Genetics and Fertility Group

Departments / Special Department / Genetics and Fertility Group
Genetics and Fertility Group


Whenever a couple fail in pregnancy even after enough sexual intercourse within a year (if not using contraceptive methods), it can be said that they are infertile. Today, different methods are employed to treat infertility. One of the amazing advances in infertility science is the Assisted Reproductive Technique (ART).
Depending on the problem of the infertile couples, they will be provided with a variety of services including intra cytoplasmic sperm injection (ICSI) or microinjection, preimplantation genetic diagnosis (PGD), and intra uterine insemination (IUI).

 The causes of infertility which require the aid of the above fertility methods include the followings:

  1. Sperm disorder (sperms have not the necessary count, motility, or morphology)
  2. The presence of antisperm antibody in the semen or in the female reproductive system
  3. The cases that require testicular sperm extraction (testicular biopsy) and extraction of sperm from vas deferens
  4. Retrograde ejaculation in patients with neurological diseases
  5. Patients with spinal cord injuries whose sperm samples are taken by electrical stimulation or a vibrator
  6. Cases where the sperm cannot penetrate the ovum
  7. Ovulation disorders
  8. Cervical and uterine problems
  9. Endometriosis
  10. Fallopian tubes blockage
  11. Congenital anomalies and adhesions in the female reproductive system
  12. Cases where the membrane of the ovum is thick
  13. Cases where there is a need to identify the gender of the fetus before implantation
  14. Case where there is a need to make sure that there are no genetic abnormalities in the fetus before implantation
  15. Infertility with unknown causes

 
Microinjection

Microinjection is the injection of sperm into the ovum cytoplasm and one of the most effective methods for assisted reproduction used in the treatment of infertility. The artificial insemination is the in vitro fertilization of the human ovum and sperm. Artificial insemination or microinjection can be divided into four stages.

 

 

 

Stage I: Controlled Ovarian Stimulation

The first stage begins with the use of ovulation induction drugs which can cause the growth of several ova instead of one ovum (contrary to the menstrual cycle in which only one ovum is released per month). Stimulating several ova can result in more embryos and increased pregnancy chance. However, the type and amount of the drugs depends on the cause of infertility, age, hormonal state of the third day of menstruation and the response of the ovaries to ovulation stimulating drugs. Different hormones such as HMG, FSH, etc., are prescribed alone or combined. The physician evaluates the effect of this drug on the growth of ovarian follicles through repeated sonographies and hormonal tests (estrogen and LH). When the size of the follicles in the ultrasound images reaches 18 to 20 mm, the HCG hormone is injected for final maturation of the ovum.

Stage II: Ovum retrieval

This stage begins 36 to 39 hours after the injection of the HCG hormone and usually takes 5 to 20 minutes. With the help of sonography images, the physician aspirates a fluid from the ovarian follicles that contains oocytes and collects it in the test tube and sends to the embryology lab. This procedure is called puncture and is usually performed under light general anesthesia. In the embryo lab, the suitable oocytes shall be identified and isolated by a special microscope and necessary operations performed on them. After emptying the follicles, the patient stays in the recovery and surgery department for a short while and can leave the clinic after several hours.

Stage III: In Vitro Fertilization (IVF) and Embryo Formation

On the day of the puncture, the seminal fluid sample of the husband is collected in a sterile container and delivered to the andrology laboratory. After initial examinations and washing the seminal fluid, healthy active sperms are selected and isolated. In microinjection, the sperm is injected into the mature ovum by a microinjection device. In artificial insemination, the sperm and the ovum are placed next to each other in a plate so that the sperm itself enters the ovum. Embryos are kept in an incubator under the supervision of an embryologist for 48 to 72 hours and in some cases up to 120 hours.

Stage IV: Embryo Transfer

This step does not require anesthesia (except for special cases and at the discretion of the physician). A suitable number of good quality fetuses are transmitted to the uterus cavity. One to two hours after the transfer of the fetus, the patient is discharged. For proper growth of the uterine wall for preservation of the embryo, the prescribed drugs such as progesterone should be taken. About 2 weeks after the embryo transfer, pregnancy status can be tests by HCG blood test.

Embryo Cryopreservation

If after embryo transfer there is additional good quality embryos, they shall be frozen and kept with the couple’s consent. The rate of pregnancy after using the frozen embryos (by vitrification method) is as high as the pregnancy rate after using the fresh embryos.

 

Intrauterine Insemination

This procedure is relatively simple and painless and can be performed without anesthesia. In this method, after the initial assessment and washing the seminal fluid sample, the healthy and active sperms are separated and injected into the uterus cavity. In a natural intercourse, almost 10% of the sperms reach the cervix from the vagina, but in intrauterine insemination, more proper sperms reach inside the uterus.

 

Preimplementation Genetic Diagnosis and Screening

Aging of the mother and the presence of genetic diseases in high-risk couples can increase the risk of chromosomal abnormalities in the newborn. Implementation of this process involves artificial insemination or microinjection. In this method, the embryo produced in the laboratory undergoes a biopsy on the third day when it is at the eight-cell stage and one or two of its blastomeres are aspirated. It is then studied for genetic evaluations by specific coloring methods.

 

Genetic Assessment Before Implantation of the Embryo

Increasing the age of the mother and the presence of genetic diseases in high-risk couples can increase the risk of chromosomal abnormalities in the baby. Performing this process involves artificial insemination or microinjection. In this method, the embryo formed in the laboratory, on the third day, is at the 8th stage of the cell, biopsied and one or two blastomers are separated from it. It is then evaluated genetically by specific coloring methods.

 

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