Assisted reproduction

Apr 15, 2012 , Veronika Fejfarová

asistovana-reprodukce.jpg - kopie
asistovana-reprodukce.jpg - kopie
Assisted reproduction is a modern treatment option for infertility. Nowadays are among the classical and commonly used methods included also methods of assisted reproduction. These are in vitro fertilization, intrauterine insemination or intracytoplasmic injection which helps the sperm to penetrate the egg. Newly, methods that allow extraction of sperms directly from the testis are used, they are called MESA and TESE.

Assisted reproduction

Assisted reproduction or artificial insemination is a modern treatment method that helps infertile couples to conceive a child. Although the assisted reproduction is relatively new way of treatment which has already celebrated many successes. The first child from the "tube" was born in 1978. Since then, thanks to these methods, millions of children were born. Assisted reproduction include techniques that directly manipulate with female eggs or with sperms of a man. Which method would be the most appropriate for infertile couple is determined by specialized expert, whose decision is based on examination that explains the cause of infertility.

Infertility

Infertility can be explained as the inability to conceive a child with regular unprotected sexual intercourse within two years. The fault lies primarily on decreasing number of healthy sperms capable of fertilization which are negatively influenced by the environment and way of life. In women is fertility affected with increasing age, lifestyle and various diseases causing impairment in the release and nidation of the egg, for example, failure of the hormones and ovaries in which is the egg fertilized and released, impairment of fallopian tubes through which is the fertilized egg transported into the uterus, developmental defects and disorders of the uterus in which the normally fertilized egg develops and grows in baby or immune system disorders that fights against male sperms or fertilized egg of the women. Proper treatment method is selected according to the causation of infertility. One of them may be assisted reproduction.

Necessary examinations

As already mentioned in the introduction, it is necessary for infertile couple to undergo a series of test to select the appropriate method of assisted reproduction. These include standard gynaecological examination of the women, ultrasound examination of the abdomen and pelvis, examination of the male sperms under a microscope, or sperm count and blood test. There is a large number of centres in which are the methods of assisted reproduction performed. In these institutions ,“ under one roof ", are also often performed necessary examinations, what is very convenient for the infertile couple. These places are generally known as the Centres of Assisted Reproduction.

Methods of assisted reproduction

The simplest method of assisted reproduction is called intrauterine insemination (IUI). In IUI is the male sperm transferred into the woman's uterus. Either it is a semen of partner or an anonymous donor. The route of sperms to the egg is shortened and the chance of fertilization is increased. Another method is in vitro fertilization (IVF). Firstly, in this method, it is necessary to hormonally stimulate the woman to initiate superovulation in which will several eggs become mature. These eggs are then taken with a thin needle under ultrasound guidance. This way harvested eggs are fertilized by male sperms which was taken in advance. It will come to in vitro fertilization. The created embryo will be then returned into the uterus. However, if the sperms are in such condition that they would not be able to spontaneously penetrate the egg, there is a possibility to help them. Accordingly, one selected sperm is injected directly to the egg with thin needle. This method is called intracytoplasmic sperm injection (ICSI).

Special methods of assisted reproduction

In previous methods, it is important that the partner has in ejaculate or semen at least some viable sperms. However, if this is not possible, there are special methods in which are sperms taken directly from the testis. The first of these options is called MESA or Micro Epididymal Sperm Aspiration. In this procedure are microsurgically aspirated sperms from the epididymal under the microscope. This is just the place where sperms mature naturally. This procedure is performed, if is the transport of sperms from the epididymis to the urethra impaired. Therefore, they are not contained  in the ejaculate or semen. Afterwards, the collected sperm is injected into the egg as well as in ICSI method. However, even if this procedure was not successful, the last option is called TESE (Testicular Sperm Extraction). In this method, testicular tissue in which are sperms formed is removed through a few small incisions. Sperms from the extracted tissues are then sought under the microscope and subsequently injected into the egg. The created embryos are also implanted into the woman's uterus in which they develop normally.

Risks of assisted reproduction

Risks and complications associated with assisted reproduction occur in approximately in 2-5% of cases. However, these are generally known risks and if they were early detected, they can be easily treated. Ovarian hyperstimulation syndrome is one of these risks. This terms represents an aggressive ovarian response to hormonal stimulation that leads to ovarian enlargement, abdominal pain, nausea or vomiting. Short-term hospitalization of the woman is necessary, if increasing difficulties occur. Another risk of assisted reproduction is an ectopic pregnancy in which the fertilized egg develops outside the uterus, usually in the fallopian tubes. This condition can directly endanger the woman's life and must be treated surgically. Also, the multiple pregnancy is classified as the risk. Its most common cause is the transfer of multiple embryos into the uterus. If there is more than two fetuses, the risk and incidence of complications for both the mother and fetuses is increasing. Therefore, it is necessary to reduce the number of developing fetuses to the desired 1-2, so the potential risks associated with premature birth of the child with very low birth weight will be minimalized

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