Medically Assisted Reproduction (MAR) is a
highly specialised and complex area of medicine that aims to help couples with infertility problems thanks to specialised hospital care.
The Centre provides the following services:
Intrauterine insemination
- In vitro fertilisation (IVF)
- Intracytoplasmic sperm injection (ICSI)
- Preservation of male and female fertility
The offer is completed with:
- Embryo culture through to the blastocyst stage
- Oocyte vitrification
- Embryo vitrification
- Oocyte thawing cycles
- Embryo thawing cycles
- Cryopreservation of sperm from both ejaculate and testicular biopsy.
In addition, at the MAR Laboratory, spermiograms can be performed on ejaculate or on urine in the case of retrograde ejaculation.
Assisted Fertilisation
In vitro fertilisation (IVF) is an assisted reproductive technique where the man’s sperm and the woman’s egg are put together in the laboratory, where fertilisation takes place. The resulting pre-embryos are then transferred into the woman's uterus.
Reproduction involves a number of stages, in which the couple and later the woman are followed up and monitored continually.
Stage 1 – Registration
MAR techniques are taxing for the couple, from both a medical/biological and psychological perspective.
- Investigation of any conditions that may affect the treatment outcome
- Investigation of any infectious diseases that may be transmitted to the foetus or partner
- Investigation of hereditary diseases that may be transmitted to the foetus
Tests and examinations to assess reproductive system functioning
- Measurement of hormone levels: these will determine the type of stimulation to be carried out, as they provide information on the ovarian reserve: it is important that these be performed by the third day of the menstrual cycle.
- Hysteroscopy: this is an endoscopy of the uterus that looks for diseases (intracavitary myomas, endometrial polyps, uterine synechiae, etc.) that could impede embryo implantation.
- Transvaginal ultrasound (TVU): assesses ovarian morphology and pathophysiology, as well as any uterine diseases (intramural and intracavitary myomas or anything else) that may result in trophic changes to the uterine wall and therefore impede embryo implantation.
- Hysterosalpingography: investigates the morphology of the uterus and fallopian tubes and any malformations/diseases.
- Spermiogram: gives information on the number of viable sperm cells for insemination and on the subsequent techniques to be used.
The Treatment
The therapies are personalised, meaning no two are the same.The main steps of a treatment cycle are:
- ovarian stimulation
- oocyte (egg) retrieval
- fertilisation
- embryo growth
- embryo transfer
Stimulation and monitoring
This involves inducing the development of a number of follicles by giving medication (gonadotropins), with a view to obtaining multiple mature eggs rather than just one, as occurs naturally every month. This step lasts approximately 12 days on average, but may vary depending on the characteristics of the individual woman.
The response to the treatment is monitored by means of various blood tests and ultrasound scans, enabling any necessary changes to be made to the treatment. When follicle growth and oestradiol levels are adequate, the day of oocyte retrieval is scheduled.
Oocyte retrieval (pick-up) and sperm sample
Oocyte retrieval is done under general anaesthesia without the need for intubation. The procedure lasts about ten minutes and the woman wakes up immediately afterwards. The number of oocytes retrieved does not always correspond to the number of follicles and the oocytes retrieved are not always mature/suitable for fertilisation. The male partner must produce a sample of seminal fluid on the same day, or, alternatively, his previously frozen semen may be used.
Laboratory: insemination, fertilisation and embryo growth
Insemination occurs on the same day as oocyte retrieval. Not all inseminated eggs will fertilise. The day after, the eggs are checked for fertilisation. Fertilisation may be abnormal sometimes, and these embryos are eliminated. It is necessary to wait one more day before checking whether or not the embryos are developing. Then, from day two, the embryos are ready to be placed inside the uterine cavity. This procedure is called “transfer”.
Transfer
The transfer is performed without anaesthesia. The gynaecologist inserts the speculum and cleans the vaginal environment. The very thin catheter containing the embryos is then inserted into the uterine cavity, where the embryos are released. The embryologist then checks that there are no embryos remaining inside the catheter. If there are still any embryos inside it, the transfer is repeated to insert the remaining embryos. Repeating the transfer has no adverse effects on the outcome of treatment.
On average,
pregnancy is achieved in 20-30% of cases following transfer. Most pregnancies reach full term.