Techniques that can be used during IVF

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Posted by IVF Specialist. Tran Hue Tran - Reproductive Support Center - Vinmec Times City International General Hospital
In vitro fertilization (IVF) is the process in which an egg is fertilized with a sperm outside the body. The fertilized egg (zygote) is raised for 2–6 days to form an embryo in culture and then transferred to the uterus..

1. What is in vitro fertilization?

In vitro fertilization (IVF) is the process in which an egg is fertilized with a sperm outside the body (in a test tube). This process includes monitoring and inducing ovulation, egg retrieval, and finally allowing sperm to fertilize an egg in a laboratory culture. The fertilized egg (zygote) is grown for 2–6 days to form an embryo in culture and then transferred to the uterus. After the embryo is placed in the uterus, it can implant and develop into a fetus. The first IVF was performed, endoscopic oocyte retrieval was performed only on naturally developing ovaries, so only one ovum was obtained, which was then incubated with sperm in a culture medium. , so the success rate is often very low.. As IVF develops, the use of hormones to stimulate the ovaries is increasingly common. Thanks to ovarian stimulation technique, it is possible to obtain a larger number of eggs and vaginally collect eggs under ultrasound guidance, along with gamete processing, culture and embryo selection, finally good embryos are placed back into the uterus for fetal formation, thereby improving the effectiveness of in vitro fertilization.

2. Techniques that can be used during IVF

Intracytoplasmic sperm injection (ICSI) According to the classical technique, egg and sperm are brought together, merging naturally to form an embryo. This method has a low success rate in cases where the quantity and quality of sperm are too poor. ICSI technique – Intracytoplasmic sperm injection was born to assist in the fertilization process between the ovum and sperm
This is an advanced assisted reproductive technology that effectively treats male infertility, especially Special application is applied to the following subjects:
All types of abnormalities in sperm count and function in men such as: low sperm count, abnormal sperm count, poor sperm motility. Male infertility due to azoospermia: There is no sperm in the semen, surgery must be performed to remove sperm. Men lack or have damage to the vas deferens (the part responsible for carrying semen from the testicles to the penis). Men who have had a vasectomy. Abnormalities in fertilization: the husband's sperm and the wife's eggs are normal but not fertilized or the fertilization rate is low, there is suspicion of an abnormality in the fertilization process between sperm and egg. Infertility of unknown cause. The wife has a small number of eggs, of poor quality. Fail many times with normal artificial insemination method. Pre-implantation genetic diagnosis. The method of intracytoplasmic sperm injection is performed to increase the chances of fertilization. A good quality sperm is selected for direct injection into the cytoplasm of the egg. After successful fertilization, the embryos will be cultured until the 3rd or 5th day, then transferred back to the woman's uterus for implantation.
At the Assisted Reproductive Center - Vinmec International General Hospital, this technique is performed using the most advanced inverted microscope system to bring the best results to the patient.

Embryo release support After the egg and sperm are fertilized with IVF or ICSI techniques, the embryo is transferred to the woman's uterus for implantation and development into a fetus. The outer shell of the embryo is a transparent membrane. In some cases, this membrane becomes abnormally firm or does not thin during embryonic development. This makes it late or even impossible for the embryo to escape and attach to the endometrium for implantation. The technique of supporting embryo drainage to thin or puncture the transparent outer membrane of the embryo has been born, making it easier for the embryo to escape and increasing the ability of the embryo to implant.
Patients applying this technique:
The patient failed many times in IVF. Older patients, few embryos, poor quality. The patient has an embryo with a thick, irregular, irregular transparent membrane. Patients with frozen embryo transfer There are currently 4 methods to help support embryo escape during IVF to increase conception rate:
Tear a part of the transparent membrane (Partial zona dissection - PZD) Thin the transparent membrane with Tyrode acid. Thin or pore transparent film by piezo method Thin or pore transparent film with laser. In which the laser method is the most modern and advanced being used at the Reproductive Center - Vinmec International General Hospital.

Embryo freezing Remaining embryos after being transferred to the uterus will be frozen for a long time, if the fresh embryo transfer cycle does not yield results or the couple wants to have more children, they will conduct frozen embryo transfer without any results. no need to undergo ovarian stimulation and oocyte retrieval from scratch. Moreover, in cases of ovarian hyperstimulation, it is necessary to freeze the whole embryo and transfer embryos in the next cycle to avoid the risk of severe ovarian hyperstimulation. . In those cases during embryo transfer cycles where the lining of the uterus is not suitable or the uterine lining is filled with fluid..., whole embryo freezing during these cycles is an effective solution. In cases of genetic diagnosis of preimplantation embryos, embryos will be frozen and thawed for transfer after normal genetic results....
Pregnancy effect between fresh embryo transfer and embryo transfer frozen are equivalent. When embryos are frozen, female patients will have more time to prepare the most perfect endometrial layer, creating optimal conditions to receive embryos for implantation.
Cryopreservation of embryos by vitrification method is the most advanced method currently being used at Reproductive Center - Vinmec International General Hospital, with this method, the survival rate of embryos after thawing increases significantly help higher implantation rate and clinical pregnancy rate.
Egg freezing Over time, as women get older, the egg quality and quantity decrease significantly, reducing the ability to fertilize.
Egg storage is to ensure quality for later childbirth, in school women of childbearing age who do not want to have children right away or women who are having health problems such as chemotherapy, radiation treatment, ovarian failure, decreased ovarian reserve,... but still want to get pregnant.
The patient may need to use ovarian stimulation drugs to increase the number of eggs (this indication varies from person to person), or simply monitor the natural cycle. Then proceed to aspirate the eggs. Eggs after poking will be evaluated for morphological quality. Only mature eggs are eligible for refrigeration. Mature eggs are frozen by vitrification and stored for a long time in liquid nitrogen.

Sperm storage Subjects wishing to store sperm such as:
Autologous sperm storage: The husband is far away, unable to collect sperm on the day of sperm injection or egg retrieval. Sperm storage before cancer treatment, testicular surgery for medical reasons, or other treatments that can affect fertility. For sperm: sperm bank.. Collect sperm samples by masturbation and put them in specially sterilized plastic bottles. In cases where it is not possible to obtain a sample by masturbation, a specialized condom can be used for intercourse. In the case of azoospermia, doctors can perform surgery such as microsurgical sperm aspiration from the epididymis (MESA), percutaneous epididymectomy (PESA). .. ... doctors always try to minimize the number of times performed surgically to retrieve sperm.
After testing and processing, sperm samples will be frozen in liquid nitrogen bottles at -196 degrees Celsius, preserved for a long time.
In vitro egg maturation (IVM) Suitable patients for IVM are women with polycystic ovaries, high-risk patients with ovarian response. eggs
In IVM, immature eggs are removed from slightly stimulated ovaries thus reducing costs and avoiding ovarian hyperstimulation syndrome. Moreover, this method does not need to follow up with ultrasound, multiple endocrine tests and shorter treatment time compared to normal in vitro fertilization.
Sperm removal surgery Spermectomy is a method for couples who do IVF while the husband has no sperm in the semen due to blockage (testicles still produce normal sperm but no sperm in semen), or non-obstructive azoospermia (testicles do not produce sperm)
Sperm removal surgery has many methods depending on the cause of azoospermia. After examination, the patient will be selected the appropriate surgical method of sperm collection: percutaneous epididymectomy (PESA), microsurgical epididymal sperm aspiration (MESA), isolation. spermatozoa from testicular tissue (TESE). On the appointment day (the day of the wife's egg retrieval), the husband fasted in the morning, during the procedure, the patient will be given light anesthesia or sedation and sperm collection according to one of the above methods.
Vinmec IVF Reproductive Center is the address of infertility - infertility treatment chosen by many couples. So far, the Center has performed fertility support for over 1000 infertile couples with a success rate of over 40%. This rate is equivalent to developed countries such as the UK, USA, Australia,...
The center gathers a team of leading experts in the field of obstetrics and gynecology nationally and internationally, trained in centers leading in the world such as in the US, Singapore, Japan, Australia and famous fertility centers in the world. Vinmec Fertility Center can perform most of the advanced assisted reproductive techniques in the world such as: classical IVF, ICSI (intracytoplasmic sperm injection), embryo freezing, culture - embryo transfer, support embryo rupture, reduce multiple pregnancies...help realize the dream of parenthood of hundreds of families across Vietnam.

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