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Antwerp Hospital Network - ZNA

In Vitro Fertilisation (IVF)/ Intracytoplasmic injection (ICSI)

In Vitro Fertilisation (IVF)

After hormonal suppression of the ovaries, hormonal preparations are used to stimulate the ovaries to produce several follicles and to ripen several ova. A punctual monitoring by blood samples and ultra-sound scans allows to follow up the growth of the follicles and to determine the expected moment of ovulation. Just before the actual ovulation (and thus at the hour sharp), these follicles are punctured under ultra-sound control. Depending on their ripeness, the eggs are brought into contact with the sperm-cells in the laboratory at the right moment. If fertilisation occurs, these fertilised ova are placed back into the womb through the cervix, usually 3 days later.

The man's sperm has to be prepared as well, as unprepared sperm cannot fertilise an egg. The sperm has to be given the capacity of fertilisation, it has to be "capacitated". This is done by centrifugation and "washing", in which the sperm-cells are completely separated from the liquid fraction. In a normal cycle, these changes occur in the uterine cervix. This implicates that before the aspiration of the ovum, the man has to donate a sperm sample by masturbation.

Cryopreservation, cryotransfer et embryobanking
When lots of ova are obtained and the fertilisation is good, it can happen that after 1 (sometimes 2) embryos have been replaced, there still are a number of "beautiful" embryos left over. These are characterised as having an excellent or good shape and structure. Of these embryos we know that after freezing and thawing, viable embryos can be obtained. The only possibility to keep embryos in this stage, is to freeze them (cryopreservation) and to preserve them in liquid nitrogen at -190°C (embryobanking).
Should the replacement of the embryo fail to result in pregnancy during the "fresh" cycle in which the ovum was picked up, this procedure allows us to replace these embryos in a later, usually unstimulated cycle. This avoids the necessity of having to go through another stimulation, which is after all a burden, and an unpleasant pick-up. Cycles after thawing produce somewhat lesser pregnancies than fresh cycles, but this possibility gives you the chance of "resting" a couple of months after the strenuous pick-ups and still leaves you a reasonable chance of pregnancy.

IVF in cases of male infertility (ICSI)

Lots of fertility problems are caused by sperm with decreased quality: numbers, mobility and shape of the spermatozoa can be abnormal, separately or in combination. The more severe the anomaly, the lesser the chances of obtaining a pregnancy by standard IVF.
Whether a couple is accepted in the IVF-programme, depends on the result of the test capacitation. Also the result of a possible IVF test cycle is important for further clearance of the file. The (not to be seen as very strict) limit under which IVF becomes very problematic is drawn nowadays at a total of about 0,5 million type A (means straight by moving) spermatozoa. When there are no (motile) spermatozoa present in the sample after the swimming-up technique, no IVF-attempt is being made, because in that case fertilisation never occurs.
Since 1993, we can, in all of these unfavourable cases, apply intracytoplasmic injection (ICSI) of one sperm-cell in the ovum.
ICSI-treatment means a real breakthrough for all types of decreased male fertility. Even when no sperm-cells are present in the ejaculate, but in the epididymis or testicle, pregnancies can be generated by injecting these surgically obtained sperm-cells in the ova by means of ICSI. Moreover, these sperm-cells, if necessary, can be frozen and thawed. For the first time in the world, the ICSI-treatment was implemented in Belgium. ZNA Middelheim kept its end up and, as one of the world's first centres, obtained ICSI-pregnancies in 1993.
With sperm qualities that are only moderately decreased, you cannot yet deduce from one IVF-cycle without fertilisation, that a pregnancy is impossible. If fertilisation fails to occur in one cycle, we do not attach an exaggerated and certainly not a definitive value to it. Often we propose a second cycle and then fertilisation does occur. If it fails again, we go to ICSI. All this is discussed individually. It is a fact that the development of IVF-techniques in which (strongly) dysfunctional sperm of the partner is used, has limited the indication field for AID (insemination with donor sperm). Nevertheless, the approach of andrologic infertility has, in practice, become more complex. After all, lots of couples with a weak sperm factor, regardless of occasional fertilisation and formation of embryos, still remain childless. Therefore, it is wise to always keep thinking about AID and not to overlook this solution. On the other hand, as a rule, we will not comply with a request for AID, if no IVF/ICSI-attempts have been made.