Consists of the injection of appropriately “prepared” spermatozoa into the uterine cavity on the day of ovulation.
In the case of normal ovulation no stimulation is effected but the natural cycle is followed, otherwise, in the same way as in other assisted fertilisation techniques the stimulation of the ovaries allows for the improvement and control of ovulation if necessary. The seminal liquid is prepared in the laboratory: specially selected spermatozoa (the most mobile) are injected directly into the uterus using a small plastic tube (catheter). This technique is totally painless and allows to get beyond the barriers that cervical mucus could create (cervical sterility) and to bring the spermatozoa near the ova.
Ovarian stimulation begins between the 3rd and 5th day of the cycle (1st day of the cycle = 1st day of menstruation) and consists of daily intra-muscular or subcutaneous injections of follicle stimulating hormone (FSH). Tracking of the cycle begins on about the 8th day of the cycle (depending on the woman’s cycle) and ultrasound is used to count and measure the follicles and evaluate the thickness of the endometrium, and the hormonal dosage to measure the levels of the hormone estradiol (E2). Continuous monitoring (every 24 to 48 hours) is indispensable in order to adapt the treatment to the observed quality of the stimulation. Once sufficient stimulation is achieved and follicular maturation ovulation can be induced, which means interruption of all the other treatment. The stimulation is induced using drugs based on human chorionic gonadotropine (HCG), that mimes a luteinising hormone peak, nevertheless, this all takes place only if the parameters are satisfactory. In rare cases the ovarian response is very high (hyperstimulation) and the treatment has to be interrupted because of the risk of multiple-pregnancies, in other cases the interruption can be motivated by a poor ovarian response (hypostimulation) therefore the therapeutic protocol has to be modified before another attempt.
Harvest and treatment of sperm
The harvest takes place on the day of insemination, via masturbation. It is effected after a 3-5 day period of abstinence and it is indispensable that the man urinates before the harvest to clean the urethra of bacterial contamination and for the same reason men are asked to carefully wash their hands and penis before the harvest. After the harvest, the sperm is prepared in the laboratory to reproduce the changes that occur during sexual intercourse when the spermatozoa traverse the cervical mucus. Using a method “capacitation” where the seminal plasma is separated from the spermatozoa, eliminating cellular remains and other cells, the most mobile and morphologically normal spermatozoa which are suitable for fertilisation are chosen. The principle is based on separating the cells based on their mobility, by making them cross liquids of different densities and spinning them. The most mobile spermatozoa traverse all the obstacles easily, therefore they are purified in an appropriate culture liquid. At this point the spermatozoa are ready to fertilise the ovum.
The spermatozoa are injected into the uterus using a very fine probe (catheter) which is introduced into the neck of the uterus. The patient can immediately return to their normal activities.
In most cases no special treatment is required. If the attempt fails the menstrual cycle returns to normal after about 12 days and if it does not occur within the 18th day the woman has to undergo a pregnancy test to see if fertilisation took place.
The success rate is between 15 and 20% in every cycle. The pregnancy is completely normal. Multiple pregnancies, however are relatively frequent: 15% twins, 3% triplets. In the case of failure you can then make another attempt, normally after a period of rest. There is no limit to the number of attempts, but after several failed attempts it is wise to consider other methods of assisted fertilisation, because evidently the problem is more complex and cannot be resolved with this method.
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