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Is it important the time of infertility?
Yes. The probabilities to get pregnant expressively reduce if the time of infertility is over 3 years. As a consequence, a specialized medical evaluation must be done as fast as possible, in order to obtain the benefits of the current treatments.
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Is the age of the couple important, as for man as for woman?
In the woman exist a slow and progressive reduction of the possibilities of pregnancy, especially after 35 years old, this situation is more important in those who didn’t present previous pregnancy.

here are no data that prove a direct relation between the age and the capacity of fecundation in the man, but, after 50, some diseases that can compromise the reduction present more frequently (example: diabete).[back]

 

 

 

 

 

 

 

 

 

 

 

 

 

How is the reproductive process in the human being?
Generally, a woman in reproductive age produces monthly only one egg. When the ovulation occurs, the egg is captured by the Fallopian tube. The man, in the reproductive stage, constantly produce millions of spermatozoa in the testis that, after a process of maturation of about 70 to 120 days, stay stored in the epididymus waiting for the next ejaculation.

If during the ovulation period the couple has sexual relations, millions of spermatozoa are deposited in the vagina. The spermatozoa look for the egg: first passing through the uterus and after getting to the tube where the egg that will be fertilized is. If the fertilization occurs, the first cell divisions start, some days after, this embryo reaches the uterus where it will implant itself.

When the egg isn’t fertilized, the menstruation occurs about 14 days after the ovulation. The doctors name it menstrual cycle, which is the period between one menstruation and the next. During this period, a couple in normal conditions has about 20% of possibilities of pregnancy.

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What is In Vitro Fertilization (IVF) and what is its efficacy?
The In Vitro Fertilization (IVF) repeats the natural process and improves the physiological conditions of the couple, fulfilling the following steps:
1. Induction of the ovulation.
When a couple is submitted to treatments with Assisted Reproduction techniques (In Vitro, ICSI, etc.), the ovary must be stimulated with medicines, in variable doses, in order to produce more than one follicle in each cycle (follicle is the place where the egg is before the ovulation).

2. Follow-up of the ovulation induction.
During the medicine administration, an ultrasonographic monitorization of the ovaries is performed to verify the number and size of the follicles. Moreover, a dosage of the hormonal levels of the estrogens, which permit to define the most suitable moment to perform the aspiration of the follicles is done, in order to get the biggest quantity possible of mature eggs.

3. Aspiration of the eggs.
When the follicles grow a little and get the adequate size (between 18 mm and 20 mm), the aspiration is performed in each of them. To make this procedure, the woman receives anesthesia. After that, with the help of an ultrasound, the punction in the superior part of the vagina is performed, reaching each ovary, aspirating the follicular liquid where the eggs are.

4. Semen sample
The man gathers a sample of semen, which will be prepared in the laboratory to be used during the procedure.

5. In Vitro Fertilization
Some hours after the recovery of the eggs and the preparation of the spermatozoa, the fertilization is performed in the laboratory. In the In Vitro fertilization, both eggs and the spermatozoa are placed together in a culture media, until the spermatozoa fertilize the eggs.

6. Development
After the insemination, the eggs stay incubated during the whole night. In the following day, it evidences if the fertilization occurred. The fertilized eggs continue in the culture media to continue their development during two or three days. During this period, it already is an embryo.

7. Embryo transfer
The number of embryos to be transferred to the woman is defined with the doctor, according to the age, cause of infertility, quality of the embryo, etc. But, generally, it’s recommended to transfer up to three embryos, to decrease the risk of multiple gestation. The transference is a very simple procedure, in which the patient does not need anesthesia. A catheter is used, which passes through the uterine cervix entrance until the endometrial cavity (place where the embryos implant) of the woman, where they are carefully deposited.

8. Implantation
It is a set of stages in which the embryo adheres and implants itself in the endometrio. After performed the embryos transfer to the woman uterus, they will have to follow these stages to reach the pregnancy.

9. Luteal phase
In a natural cycle, after the ovulation event, starts the production of a hormone called progesterone, which is very important for the occurrence of the implantation. Generally, when the follicular aspiration is performed, the production of progesterone is insufficient, being necessary to administer it intra-muscular, oral or vaginal via after the aspiration. The period of progesterone administration varies according to each case, which can be administered until the 12ª week of gestation.

10. Pregnancy test.
The pregnancy test is performed between the day 12 and 14 after the embryo transfer. The blood levels of a hormone that is produced in the tissue that will form the placenta, called hCG (choryonic gonadotrophin hormone), are measured.

In Latin America there is a global rate of pregnancy of 27.8% by cycle of In Vitro Fertilization (IVF), according to the Latin American Register , 1998[back]

 

 

 

 

 

 

 

 

 

 

 

What is ICSI and and what its efficacy?
The Intracytoplasmatic Sperm Injection or ICSI, according to its abbreviation in English, is a treatment purposed for men with the following diagnosis:
? Low counting of spermatozoa;
? Absence of spermatozoa in the ejaculate;
? Motionless or motion without progression spermatozoa;
? Low percentage of spermatozoa with normal morphology.
However, in the present time, some centres use ICSI for all cases.
The ICSI is an Assisted Reproduction technique that differs from the In Vitro Fertilization (IVF) in the way of proceeding the insemination. While in IVF the eggs and the spermatozoa are placed together in a culture media for the occurrence of the fertilization, in ICSI the mature egg is captured and the spermatozoon is carefully injected in its cytoplasm for the occurrence of the fertilization. Microscopy and instruments with millimetric movements are used to do this procedure.

The other steps of the ICSI procedure are identical to the performed for IVF, previously described in details.

In Latin America, there is a global rate of pregnancy of 29% by ICSI treatment cycle, according to the Latin American Register , 1998.

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Do these treatments increase the probability of abortion or child born with problems?
No. The percentage of children with malformations in the general population is of 2 – 5%. Between 1996 and 1998, the Latin American Register of Assisted Reproduction published a rate of 1.1% for all techniques performed.
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