IVF is the in vitro fertilization-embryo transfer technique. It is a technique in which eggs are removed from a woman’s body, cultured in a vessel, and then technically treated sperm are added. After the eggs are fertilized, the culture is continued until early embryos are formed, and then transferred to the uterus for implantation and development into a fetus until delivery. Who needs in vitro fertilization-embryo transfer (1st generation IVF)?
① Sperm and egg transportation disorders caused by various factors;
② Ovulation disorders in the female partner;
③ Endometriosis of the female partner
④ Low or weak spermatozoa in the male partner;
⑤ Unexplained infertility;
(6) Immunological infertility.
What is microinjection of single sperm in oocyte plasma (second generation IVF)? It is an assisted reproductive technology that uses a microinjector to inject a single sperm into the oocyte plasma to achieve fertilization Who is suitable for second-generation IVF? It is suitable for
① Severe oligospermia, weakness and teratospermia;
② irreversible obstructive azoospermia;
③ Spermatogenic dysfunction (excluding genetic defects);
④ In vitro fertilization failure;
⑤ Abnormal sperm acrosome;
(6) Immunological infertility;
(7) Pre-implantation embryo genetic examination is required.
Under what circumstances should embryos be frozen for freeze-thaw embryo transfer?
①Preservation of the remaining embryos: If multiple high-quality embryos are obtained during one in vitro fertilization treatment, and 2-3 embryos are usually put back into the uterine cavity for each transfer, the remaining embryos can be frozen and preserved. If the pregnancy is not successful this time, the embryos can be thawed and reimplanted into the uterine cavity at an appropriate later cycle. This technique avoids the mental and physical pain and financial burden caused by another ovulation promotion and egg retrieval procedure, and the clinical pregnancy success rate is the same as that of fresh embryo transfer.
②In the treatment cycle the female partner has a thin endometrium, fluid in the uterine cavity, too many eggs retrieved there is a risk of ovarian hyperstimulation, unsynchronized endometrium and embryo development unsuitable for embryo implantation, and the female partner is unwell.
The cost of in vitro fertilization includes 3 parts.
① Pre-operative examination fee: 4000-5000 RMB for both partners;
② Ovulation drugs: domestic and imported drugs, about 5000-7000 RMB;
③ Surgery fee: 11,000-15,000 RMB.
At present, the cost of an IVF procedure in our department varies depending on the medication regimen and whether special treatment (such as intracytoplasmic single sperm injection) is needed for each individual, and currently costs about 25,000 – 30,000 RMB per cycle.
What are the success rates and outcomes of IVF assisted conception?
The success rate of IVF technology depends on the age of both partners, especially the age of the female partner, thus the success rate varies from 40-70%. After obtaining a pregnancy through this technology, as with natural conception, there is still a risk of miscarriage, premature birth, ectopic pregnancy, abnormal pregnancy, fetal malformation, etc. Therefore, patients need to be fully informed, undergo prenatal checkups on schedule after conception, and receive follow-up visits from the treatment unit carefully.
Pre-operative preparation for IVF
① First of all, in accordance with the national population and family planning policy have three original documents.
ID card of both parties;
Marriage certificate of both parties;
Family planning certificate (birth certificate transferred to this year’s plan) / in line with the one-child birth policy without a birth certificate card in the local family planning office to print the basic information card of women of childbearing age (and stamped with the official seal of the family planning office and attached to the phone number of the family planning office)], and will keep copies of the above documents in our department;
② both parties to improve the relevant laboratory tests to exclude unsuitable for surgery, pregnancy
IVF technical procedure.
① Controlled superovulation and follicle monitoring: Controlled superovulation technique is used to enhance and improve ovarian function to achieve the goal of obtaining multiple healthy eggs to provide multiple embryos for transfer. Follicles are also monitored using vaginal ultrasound and blood hormone levels.
(ii) Egg retrieval: Egg retrieval is performed under intravenous anesthesia with transvaginal ultrasound guidance by passing the retrieval needle through the vaginal fornix to the ovaries and aspirating the eggs, which are immediately transferred under a microscope to a culture dish containing embryo culture fluid and incubated in an incubator.
③Sperm collection and semen processing: On the day of egg collection, the husband extracts sperm by masturbation in the hospital sperm collection room; the semen is handed over to the laboratory staff for processing
④Insemination and embryo culture: done by the laboratory specialist in the culture room. 4-6 hours after egg collection, the treated sperm and eggs are placed in the same Petri dish and co-cultured for 18 hours before fertilization can be observed under a microscope. If the sperm quality is too poor to allow natural fertilization, fertilization must be forced by microinjection.
⑤ Embryo transfer: After 3 days of in vitro culture, the fertilized egg can develop into an 8-cell embryo. At this time, the number of embryos to be transferred is determined by the patient’s age, whether or not she has ever been pregnant, and the quality of the embryos, and the excess embryos can be frozen and preserved. Currently, most of the embryos are transferred on the third day after fertilization, and some are cultured until the blastocyst is formed on the fifth day before transfer. No anesthesia is required for embryo transfer.
(6) Luteal support: Embryo transfer requires oral or injectable progesterone drugs for luteal support.
(vii) Follow-up: 14 days after transfer, urine test or blood sampling to determine whether pregnancy is present. Ultrasound examination 35 days after transfer to determine intrauterine pregnancy, exclude ectopic pregnancy, multiple pregnancy, etc.; in case of triplet pregnancy, reduction must be performed. After 3 months of pregnancy, the IVF mother will be like a normal pregnant woman.
Commonly used ovulation protocols for IVF pregnancy
I. Long protocol
1. Indications: Age <35 years, ≥5 basal follicles per ovary, basal endocrine signs of normal ovarian function.
2. Dosing regimen
7 days after ovulation or 5 tablets of oral contraceptive pills (equivalent to the 21st day of menstruation), start subcutaneous injection of Treprostin; come to the hospital for blood check 14-18 days after down regulation, and start to use ovulation-promoting drugs after down regulation reaches the standard, strictly follow the doctor’s prescription, and follow up the examination on time, when the follicle size and blood hormone level are suitable, stop using ovulation-promoting drugs and inject HCG, i.e. give night injection (HCG), and come to the hospital 34-36 hours after the night injection. Come to the hospital for egg retrieval 34-36 hours after the overnight injection.
Ovulation promotion with short or light stimulation protocol
1. Indications: Age ≥35 years, <5 basal follicles per ovary, endocrine indication of decreased ovarian reserve.
2. Dosing regimen
Inject both treprostin and ovulation drugs on the second day of menstruation, come to the hospital for blood hormone check and ultrasound on the 5th day, increase or decrease the dosage of drugs according to the follicle development, continue to use until the follicles are mature, decide the time of HCG injection, retrieve eggs 34-36 hours after HCG injection, luteal support after egg retrieval, embryo transfer on the 3rd day, check blood and urine HCG on the 14th day after transfer to determine whether conception.
III. Microstimulation protocol
1. Indications: Currently, microstimulation protocols in our department are mostly used in patients with poor ovarian reserve.
2. Medication regimen: 1 tablet of clomiphene daily on the 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th and 11th days of menstruation and 2 injections of urotropic hormone on each of the 6th, 8th and 10th days of menstrual land.