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How do you evaluate the results of IVF-ICSI

letto 5313 volte | autore: Claudio Manna, ginecologo specialista in fecondazione assistita (vai al curriculum)


How do you evaluate the results of Medically Assisted Procreation (MAP)

For a couple, but also for the medical team, only the result really counts and obtaining a child in good health.  It is, therefore, not enough to furnish the results of  assisted fertilisation activity in only in terms of the number of children born.

Understanding and interpreting the results of assisted fertilisation
In effect, the global results are nothing other than average statistics that can be very different from the individual probabilities, each birth is a result of a complete chain of events that represent just as many obstacles to get over, each stage presents with its own difficulties, and not all couples are the same.  Therefore, with every method of assisted fertilisation, the results of every stage have to be evaluated, the global results, the factors that regulate individual probability, and finally the short and long term risks.

IVF (In vitro fertilisation) with micro-injection (ICSI)
ICSI is almost exclusively indicated for male infertility: the injection of only one spermatozoon into the ovule allows fertility to be achieved even in the case of  extreme spermatic insufficiency.  The cases of female infertility treatable with ICSI are exceptionally few, and always regard an abnormality where the ovule impedes the spermatozoon from penetrating. The systematic use of ICSI in place of  classic IVF does not improve the probability of obtaining a pregnancy.

Fertilisation failures were numerous before the advent of ICSI.  The situation has improved greatly and classical IVF is no longer used in serious cases of spermatic insufficiency.  The failures of ICSI are rare, about 6%, and they are essentially failures of female origin, concerning the woman’s age and the harvest of a scanty number of mature ova. The results of ICSI are better than those of  classical IVF, but this does not mean that ICSI is a better technique.  In effect, the difference is not because of the technique itself but rather the fact that the cases that are treated are not identical. Many controlled studies have shown that resorting to ICSI for patients who have tried IVF does not improve their results.  Global statistics correspond with average statistics, and their value is for the entire number of people treated.  With reference to couples, the probability of success depends principally on three factors: the diagnosis, the number of embryos transferred and the woman’s age.

Artificial insemination
Artificial insemination comprises of the introduction of spermatozoa into the female genital apparatus at the level of the uterine neck or further into the uterine cavity or the tubes, that is into the peritoneal cavity.  During intracervical insemination the sperm is simply deposited into the cervical mucus with a cannula , prolonging the contact and protecting the spermatozoa from vaginal acidity.  Insemination has to occur immediately before ovulation: when cycles are regular, the approximate favourable moment can be determined using a temperature curve and from an examination of the mucus. This moment represents the nadir, that is the day with the lowest point on the curve before the temperature increases.  The mucus is abundant, limpid and slimy.  If, however,  the cycle is irregular it is necessary to resort to ultrasound monitoring and doses of hormones, and often the stimulation of ovulation.  In this case the favourable moment comes 36 hours after the beginning of ovulation.

Intra-cervical insemination is indicated when the post-coital test (Huhner test) is negative while the mucus penetration test in vitro is positive.  This can come about as a result of many causes Ejaculation disturbances, retrograde ejaculation, low volume of ejaculation and poor quality sperm. The statistics regarding cervical insemination are dated because since 1985, this technique has been fundamentally abandoned in favour of IUI, intrauterine insemination which guarantees better results.  Nevertheless, this technique can be very efficient when the aim is to simply correct a defect concerning the meeting of the ovum and the spermatozoon in the presence of mucus, normal sperm and normal ovulation.  The percentages of pregnancy are about  15-20% per cycle in this rare instance but go down to 4% for reasons of spermatic insufficiency.  Intra cervical insemination is used today only for one principal reason: for insemination with donor sperm, it is the least medicalised method because it can be performed during a spontaneous cycle, without hormonal treatment (that is without the stimulation of ovulation) on condition that spontaneous ovulation is normal.  Nevertheless, if  ovulation is abnormal, stimulation is therefore made necessary and this then leads the way to intrauterine insemination which guarantees normal results.

Intrauterine insemination involves the introduction of spermatozoa directly into the uterus at the time of ovulation.  In spontaneous cycles the results are poor.  The treatment is always combined with ovarian stimulation and the percentage of pregnancy depends largely on the type of stimulation used and also on whether the attempt is to form only one or more ovules.

Disclaimer: the information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician.

venerdì 21 marzo 2008

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