Clinical Assisted Reproduction Clinical Assisted Reproduction
BASIC INFORMATION TO COUPLES APPLYING
FOR CLINICAL ASSISTED REPRODUCTION
We are frequently met with couples asking similar questions on CRT (Clinical Reproductive Techniques). Here is a summary of answers to FAQ.
Which clinical reproductive techniques are most often used ?
1. Artificial insemination with sperm of spouse (IUI) or with sperm of donor or bank (IAD). This technique is used when the spermatozoon of the man and the ovule of the woman do not mate easily. The cause can be that of quantitative or qualitative insufficiency of the sperm; ovulation problems; inadequate cervical glaires; ejaculations problems or unexplained infertilities.
2. In vitro fertilization or IVF. It is practised in the cases of failure of IAC; pathologies tubaires (stopped horns) and certain insufficiencies of sperms.
3. The ICSI (intra cytoplasmic sperm injection) consists in injecting only one spermatozoon directly in the ovocyte. This technique which increases the chances of success of IVF is particularly indicated in very bad sperms.
How is held an insemination ?
It is held in 3 stages :
1. Stimulation of the ovaries by tablets taken during 5 days or by injections. That concerns women who have disorders of ovulation. This stimulation is supervised by vaginal echography and possibly hormonal measurements.
2. Causing ovulation by an injection as soon as the follicules are mature.
3. Insemination itself is carried out the day of ovulation. The spermatozoa prepared beforehand in laboratory are deposited in the uterine cavity. Indeed the spouse leaves his sperm at the private clinic the very morning after a 2 to days abstinence.
A pregnancy test is carried out 2 weeks after insemination. The success rate is 10 to 15%.
How is held an IVF ?
It is held in 4 stages after assessment, possible treatments of infections and other factors like fibroids.
1. Ovarian stimulation : these are daily injections according to a long or short protocol. Injections starting at the very beginning of menstruations (short cycle) or a week before menstruations begin (long cycle). Injections are done during approximately 2 weeks. This stimulation is monitored through vaginal echography and hormonal measurement.
2. Puncture of the ovules: it is done under local anaesthesia or limited general anaesthesia before eating or drinking. The puncture collects 3 to 10 ovules on average.
3. At the laboratory stage: ovules are put in contact with the spermatozoa or one proceeds with ICSI. This stage takes 2 to 3 days but can go up to 5 days when the patient has produced many ovocytes; one then practises a coculture allowing a transfer of embryos 5 days after the puncture. This technique increases very much the chances of pregnancy.
4. The transfer of the embryos:
Embryos are replaced in the uterus 2 to 5 days after the puncture. One replaces 2 to 4 embryos according to the context and the age of the woman. A hormonal treatment is advised during 2 weeks while waiting for the results of the pregnancy blood test. It is continued in the event of positive test and stopped if the test is negative.
Which examinations are to undergo before a CRT?
A clinical examination is always essential; according to the context, a minimal assessment is advised.
1. For the woman:
A vaginal smear: PCV + antibiogramme
Chlamydiae serologies, HIV, syphilis, hepatitises B and C
A hysterography (HSG) radio of the tubes
A pelvic and endovaginal echography
A hormonal check if possible and according to the context: prolactin, FSH LH, Oestradiol;
A blood group and an electrophoresis of haemoglobin.
2. For the man:
A spermogramme with culture and antibiogramme
Serologies of chlamydiae, syphilis, HIV, hepatitises B and C
A blood group, an electrophoresis of haemoglobin
Hormonal check eventually.
Until which age can one take a CRT?
There is not a limiting age for a CRT, but one should known that chances of success strongly depend on the age of the woman. They are 25 to 30 percent with 25-30 years to drop to hardly 10 percent at age 40. It is necessary to be able to know when to stop the attempts with CRT and swith to other options like the Gift of ovocytes or Adoption.
After which time can one take again a CRT?
An IUI can be done every month when there is no complication. An IVF can be taken again two months later.
Which are the main complications after a CRT?
The treatments through CRT call upon powerful drugs whose regulation requires precautions
and require supervision for allergy risks.
Ovarian hyperstimulations: they cause pelvic and abdominal pains with increasing levels
often requiring a hospitalization.
Miscarriages in 20°/° of the cases.
Extra-uterine pregnancies
Multiple pregnancies themselves causing miscarriages.
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