Artificial Impregnation. There are Fewer Risks Than With Appendectomy

18.02.2019 09:47:29

Doctor Gernot Tews explains why there are fewer multiple pregnancies now, and when IVF will not help couples.

The reproduction specialist Gernot Tews set up a department of artificial impregnation at the Landes-Frauenklinik hospital in Linz, later in Wels and now he runs the Institute for Fertility Treatment in Wels.

What risks linked with artificial impregnation techniques are revealed today?

Gernot Tews: The risk of infertility treatment is less than with appendectomy or tonsillectomy. The most negative event is when pregnancy does not occur. It happens to about 60% of women. But treatment should not be hasty. A possible complication is ovarian hyperstimulation syndrome (after hormone therapy, there may be indisposition, even a disease which is treated on an inpatient basis). This complication has occurred in 1.5% of the treatment cases in Austria, that is, in about 150 women. Bleeding, infection and other complications are much less common.

For many years, multiple pregnancies were common, as several embryos were transferred. How has the situation changed?

Gernot Tews: Multiple pregnancies have become less common. In the first days of IVF, our success rate was 10%, and so that it would increase, several embryos were transferred, up to three in Austria and up to six in the United States, in the hope that at least one could implant. The percentage of successful treatment cases has increased, and therefore the percentage of multiple pregnancies. Twin and triplet pregnancies always reveal risks to the mother and babies, primarily because they are often born prematurely. The techniques have improved since then, so in most cases it is enough to implant one embryo.

When is it time to give up fertility treatment?

Gernot Tews: This cannot be said without reservation. The focus is on treatment with regard to personal peculiarities. There are 44-year-old women who can be cured perfectly well, and 39-year-olds who cannot become pregnant, for example, because of premature menopause. In such a case, one cannot even begin treatment, since the eggs are no longer formed. It also depends on whether the cause of the infertility is found in a man, a woman, or both. Depending on the hormonal balance and semen analysis, a patient-centred treatment plan is discussed. According to the law on reproductive medicine, we are obliged to offer patients the most careful treatment.

Are there any requests from the couple regarding the choice of the embryo as far as, for example, gender is concerned?

Gernot Tews: Currently, genetic analysis of embryos is permitted only in case of certain indications. So they are carried out if there are genetic diseases in the family, for example, cystic fibrosis. But the goal should not be to study the embryo with a beating heart, with the subsequent interruption of life, depending on the results, but in conducting tests in due time. Couples rarely ask for this, since they bear the expenses. Preimplantation genetic diagnosis costs about three times more than one IVF protocol.

Now ICSI, a method in which a sperm cell is injected into an egg cell, is more commonly used than IVF in which egg cells and sperm cells are fused together. Why?

Gernot Tews: Firstly, semen quality in men has become worse in recent years. But all men cannot be called sick. It can also be a precautionary measure, as the ICSI success rate is higher than with IVF. We proceed from the assumption that naturally fertilized eggs, as well as those into which the sperm cells have threaded themselves, rather than the implanted ones, are genetically stronger. If we have about ten ova, we often do as follows: half of them are fertilized in the natural way (IVF), and the second half by using ICSI. More often we take whole eggs fertilized in this way.