Are you for or against artificial wombs
The process of in vitro fertilization
In-vitro fertilization (IVF), colloquially known as “artificial insemination”, comprises many different individual steps. In addition to hormonal stimulation, this also includes minor surgical interventions.
In in vitro fertilization (IVF), fertilization does not take place in the woman's body, but "artificially" in the laboratory. Treatment often extends over several weeks.
With IVF, hormone treatment is almost always necessary for the woman. The doctor then takes egg cells from the ovary and combines them with the partner's sperm cells in a laboratory glass. If fertilization is successful and the fertilized egg cells continue to develop, one to a maximum of three embryos are transferred into the uterus.
In Vitro Fertilization - The course of a treatment cycle
With hormones, the woman's own hormone production is suppressed and natural ovulation is prevented. The controlled stimulation of egg cell maturation then begins up to 14 days later.
Stimulation of egg maturation
So that as many egg cells as possible can mature at the same time, women will now be given hormone preparations every day for around 11 days.
The doctor regularly checks the blood values and uses ultrasound to check the size and maturity of the follicles.
Induction of ovulation
When enough large enough egg cells have matured, ovulation is triggered with a hormone injection.
Removal of the egg cells
The egg cells are removed from the follicles with a fine needle, usually through the vagina.
Provision of the sperm
On the day of egg collection, the partner wins sperm through masturbation or a frozen semen sample is prepared.
Fertilization in the laboratory
The egg cells are brought together with sperm cells in a nutrient fluid. 16 to 20 hours later you can tell whether fertilization has occurred.
Transfer of the embryos
If the fertilization was successful, there will be two
Transfer up to three embryos through the vagina into the uterus up to five days after the egg collection.
A blood test can be used to determine whether a pregnancy has occurred.
Once the embryo has established itself, the doctor can now also detect the pregnancy on ultrasound. Often the heartbeat of the embryo can already be seen.
If it didn't work out
IVF treatment is very complex and does not guarantee success. Every single step can fail. Then a break is good to regain your strength mentally and physically and to calmly consider how to proceed.
In the case of in vitro fertilization or ICSI, the treatment usually begins with so-called downregulation. Hormone preparations (GnRH agonists or GnRH antagonists) suppress the woman's own hormone secretion and thus prevent uncontrolled ovulation.
Depending on the treatment regimen, targeted hormonal stimulation of the ovaries begins up to 14 days later. It is supposed to stimulate the ovaries to allow several follicles to mature at the same time. This increases the chances of obtaining several fertile eggs.
Different hormone preparations can be used individually or in various combinations for hormone stimulation. They are injected or taken as a tablet. In most cases, prior to in-vitro fertilization or a preparation containing the hormone FSH (follicle-stimulating hormone) is injected. The woman can do this herself or leave it to her partner. Since over-stimulation of the ovaries can occur in rare cases, the treatment must be closely monitored by a doctor.
In some cases, there is no need for hormonal stimulation of the ovaries. In vitro fertilization then takes place in the woman's natural menstrual cycle (Natural Cycle IVF).
Ovulation is initiated
About a week after the start of the hormone stimulation, the doctor will check the size and maturity of the developing egg cells several times. To do this, he or she performs ultrasound examinations and determines the hormone levels in the blood. When the egg cells have matured and they appear capable of fertilization, the woman stops taking hormones. Ovulation is initiated with an injection of the hormone HCG (human chorionic gonadotropin) or an agonist - around nine to eleven days after the start of stimulation.
Removal of the egg
About 36 hours after initiation of the injection, the doctor takes egg cells from the matured follicle with the help of a fine needle (follicular puncture). The procedure is usually performed through the vagina and ultrasound on the screen. In rare cases, the egg cells are obtained by laparoscopy. If necessary, the woman is given sedatives or pain relievers and a brief general anesthetic. Slight bleeding and a feeling of sore may occur after the puncture.
Fertilization in the laboratory
On the day of the egg collection, fresh or frozen (cryopreserved) sperm from the partner is required. To do this, the man masturbates in a special room in the reproductive medicine center. Some men have difficulty with “made-to-order” ejaculation. You can discuss the problem with the doctor to find another solution. For example, the man can collect his semen at home and bring it to the center in a special container, provided the way is not too far.
In the case of severe fertility problems in the man, sperm obtained through a testicular biopsy and then frozen (cryopreserved) sperm can be thawed in good time.
Before the semen and egg can be brought together, the seminal fluid is processed in the laboratory. The aim is to improve the fertilization capacity of the sperm cells and to prevent possible allergic reactions in women. Then egg cells and sperm cells are brought together in a nutrient liquid and placed in an incubator. This is where the egg cells are fertilized - for in vitro fertilization.
The fact that a sperm has penetrated the egg can be recognized under the microscope by the two “pronuclei” that contain the genetic material of the sperm and the egg. In this pronuclear stage, the egg cells are selected that are later to be transferred to the uterus. The other egg cells are either destroyed or frozen. In this way, they can be used for a possible further attempt at treatment without the egg cells having to be removed again.
The transfer of embryos to the uterus
When one or more egg cells have been fertilized, they are placed in an incubator where they continue to develop. Between the second to a maximum of six days after the egg collection, the doctor then transfers one to a maximum of three of the embryos that have been created into the uterus. This is done using a thin, flexible tube (catheter) through the vagina. Most women find the procedure little or no pain.
"Hatching aid": Assisted hatching
In special cases, for example after three unsuccessful embryo transfers or if frozen (cryopreserved) egg cells in the pronuclear stage are thawed, one could try to improve the conditions for the implantation of the transferred embryos. To do this, the outer shell of the embryo is scratched with a laser device (assisted hatching). However, a clear improvement in the chances of success through this procedure has not been proven.
About 14 days after the transfer of the embryo or embryos into the uterus, the pregnancy hormone in the blood can be used to determine whether a pregnancy has started. To be sure, the doctor will do several check-ups. About a month after the transfer, an ultrasound examination can be carried out to determine whether the embryo is alive and whether it is a single or multiple births.
Opportunities and Risks of In Vitro Fertilization
According to the German IVF registry, the birth rate after in vitro fertilization is 15 to 20 percent per treatment cycle. The chances of success, however, depend to a large extent on the existing fertility disorder and the age of the woman. Studies also suggest that smoking can have a negative impact on the success of IVF. Lower birth rates per treatment cycle were observed in couples who smoked during IVF treatment than in non-smoking couples.
With any in vitro fertilization, individual treatment steps can fail. It is possible that, despite hormone stimulation, no fertile egg cells are found. Or there is no fertilization. Often the embryo does not implant in the uterus.
Hormone stimulation can be emotionally and physically stressful and associated with health risks. In rare cases it leads to the so-called overstimulation syndrome, in which the woman's body "overreacts" to the hormone preparations. Abdominal pain, nausea, feelings of tension in the abdomen and shortness of breath may occur. The doctor must then be notified immediately. Clinical treatment is necessary in rare, severe cases.
If two or (rarely) three embryos are transferred, there is a risk that a multiple pregnancy will develop. For a pregnant woman, it entails a significantly higher level of physical strain. The risk of premature labor and premature birth is also significantly increased in multiple births.
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