IUI, ICSI and IVF…huh?

IUI, IVF, ICSI – what do they all mean?

These are all different methods available to try and help couples conceive.  Their names might seem a bit confusing at first, but hopefully this post will try and clear things up a bit!

IUI- Intrauterine Insemination

Also known as artificial insemination, this method can be used in couples affected by ovulation problems or mild endometriosis, as well as problems with the cervix or when there is a male infertility problem such as impotence of premature ejaculation [1].  IUI is not used in couples with ovarian failure, or problems with the fallopian tubes, such as damage or a blockage.

The idea of IUI is that the better sperm (faster moving) are removed from a semen sample and then only these are placed inside the uterus around the time of ovulation in the woman (36-40 hours after), giving the best chance for fertilisation of the egg.  The time of ovulation is the time in the monthly cycle when the egg is released from the ovary (around day 15 of the cycle).  IUI can be used with or without the use of fertility drugs that increase the number of eggs released during ovulation.

A special instrument called a speculum is inserted into the vagina to make space for a small catheter that is inserted into the uterus.  The specially selected sperm are inserted through the catheter in the hope that one will fertilise the newly ovulated egg.  It is a quick and painless procedure that causes little risk to the woman.  This procedure can be carried out multiple times on different cycles if the previous unsuccessful.IUI-process-and-sucess

IVF- In vitro fertilisation

As discussed in the last post, IVF is when the egg and sperm gamete cells are collected from the parents and allowed to fertilise outside of the body in a dish in a laboratory.  The sperm can be left to naturally fertilise the egg, or can be directly inserted into the egg cell.  This is known as Intra-cytoplasmic sperm injection (ICSI).

ICSI- Intra-cytoplasmic sperm injection

Directly injecting a sperm cell into an egg cell means that even men with a low/zero sperm count, or those that have poor sperm motility can father a child.  ICSI can be carried out if previous tries with IVF have been unsuccessful, or the embryos are not fertilised without help.

A semen sample is collected from the man, and the best quality sperm cells are used to fertilise eggs from the woman, outside of the body by embryologists.  Sperm can be collected from a fresh sample or in men unable to do this due to errection problems due to spinal injuries or other disorders a sample can be collected direct from the epididymis using a syringe (where the sperm are located whilst they mature).  Extra sperm collected may be frozen for use later on in future cycles.

The best sperm are used to fertilise an egg, which is then transferred into the woman’s uterus 2-3 days after growing in a lab, exactly the same as in IVF, or after 6 days as a blastocyst transfer.  It is then a waiting game, waiting for the date in which a pregnancy test can be taken to given a result of a positive pregnancy of a failed cycle of IVF…a day that can cause either great joy or disappointment to couples that have gone through these procedures.icsi

Below is a really good youtube clip detailing the ICSI process, as well as other processes such as the collection of eggs during IVF and ICSI.

Counselling is always offered to couples undergoing these assisted reproductive methods as it can often be physically and emotionally draining [2].  Counselling is offered before, during and after IVF treatment (successful or not) to help manage the whole process and dealing with any issues in regards to the couple’s fertility.

References/extra reading

[1]  What is IUI and how does it work, Hfea, available at: http://www.hfea.gov.uk/IUI.html

[2] IVF support, available at: http://www.nhs.uk/Conditions/IVF/Pages/Recovery.aspx

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Natural Conception Vs IVF

Many people talk quite freely about IVF, about how it can help infertile couples to conceive a child.  However, how many people actually know all the details, whether it is about a naturally conceived child, or through the aid of IVF, how much do people know?

Natural conception!

This is how most of us came to be, through the joining of two parental gametes, the oocyte (egg) and the sperm.  After being released as a result of sexual intercourse, sperm have a tough journey through the female genital tract, and many do not survive before reaching the uterine tubes- the location of the egg.  The sperm are aided in this passage by the fructose rich fluid they are in that provides the much needed energy.  Once the successful sperm have reached the egg they must undergo capacitation- this prepares the sperm for entry into the egg by removing glycoproteins on the acrosome as well as changing the membrane potential and charge.fertilisation02

The successful sperm then penetrates the layers of the egg, which in turn prevents other sperm from doing the same.  The part of a sperm cell called the acrosome releases enzymes such as hyaluronidase, and receptors bind to ZP3 molecules on the egg which allows the sperm to break through the layers of the egg, the corona radiata and zona pellucida [1] . This allows for the fusion of the two gametes, with only the head of the sperm entering the egg cytoplasm, causing reactions that prevent other sperm from doing the same [2].  It really is a race to the finish line! The fertilised egg then becomes known as a zygote [3].  The two nuclei of the sex cells fuse and the chromosomes pair up, allowing cell division (mitosis) to occur as it moves down the fallopian tubes towards the uterus, where the growing ball of cells continues to divide and differentiate for 9 months until a baby is born!

IVF

IVF is when the fertilisation of an egg by a sperm happens outside of the human body.  The egg and sperm are taken from the two future parents and the two gametes (the egg and the sperm) are placed together in a culture medium which allows fertilisation to occur.  The fertilised egg will then start to multiply, and upon reaching the 6-8 cell stage, the embryo is placed directly into the women’s uterus in the hope it will continue to grow as a naturally fertilised egg would.  This is achieved through implantation of the embryo into the uterus wall, making a firm connection needed for the embryo to get nutrients from the mother.  Either one or two fertilised eggs can be inserted back into the woman, however, multiple embryos run the risk of multiple pregnancy.

fecundacion-in-vitro2.jpg

So whether a baby is born through natural conception, a process that has been occurring for millions or years, or through the relatively new method of IVF, once implantation occurs, the fertilised egg, or the embryo continues to grow.  If everything goes well then the embryo develops into a foetus, developing more human characteristics every day, until after 9 months of being lovingly carried around by the mother, a baby is born into the world! An amazing end product of months of endless chemical reactions and the growth of cells.

References/extra reading

[1] Finlayson and Sanders (2007) Endocrine and Reproductive Systems. Mosby Elsevier. Page 177

[2] Patrat, Serres and Jouannet (2000), The acrosome reaction in human spermatozoa, Biology of the Cell 92: 255-266

[3] http://www.embryology.ch/anglais/dbefruchtung/akrosom02.html

http://www.nhs.uk/conditions/pregnancy-and-baby/pages/getting-pregnant.aspx

IVF Video Podcast. Patrick Steptoe FRCS, FRCOG – “Test Tube Baby – The First Birth”

Amazing video of the birth of Louise Brown in 1978, the First Test Tube baby!
Born at 5lb 12oz with a “good healthy cry.” The first of many IVF babies to be born.

louise brown

Louise Brown, at birth in 1978, and much more recently!

My DNA your egg

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Introduction to IVF

For most couples wanting to have a baby it is a decision thought through and within one year, 85% of these will have conceived naturally.  But what about those that can’t, the couples that spend years trying, the individuals that want to become single parents, or homosexual couples wanting to start a family?

baby-face

“Would IVF be the answer for us…?” A question that is becoming more frequently asked between couples in the UK.   With around 1 in 7 couples unable to conceive naturally, in vitro fertilisation is on the rise in the UK.  With many reasons for infertility ranging from low sperm count in men to endometriosis in women, scientists are finding new ways in which pregnancy can become possible where previously not.

The Beginnings of IVF

IVF has come on leaps and bounds since it was first introduced.  Although having a baby through IVF does not come easily to all.  Latest figures from 2009 show a 25.2% success rate (as measured by the Human Fertilisation & Embryology Authority, HFEA) of a woman giving birth to a live baby through use of her own eggs.  This is a figure that has remained steady in the last couple of years, with the number of multiple births on the decrease- great news for potential parents.

IVF has always been a controversial subject ever since the first ‘test tube baby’ was born in 1978, with those believing that this artificial procreation method is wrong, for reasons including religious and ethical grounds. Playing God is a major issue for many people, and if IVF is allowed, where will it end? The recent controversial 3 parent IVF technique, where with this leave the 3 parents on ethical and legal grounds? So many questions with so many people having varying opinions.

Research and the method of IVF techniques are strictly regulated by many laws that have been in place from the 1980s when IVF was first introduced starting with the development of the Warnock Committee Inquiry, followed by many more including the Human Fertilisation and Embryology Act of 1990, which was amended in 2008.  These legislations are not the only ones present, with many other Bills and Acts in place to ensure the correct usage and storage of eggs, sperm and embryos.

The Human Fertilisation & Embryology Authority (HFEA)

The HFEA  is in place to ensure these regulations are adhered but also has advisory and monitoring roles as well as supplying information, making it easily accessible to all sectors, including patients, clinic staff, donors, as well as those conceived through donors.  The guidance and advice provided is an invaluable source of information for all alike.

With lots of legal aspects to think about, it must not be forgotten the true nature of IVF, to help infertile couples to conceive a baby.  There are several methods that can help achieve this and this blog will go through the steps from the IVF techniques and processes, the causes of infertility and other relevant areas of interest to do with IVF.  I hope you find this blog interesting, and I hope I enjoy writing it!  IVF has always been an area of my interest and is an ever growing area of science with very relevant topics that one day may affect my, or your life.

Enjoy!