Many women who have difficulty becoming pregnant can conceive with medical assistance. One form of treatment is ovulation induction. During ovulation induction, the patient takes medication to produce one or more eggs from her ovaries. The medication comes in two forms: oral (Clomiphene Citrate; Clomid™, Letrozol™) and injectable (Gonal F™, Puregon™, Elonva™, Menotrophin™).
Female patients are given medicine to stimulate the maturation of eggs on the ovaries. These eggs are then retrieved, placed in a special solution outside the woman's body, and combined with sperm. The resulting embryos are nourished in an incubator. At a predetermined stage of development, the embryos are replaced into the uterus to continue normal fetal development.
ICSI (Intra Cytoplasmic Sperm Injection)
Severe male factor infertility, once an impenetrable barrier to parenthood, has virtually ceased to exist. ICSI involves the insertion of a single sperm directly into a mature egg obtained from the ovary of a woman undergoing in vitro fertilization. Often, this results in fertilization and the development of a normal embryo. The babies born after ICSI are just as healthy as babies conceived spontaneously.
The form of the sperm is a very relevant prediction factor for fertilization in natural pregnancy, IUI, IVF, ICSI.
Sperm mutation through large vacuoles within the sperms act as factors that decrease fertilization by ICSI.
An increase in pregnancy rate is achieved by selecting normal sperms from sperms with large vacuoles through a zoomed in screen.
Candidates for IMSI technique IVF-ET patients from Testicular sperm extraction(TESE)
Cases with Teratozoospermia (normal sperm below 4%, globozoospermia,
pin-head sperm in strict morphologically sperm examination)
Recurrent failure cases of fertilization and implantation
Cases of recurrent miscarriage
IMSI methods and advantages
Fertilization and embryodevelopment can be enhanced By observing the sperms
through a 10,000X magnified screen during ICSI and screening for abnormalities
Implantation and pregnancy rate can be increased through a higheer normal
embryo ratio by selecting more normal sperms for Teratozoospermia or TESE cases.
IMSI can minimize chromosomal anomaly or embryo developmental failure from recurrent pregnancy failures and fetal loss.
Laser Assisted Hatching (Laser AHA)
The technique uses a laser to create an incision on the surface of the embryo, facilitating hatching and implantation
Laser assisted hatching basics An embryo is enclosed by a zona pellucidae composed of threee proteins (ZP1, ZP2, ZP3) for protection. Hatching occurs as the invisible shell becomes thinner from the expansion pressure of the embryo as it goes through cleavage. The hatched embryo forms the placenta through the implantation process from the signal transduction with the inner wall of the uterus. Embryos from IVF-ET may have abnormally thick shells due to various conditions in the body, leading to failure of implantation from hindered hatching process.
Candidates for Laser AHA
IVF-ET patients over the age of 35
Recurrent failure cases of IVF-ET
Embryo with Thick ZP by Frozen-thawed
Embryo with unusually thick ZP
Supported by MERCK Serono Co.
Technique used to thin or penetrate the ZP of the embryo using a laser with the wavelength of 0.48um
Safer compared to conventional methods(mechanical incision, chemical removal, proteolytic removal) and can minimize the exposure of the embryo
The effectiveness of Embryo Glue during implantation
Supported by MERCK Serono Co.
Implantation improvement by using embryo glue of high hvaluronan concentration
Facilitation of In vitro culture of embryo
Implantation facilitation of embryo
Improved survival rate of cryopreserved embryo
Hyaluronan is a glycoprotein composed of Glucosaminoglycan which can be found in follicular fluid, oviductal fluid, Uterine fluid (Lee & Ax, 1984; R-Martinez et al, 1998).
Hyaluronan facilitates the implantation of embryo inside and outside the body.
The concentration of Hyaluronan increases dramatically during implantation.
TESE (Testicular sperm extraction)
Some men suffer a blockage or other abnormality that prevents the passage of sperm through ejaculation. A minor surgical procedure can be performed where sperm is retrieved from the epididymis or directly from the testicle itself. This sperm is then injected (ICSI) into the mature eggs obtained through IVF. Sperm from Testicular / Epididymal Sperm Aspiration can be successfully cryopreserved for future use.
Advanced cryopreservation techniques allow selected embryos to be frozen for the couples' later use. When thawed at a later date, these embryos can be transferred to the woman's uterus in a menstrual cycle with little or no premedication. The babies born after cryopreservation are just as healthy as babies conceived spontaneously.
We already know that with natural conception, embryos arrive in the uterus at day 5-6 after fertilization. With present-day IVF, however, embryos are routinely transferred back to the uterus on day 3 after fertilization. Recent breakthroughs have been made in the science of nurturing embryos in the laboratory. These discoveries have allowed the embryos from select patients to benefit from an additional 2 to 3 days of growth prior to embryo transfer. By growing embryos to the blastocyst stage, we are able to transfer fewer embryos without lowering the chance that a patient will become pregnant. This breakthrough will help maintain the high pregnancy rates that patients have come to expect while decreasing the risk of conceiving a high order multiple pregnancy.
Preimplantation Genetic Diagnosis (PGD)
Preimplantation genetic diagnosis (PGD) is an assisted reproductive technology for the diagnosis of a genetic disease in early embryos prior to implantation and pregnancy in an IVF cycle. This technology is effective for aneuploidy screening and the diagnosis of unbalanced inheritance of chromosome abnormalities such as translocations or inversions.
FISH (Fluorescent In situ hybridization) technique
FISH is the most commonly applied method to determine the chromosomal constitution of an embryo. The cells are fixated on glass microscope slides and hybridized with DNA probes. Each of these probes are specific for part of a chromosome, and are labelled with a fluorochrome.
PCR (Polymerase chain Reaction) technique
PCR provides the possibility to obtain a large quantity of copies of a particular stretch of the genome. It makes it suitable for all kinds of genetic diagnosis.