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- In Vitro Fertilization (IVF)
This technique consist in placing an egg in contact with 20-30,000 sperm in a Petri Box and let them incubate in a special liquid medium so fertilization can occur. All this steps are conducted under extremely well controlled conditions of temperature, oxigen concentrations, Carbone Bioxide, Humidity and special culture means for mature eggs and sperm.
The eggs are obtained by Vaginal Ultrasound Guided Aspiration. Sperms can be obtained by masturbation or by Subcutaneous Aspiration of the Epididymis (click here to watch video) or by Testicular Biopsy. The eggs and th sperm are then placed in a liquid medium so fertilization and embryo development can occur.
Embryo Transfer in IVF 
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If the embryos are developing normally, the woman will return to the clinic
to have the embryos transferred into her uterus. The embryos will usually
be at the two to eight cell stage. Some clinics are now letting embryos
grow for 5 days to the blastocyst stage
The embryos and a small amount of the liquid medium
in which they have been growing are drawn up into a soft rubber tube or
catheter which is inserted into the vagina, through the cervix and into the uterus. The embryos
are flushed gently out of the catheter. Ultrasound may be used to help
the doctor place the embryos in the uterus. The woman may be instructed
to stay in bed for several hours with her head lowered and feet raised.
Discharge from the clinic occurs anywhere from 4-6 hours after embryo
transfer. Progesterone will
be given daily to maximize the chances of getting a good uterine lining
for implantation to occur.
Indications:
Tuboperitoneal factor (adherent process)
Male Infertility (Male factor from minor to moderated, 5-20Mill/Ml, motility 20-50%
IDIOPATHIC INFERTILITY (UNEXPLAINED INFERTILITY). No reason can be found to explain the cause of a couple's infertility.
IMMUNOLOGICAL RESPONSE. This condition occurs when either partner produces sperm antibodies, which can cause infertility.
Contraindications:
Severe Male Infertility (<1.5mill. total motility o <5mill./ml, motility <= 20%, FN <=20%, Progression 1-2).
Scarce number of eggs: Less than five mature eggs.
- Intracytoplasmic Sperm Injection (ICSI)
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Sperms can be obtained by masturbation or by Subcutaneous
Aspiration of the Epididymis or by Testicular Biopsy.
This is a technique in which a single sperm is directly inserted into an individual egg with the help of a micromanipulator. The egg is left for incubation in a liquid medium so fertilization can occur. Fertilization is verified after the first 24 hours and the embryo transfer is conducted during the first 2-5 days.
Indications:
Quality and Quantity Sperm alterations during ejaculation that does not allow its inclusion on a conventional IVF program. ICSI could be indicated if any of the following parameters is altered after the sperm and semen analysis. Total count < 5 millions and/or motility <30% and/or normal morphology < 30%).
When it is not possible ot obtain sperm out of the ejaculation (Azoospermia), and this are taken either from the Epididymis or from a testicle.
Obstruction of the Vas Deferens or an abscence of it. (1-2% of secondary male infertility, complete abscence of it or Cystic Fibrosis mutations.
Unexplainable failure of conventional IVF (Three consecutive IVF failed procedures)
Reduced Fertilization (<50%)
Positive anti-sperm antibodies (<50%)
Endometriosis (Grade II and IV)
Poor responders and/or age>39 years.
Contraindications:
Chromosonal and/or genetic alterations of the male gamete.
- Gamete Intra-Fallopian Tube Transfer GIFT)
A surgical procedure in which a sperm - egg mixture
is transferred into the fallopian tubes where natural fertilization may
occur.
This procedure is conducted through Laparoscopy. The H.O.C. Protocol, Follicle Aspiration, as well as the Luteal Phase supply are delivered in a similar way as in IVF.
Nowadays, the need to verify if fertilization has occurred, as well as its invasive nature and the requirement of at least one tube to be in good condition has made of this tecnique to be less practiced.
Pacients that present an obstruction of their fallopian tubes are not good candidates to this procedure.
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