In vitro

Thanks to in vitro fertilization, many infertile couples in Poland have become parents. You too can be one of them!

Take advantage of the in vitro procedure at the Gyncentrum clinic

What is in vitro?

In vitro fertilization is the fusion of an egg cell with a sperm in a laboratory setting. Reproductive cells are taken from a woman and a man beforehand, and after fertilization they are transferred into the patient’s uterus. Pregnancy obtained through IVF proceeds in the same way as pregnancy obtained naturally. The in vitro method is used only when all other methods have failed to produce the desired result, and in case of failure, the procedure can be repeated.

It is worth remembering that in vitro fertilization is the last chance for many couples to have a child. According to the ESHRE(European Society of Human Reproduction and Embryology) association, it has already given birth to more than 8 million children who are growing and developing healthily. The number of people who have achieved their dream of parenthood thanks to IVF is also on the rise. In Poland, the Gyncentrum clinic is helping to fulfill the dream of having a child through IVF.

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WHY GYNCENTRUM

Why should you trust us?

  • We have been supporting infertile couples in their efforts to have a child for more than 20 years.
  • In the city’s IVF programs, we achieve up to 80% success rate – and that on the first attempt – and 95% success rate in the “2+1” program. In practice, this means that almost everyone who decides to receive treatment at the Gyncentrum clinic comes out of it with a child.
  • We take responsibility for our work. At Gyncentrum, you either get pregnant or we guarantee a 100% refund.
  • Thanks to our work and the commitment of our specialists, thousands of babies have already been born.
  • We have the largest reproductive cell bank in this part of Europe .
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Indications for IVF

The IVF method is the most advanced form of infertility treatment. Specialists recommend it only when other methods have failed. Such a situation may occur in the case of infertility caused by:

Female factor

  • absence or permanent damage to the fallopian tubes, obstruction of the fallopian tubes preventing the movement of egg and sperm for fertilization
  • ovarian dysfunction, polycystic ovarian syndrome
  • ovulation disorders
  • hormonal disorders
  • endometriosis
  • unsuccessful attempts at intrauterine insemination

The male factor

  • testicular damage
  • reduced semen quality: low sperm motility, abnormal sperm structure
  • lack of sperm in the ejaculate
  • absence of ejaculate – aspermia

Idiopathic infertility (unexplained origin) – the inability to have offspring in the absence of any abnormalities in basic diagnostic tests.

Other indications

  • immunological infertility – occurs when the body of both the woman and the man produces antibodies that destroy reproductive cells
  • HIV and HCV carrier by one of the partners
  • burden of genetic diseases
  • anticancer treatment
  • lack of pregnancy within 3. years of efforts
  • woman’s age above 35 years

In vitro fertilization - diagnosis, course of procedure

Diagnostics before IVF

The in vitro fertilization procedure is a multi-stage process. We should begin it with a thorough examination of the health of the parents-to-be, so that we can be sure that it will not interfere with the entire in vitro fertilization procedure. The course of diagnostics is different for a woman and a man. At the outset, the patient should perform a cytology and hormonal tests (prolactin, AMH, FSH and TSH), and the man a general semen test. If all the test results are normal, the next stage of diagnosis can begin.

More about infertility diagnosis

During its course, a woman must go for the following tests:

  • APTT
  • Glucose level
  • Anti-HBc antibodies
  • Smear of the cervical canal for chlamydia
  • Anti-HCV antibodies
  • Sodium level
  • Potassium level
  • VDRL
  • Antibodies to cytomegalovirus
  • Blood morphology with blood group determination
  • Anti-HIV antibodies
  • HBs antigen
  • Antibodies against toxoplasmosis

In turn, the man must perform:

  • Anti-HBc antibodies
  • Anti-cytomegalovirus antibodies
  • Anti-HIV antibodies
  • Anti-HCV antibodies
  • HBs antigen
  • VDRL
  • Blood group test

Sometimes the couple is also asked to perform other tests before in vitro fertilization. Among others, a karyotype test or immunological tests may be ordered. The course of diagnostics is always adjusted individually. At the Gyncentrum clinic, the patient is the most important thing for us, so before in vitro fertilization we want to be sure that nothing will interfere with the procedure.

Course of in vitro fertilization

Once the diagnosis is completed, the actual part of in vitro fertilization can begin. It consists of four phases.

First phase – hormonal stimulation

Hormonal stimulation of the ovaries is used in order to obtain more mature Graaf follicles with egg cells at one time (during a normal menstrual cycle, one egg cell is produced, as a result of hormonal stimulation of the ovaries, 5-10 egg cells are obtained). The stimulation process is carried out on the basis of the so-called stimulation protocol, which is created by the doctor individually for each patient. Drugs for stimulation are in the form of subcutaneous injections, which the patient administers to herself at fixed times of the day.

During stimulation, the patient remains under the constant control of the doctor, who monitors the development of egg cells and controls the level of estradiol in the blood. When the follicle reaches an appropriate size (>16 mm), the doctor decides to end stimulation and sets a date for an LP (egg retrieval). The patient also receives hCG hormone once to induce ovulation.

Phase two – collection of egg cells and sperm

  • Puncture – oocyte retrieval: within 36 hours of administration of hCG hormone, before the Graaf’s follicles spontaneously rupture, an ovarian puncture procedure is performed. Under ultrasound guidance, the doctor pricks the Graaf’s follicles with a needle, through the vaginal vault, and retrieves the follicular fluid along with the egg cells. The procedure takes about 15-20 minutes and is performed under short intravenous anesthesia under the constant care of an anesthesiologist. Immediately after the procedure, the patient stays at the Gyncentrum Clinic in the day room for about 2 hours. The doctor also determines the dosage of post-stimulation medications designed to prepare the uterine mucosa for embryo implantation.
  • Semencollection: if semen parameters allow in vitro fertilization, semen is collected on the day of the partner’s ovarian puncture. The man donates semen as a result of masturbation. The entire procedure takes place at the Gyncentrum Clinic in a specially prepared room, guaranteeing intimacy and discretion. Sperm donation should be preceded by 3-5 days of sexual abstinence.

Third phase – fusion of egg and sperm (in vitro fertilization)

In a laboratory setting, the embryologist prepares the egg cells and sperm for fertilization:

  • the ova, obtained during ovarian puncture, are isolated from the follicular fluid and then placed in special media
  • after sperm purification, the best and most mobile sperm are used for fertilization.
cztery-dostepne-metody-in-vitro-banner-gyncentrum strzałka w dół

After the preparation of the reproductive cells, fertilization takes place, which is carried out by one of the four available methods:

IVF – the classic method of in vitro

Spermatozoa are added to the culture dish with oocytes in the appropriate proportion. The combined gametes are placed in a greenhouse, reproducing conditions close to natural ones. In the incubator, constant conditions are ensured, i.e. temperature of 37 degrees C, increased humidity and CO2 saturation, and reduced O2 content. Fertilization occurs spontaneously within 18-20 hours. On the second or third day, the embryos are ready for embryotransfer. Currently, increasing the chances of fertilization, the classic IVF method is being replaced by ICSI / IMSI techniques.

IVF-ICSI

ICSI ( intracytoplasmic sperm injection) is a method of in vitro fertilization involving the intracytoplasmic injection of sperm.

What does the procedure involve?

 

The embryologist, using a micromanipulator, places one sperm directly inside the egg cell. Then, as in the classic IVF method, he places the combined cells in an incubator, where, under conditions similar to those in the woman’s body, the pre-nuclei of the partners’ gametes fuse and cell divisions take place. Most often, after two or three days, the transfer of the embryo or embryos into the uterine cavity is performed.

When is the ICSI method used?

 

The ICSI method is used when diagnosed with reduced sperm parameters (low sperm count, reduced sperm motility, abnormal sperm structure), the presence of antisperm antibodies, or when previous IVF treatments have failed.

IVF-PICSI

IVF – PICSI (Physiological Intracytoplasmic Sperm Injection), or so-called physiological ICSI. In the classic ICSI method, the sperm is selected on the basis of motility and morphology. The PICSI technique allows selection of the sperm on the basis of morphological characteristics and the ability to bind to hyaluronic acid. This is a characteristic that indicates the maturity, functionality and ability of a particular sperm to fertilize an egg.

IVF-IMSI

IMSI ( Intracytoplasmic Morphologically Selected Sperm Injection) is an in vitro method involving the intra-cytoplasmic injection of morphologically selected, best quality sperm. It is the most modern method of in vitro fertilization, with the best results in terms of increased clinical pregnancies and lower miscarriage rates.

What does the procedure involve?

 

Immediately before the sperm is injected into the egg, the embryologist evaluates the sperm head under very high magnification. The Gyncentrum Clinic uses microscopes with the latest MSOME ( motile sperm organelle morphology examination) technology, which allows analysis of the sperm at ≥ 6,000 times magnification (6 times higher than that of a traditional microscope), making it possible to extract the highest quality sperm. After selecting the sperm for fertilization, a single male gamete is transferred inside the egg cell. This uses a micromanipulator and dedicated needles. The combined gametes are placed in an incubator, which reproduces near-natural conditions in terms of temperature, humidity and atmosphere. After two or three days, the growing embryos are used for transfer.

When is the IMSI method used?

 

The IMSImethod is especially recommended for couples with male factor infertility:

  • increased sperm DNA fragmentation
  • for sperm retrieved directly from the testes or epididymides during the TESA/PESA procedure.

IMSI is also recommended for couples who have failed to obtain offspring during previous IVF-ICSI attempts.

Phase four – transfer of embryos into the uterine cavity

After an appropriate period of time has elapsed since the fertilization of the oocytes, at the most appropriate stage of embryo division or after the formation of a blastocyst, embryiotransfer is performed, i.e. the transfer of the embryo or embryos into the patient’s uterine cavity.

etap-czwarty-transfer-gyncentrum
EFFECTIVENESS OF IN VITRO

What affects the effectiveness of the IVF method?

In vitro, like natural insemination, does not always result in pregnancy. However, we can try on our own to slightly increase the chances of the procedure’s success. To do this, we need to take special care of our lifestyle before starting IVF. If we are struggling with overweight or obesity, let’s shed the excess weight. They can significantly reduce the chances of pregnancy. Let’s also make sure that our diet is balanced and varied. It is also extremely important to get regular physical activity, get enough sleep and hydrate your body.

The effectiveness of IVF can be greatly reduced by stimulants. In preparation for conception, we should completely give up drinking alcohol and smoking cigarettes and other tobacco products. This will greatly increase our chances of having a baby. Before IVF, we should also not forget about our psyche.

Problems with getting pregnant are often the result of mental block or long-term stress. So it’s worth taking a little care of our well-being before we start the IVF procedure. A consultation with a psychologist can help. It also wouldn’t hurt to meet with friends often and give yourself small pleasures.

para przygotowująca zdrowy posiłek w kuchni
What does the procedure consist of?

 

Embryo transfer into the uterine cavity takes place on the second, third or fifth day from the day of ovarian puncture. At this stage, the embryo has 4-8 cells or forms the blastocyst stage. The embryos are placed, along with a small amount of transfer fluid, in a special catheter with which they are inserted into the uterine cavity. In a typical case, one or two embryos are administered. The embryo transfer procedure takes place in the gynecological position, is painless and does not require anesthesia. The patient can go home on her own immediately after the procedure.

Recommendations after the procedure

 

After embryo transfer, a woman can return to daily activities. However, it is recommended that for a week after the transfer she avoid sexual intercourse and orgasms, which result in uterine contractions. For several days after the transfer, it is also necessary to take progesterone, which affects the proper implantation of the embryo. If you experience worrisome symptoms, contact your health care provider as soon as possible.

FAQ

Frequently asked questions
about in vitro

What is in vitro fertilization?

In vitro is the creation of an embryo under unnatural conditions, in glass, but with the provision of all the mimicry, that is, the resemblance of all the states that occur in natural conditions. The most common method of fusing a sperm with an egg cell is called ICSI, or under high magnification – IMSI. In the laboratory, this is done in vessels, in suitable substances that mimic the natural conditions that the oocyte would encounter in the patient’s reproductive tract in the fallopian tube and later in the uterus. The sperm is also provided with such a substrate, in which it feels like it is in the natural pathways.

What is the first visit to an infertility clinic like?

First, the doctor will conduct a medical history, gynecological examination and ultrasound. He will also review the history of previous treatment. It is always a good idea to bring the results of all previous tests with you to the first visit. Based on the information gathered, the doctor will assess the patients health, present treatment options, and order additional diagnostic tests if necessary. This is also the time for the patients themselves to ask questions, so it is a good idea to prepare for the first visit in advance, for example, by writing down all the burning questions on a piece of paper. During the appointment, the doctor will ask questions such as the date of the last menstrual period, the regularity and length of cycles, the course of treatment to date. In addition, he or she may ask whether there has been a problem of infertility among family members (parents, siblings, grandparents), and about childhood and current diseases. The visit is also likely to include questions about contraceptive methods used so far, lifestyle, libido and the puberty process.

There is no one-size-fits-all set of tests that should be done before the first visit to an infertility clinic. In order for patients to get the most out of the visit and for the doctor to gather as much information as possible about the patients’ health status already at this stage, it is recommended that the woman perform basic laboratory tests, i.e. blood count, hormonal tests TSH, AMH and prolactin. The man, on the other hand, should provide the results of a basic semen test on sperm motility and physical and chemical parameters. In addition, it is worth examining sperm morphology and viability, as well as the presence of antisperm antibodies and active leukocytes.

What are the indications for IVF?

In the case of a woman, indications for IVF may include hormonal disorders, obstruction of the fallopian tubes, low ovarian reserve, endometriosis, idiopathic infertility (of unknown cause). In the case of men, the indication for IVF is primarily low semen parameters – their insufficient number, too weak motility, errors in structure.

Can the effectiveness of IVF be increased?

Yes! Today, infertility clinics have at their disposal many tools and techniques , which increase the effectiveness of in vitro fertilization. These are primarily:

 

  • IMSI (Intracytoplasmic Morphologically Selected Sperm Injection), an in vitro method involving the intra-cytoplasmic injection of morphologically and qualitatively selected sperm. This is achieved through the use of an optical microscope with a digital imaging track, which allows analysis of the sperm on a monitor screen at 6000x magnification. In comparison, ICSI offers the possibility of 400-fold magnification. The IMSI method increases the chance of success of the in vitro fertilization procedure and maintenance of pregnancy. In addition, the technology reduces the miscarriage rate in patients whose partners are diagnosed with teratozoospermia.

 

  • Assisted Hatching (AH) is a procedure that involves incision of the embryo’s transparent sheath, immediately prior to transfer into the uterine cavity. This makes it easier for the embryo to leave the sheath that surrounds it. AH thus increases the chance of proper embryo implantation.

 

  • MSOME (Motile Sperm Organelle Morphology Examination) is an examination of the morphology of motile sperm. It is performed under high microscopic magnification (6000-8000x). It allows an accurate assessment of the intracellular structures of sperm cells. The use of sperm selected by the MSOME technique for in vitro fertilization increases the chances of achieving a pregnancy.

 

  • Preimplantation diagnosis – PGT (preimplantation genetic testing) involves evaluating the embryo for genetic abnormalities. They are performed on cells taken from embryos created during the IVF procedure, before the woman becomes pregnant. Early detection of defects and transfer of healthy embryos reduces the risk of reproductive failure and the birth of a child with a genetic defect.

 

  • EmbryoGlue, a medium characterized by a high content of hyaluronate. It is also rich in all the nutrients necessary for proper embryo development. Thanks to its high hyaluronate content, EmbryoGlue creates optimal conditions during embryo transfer. The use of this technology increases the rate of embryo implantation and pregnancies received.

 

  • EmbryoGen, which is a specialized culture medium enriched with GM-CSF (Granulocyte-Macrophage Colony-Stimulating Factor). GM-CSF is produced in the epithelium lining the fallopian tubes and uterus, as well as in the ovary, under the influence of estrogen. Its deficiency can be detrimental to embryonic development. By ensuring proper levels of GM-CSF, EmbryoGen influences cell division and optimal embryo development.

 

  • The Primo Vision Time Lapse embryo monitoring system provides the ability to continuously observe embryo development without removing the embryos from the incubator. This, in turn, protects them from harmful external influences. A specially designed digital microscope, placed in the incubator, takes pictures of the embryo at a frequency of every 5 minutes. It then creates a video of its development from hundreds of photos. This is hugely important in selecting the most promising embryo for transfer.
How is an egg cell evaluated for IVF?

The egg cell, which is given to the embryology laboratory by the attending physician during the LP, needs to be cleared of the so-called cumulus cloud, i.e. a mass of granulosa cells. Such a cell, in order to fuse it with a sperm, must be mature. When it has a clearly visible directional corpuscle, a shapely transparent sheath, if the space around the plasma is well formed and we have no granules, vacuoles there, then such a cell is ready for fertilization.

How is semen evaluated for IVF?

Semen, once donated in a special dedicated room, must be processed. We can treat it. We can remove various structures from it that would interfere with our ability to make a successful insemination. We can also sort the sperm. We do this by using a magnet – a special device that works like such a technical “maze”. After sperm is sprinkled, the sperm flows by itself into such a dedicated well, from which the embryologist then collects it. If the sperm turns out to be the right one, before we perform fertilization.

In evaluating semen, we are concerned with determining whether the sperm has a well-formed head, whether it has a well-formed acrosome, whether its movement is progressive. If there is something wrong with the sperm, we look for the causes of this condition. We are committed to selecting that best sperm, capable of fertilization.

How does the embryology lab work?

In the embryology laboratory, we receive our partner’s sperm from our andrology department, while from the doctor we receive oocytes that are ready to be purified, and if they are mature and of the right quality, we can fuse them together with male gametes under sterile conditions, the right environment, in vitro. We expect that within several hours, two specific structures called male and female pre-nuclei will be produced and a zygote will form. Once it reaches the blastocyst stage, it is ready for implantation. We can administer it into the patient’s uterine cavity and within literally several hours expect the pregnancy to develop successfully.

I have my first transfer ahead of me. What should I avoid after the transfer?

After the transfer, avoid excessive physical activity and sexual contact that causes cramping. Hot baths should also be avoided.

How many embryos are transferred during the IVF procedure?

At the time of transfer, it is recommended to administer only one embryo into the uterus. In justified cases, it is possible to transfer two – for example, when a woman is already over 35 years old and therefore less likely to implant an embryo, or is after unsuccessful attempts at in vitro fertilization. When recommending the transfer of a single embryo, the clinic is guided primarily by the patient’s welfare and wants to provide the future child with the best possible conditions for development. Transfer of a larger number of embryos is associated with the likelihood of multiple pregnancies – twins, triplets, quadruplets. Meanwhile, each such pregnancy is a greater risk of complications. Of course, all remaining embryos created as a result of the IVF procedure undergo vitrification (freezing) and are used in subsequent pregnancies.

How far in advance of the transfer is the embryos thawed?

Thawing of embryos occurs on average 2 hours before the scheduled transfer.

I am after cryotransfer of two embryos (3rd day). The result is negative. When can I have another transfer?

If there are no contraindications from the doctor the next transfer can already take place in the next cycle.

Is it possible to use donor/ donor egg sperm/cells in IVF?

Yes, it is as possible. The whole procedure begins with the adoption of oocytes / sperm. The patient (recipient) receives oocytes taken from an anonymous donor. The donor oocytes are fertilized under laboratory conditions (in vitro) with the sperm of the recipient’s partner or, similarly, with the sperm of an anonymous donor. The resulting embryo is then transferred into the recipient woman’s uterine cavity. Indications for IVF with a donor egg are low ovarian reserve, condition after removal of both ovaries, chemotherapy, premature expiration of ovarian function.

Who can become an egg cell donor?

To become a cell donor you need to meet several conditions:

  • be no less than 18 and no more than 35 years old
  • be in good health
  • the woman should not be burdened with genetic diseases
  • all tests for sexually transmitted diseases (HIV, hepatitis B and C, syphilis, HTLV) must be negative
  • no addiction to alcohol and drugs including marijuana
Does the oocyte retrieval procedure hurt?

The oocyte retrieval (puncture) procedure is performed under general anesthesia. Immediately after the procedure, the patient stays at the Gyncentrum Clinic in the day room for about 2 hours. After the procedure, light spotting and lower abdominal pain, similar to menstrual pain, are possible. You cannot eat, drink or chew gum for at least 6 hours before the procedure.

How to become a sperm donor?

First of all, you must meet the following criteria:

  • be not less than 18 and not more than 35 years old
  • be in good health
  • a man should not be burdened with genetic diseases
  • all tests for sexually transmitted diseases (HIV, hepatitis B and C, syphilis, HTLV) must be negative
  • no addiction to alcohol and drugs including marijuana
  • the candidate must have at least a high school education with a high school diploma
  • The first step to become a sperm donor at the Gyncentrum Sperm and Ova Bank is to fill out the form available on the WEBSITE. We will then send further instructions and a link to the questionnaire to be filled out and returned to you at the email address you provide. Once the information from the questionnaire has been analyzed and the evaluation is positive, you will be contacted by the program coordinator to schedule an appointment.
What is insemination?

Insemination involves the direct introduction of specially prepared semen into the uterine cavity. This is done with the help of a thin catheter, which makes it possible to bypass the barrier of cervical mucus and the antibodies, bacteria and fungi in it. The procedure is intended to increase the likelihood of the egg meeting the sperm, and thus increase the likelihood of conceiving a child. Insemination can be performed both during a natural cycle and after prior ovulation stimulation. Semen from the husband, partner or donor can be used for insemination.

How to calculate the gestational age and delivery date after IVF?

It is calculated in the same way as for a pregnancy conceived naturally. Its onset is considered the first menstrual day of the cycle in which the embryo was transferred to the uterus or in which insemination was performed. If, as a result of hormonal stimulation, the menstrual cycle has shifted, the day of ovarian puncture is treated as the day of ovulation. Then 14 days are subtracted from this day (because, on average, ovulation occurs after that many days after the onset of menstruation) and it is this date that is considered the beginning of pregnancy.

What is genetic diagnosis before IVF?

Performing appropriate genetic testing before IVF allows you to better prepare for the entire in vitro fertilization procedure. It also allows to start possible treatment, increasing the chance of IVF success, i.e. conceiving and giving birth to a healthy child.

Couples undergoing IVF are advised to have a karyotype test, i.e. a set of all chromosomes.

In addition, a man should be tested for mutations in the CFTR gene, a mutation responsible for the development of cystic fibrosis, which can lead to changes in the reproductive system, such as missing or obstructed vas deferens. A third important test for a man is genetic testing of the AZF region for a microdeletion that may occur there. This is because this region contains genes encoding proteins involved in the process of sperm formation – spermatogenesis.

Women, on the other hand, are recommended to undergo genetic testing for mutations responsible for congenital thrombophilia, i.e. mutations in the gene for factor V of the blood clotting system (factor V Leiden) and the prothrombin gene. Both mutations are a major cause of the development of thromboembolism, and are also responsible for spontaneous miscarriages and other obstetric abnormalities.

What is preimplantation diagnosis?

Preimplantation genetic testing involves evaluating an embryo for genetic abnormalities. They are performed on cells taken from embryos created during the IVF procedure, before the woman becomes pregnant.

Early detection of defects and transfer of healthy embryos reduces the risk of reproductive failure and birth of a child with a genetic defect. Preimplantation genetic tests can diagnose Turner syndrome, Down syndrome, Edwards syndrome, Patau syndrome, Klinefelter syndrome, hemophilia, tuberous sclerosis, Huntington’s disease, cystic fibrosis, spinal muscular atrophy (SMA), Duchenne muscular dystrophy and Becker muscular dystrophy, among others.

There are several types of preimplantation genetic tests, including: PGT-A, PGT-M, PGT-SR and the newest technique for embryo genetic diagnosis – karyomapping.

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