVF? Today, Superior A.R.T. has the answers.

What is IVF?

In Vitro Fertilization, more commonly referred to as IVF, is a method to help people who are unable to conceive naturally (internal fertilization) to be able to have a baby safely via external fertilization. In this assisted reproductive technique, a doctor will collect a woman’s eggs from her ovaries, before bringing them to be fertilized, with sperm retrieved from the man, in a laboratory dish. Once the eggs are fertilized, they will be grown to become good quality embryos. Then doctor will then transfer some of them back into the woman’s uterus, with the hope that at least one of them will be able to implant and grow to become a fetus.

When is In Vitro Fertilization (IVF) usually used?

The conditions most often leading to IVF includes:

• Where a woman suffers from pelvic adhesions,
• Where a woman suffers from chocolate cysts,
• Where a woman suffers from blocked or damaged fallopian tubes,
• Where a woman suffers from ovulation disorders due to some general or personal medical conditions,
• Where a man suffers from infertility issues such as a low sperm count, low sperm motility, abnormal sperm morphology, etc.

How is In Vitro Fertilization (IVF) done?

The IVF process essentially comprises four steps as follows:

1. Stimulate egg production

In the first step, on the second or third day of your period, your doctor will prescribe injectable medications to stimulate your egg production. If your ovaries produce too few eggs, the doctor may add further suitable fertility medications to help the follicles (each containing an egg) on your ovaries to grow. However, before the stimulation a doctor will check first whether your body is ready. This is done through monitoring your hormone levels via blood tests, and by checking your ovaries via ultrasounds. If everything shows good signs, then the stimulation can begin. You will be given a single dose of injection every day for 8-12 days. What kind of injectable medications you will receive depends on your hormone levels, your numbers of potential eggs, and your medical history of infertility treatment (if any).  After 8-12 days, the follicles on the ovaries, each follicle contains an egg, will normally grow to 18-20 millimeters and be ready to be harvested and eggs retrieved. To retrieve all of your eggs, your doctor will also usually prescribe another injectable medication, known as a trigger shot, to make your ovaries and eggs ready for the retrieval process.

2. Retrieve eggs and sperm

36 hours after your trigger shot, your eggs will be retrieved through a minor surgical procedure, in which a doctor will use ultrasound imaging to guide a thin needle through your pelvic caivity to remove or retrieve your eggs. If it sounds painful don’t worry, as you will be sedated, given pain medications, and the whole process usually only takes 15-20 minutes.

Around the same time as your eggs are being retrieved, your partner’s sperm will also be collected. Then, the eggs and sperm will be mixed together, and allowed to fertilize on their own in a laboratory dish.

However, before this fertilization process can begin it is important to check the sperm by semen analysis to see if they are qualified. Good quality sperm must show signs of good sperm concentration (number), good sperm motility (strength), and normal sperm morphology (shape). This semen analysis is important because in IVF a sperm must be strong and healthy enough to swim to meet an egg and then, after it meets an egg, penetrate through an eggs wall to fertilize the egg.

If the quality or number of semen is below standard, the egg  and sperm may be fertilized via an alternative fertilization process called ICSI. In ICSI, instead of letting the eggs and sperms fertilize on their own in a laboratory dish as in IVF, healthy sperm are specially selected and a single sperm is injected into each mature egg to achieve fertilization. Because you can inject only one egg at a time, and the egg is prone to damage, ICSI normally takes a longer time and requires an experienced fertility scientist.

Once fertilization occurs, the fertilized eggs are considered embryos.

3. Finding the perfect embryos

After the eggs and sperm are fertilized and become embryos, they will be cultured for 5 – 6 days in the laboratory so that some will grow and survive to the blastocyst stage, ready to be implanted in the lining of your uterus. Those that cannot become blastocysts are considered basically too weak and incompetent, and will not be transferred back to your uterine cavity.

4. Transferring the embryos

Finally, following the embryo culture process, and after your uterus is ready, blastocyst embryos will be transferred into your uterus. We then wait for about 10-11 days, hoping one of them shall be strong enough to implant in your uterus and begin to develop as a fetus, before doing a pregnancy test.

How many embryos will be transferred?

A woman’s physical condition and the quality of embryos will determine how many embryos can be transferred. Only one embryo, for example, can be enough if that embryo has been genetically tested and shows all the signs of good quality and success, as advised by our scientists and doctor.  To reduce the risks and problems associated with multiple pregnancies, usually no more than two embryos will be transferred

How safe is In Vitro Fertilization (IVF)?

In Vitro Fertilization is considered a safe medical procedure but, like all medical procedures, there are risks and in a few cases complications may occur. Complications during the treatment, and in any subsequent pregnancy, can include Ovarian Hyperstimulation Syndrome (OHSS), internal bleeding or infection after egg retrieval, multiple pregnancies, birth defects, and miscarriage. It is therefore important that you carefully select an IVF clinic with a good reputation and excellent medical staff.  A good doctor will be able to provide an IVF treatment that is suitable for each individual’s physical conditions and reduces the risk of complications.

How successful is In Vitro Fertilization (IVF)?

Globally the success rate of In Vitro Fertilization will vary widely between clinics from below 40% to as high as 70%+. Again it is important to select a good clinic. In addition, success rates will vary between women, based mainly on their reproductive history, age, and the cause of infertility. As well, lifestyle factors such as smoking, obesity, stress, etc. may contribute to a reduced success rate. While younger women are generally more successful with IVF, increasingly there are many successful cases with patients of more advanced maternal age.  The earlier you seek a direct consultation with an experienced IVF doctor, the greater your chance of success. The doctor will also be able to assess your fertility potential and give you a more precise and accurate indication of your potential success rate following IVF treatment.

References