How do we get the highest success rate in IVF and ICSI operations? A question that is frequently asked not only by patients, but also from fertility and fertility treatment centers. To answer this question in a scientific way that depends on medical studies and research in their results, we must review some factors that help achieve the highest success rates for IVF, which is one of the tremendous leaps in the field of infertility treatment. I have husbands.
According to Dr. Hamad bin Ali Al-Sufyan, a consultant infertility, IVF, gynecological and obstetric surgery at the Neurology Medical Center.
There are factors that increase the chances of success for IVF
· Age of the wife, whenever the age is less than 40 years, the wife''s response to stimulants increases, in addition to producing a large number of mature eggs with sizes ranging from 16 to 24 mm.
The quality of the husband''s sperm in the semen in terms of (number, movement, and natural shapes) that increases the chances of success for the operation.
The role of the laboratory and advanced technologies is a very important issue, especially quality control and accuracy in dealing with sperms, sperms, eggs, and embryos, maintaining the appropriate environment, fluids, and tools used inside the laboratory, and monitoring the absence of bacterial transmission, whether in incubators, air, or others.
The thickness of the endometrium, which increases the rate of implantation of the embryos, the minimum rate is 8 mm, and it is preferable to reach between 10 to 12 mm.
· And recently we use the methods of micro-modulation and the technique of finishing the embryo wall using the laser ASSISTED HATCHING, which helped to raise the percentage of embryos implantation, especially in cases of repeated repetition.
The psychological factor of the couple, which is very important and increases the success rate of the operation, despite the neglect of many of this aspect. The stable psychological state may help the embryos implantation because there are orders issued from the brain to the womb to secrete endorphins that prevent the embryos from settling in the womb, so we advise the couple to stay away from anxiety and nervous tension And maintaining psychological stability and good cohabitation between spouses and understanding of the psychological conditions that the wife is going through.
Immunomodulation
Repeated unsuccessful IVF surgeries for three or more attempts, with the presence of excellent embryos, made researchers focus on collecting studies and research that indicated that the reason may be the failure of the endometrium to receive the fetus, and that there are immune bodies working to reject implantation of embryos and it is difficult to investigate and analyze for most of them The immune modulation process begins with a hysteroscopy that takes place inside the clinic and with a simple local anesthesia, and the use of some drugs that reduce the rejection of the uterus to the fetus and increase the chances of implantation begins at the start of treatment until the occurrence of pregnancy and the fetal pulse, with a solution taken through feeding for a period of two to three hours one time Every month for 3-5 months.
To clarify some medical definitions of assistive methods of pregnancy.
Industrial injection process (IUI) internal injection
The husband''s semen sample is prepared in an accurate and safe way in the laboratory, and it is injected into the uterine cavity using a very thin tube without any pain, and this is what is called intrauterine insemination.
In vitro fertilization (IVF), external injection
It is an external fertilization process that takes place in the designated laboratory. The eggs are withdrawn from the wife when they mature, each egg is combined with more than 100,000 sperms and the fertilized eggs are placed in a special and appropriate incubation in which to have divisions. After the eggs are fertilized and develop into embryos, they are returned to the uterus. This method is called external fertilization.
ICSI-IVF, external injection
This method is one of the latest techniques for treating infertility, but the difference is from the IVF process, the in vitro fertilization method. Each egg is injected into one spermatozoon after removing the cells surrounding the egg and requires high technology and experience Steps of the IVF process:
IVF treatment begins with the ovarian research to produce the largest possible number of eggs by giving hormone needles, as ovarian stimulation is necessary because by increasing the number of eggs, the likelihood of forming a greater number of fertilized embryos increases the likelihood of forming a greater number of fertilized embryos and thus the success rate is higher than having only one egg. The response to treatment is followed by a vaginal ultrasound to determine the number and size of valid eggs. Also, constant follow-up is necessary to prevent any complications that may occur. When the eggs have reached maturity, an H.C.G needle is given to complete the maturation of the eggs. And after 32 to 36 hours of taking this needle, the eggs are removed under local or general anesthesia. This process takes from 30 to 45 minutes in which the eggs are removed without surgery with the help of a vaginal ultrasound, and the patient must be present usually an hour before, where the anesthesia is given as a sedative and pain reliever. Then the vagina is cleaned with a sterile material, and then the device is ed into the vagina. The process of removing eggs gradually from one of the ovaries, and this process is repeated for the other ovary.
After the egg retrieval process and its transfer to the laboratory, the cells surrounding the eggs are removed, after two to four hours of the egg retrieval, the mature eggs are ed and then left in the incubator for two hours to prepare the semen sample by washing it, separating the dead and deformed sperm and choosing the best sperm. The stage of microscopic injection comes, and the microscopic injection depends on choosing a single sperm using a very sophisticated and accurate electronic microscope, then the sperm is injected into the cytoplasm of the egg that was previously prepared for this purpose, and the injection is done by a fine needle that is only visible under the microscope.
The eggs are examined after 24 hours to make sure fertilization has occurred, and after another 24 hours, the examination is done to ensure cell division, which means the passage to the transfer of embryos to the womb. The rate of implantation of embryos in the uterus increases with the presence of the technique of finishing the embryo wall by laser, which is called the method of nesting, so the importance of the laboratory comes in modern techniques, devices, accurate experiences and maintaining continuous quality to increase the success rate of the operation.
Then the embryos are transferred to the patient''s uterus after the egg splits, using ultrasound, which provides an opportunity to determine the dimensions of the uterus so that the doctor can transfer the embryos without touching the upper wall of the uterus, in order to avoid the occurrence of uterine contractions that may lead to a decrease in the success rates of implantation. And the use of special catheters for the transfer of embryos that can be seen easily by ultrasound during the embryo transfer process helps in choosing the most appropriate position for the embryos inside the womb, which may differ from one woman to another.
There is a specific period that the uterus accepts the fetus and allows its implantation, and this period ranges from 12 to 18 hours, which is not fixed and varies from one woman to another and from one monthly cycle to another. Despite the efforts and recent scientific research exerted from blood and cell analyzes and ultrasound follow-up that is being made to determine this period with the aim of raising As a result of positive pregnancy and implantation of embryos at the highest rates, this period is still unseen.
Many of the reasons for the failure of the IVF program come after all the steps of the program have been successfully completed, and the reason for the failure of the last stage of the adhesion of the fetus in the womb is one of the medical solutions used in the treatment of these cases.
Assisted Hatching
Assisted Hatching, according to Dr. Al-Sufyan, is one of the modern techniques to increase the chances of embryos attached to the endometrium after being returned, which constitutes the most obstacle facing the success of IVF programs. This is what a group of couples who have multiple attempts at them suffers, and in every attempt, embryos of good classes and qualities are returned, the result of pregnancy is negative due to the lack of implantation of the embryos in the endometrium for reasons that are not clinically diagnosed as the wall of the egg acts as a mechanical barrier that prevents the dissolution of the egg or the embryo by the influence of cells Attacking immunity, physiological absorption, or the influence of toxic biomaterials. And recently, modern techniques in IVF have shed a bright light on the functions of the egg wall.
