IVF ICSI in Bangkok
Assisted reproductive technology is a method of treating infertility with the introduction of sperm and eggs from the body and having fertilization outside the body for supporting pregnancy. There are many types of assisted reproductive technology, such as In Vitro Fertilization (IVF), assisted fertilization by injecting sperm into the egg cell (ICSI), transferring germ cells into the fallopian tubes (GIFT: Gamete Intra Fallopian Transfer), transferring the embryo into the fallopian tube (ZIFT: Zygote / Embryo Intra Fallopian Transfer). By the way, the current method that is widely popular is IVF and ICSI.
What is IVF and ICSI?
What are the differences?
IVF (In Vitro Fertilization)
This word is derived from Latin, “In Vitro” means outside the human body, which means here within the glass tube or inside the test tube itself
In Vitro Fertilization (IVF) is a method of treating infertility by taking sperm and eggs from the body and having fertilization outside the body. Originally the fertilization is made in a test tube or glass tube, nowadays often use a plate of culture (Plate).
The method is that after placing the egg and sperm cells together in a culture dish by allowing the sperm to swim into the natural egg cell itself. Once the sperm can be fertilized with the egg will develop into a small embryo. By The embryo will be cultured in the incubator until the appropriate stage and then transferred back to the uterus to achieve implantation or pregnancy itself.
What is ICSI (Intra Cytoplasmic Sperm Injection)? How is the difference from IVF?
ICSI is fertilization process by injecting sperm into the egg cell and also be as an alternative of assisted reproductive technology that is often used to treat infertility in spouses whose male partner has and abnormal sperm or unhealthy sperm. Also ICSI is used for the couples who have experienced failure from fertilization of eggs and sperm in IVF technique. Because of in IVF process, found that the sperm could not penetrate the egg shell itself as the sperm quality had poor quality or sometimes the female has problem with the egg shell so thick that sperm cannot penetrate.
The embryologist can help by selecting only one strong sperm and use a tiny needle penetrate the egg shell and inject that sperm directly to the egg cell under the microscope which is called this technique as ICSI.
ICSI is currently a popular method around the world because it can increase the fertilization rate and success rate more than the IVF process.
ICSI (Intra Cytoplasmic Sperm Injection)
Who is suitable to be treated by the IVF/ICSI method?
- Female has a tubal factor that cannot be corrected by surgery, such as clogged stenosis, edema, or without a fallopian tube from congenital malformation or had surgery on the fallopian tubes on both sides.
- Female has severe endometriosis by having the pelvic adhesion and fails from medication or surgery. Or having fibrosis from the surgical operation of the oviduct tubes to be disabled
- Female has problem with chronic anovulation, failed fromm the treatment by oral or injectable medicines, or having small amount of eggs.
- Male Factor from the quantity of sperm less than 10 million count/ml (Oligozoospermia), low motility (Asthenozoospermia) or very unusual shape (Teratozoospermia) or not found sperm (Azoospermia) or Cannot ejaculate sperm. (Aspermia)
- Many time failures of treatment by injecting into the uterus (IUI)
- The couple have an unexplained infertile or have tried to have a baby more than 2 years but not succeeded.
- The couple who had been tested for Preimplatation Genetic Testing (PGT), or had been found abnormal genetic disease that can be transmitted to children , or had been pregnant with disabilities children, or frequent miscarriage due to chromosomal abnormalities.
- The couple who want to keep germ cells or embryos before cancer treatment With chemotherapy or radiation, such as breast cancer, lymphoma Leukemia or other diseases such as SLE (Systemic Lupus Erythematosus).
- The women who has Pelvic Organ Abnormal, oviduct abnormal or reproductive organs abnormal or no uterus from surgical removal (not pregnant itself) or in the absence of ovaries due to ovarian surgery on both sides. This style requires a third person to help with treatment.
Preparation steps before treatment
Female and male eat 5 nutrition food groups, take supplement with appropriate vitamins. Rest enough by sleeping at least 8 hours per day, exercising regularly. Refrain from smoking or drinking alcohol in order to allow the body to respond to hormones, better treatment. Strictly follow the doctor’s suggestion as mentioned above.
Procedures and duration of IVF
When you receive treatment at Smile IVF Clinic, doctor will provide care about your infertility problems.
The process takes time approximately 4-6 weeks as follws;
- Check for infertility causes by standard methods
To assess the suitability to provide treatment with assisted reproductive technology in each method.
- Check the number of preliminary eggs by transvaginal scan and measure hormone levels together with injections to stimulate the ovaries. The injection will start at the beginning of menstrual cycle or Day2- Day 3 of the menstrual cycle, take 8-10 days.
- Examine, monitor the response of the ovary, the size of the egg with a high frequency detector together with a blood test. When the egg size is 18 mm, the number of eggs will be 2-3, there will be the injection for making the ovulation within 35-40 hours, and then for egg collection.
- The egg collection will make the patient to deep sleep by anesthesiologist. Then use a small needle with a high frequency sound wave detector via the vagina for collecting the egg. After that the eggs will be checked the number and quality by scientists.
- Husband will collect sperm on the same day of egg collection and after that this sperm will pass through the preparation process in the laboratory
- Eggs will be mixed with sperm that has been prepared. In order to achieve the embryo and culture in the incubator.
- When the embryo is fertilized, it will be cultured to the appropriate stage, such as Clevage, Day 2 or Day3, Blastocyst in Day 5 or Day 6 will be transferred by the stage and age of embryo, called FRESH embryo transfer.
In case some of the case cannot do FRESh embryo transger then there will the process of biopsy or cutting the cell for chromosome disorder screening. For screening chromosome disorder is needed to keep the embryo for freezing and come back in the following month for Frozen Embryo Transfer.
- After transferring the embryo into the uterus in a fresh cycle, the medications will be provided to support pregnancy for 10-14 days. After that, doctor will set the appointment for a blood test to confirm the pregnancy. If successful, make an appointment to follow up check until birth.
- For the case that unsuccessful and still left the frozen embryo, doctor will analyze the cause,, make corrections and appointment to transfer the embryo in the next menstrual cycle.
Stage of embryo for embryo transfer
- Cleavage phase, aged 2 or 3 days after fertilization (Cleavage Transfer).
After the fertilization, the embryo will be cultured until the cells are divided into 2-4 cells, takes time for 2 days and 6-8 cells take time about 3 days. The embryo will be transferred base on the age of embryo, for example, age 3 days will transfer the embryo 3 days after the date of egg collection.
- Blastocysts, age 5 or 6 days after fertilization (Blastocyst Transfer)
Blastocyst transfer is a new technology that helps to achieve a higher pregnancy rate compared to transferring Cleavage stage. By cultivating the embryo outside the body until the embryo grows to the stage of embedding (using a period of 5 or 6 days after fertilization) called Blastocyst and then transferring to the uterus to allow the embryo to become embedded and become pregnant. In this way, the embryo is ready to be embedded then increase more chances of pregnancy.
- Cleavage Blastocyst (Biopsy Transfer)
Nowadays, the latest technology helps to achieve higher pregnancy rates and reduce miscarriage.
There is an embryo screening before embryo transfer by culturing the embryo until the age of 3 days or 5/6 days after fertilization. After that, there is the process of cutting cells to send a test called Cleavage Biopsy, Blastocyst Biopsy, respectively, then freezing the embryo to stop growing and wait until the embryo screening results are known. Selecting the normal embryo to be used by thawing the embryo and transferring to the uterus in frozen embryo transfer (FET) cycle.
Chance of success
The opportunity to conceive from the IVF per treatment cycle will depends on the age of the couple, quality of sperm, number and quality of eggs that are obtained in each round and the readiness of uterus to receive the embryo. If the patient has sufficient number of good quality eggs about 15 eggs or more, the overall success of the cumulative pregnancy will be around 50-60% and better to 70-80% with at least 2 normal chromosome embryos be transferred. By dividing the success rate from 35 to 40 percent per cycle in which the embryo is transferred in the stimulated or fresh cycle. Up about 40-50 percent per cycle with the embryo transfer in the freezing cycle. In the case of transfer the embryos that are screening for chromosome and found that they are normal, the successful pregnancy rate will increase to 60-70 percent.
In addition, generally after the embryo transfer and pregnancy from IVF still have a chance to miscarry by about 15-20 percent depending on the age of women and men, embryo quality, the availability of the uterus. For the embryos that were screened for chromosome, found that can reduce the rate of miscarriage to 5 percent
Pros of IVF/CSI
It is a safe treatment technique and has been used for about 40 years. It can help solve almost all infertility problems whether the factor from incomplete or strong sperm of the male side, or the growth/ the response of the female egg. The doctor can adjust the treatment to suit each patient’s individual including helping of experienced embryologist for fertilization / culture embryo from the beginning can known the quality of the embryo. For these reasons, it makes the greatest opportunity and can plan the pregnancy period appropriately and easier to become pregnant when compared to natural methods or injections (IUI). It also helps to screen children who are healthy and reduce genetic disorders or reduce disabled children.
Cons of IVF/ICSI
This method requires advanced technology and supervised by experienced people, therefore the treatment cost is quite high. This also causing some patients is not be able to access the service and the government of Thailand does not have a policy budget to support for infertility. Future expectations if there is support at this point will be very beneficial to the group with infertility.