In Vitro Clinic is a leader in the field of artificial fertilization and reproductive health not only in Georgia, but in post-soviet countries. In vitro fertilization was founded 20 years ago by the team of Mr. Gia Tsagareishvili and Ms. Natalia Khonelidze and so far it became a token of brining happiness for thousands of hopeless couples. Which factors condition way out of in vitro fertilization – in connection with this will speak Natia Popkhadze, the obstetrician – gynaecologist, reproductologiyst of In vitro Clinic: in vitro fertilization is a choiceness method of infertility treatment, when fertilization of the ovum and spermatozoon is implemented in a vial. Procedure is conducted in case all other treatment methods are unsuccessful and comprises of several stages, correct management of the patient at each stage defines a final successful result.
– At theinitial stage is implemented preparation of the patient;
– What does the process of the patient’s preparation include?
Preparatory period implies complete clinical and laboratory investigation of the couple when are assessed:
– Woman’s hormone profile , function of thyroid, adrenal, pancreas and other endocrinic glands;
– Anti- Mullerian level – marker assessing follicular reserve of the ovaries;
– Immune, serologic, biochemical profile;
– If necessary thrombophilia screening, other genetic investigations;
– Gynecological ultrasound examination enable to asses quantity of antral follicles in ovary and also all those gynaecological pathologies that exert influence upon a woman’s reproduction
During the preparatory period sometimes is put the question of necessity for surgical intervention, for this or that indication, for the purpose of correction of gynaecological
pathology it is necessary to conduct hysteroscopy and laparoscopy.
– Particularly in which cases it is necessary to conduct hysteroscopy and laparoscopy?
1. Conduction of hysteroscopy is necessary if exists suspicion of internal pathologies of uterine cavity (polyp, myoma, hyperplasia, intracavitary ingrowth, etc.). By means of it becomes possible to give a final diagnosis and correct respective problem that significantly improves way out of in vitro fertilization;
2. Routine use of laparoscopy is not called to, though in certain situations its conduction is necessary as from diagnostic , so from treatment standpoint;
– As concerns male infertility…
Approximately 30 % of infertility is conditioned by male factor. Fertilization process depends on the
quantity of spermatozoa in sperm, ability of their movement and morphology. In vitro fertilization solved infertility problem in medicine during such diagnoses as asthenozoospermia, oligospermia, azoospermia. Today exists possibility to conduct micromanipulations on seminal glands, TESA, TESE. During azoospermia (absence of spermatozoa in sperm) by the mentioned intervention is implemented taking of material from seminal glands, from which endocrinologist releases single healthy spermatozoa that are enough for conduction of in vitro fertilization.
Not less importance is conferred to the patient’s motivation and observance of healthy lifestyle that implies correct nutrition, putting sleep regime unto order and releiving stress, refusal of harmful habits, etc. By researches is established that as excess weight, so body mass deficit exert negative influence upon reproductive function, pregnancy course and newborn’s health.
During the preparative period it is required pre-therapy of the patient that is particularly important for the patients with unreliable prognosis.
What do “patient with unreliable prognosis” and the term “pre-therapy” imply?
In a separate group we can pick out those patients who have a scanty ovarian reserve, as well as
also weak response to stimulation in the past. In frequent cases in such patients a significant improvement of unreliable prognosis causes prescription of so called DHEA preparations, testosterone, various food additives.
– Which stages the patients need to undergo before the final result?
For further management of the correctly prepared patient a correct choice of stimulation protocol is important. Decisive importance is conferred to in vitro embryologic laboratory, experienced, qualified embryologist and the following aspects: sperm processing and selection, cultivation soils of embryos, selection of transferrable embryos, if necessary, during existence of indication is also conducted “assisted hatching”, PGS, PGD.
In some situations it is necessary to freeze embryos by so called vitrification method and their defrosting in the following cycles – transfer into the uterine cavity. Foundation of the mentioned technique significantly improved results of in vitro fertilization.
Embryo transfer (transfer of embryos into the uterine cavity) is the last stage of in vitro fertilization and of course decisive importance is conferred to correct planning of this procedure in time, technically correct conduction with use of appropriate material (catheter).