Synonyms
- Reproductive medicine
- In vitro fertilization
Introduction
If all therapeutic attempts to induce pregnancy have failed (see: Unfulfilled desire to have children), the procedures of reproductive medicine, also called artificial insemination, are applied.
Homologous insemination
This artificial insemination procedure is used for some sperm associated causes of male infertility (see above). These include insufficient ejaculate volume (parvisemia), insufficient sperm concentration in the ejaculate (oligozoospermia) and abnormal sperm motility (asthenozoospermia). The sperm of the partner are transported directly into the woman’s uterus.
Since the woman’s cervix is bypassed as a possible obstacle to passage, this procedure is also used in cases of cervical infertility (see above). The sperm can be used directly after preparation or frozen for a longer period of time. If the man is about to have an operation or radiation of the genitals, e.g. within the scope of a cancer operation (e.g. prostate cancer), the couple can preserve the sperm in advance by freezing them.
Heterologous Insemination
In this artificial insemination, in contrast to homologous insemination, the sperm comes from an unknown donor. It is used when the quality or quantity of the partner’s sperm is insufficient for homologous insemination.
In vitro fertilization (IVF)
Translated, this procedure is called “fertilization in the test tube”, since in contrast to insemination, in vitro fertilization takes place outside the womb. The procedure usually involves four steps:
- The first step is the hormonal stimulation of the ovary. The hormone GnRH, which acts on the pituitary gland (hypophysis), causes the synchronous maturation of oocytes in their envelope (follicle) in the ovary.
- In addition, the hormone FSH (follicle stimulating hormone) is administered, which promotes follicle maturation.
If the ultrasound control shows a sufficient size of the follicles, ovulation is triggered by the hormone HCG (human chorionic gonadotropin). If the woman refuses hormonal pre-treatment, this step can be omitted. However, there is a risk that not enough mature egg cells can be obtained in the following step, which could rapidly reduce the success rate.
- The next step is the follicle puncture.
The contents of several follicles, i.e. the oocytes, are aspirated by laparoscopy or vaginally under ultrasound guidance.
- The final step is the in vitro cultivation. The prepared male sperm are added to the eggs in a culture medium. After about 17 hours, a microscopic examination is performed to determine whether fertilization has occurred in the culture medium.
A maximum of three fertilised eggs are then developed into embryos and transferred to the woman’s uterus after a further two days. The remaining fertilised eggs can be frozen and used in another attempt. After the transfer, the woman is given a pregnancy-sustaining hormone (HCG or progesterone) to help the embryo implant in the uterus.
Artificial insemination is used when the conditions for insemination (see above) are insufficient or previous inseminations have been unsuccessful.
On the man’s side, this is again the case with sperm impairments, on the woman’s side, if a meeting of sperm and egg cell is prevented, e.g. by anatomical obstacles or adhesions of the fallopian tube. Depending on the age of the patient, pregnancy can be achieved with this procedure in one in ten to one in four women. As with all hormonal stimulation of the ovary, there is also a risk of hyperstimulation syndrome (see below).
In this procedure of artificial insemination, the first two steps (hormonal stimulation of the ovary, follicle puncture) are identical to those of IVF. In the last step, however, individual sperm from the partner, which can be obtained directly from the testicles or epididymis, are introduced directly into the woman’s egg using a glass pipette. This is why the procedure is suitable even in cases of severe impairment of the male sperm or ejaculate, which have made all other methods of reproductive medicine unsuccessful.This also includes the complete absence of sperm in the ejaculate (azoospermia) or ejaculation disorders.
