In vitro fertilisation

IVF (in vitro fertilisation), or the fertilisation of an ova outside of the body, is the most frequently used method of fertility treatment in the world

In Vitro Fertilization is the most frequently used method of fertility treatment in the world and Estonia. With the help of IVF more than 8 million children have already been born in the world, and in Estonia more than 600 children are born each year with the help of IVF, which accounts for nearly 4% of all new-born children.

The main indication for IVF is when infertility is due to the absence, obstruction or probable dysfunction of the fallopian tubes. IVF treatment is also used for other causes of infertility – changes in a man’s sperm, ovulation disorders, and infertility of unknown cause.

Sperm from a woman’s spouse, a specific male to whom she is not married, or a donor sperm, can be used to perform in vitro fertilisation.

Kui vajad doonorit
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Each patient is assigned an individual treatment dose that depends on their age and the results of the hormonal tests performed. Preparatory treatment for the IVF procedure lasts for at least 2-4 weeks.

Hormonal treatment is used to induce superovulation, the purpose of which is the simultaneous maturation of multiple oocytes. The oocytes are then extracted from the ovaries during an ultrasound-controlled procedure, using a fine catheter inserted through the top of vagina. This is also called oocyte pick-up (OPU). The procedure is not painful, and a short-term intravenous anaesthesia is used to provide pain relief.

The sperm required for fertilisation is donated by the partner on the same day that the oocytes are extracted from the ovaries. It is recommended that intercourse and ejaculation be avoided for a period of 2-5 days prior to the giving of the semen sample. The semen sample is given in a separate designated room.

If for some reason it proves impossible to provide the semen sample on the same day (absence due to work, etc.), it is possible to freeze the semen beforehand for use at the appropriate time. The fertilisation of ovum takes place under laboratory conditions. The ovum is exposed to semen in a special Petri dish, to allow for the in vitro fertilisation of the ovum. Using this method, the sperm finds and fertilises the ova on its own. Ova fertilization is checked approximately 20 hours after being brought into contact with the sperm. Ova fertilization is individual and depends on the quality of the ovum and the sperm, as well as the method chosen. In most cases, at least 50% of the ovum are fertilized, but there may be situations where fertilization does not occur Fertilized eggs are grown in special laboratory incubators for a maximum of up to 6 days, as desired. Conditions within the incubator are carefully monitored to ensure the correct temperature, gas composition and level of humidity.

A total of 1-3 fertilised eggs or embryos are selected for implantation in the uterus. According to Estonian law, a maximum of 3 embryos can be transplanted at one time. In practice, we usually transplant a single embryo to reduce the risk of multiple pregnancies. The embryo or embryos are transferred using a special catheter and the procedure is generally painless. Prior to being transferred, the woman begins hormone treatment to support the implantation of the embryo to the uterine lining, which continues after the transfer according to the doctor’s instructions Any good quality remaining embryos from the transfer are frozen, stored in liquid nitrogen and, if desired, used later. Embryos may be stored for up to seven years.

Tuuli Dmitrijeva, vanemembrüoloog, LTKH viljatusravikeskus

In Estonia, about 4% of the children born each year are thanks to in vitro fertilisation. As a result of IVF, almost 40% of women under the age of 35 become pregnant. The treatment can be repeated, if necessary.

ICSI mikroskoop ja mikromanipulaatorid

The Intracytoplasmic Sperm Injection (ICSI) procedure is a modification of the IVF procedure for in vitro fertilization, which is used primarily in the case of more severe male infertility. ICSI has been used in the treatment of male infertility since 1988, and with it a major breakthrough was achieved in the treatment of male infertility. In the ICSI procedure, a single sperm is selected under a microscope and injected directly into the ovum using a micropipette.

The use of ICSI is indicated in the case of poor sperm quality: low sperm concentration, motility or appearance (morphology). The ICSI procedure should also be used if fertilisation of the ovum during the previous IVF procedure proved insufficient. If sperm is absent from the semen, it is possible to obtain them from the testicular fluid or testicular tissue – this requires a simple procedure, in which a tissue sample is taken from the testicles after local anaesthesia or short-term anaesthesia. Sperm are isolated from the sample under a microscope and injected into mature ovum during the ICSI procedure. The results of the treatment are equivalent to those of sperm isolated from semen.

Fertilized ova are grown in special laboratory incubators for up to 6 days. Conditions within the incubator are carefully monitored to ensure the correct temperature, gas composition and level of humidity. A total of 1-3 embryos are then selected for implantation in the uterus.The remaining embryos are frozen, stored and used later, if necessary.In Estonia, as well as around the world, the ICSI method is used to fertilise ovum in about half of in vitro procedures. Pregnancy outcomes are similar in the case of IVF and ICSI, with approximately 40% of women under the age of 35 becoming pregnant. If the procedure wasn't successful, it is possible to transfer a frozen embryo or undergo a new IVF or ICSI cycle.

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