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    FERTILIZATION / MICRO-INSEMINATION

     

    In Vitro Fertilization (IVF) is the most widely known method in the area of Medically Assisted Reproduction and involves the fertilization of the ovum (egg) and the incubation of the embryo that are produced in laboratory conditions. The process is separated into various stages that start by investigating the existing fertility through a complete testing of both the female and the male factors as well as blood and hormonal check-up. Next comes the ovarian stimulation through medication that leads to embryo transfer, which is in fact, the completion of the procedure.

    Fertilization of the oocytes is either done with the method of classic In Vitro Fertilization (conventional IVF) or with the method of Intra-Cytoplasmic Sperm Injection (ICSI)

     

    Fertilization

    • Conventional IVF

    Conventional IVF  is the most widely known and the first used method in the area of Medically Assisted Reproduction. That involves the co-incubation of the oocyte/s with sufficient number of specially prepared, motile spermatozoa for a period of 16-18 hours. Thus, the most progressive motile and usually normal forms of spermatozoa penetrate the zona of the oocytes, as it happens in natural conception, and fertilization occurs.

     

    After the co-incubation period (16-18 hours) the embryologists identify the properly fertilized oocytes and the embryonic life begins, under special conditions in special designed incubations.

     

    • ICSI ( Intracytoplasmic Sperm Injection)

    ICSI is the most revolutionary method in IVF, since its  accidental start in 1992 by Palermo in Brussels. With this method, millions of children have been born worldwide, from their own father genetic material, even in cases with extremely low semen parameters.  

     

    For the procedure, the oocytes after the retrieval are isolated from the  surrounding cells (cumulus mass cells) and only those which are mature (Mataphase II) are forwarded for micro-insemination.

     

    In a micromanipulation system, one spermatozoon  is selected and aspirated into a special micropipette and inserted into each oocyte’s cytoplasm. The inseminated oocyte is then kept in culture conditions in an incubator and 16-18 hours later, embryologists check the evidence of two pronuclei in the cytoplasm (female and male) indicating the successful insemination technique. Further in vitro culture conditions are exactly the same as in conventional IVF.

    • Improvements of ICSI: IMSI / PICSI (Physiological Intracytoplasmic Sperm Injection)

     

    PICSI (Physiological Intracytoplasmic Sperm Injection) Method
    It is a way of fertilization based on the sperm’s and oocyte’s physiology, hence the name Physiological ICSI (PICSI).


    Its difference with ICSI is in the use of special plates and culture mediums where small quantities of processed sperm sample of the husband are placed.
    In this material the binding of immature sperm forms is impossible because they do not have the suitable receptors. On the contrary, spermatozoa with distinctly limited chromosome aberrations and significant improvement of their nucleus’ maturation are bound and selected for fertilization.

     

    IMSI (Intracytoplasmic Morphologically Sperm injection) Method

    It is an improvement of the technique of Micro-insemination (ICSI) where morphologically selected spermatozoa are injected during the fertilization.

    It is used in cases of severe astheno-terato-spermia where in the man’s sperm sample there are many spermatozoa with deviant morphology. With the help of special lenses high definition microscopy is achieved as well as enlargement of the image of the spermatozoa at about 6500 times. Therefore, we have detailed illustration of their head and morphology and only the best spermatozoa  in terms of morphology are used for the oocyte insemination. Disadvantages of the method are that it is time consuming, not easily applied and doesn’t seem to be very sufficient.

     

    FAQs About Fertilization method

    When is ICSI the first choice technique for fertilization?

    Some indications for the ICSI procedure may are upon to male, female factors or combination of both:

    • Impaired semen parameters (low concentration and/or motility, very many abnormal forms, presence of oxidative stress etc) 
    • Presence of various cells in the sperm, cause of chronic inflammation
    • Specific medical history (i.e. PGT cycles)
    • Warming and fertilization of previously vitrified oocytes
    • Many failed previous IVF attempts , with/and low impact

    Which technique between PICSI or IMSI proved to have better results and be more successful?

    In each technique (PICSI or IMSI) we used either separately or in combination, we select mature and morphologically normal spermatozoa.

    Especially for the PICSI method, which is used extensively in the IVF Athens Center, there is distinct improvement of the embryo quality, increased chance of implantation, increase on the rate of clinical pregnancies and decrease of the clinical miscarriages.

    We are here to answer any questions and discuss with you.