Assisted reproduction techniques
Homologous and heterologous, 1st and 2nd level

One of the most common causes of female infertility is anovulation, i.e. the absence of ovulation, which may be accompanied by menstrual irregularities or even amenorrhoea.

These days, several drugs are available which can induce ovulation. They are becoming increasingly advanced and clinically efficient, which makes it possible to maximise therapy customisation in order to achieve the desired result.

It is a 2nd level treatment that consists of several stages:

Ovarian function stimulation

The first phase involves stimulation of the ovarian function in order to induce multiple follicle growth.
This is necessary because in vitro (i.e. in the laboratory) the probability of each individual oocyte being fertilised and developing into a foetus is lower than normal.
Multiple follicular growth allows more oocytes to be obtained per single ovulation, thus increasing the chances of achieving pregnancy.

Egg retrieval – PICK-UP

Follicles that are found to be sufficiently mature at the last stage of monitoring (diameter >16 mm) are aspirated and the follicular fluid obtained is immediately checked under the microscope for the presence of oocytes.
This is done using a simple needle aspiration technique while the patient is under sedation. The process is absolutely painless, transvaginal and aided by ultrasound.

In vitro insemination and embryo culture

Shortly after egg retrieval, the male partner is asked to produce a semen sample through masturbation.
After that, the sperm and oocytes will be placed in contact until the outcome of the insemination is ascertained.
Oocytes that show signs of normal fertilisation (oocyte with two pronuclei) are maintained in culture.
During this period the two pronuclei disappear, forming the zygote. This phase is followed by the first division of the cell, the moment in which we are in the presence of the actual embryo.
At our clinic, prolonged embryo culture is adopted up to the BLASTOCYST stage (5th - 6th day), a stage which can be reached in 90% of cases when there are at least 3 good quality embryos 48-72 hours after insemination, with results in terms of successful pregnancy of over 50%.

Embryo transfer – TRANSFER

On the day of the transfer, the embryos are transferred with a catheter into the patient's uterine cavity.
It is important to remember that the implantation process depends on both the quality of the embryos and the ability of the uterus to receive them.

Cryopreservation of remaining embryos

The remaining embryos that are not transferred and that show signs of viability are appropriately cryopreserved for possible subsequent cycles, without the need for re-stimulation.

Pregnancy tests

Approximately two weeks after the transfer, the ß-HCG dosage is analysed. This is a hormone produced by the embryo once it has implanted, and from this the outcome of the treatment can be ascertained.
If positive, about 20 days later a ultrasound will follow to test for the presence of the gestational chamber. Once observed, the pregancy will be monitored following months.
This technique is suitable in situations of tubal infertility, moderate to moderate-severe male infertility and in the event that intrauterine insemination fails.

The Assisted Medical Reproduction laboratory at the CMR clinic has been working with this particular type of embryo culture since 1998. It involves prolonged laboratory culture of the embryos until day 5 or 6, when they reach the blastocyst stage. They are then transferred into the uterus.
The blastocyst stage is reached in 90% of cases when there are at least 3 good quality embryos 48 to 72 hours after insemination, with results in terms of successful pregnancy of more than 50%.
Our laboratory has adopted the latest-generation GERI incubator with an INTEGRATED TIME-LAPSE facility, which, thanks to an integrated high-resolution video camera in each of the six incubation chambers, allows us to observe the development of embryos without disturbing them.

Each chamber is designed to contain the embryos of a single patient, eliminating the need to open the chamber containing other patients' embryos.
Geri enables PMA specialists to monitor every detail of embryo development conditions. It allows comprehensive observation of incubation conditions and specific safety mechanisms to ensure that an optimal culture environment is maintained at all times.
This state-of-the-art technology minimises stress on the embryos by ensuring optimal conditions for their growth and maximising pregnancy outcomes.

At CMR, the GERI incubator is used in 100% of the treatments performed.

Heterologous fertilisation is a medically assisted reproduction treatment available to couples with irreversible infertility or sterility problems.

This option became viable again in Italy in 2014, when the Constitutional Court, through sentence 162/2014, declared the ban on heterologous fertilisation imposed by Law 40/2004 to be unconstitutional.

This treatment involves the use of assisted fertilisation techniques, in which gametes (spermatozoa, oocytes or both) are provided by a donor from outside the couple.

We're talking about:
● heterologous fertilisation with egg donation
● heterologous fertilisation with sperm donation
● Heterologous fertilisation with egg and sperm donation (double heterologous)

Find out more by visiting the PGT-A Heterologous Fertilisation page

Preimplantation Genetic Testing of Monogenic Anomalies (PGT-M), previously referred to as PGD, is a technique that allows genetic diseases or chromosomal alterations to be identified in embryos at very early stages of development, generated in vitro by couples at high reproductive risk before their implantation in the uterus.

This test combines the use of IVF techniques with the most innovative research in the field of genetics. Patients requesting access to pre-implantation diagnosis techniques will begin medically assisted reproduction (MAR) treatment, which involves retrieving oocytes to be fertilised with sperm by means of ICSI. Once fertilisation has taken place, the embryos that have reached the blastocyst stage will be biopsied. During the procedure, cells will be extracted and their DNA will be analysed specifically in relation to the genetic disease to be tested for.

Embryos not affected by the genetic disorder, previously cryopreserved at the end of the in vitro fertilisation and biopsy procedure, can then be transferred into the uterus. After that it will be necessary to wait for the implantation outcome and to check for the presence of the gestational chamber. To date, diagnostic protocols exist for more than 200 monogenic, autosomal dominant, recessive or X-chromosome-related diseases. Genetic diseases that are very common in Italy, in which the PGT-M has a valid application, include Beta-Thalassaemia, Sickle Cell Anaemia, Haemophilia A and B, Dystrophy Duchenne-Becker Muscular Disease, Myotonic Dystrophy, Cystic Fibrosis, Spinal Muscular Atrophy (SMA) and X-Fragile Syndrome.

To find out more visit the website of the Genome Laboratory in Rome.