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Check up for failed attempts of Assisted Reproduction in other centres

letto 2996 volte | autore: Fertilita.org

         

Generally, the results of cycles of Assisted Reproduction depend principally on 3 factors:

  • the standard of the centre (there are centres that have less than 10% pregnancies and centres that have more than 50%)
  • the age of the woman (higher the age, lower are the results)
  • the ovarian response to stimulation (which is generally linked to the age of the woman)

Therefore, the principal causes of failure are caused by:

  • the poor standard of the centre to which you go
  • the advanced age of the woman
  • bad response to ovarian stimulation

These factors negatively influence the quality of the embryo, on which the failure of the cycle principally depends.  In fact, it is known that implantation is  also linked to the uterus, but in a much  lower scale that to the embryo.  The quality of the embryo principally depends on that of the ovum (to a much lower degree to that of the spermatozoon). Bad ova generally depend on bad stimulation:

The uterus
Sometimes the uterus presents with myoma, polyps and other formations that can impede the implantation of the embryo and favour abortion.  This can occur if the uterus is not examined well before the beginning of Assisted Reproduction, and these defects are not found and removed.

Immunological factors
Many studies highlight the presence of circulating antibodies of various types that can impede implantation and cause abortion.  A study of these antibodies should be undertaken in the case of failure of a cycle of Assisted Reproduction.

Psychological factors
It is often debated whether anxiety or other psychological factors can play a role in the failure of an embryo to implant.  It seems that excessive and uncoordinated contractions of the uterus can impede implantation.  Perhaps adverse psychological conditions  can influence uterine contractibility, this however is not scientifically well documented. Certainly, relaxed conditions on the other hand, are beneficial for the results of cycles of FIVET or ICSI

The procedure that we describe apart from reflecting the care and attention that our centres naturally dedicate not only to patients from other centres, but to all couples who come to us for Assisted Reproduction.

Examinations before a new attempt at Assisted Reproduction

When a couple who have previously had one or more failed attempt at Assisted Reproduction come to one of our centres, all our attention is concentrated on maximum personalisation of the procedure in all the phases because every patient is different from the next and it is necessary to adapt all the phases of the Assisted Reproduction cycle to the organism that is undergoing  the procedure at that moment in order to maximise the results obtainable.

We perform a very profound hormonal study before we begin the stimulation.  This allows us to put the most ideal form of stimulation for the patient (type of drugs, quantity, method of administration). In the same cycle of tests we perform the so called “test of transfer”, that consists of  a simulation of transfer in order to choose the type of catheter to use, to know the exact place to position the embryo (because they are not all of the same dimensions), and to know ahead of time the exact path that the catheter has to follow, especially at a uterine level.

If we find big obstacles that render transfer difficult, these are removed. In fact real transfer should be a quick and absolutely painless manoeuvre. It is necessary to have a certain amount of capability and sensitivity to transfer embryo transfer, which is a very delicate and critical manoeuvre. The test of transfer is part of an accurate study of the uterus that includes a hysteroscopy.  Any polyps or submucal fibroids should be removed, in as much as any conditions of  endometriosis (inflammation of the endometrium) that are found during the hysteroscopy and can impede implantation of the embryo should be cured.  Profound tests are performed to identify  antibodies and pathologies that could impede Implantation of the embryo. In the case that these antibodies are found particular therapy is prescribed.

The execution of FIVET (Fertilisation In Vitro and Embryo Transfer) or  ICSI (Intracytoplasmic Sperm Injection)

Stimulation involves the use of various drugs to adapt to the “endocrine type” of the patient in care.  Particular attention is given to women who tend to develop few follicles (“low responder”), using special preparations that precede actual stimulation.  Even someone who tends to respond with an excessive number of follicles is treated with a special protocol of therapy, not so much to avoid the syndrome of hyperstimulation, but above all, to improve the quality of the ova that are harvested, which in these cases are immature or dismature and give way to bad quality embryos.

The heart of stimulation, because it allows it to be as efficient as possible, is the monitoring, that we perform with extreme care and attention. In fact everyday and ultrasound is performed and the dosages of at least 3 hormones are checked, in such a way that these can be adapted  and modify the type and quality of the drugs to obtain an optimum development of the follicles that give ova of the highest possible quality.  This program allows us to best evaluate whether something is wrong, and therefore interrupt stimulation without arriving at the harvest of the ova and at the transfer of embryos  that would have had no possibility of implantation.  The monitoring that we perform also undergoes a computerised analysis  using particular informatic programmes that can help with the decisions on which drugs to use day after day.

Laboratory procedures
In our centres we keep a very tight control of the conditions of cellular culture, for both bacterial pollution and for substances that are potentially toxic for the ova and for the embryo, using special filters for the air.  To improve the quality of the embryos we can use a certain number of special techniques. Hatching consists of making a small incision on the outer shell of the ovum, called the “zona pellucida”, using special substances and ideal micro utensils. This is performed to allow the embryo to break out easily and implant in the endometrium.

Culture
Culture is a laboratory technique that consists of keeping the embryo submerged not on its own in a special liquid but with other cells that perform the task of absorbing toxic substances that are produced by the embryo itself or by the ambient, and produce growth factors that help it to develop better. Since the quality of the ova represents the most critical element for the positive outcome of a FIVET or ICSI attempt, when the ova produced are bad regardless of all efforts made before stimulation, the probabilities of having good embryos are almost inexistent.

From transfer onward
Transfer is an extremely delicate and complex moment in all cases and is a critical phase because if a manoeuvre that lasts a few seconds is messed up you run the risk of compromising  all the work that was done before!  Botched transfers, not surprisingly, are more frequent than people believe.  To be sure that the catheter is effectively inside the uterus and in the correct place we follow its progress with ultrasound.  It is possible to even see the drop that contains the embryo come out of the catheter.  After transfer, apart from progesterone that is prescribed special pharmacological therapy is undertaken, differing from case  to case that renders the endometrium more receptive to the embryo.

lunedì 23 marzo 2009


Risorse video
The first consultation
Couples already in consultation
Couples with previous failed attempts
When can we say “there is an infertility problem”?
Secondary infertility
Transforming a possibility into a success


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