In vitro fertilization: assisted reproduction technique This infertility treatment is the third step in the assisted reproduction techniques ladder. This treatment brings the best pregnancy rate. Also called in vitro insemination, this technique is performed in assisted reproduction centers due to its high complexity. Indications for in vitro fertilization Couples that didn’t succeed with 4 intrauterine insemination cycles. Woman with obstructed Fallopian tubes. Moderate or severe decrease in the number and motility of sperm. When men have had a vasectomy in the past. In vitro fertilization consists in impregnating the eggs with the sperm in the lab, in order to obtain embryo that will after, be placed inside the uterus. This technique exists since 1978 when, Louise Brown, first baby to be conceived by this technique, was born in England. Through all these years, this method has improved and is used nowadays in thousands of clinics around the world. When first starting with this technique, the question of affecting the development or growth of the child was a big issue. After some decades, today we know that the use of this technique does not affect the child. 5 million babies have been born through in vitro fertilization since 1978. The objective of this technique is to ensure the impregnation of the egg by the sperm, correcting any factor causing infertility both in the male or female companion. In this technique, both male companion or donor semen can be used. In vitro fertilization procedure The in vitro fertilization procedure has 5 steps: Ovarian stimulation It consists in stimulating the ovaries with oral or injected medicines, making them produce one or two eggs. This stimulation lasts between 8 and 14 days. It is very important to have ultrasounds every 3 or 4 days to control adjunting the dosis the number and growth of eggs that are being developed. When it is observed through ultrasound that the folicules reached the right size, this indicates the prefect moment to make them ovulate through an injection. The doctor will indicate the exact moment when the medicine to ovulate should be applied, having the extraction of the eggs done 36 hours before the ovulation. This control should be done by specialists, through vaginal ultrasound, in order to avoid any complication such as a multiple pregnancy or ovaric hyperstimulation syndrome. Show more Semen preparation in the lab The day of the eggs extraction, just a few hours before the procedure, the semen sample is prepared. This sample is capacitated in the andrology lab to select the best sperm. Once selected, they are prepared to impregnate the egg. Ovarian punction: egg extraction Before the ovulation happens, the eggs are extracted and placed in culture media inside special incubators in the embriology lab. The extraction is performed with a needle that is introduced in the vagina with the help of an ultrasound. This step is known as ovarian punction. This procedure lasts about 20 minutes and a light sedative is used in order to ease the pain. It is not necessary any incision so, there will be no scar. After the punction, the patient remains at ease for some hours, waiting for the effects of the sedative to go away. The patient can go home righ after. Insemination of the eggs and embryo culture Once we have the sperm and eggs, the impregnation is done in the embriology lab. This can be done in 2 ways: Conventional in vitro fertilization: in a drop of culture media, some capacitated sperm is placed together with the egg. This way, the Intracytoplasmic sperm injection joins the egg to fertilize it. Sperm Intracytoplasmic sperm injection: with the help of pipettes and an special microscope, one sperm is chosen and injected directly inside the egg After, the inseminated eggs are placed inside incubators and left in the culture during 19 hours, when then they are observed to know if they are fertilized or not. Embryo transfer After 3 or 5 days in culture media, the embryo are transfered inside the uterus. This is a procedure that does not need anesthesia, lasts a couple of minutes and the disconfort is similar to that of a Pap test. 15 days later, a pregnancy test is done.