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Methods of treatment – Embryologist care
Conventional in vitro fertilisation (IVF)
In young couples, where the male has a good spermiogram, the woman has enough high-quality eggs and no other infertility factors are expected, it is possible to have the collected eggs cultured together with sperm to allow for spontaneous fertilisation.
The conventional IVF method is the original method of in vitro fertilisation. This method is not recommended in the presence of immunological infertility factor.
This method does not allow for the embryologist to interfere in this process. Currently, this method is increasingly being replaced by ICSI/PICSI.
Intracytoplasmic sperm injection into the egg (ICSI or PICSI)
Sperm is carefully selected under a microscope (most often based on its morphological characteristics and motility) and injected into the egg using a special device (micromanipulator) to ensure fertilisation. Fertilisation is generally more likely than in conventional IVF.
In addition, a modified version of this method (PICSI) selects sperm cells based on their ability to bind to an egg (this process can be artificially simulated). Only mature sperm cells (more often with intact genes) produce receptors on their surface carrying this ability. After the injection of such selected sperm into the egg, specific couples (in multiple cycles, male genetic factor, couples with a history of miscarriages, etc.) have a higher probability of fertilisation, better embryonic development and a lower frequency of miscarriages than with standard ICSI.
In addition to an unsatisfactory spermiogram, ICSI indications include the high age of partners, unsuccessful fertilisation in previous cycles using conventional IVF or a low number of collected eggs. However, the ICSI method is often used due to the generally higher success rate of egg fertilisation.
Prolonged embryo culture means the culture of embryos from egg fertilisation to the transfer of the embryo in the stage of the so-called blastocyst to the uterus (5th resp. 6th day of culture). Prolonged culture mimics the course of natural pregnancy – in the first days after fertilisation, the embryo moves in the fallopian tube to the uterine cavity, which is reached on the fifth or sixth day. Prolonged culture is used as a method of selecting the highest quality embryos, because embryos with a higher probability of IVF success will grow by the end of in vitro culture.
Elective single embryo transfer (e-SET)
The current trend in assisted reproduction in the Czech Republic is the transfer of one high-quality embryo, as incentivised also by the reimbursement policy of health insurance companies. Infertility treatment by transfer of one high-quality embryo leads to a significant reduction in multiple pregnancies compared to the recently common transfer of two embryos. The selection of the highest quality embryo for transfer is facilitated by state-of-the-art embryological procedures, including a high-quality embryo cryopreservation programme, which is very important in this case. The transfer of one carefully selected embryo at the end of the culture process does not reduce the likelihood of success compared to the previously common transfer of two embryos.
Assisted hatching is disruption of the outer envelope of the embryo, which is performed to facilitate the attachment of the embryo in the uterus after its insertion. Current laser technology can gently thin the embryo's envelope, or completely disrupt it. It is performed in embryos with a stronger outer envelope. However, this approach is widely used for thawed embryos, where the embryo envelope can change its structure due to cryopreservation, making natural hatching difficult.
Cryopreservation (freezing) of germ cells and embryos
As a standard, embryos are frozen after artificial insemination at the end of their development in the laboratory (5th resp. 6th day of culture). Furthermore, sperm can be frozen, most often due to the absence of a partner during the artificial insemination cycle, fluctuations in the quality of ejaculate over time or also for medical reasons. These frozen cells and embryos can be stored for many years.
Embryos that have been frozen can be thawed and used for a new transfer into the uterus. The probability of an embryo’s survival after the freezing and thawing process is high (over 90%). The success rate after thawed embryo transfer is the same as for fresh embryo transfer.
Examination of sperm chromatin integrity
One of the hidden causes of reduced male fertility is the damaged chromatin integrity of sperm (simply put, the genetic information contained in the sperm is damaged). At the time of fertilisation, the sperm carry genes into the egg which are necessary for the further development of the embryo. Damage to these genes significantly affects male reproduction by reducing the likelihood of egg fertilisation and increasing the likelihood of miscarriages.
Sanus CAR Jihlava provides examination of chromatin integrity using sperm chromatin structure assay (SCSA), which is the most accurate, globally recognised method with strong diagnostic and prognostic significance.
Continuous monitoring of embryo development during culture (PrimoVision)
During culture, embryos that meet the developmental requirements at certain critical points in the culture (standard culture) are selected for transfer. It turns out that there are deviations from the "ideal" development between these moments, which can have a negative impact on the success of pregnancy and birth of a healthy child. This especially applies to the moment of formation of primordial nuclei after egg fertilisation, speed, regularity of cell division in the embryo, axis of division of these cells, formation or absorption of non-nuclear cell fragments in the embryo and other factors. The embryos are continually monitored by a special high-resolution camera that communicates with the computer control unit. The whole development is recorded, without disturbing the stability of the environment during the culture of embryos.
This approach predicts further embryo development and is prognostic in terms of the likelihood of a healthy baby. The method is particularly suitable in programmes with the transfer of only one embryo (e-SET).
The SANUS Centre for Assisted Reproduction in Jihlava offers this unique method to select the highest quality embryo in the infertility treatment programme.
Preimplantation genetic examinations of embryos
Assisted reproduction currently has to manage the steady increase in the age of couples wishing for their first offspring. This is largely reflected in the genetic quality of the embryos, and the prognosis for IVF success is usually lower than in couples with better prognosis.
Such couples and in general couples after repeated failures to conceive, repeated miscarriages, with chromosomal abnormalities, severe damage in the male partner's spermiogram, and many other indications may use preimplantation genetic screening (PGS). The number and structure of all chromosomes in the embryo of this couple are examined, and only an embryo with the correct genetic structure is transferred. Such an approach helps these couples achieve as good results as couples with a good prognosis.
Sanus CAR Jihlava offers these state-of-the-art procedures. In the cases described above, PGS is covered by health insurance.
In some cases, the infertility of couples is caused by genetic problems hidden in the germ cells. These are most often problems in the structure and number of chromosomes, defects of individual or entire groups of genes causing serious genetic diseases. In these specific cases, it is important to purposefully design a suitable examination, which would allow for the selection of an embryo without this genetic damage for transfer.
The Sanus Centre for Assisted Reproduction Jihlava offers professional consultation and subsequent preimplantation genetic diagnostics for couples with a genetic cause of infertility.