IVF or in vitro fertilization (IVF) with the transfer in the uterus of embryos (ET). Is without a doubt among the assisted reproduction techniques more used and is indicated in many situations: from the sterilità tubal severe to subfertilità male, fromendometriosis to the sterilità immunological investigations.
it Is a method with good probability; of success but it is not; without its limitations: it is complex, expensive, and involves choices of an ethical one. the V. Law 40
The couple is initially subjected to laboratory investigations to confirm the diagnosis of sterilità: if there are the conditions your doctor is considering the possibilityà to resort to IVF. At this stage, if the couple want to, can; to be able to doctor or a psychologist to help overcome problems, fears and anxieties.
At the beginning the woman has to undergo an injection of hormones, in the hours and days prescribed. After a few days of home treatment begins, a phase that requires the daily attendance of the clinic: for 5-10 days will haveà to submit to a blood draw in the morning, for establishing, through the dosage of estrogen the amount; the right of hormones to be injected, and an ecografìto assess the number of follicles in evolution, their diameter and the normalityà of their progression to the maturità.
The woman after the pickup back to the house and in the afternoon, on the telephone, is given to the dosage of gonadotropins. Is a fundamental practice in order to stimulate the ovaries to increase the production of oocytes (in nature, a woman produces only one oocyte cycle).
When the doctor indicates, the woman will haveà to submit to an injection of HCG (the hormone produced by the pregnancy); begin a delicate phase: within 34-36 hours after the injection will be collected oocytes for in vitro fertilization.
In the IVF, in fact, oocytes and sperm are made to meet in the “tube” and only after the creation of the pre-embryo will be put back in the woman.
Within 36 hours from the injection of HCG, the woman is hospitalized, in analgesia, is subjected to the removal of the oocytes. You insert a thin needle into the vagina to reach the ovary, and it sucks in the follicle. The woman does not realize of nothing, does not feel pain and not avrà a traumatic memory of the intervention.
In about 10-20 minutes everything is finished. In the meantime, the man will haveà to provide the seminal fluid. Può be of help, in the earlier days, freeze in advance a sample of the seed so as to ensure the successful completion of this phase of IVF.
In the laboratory, the seed is prepared in such a way to be the più “fruitful” as possible. And it is at this point that it presents an ethical dilemma related to IVF: how many eggs fertilize. The decision will comeà taken in advance to the doctor together.
The starting point is simple: the more eggs you fertilize, the più pre-embryos are created. Più pre-embryos are implanted in the uterus, the greater will be the probability to have a pregnancy. However, it is possible that implanted not only a pre-embryo, but to all those reintroduced into the uterus: they are not rare, in fact, the pregnancies plurigemellari (5%).
facing these issues, a first road is that of the reduction of the rooms, pointing towards: it implants all the pre-embryos produced to intervene in the case of multiple implants, by stopping the development of a number of pre-embryos that have taken root.
A maneuver not without moral consequences, for many couples unacceptable.
The Companyà italiana for the Studies on the Fertilityà and on the Sterilità (SIFES) recommends that you not transfer more than three pre-embryos in women less than 36 years and four in women over 36 years old.
And what to do with them? Without a doubt, if it fertilizes a larger number (more than 4) to what andrà to plant, choosing the best eggs. To increase the possibilityà success è can, in fact, the study of the pre-embryos and implant only those considered to be “più strong,” neglecting those with little chanceà of success.
The other, provided a" valid, can be frozen (permission must be given before the start of the treatment), and placed at the disposal of the couple in case of failure of IVF, both for future pregnancies. The new plant può be made in the course of a cycle, spontaneous or artificial, are administered estrogen and progestin).
there is another way, that there is more support among catholics, and it is that of the “simple case”: we fertilize only two or three egg and it implants in the uterus all the pre-embryos produced. The percentage of success, of course, decreases becauseé not è said that all of the fertilised eggs become pre-embryos. the V. Law 40
At this point the woman after a few hours può go home: willà wait two days before having to transfer to the uterus of the pre-embryos. In the laboratory, kept under control the development of the fertilized oocytes, and you choose (as long as" the couple has given permission for those to be implanted and which ones to freeze. It is a delicate moment, and not devoid of implications that are difficult: it is possible that no oocyte is fertilized and, therefore, that the IVF is not practicable.
If all goes well, after two days, the pre-embryos are transferred into the uterus through a thin catheter. Is an intervention that does not require hospitalization, is painless and non-invasive.
At this point, if it has or not a pregnancy, it depends on the good qualityà of the pre-embryo and the proper maturation of the endometrium.
The first verdict, thanks to a blood test after a wait of about two weeks: if the outcome is negative there is no hope, the IVF has failed, if it is positive you want to say that you è scored the first point in favor, but è well not too much to hope for.
to be able To say with absolute certainty that the pregnancy is in place you need to repeat the exam a second time (remember that before the egg retrieval, the woman is subjected to an injection at the base of the pregnancy hormone remains in the bloodstream for a long time, and può influence the test), and have confirmation from the ultrasound.
È possible that the encourages tion of the ovaries performed before the oocyte pick-up may induce a syndrome of hyperstimulation of which we have spoken also about the induction of ovulation.
Given that the syndrome of dà signs of onset, the roads are different: decide not to pick-up the eggs and start again after a waiting period of a new cycle; to pick-up the oocytes, fecondarli and freeze them to implant them later once the syndrome is disappearance.
Fertilization in vitro on spontaneous cycles
If the couple requires, it is possible to perform fertilizations in vitro on spontaneous cycles. That is to say, withdraw the oocyte produced naturally by the woman, without being subject to ovarian stimulation. This solves the problem of hyperstimulation syndrome, of the “waste of the embryos and multiple pregnancies but, without a doubt, reduces the possibilityà of success. To this we must add that the withdrawal of the oocyte è più difficult because it is foreseeable that the time is ripe.
Ettore Cittadidini, Carlo Flamigni, A Child, wanting to be able to have – And. The New Italy Scientific
page updated on December 27, 2007