Artificial Reproduction
Artificial reproduction refers to the medical technique that allows couples unable to conceive to have a child, regardless of sexual intercourse. It dates back to 1978 when England announced the birth of the first test-tube baby, after in vitro fertilization (IVF), from an egg extracted from a pre-ovulatory follicle and the transfer of the embryo (ET) into the uterus.
The topic of artificial reproduction offers numerous points for reflection, although much of the discussion arises from misinformation; one of the classic examples is the confusion generated when discussing the two main methods of assisted reproduction: intrauterine insemination and IVF.
Intrauterine insemination refers to the medically assisted procedure that is performed in vivo, meaning that sperm is inserted into the woman's body with the hope of achieving fertilization.
Although intrauterine insemination can be performed during a natural cycle, to increase the chances of success, ovarian stimulation is usually done to induce the maturation of at least 1/3 follicles, monitoring the treatment with ultrasounds to determine the optimal moment for insemination.
Once the favorable day is determined, the spouse must deliver a sperm sample (a couple of hours before insemination) to the laboratory, where it is processed to recover motile sperm, concentrating them in a reduced volume and directly inserting them into the uterus via a cannula.
This technique is absolutely quick (it takes just a few minutes) and painless, so the patient will be discharged immediately after insemination.
To increase the chances of success, the woman will take progesterone until the pregnancy test, and, in case of a positive result, will continue taking it.
As for the success rates of this technique, they are around 15-20% per attempt.
For intrauterine insemination, a minimum of 2-3 million progressively motile sperm is required.
If after a series of 3-4 cycles the insemination is unsuccessful, it is advisable to move on to in vitro fertilization (IVF).
When discussing IVF, we refer to in vitro fertilization with embryo transfer (ET), meaning the artificial fertilization of eggs with sperm in the laboratory, replicating in vitro what normally occurs in the female tube.
In vitro fertilization consists of 4 phases:
The production of eggs is stimulated through medication to induce multi-ovulation, allowing for multiple cells to be fertilized, thus increasing the chances of success. The aspiration of the eggs will occur when they are deemed mature. The stimulation process can be canceled if an ultrasound reveals a high number of follicles, to avoid what is known as ovarian hyperstimulation syndrome.
When the eggs are mature, they are retrieved via ultrasound in the operating room (under sedation) using a needle aspiration technique. The procedure lasts about 15 minutes, and the patient can return home after about two hours. At this point, the follicular fluid collected will be analyzed in the laboratory to estimate the quality and quantity of the eggs.
The union of egg and sperm will occur on the same day as the retrieval, so a sample of the spouse's sperm is required. There are two possibilities for fertilizing the eggs: placing the sperm together with the eggs in a special culture medium (IVF) or injecting a sperm into each egg via Intracytoplasmic Sperm Injection (ICSI), using a microscope to ensure the egg-sperm union. After 16-20 hours, the number of fertilized eggs will be assessed under a microscope; subsequently, the eggs will begin to divide, leading to embryonic development, during which the quality of the embryos will be evaluated, and it will be decided which ones will be transferred to the uterus. Any surplus embryos of good quality will be cryopreserved for potential future attempts.
The process of reintroducing the embryos is simple and quick and does not require anesthesia; they are placed back in the uterus using a thin plastic cannula, through the cervical opening, under ultrasound supervision, to ensure correct placement within the uterine cavity. If one or both parents are carriers of genetic anomalies, or if one wishes to ensure the transfer of embryos with a normal chromosomal map (karyotype), preimplantation genetic testing (PGT) can be performed.
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