Reproductive Medicine

Intrauterine Insemination medical technology (assisted reproductive technology), which is the introduction into the woman’s cervical canal or uterus of the sperm of a man obtained in advance outside of sexual intercourse. It is used for medical purposes to achieve pregnancy in infertile couples, or to obtain pregnancy in single women, carried out in an outpatient setting of gynecological medical facilities. The procedure is carried out during the periovulatory period (ovulation days), the time of which the gynecologist determines in accordance with the means at his disposal . Artificial insemination can be used both in the natural cycle of a woman and with the use of hormonal stimulation of superovulation.

Sperm for intrauterine insemination is obtained either immediately before the administration procedure (1-3 hours before the procedure), or thawed semen is used, which was cryopreserved in advance. For the introduction, either native (untreated) sperm or pre-treated sperm is used. Sperm processing consists in separating sperm from seminal fluid, for this purpose two or three times reprecipitation of sperm is carried out in a centrifuge with dilution of sperm with physiological medium.

IVF technology is carried out in specialized medical institutions in an outpatient setting. For the in vitro fertilization procedure, it is necessary to obtain eggs, obtain sperm, in vitro fertilization, grow an embryo, introduce the embryo into the uterine cavity of a woman.

For stimulation, injections of follicle-stimulating hormone (FSH), luteinizing hormone (LH), chorionic gonadotropin (ChG) injections are used, in combination with gonadotropin-releasing hormone agonists or antagonists (GnRH). The mode of administration of certain preparations inducing superovulation is called the “stimulation scheme” or “protocol”. There are several schemes for stimulating superovulation, but the final amount, types and duration of drug administration are selected individually for each woman, depending on her age, the cause of infertility and the follicular (ovarian) reserve. Superovulation stimulation can take from 7 to 20 days and is an injection or taking tablets.

If it is impossible to use the sperm of the husband or if the patient does not have a sexual partner, the use of sperm of the donor is possible.

Gamete Intra-Fallopian Transfer (GIFT) combines modern medicine with the natural process. Many people believe that the union of sperm and egg is the beginning of life, and it should begin in the body, not in the Petri dish. The GIFT works by collecting sperm and donor eggs, mixing them and then re-introducing this mixture into the fallopian tube. This form of ART is useful for men with low sperm count. It is also known that it gives successful results for women suffering from endometriosis. However, it is recommended that women who have problems with the fallopian tube should not seek this treatment.

Intracytoplasmic Sperm Injection (ICSI) the introduction of a sperm into the cytoplasm, intracytoplasmic injection of sperm) is a method of treating infertility, one of the auxiliary methods of artificial insemination (IVF). The ICSI procedure for IVF is used when at least one circumstance is present:

• reduced sperm count in semen;
• reduced sperm motility in semen;
• many abnormal sperm in semen;
• sperm contains antisperm antibodies (ASAT);
• undiagnosed pathologies of sperm or eggs.

The ICSI procedure is carried out under a microscope. To manipulate the egg and sperm, glass micro-tools are used - a microneedle and a micro-suction cup (holding capillary). Microinstruments are attached to micromanipulators - devices that allow you to translate large hand movements (via joysticks) into microscopic movements of instruments. For ICSI, the embryologist tries to select the fastest and morphologically most normal sperm. It is immobilized by a microneedle strike (breaking the tail) and sucked into a microneedle. Then, holding the egg on a micro-sucker, pierce the egg cell with a microneedle and introduce a sperm inside it.Despite the apparent unnaturalness of such fertilization, embryos obtained using the ICSI procedure have normal developmental abilities, and children born after IVF using ICSI do not differ in their physical and mental abilities from children conceived naturally.

Intracytoplasmic morphologically selected sperm injection (IMSI)

During the ICSI procedure, sperm sampling is performed at a 400-fold increase, while the addition of the IMSI method to the ICSI procedure allows the selection of the best, according to morphological characteristics, sperm cell at a magnification of 6600 times. And these details are of great importance, as they may indicate a pathology of the sperm genetic material, which in turn is critical for the fertilization and normal development of the future embryo. IMSI is recommended:

• Patients with 1-2 failed ICSI attempts and patients with male infertility and a high level of teratozoospermia, i.e. with an increase in the number of pathological forms of sperm.
• Sperm in the IMSI procedure is selected with an increase of more than 6,000 times. To obtain such an increase, the microscope for conducting IMSI must be equipped with special optoelectronic equipment. Sperm sampling with IMSI is much longer and painstaking than with traditional ICSI. In particularly difficult cases, hours of operation may be required to select a normal sperm. All these efforts are aimed at increasing the likelihood of pregnancy and reducing the possibility of spontaneous abortion.