Following always updated techniques in the field of medical assisted reproduction we can suggest the most appropriate path for each couple that comes near our clinic following his progress step by step and having as main purpose making decisions together.
Listening and support are essential; the goal is to make decisions together.
> Collecting the anamnesis (“the couple’s history”)
> Checking the previous examinations
> Asking for new examinations
The first visit is essential to plan the entire itinerary of the program that the couple will follow, to understand what are its stages, to examine all the clinical history, to plan the timing and to determine possible treatments. In this first visit, the connection between the couple and doctors will be established therefore it is necessary that both partners are present.
To proceed with assisted reproduction techniques of the second level (FIVET and ICSI), a team of specialists have to certify the condition of infertility and acceptance inside of the program, based on the law…
These tests allow to determine the most appropriate ART methodology and therefore to maximize the probability of a positive outcome for the couple. For example ICSI may be preferred compared to vitro fertilization in cases where there is a decreasing seminal fluid condition compared with the precedent quality.
Some of these examinations include:
Women:
> Blood group (also according to Rhesus)
> A complete blood count
> Hemoglobin Electrophoresis (required at least one of the partners)
> Screening for cystic fibrosis (required at least one of the partners)
> Indirect Coombs test (in cases of Rhesus negative group)
> Rubella IgG antibodies of IgM, IgG and IgM anti Toxoplasmosis, IgG and IgM anti Cytomegalovirus (if are negative results from previous examinations)
> HBsAg HbcAb, HCV, TPHA (Treponema pallidium, Hiv Test)
> On the 2nd or 3rd menstrual cycle measurement of levels: FSH, LH, TSH, Estradiol 17b, beta inhibin, anti mullerian hormone, prolactin
> On the 2nd day, or maximum in the 6th day of the menstrual cycle a transvaginal ultrasound is being done to assess the ovarian accessibility for obtaining the eggs and in order to count antral follicles
> Vaginal swab + cervical to check the possible presence of chlamydia and mycoplasma
> Pap test
> Mammography depending on age or risk factors
> In specific cases, the karyotype analysis
Man:
> Blood group (according to the system also Rhesus)
> Hemoglobin Electrophoresis (required at least one of the partners)
> Screening for Cystic Fibrosis (required at least one of the partners)
> HBsAg, HbcAb, HCV, TPHA, Hiv Test
> Examination of the seminal fluid (eg: swim up)
> Testosterone, FSH, LH, estradiol
> Other checks depending on the clinical history
For some of these tests it is necessary that the couple have a copy which will be attached to the patients consensuses file and will be preserved in the archive of the clinic. There are also several necessary tests in order to provide patient’s safety in the cases they go through anesthesia, for example the egg collection which is a simple surgical procedure is performed under general anesthesia (sedation anesthesia).
During this visit the main highlights are:
> The physician assesses the analyzes requested by him on the first visit
> Make a diagnoses or other required examinations
> If examinations are adequate the therapeutic program is determined and furthermore is established what medical therapy of the assisted reproduction will be followed by discussing it with the couple
Decisions possible at this moment are:
> The couple decides not to proceed further with the treatment
> Deciding to undergo intrauterine insemination (Level One)
> Deciding to undergo IVF-ICSI (Level Two)
Level I: Intrauterine Insemination
> Defining and giving instructions about the stimulation therapy
> Defining and giving instructions about the stimulation therapy
> Intrauterine insemination
The woman’s ovulation cycle is monitored both at home by using ovulation predictor kits and at the clinic by ultrasound and blood tests. Hormone injections are used to time ovulation, and fertility drugs may or may not be used by the patient to increase pregnancy chances.
The morning of the procedure, the male will provide a semen sample. For best results it is recommended that the male practices sexual abstinence for two to five days before the procedure. The sperm cells that have been collected are analyzed, separated and “washed.” The sperm cells are then placed into a specially designed fluid to help them survive.
Next, the millions of sperm are inserted into the woman’s vagina similarly to how a Pap smear is performed. The sperm is placed near the fallopian tubes opening, at the top of the uterus. The process is quick and performed in the clinic.
Although uncommon, risks of the procedure may include uterine cramping, infection and possible venereal disease through the transmission of the sperm.
The pregnancy success rate is five percent to 20 percent per cycle. The wide range accounts for many variables including the woman’s age, a healthy reproductive system and total sperm count. Taking fertility drugs can increase the chances of pregnancy by stimulating the ovulation of multiple eggs. The largest risk to consider when using fertility drugs, however, is the potential of conceiving twins.
In cases where IUI is not successful after the first cycle, patients may decide to continue with IUI (averaging three to six cycle attempts) or move on to another method with a higher success rate – in vitro fertilization (IVF).After insemination, the woman is lying on a gynecological chair for a few minutes and then can keep going normally through her daily activity. After 14 days the woman is asked to carry out an analysis in order to determine the beta hCG hormone levels in order to determine whether she is pregnant or not. If the test turns out negative, the procedure can be repeated many times without a pause, from a stimulation cycle to another. However, an ultrasound is performed to verify the absence of any possible obstacles to continue the procedure.
The Second level IVF-ICSI
> Defining and giving instructions about the stimulation therapy
> Ultrasound monitoring and multiple ovulation induction
> Pick-up
> The embryo transfer
> The embryo transfer
Positive result (increased value of beta hCG) : Pregnancy
> Continue with supportive therapy during the pregnancy
> Ultrasound after 2-3 weeks to assess the progress of pregnancy
Negative result (decreased value of beta hCG) : No pregnancy
> Ignoring the supportive therapy and waiting the menstrual flow
> Programming a future embryo transfer with frozen embryos or oocytes FET
> Programming a new attempt from the beginning
