Solutions and treatments

FOR WOMEN

Artificial insemination, or IUI, is a common fertility treatment used for various fertility problems. This method is considered less invasive than some MAP (Medically Assisted Reproduction) techniques, since the crucial steps necessary for conception must occur naturally, without any medical assistance.

What happens during the IUI
  • During a gynaecological examination, the doctor inserts a thin, flexible catheter into the patient's cervix to deposit a sperm sample in her uterus. This insertion is painless and the patient can resume her daily activities within minutes.
  • Semen introduced into the patient's uterus was washed in the laboratory to remove seminal fluid and make it more concentrated.
  • The sperm can come from the spouse (intra-couple artificial insemination or with the spouse's sperm, IAC) or from a donor (artificial insemination with donor, IAD).
Indications for IUI using the spouse's sperm
  • Male infertility problems associated with low sperm count or disorders of sperm motility or morphology.
  • Male infertility following cancer treatment (where the patient, in anticipation of this problem, has had his sperm frozen prior to the start of treatment).
  • Repeated failure of ovarian stimulation.
  • Unexplained infertility.
Indications for IUI using donor sperm
  • Major sperm abnormality, such as a complete absence of sperm.
  • Inherited genetic diseases or contagious diseases that could be passed on to the spouse.
  • Isolation or other problems.
  • Male infertility following cancer treatment.

By definition, artificial insemination deposits sperm in the woman's uterus. In vitro fertilisation (IVF) goes beyond this procedure by fertilising the woman's egg with the man's sperm outside the woman's body. The term "test tube babies" is a synonym for IVF.

Since 1978, the year Louise Brown (the first person to be born as a result of IVF) was born in Great Britain, the technique has gone far beyond its original indication of treating tubal infertility. Today, more than half of all IVF procedures are performed for other reasons, for example, to treat unexplained infertility and to increase the chances of success in cases of male infertility.

For most people, IVF is simply the joining of two gametes in a test tube. But for couples who have decided to undergo IVF treatment, the process involves countless clinic appointments, blood tests and injections, as well as constant questions and encouragement and a lot of waiting. Waiting for the test results, waiting for the embryos, waiting for the pregnancy test, waiting for a child to come into their lives.

Couples undergoing IVF treatment face several challenges, including learning all about the procedure, which includes a lot of information to digest that is not always easy to understand. Before you decide to undergo treatment, we suggest that you learn as much as possible about IVF treatment by consulting your doctor and researching the many books and websites that exist on the subject. Being well informed about everything involved in the procedure will give you peace of mind when you start your IVF treatment.

 

Preliminary stages of IVF

You and your partner will meet with one of our doctors. At this time, you will receive your diagnosis and discuss with your doctor whether IVF is the best treatment for your particular situation.

Once you have decided to undergo IVF, a baseline assessment will be carried out, as well as several other meetings, appointments and tests:

  • A consultation with a fertility counsellor or psychologist.
  • Another appointment with your doctor to work out your plan for IVF.
  • A meeting with your nurse, during which the nurse will review with you all the information relating to each stage of treatment. She will also give you your medication and explain the treatment schedule and how to take your medication.
  • Consultation with the urologist if epididymal sperm aspiration or testicular sperm extraction is required. It may also be necessary to take a blood sample for genetic analysis. Patients can have these tests done at the Procrea Fertility Clinic or choose another clinic.

All of these preliminary steps help you to prepare for IVF by correcting any identified problems and providing you with all the information you need to understand the process. The steps of the IVF process are explained below.

 

Step 1: Ovarian suppression

The first step is to suppress ovarian function by administering an oral contraceptive and/or a drug that inhibits the pituitary gland. This step is not always required and your doctor will determine whether or not it is necessary in your case. During the suppression phase, estrogen levels become low, as in menopause, resulting in some similar side effects, such as hot flashes and mood changes. This stage (if determined to be the best choice for you) allows us to replace your natural cycle with an artificial cycle, which is then controlled with prescribed medication.

 

Second step: Ovarian stimulation
(superovulation)/controlled ovarian hyperstimulation (COH)

Ovarian suppression is achieved when estradiol levels are sufficiently low, as described in step 1. At this point, ovarian stimulation can be started to establish an 'artificial cycle'. Your ovaries usually produce and release only one egg per cycle. Although this is sufficient for natural conception, IVF conception usually requires several eggs.
To obtain more than one, ovarian hyperstimulation is used. These drugs stimulate the development of several ovarian follicles, allowing the retrieval of several eggs.

  • Estradiol level: this blood test is used as an indicator of your response to medication.
  • Luteinizing Hormone (LH): This hormone needs to be suppressed to prevent your body from releasing eggs too soon.
  • Transvaginal ultrasound: this is used to check the number and diameter of follicles that have developed during ovarian stimulation.
 
Stage 3: Initiation of the egg maturation process

When the follicles are large enough and hormone levels are adequate, it is time to trigger the ovaries to prepare the eggs for maturation and ovulation. Triggering is done by injecting human chorionic gonadotropin (hCG, a pregnancy hormone similar to LH) or a recombinant hormone.

 
Step 4: Egg/oocyte retrieval (also called egg collection)

The eggs are retrieved transvaginally using ultrasound guidance. Once the mature follicles are located, the doctor punctures each one with a needle attached to the probe and sucks out the fluid. You will be given a local anaesthetic or sedative by intravenous (IV) infusion. If you wish, you can follow the procedure on the ultrasound screen. The embryologist analyses the contents of each follicle under the microscope. When the procedure is complete, you will be informed of the total number of eggs collected. On the same day, these eggs will be brought into contact with in vitro spermatozoa in order to be fertilised and subsequently form embryos.

 
Step 5: Embryo transfer

Embryo transfer involves depositing one or more embryos (usually one) inside the patient's uterine cavity, usually on day 5 of the cycle.This procedure requires the patient's bladder to be filled so that better visualisation can be achieved with the abdominal ultrasound probe.

 
What next?

Waiting for the pregnancy test is often the most anxious time for patients undergoing IVF treatment. A blood test is carried out 12 days after the transfer; this test accurately detects the pregnancy hormone (hCG) in your blood. You will be called on the same day with the result, which we hope will be positive.

Improve your chances of conceiving
Ovulation induction is a term used to describe the use of oral or injectable fertility drugs (gonadotropins) to stimulate the production of mature eggs by the ovaries. Ovulation induction aims to cause the development and ovulation of one or more eggs in a woman who does not normally ovulate. Depending on your diagnosis, your doctor will prescribe the most appropriate treatment for you. Ovulation induction is indicated in the following cases:
  • You have ovulation problems that have not responded to commonly prescribed medications (such as clomiphene citrate).
  • You have unexplained infertility and want to try ovulation induction to increase the number of eggs produced in each cycle. With higher egg production, the chances of conception also increase. In order to benefit from ovulation induction, you must have a normal uterine cavity and at least one normal fallopian tube and your partner must have a normal sperm count.
In the general population, pregnancy occurs in 20% to 25% of healthy, fertile couples each month that they attempt to conceive. In our experience, ovulation induction generally results in a pregnancy rate of 10% to 20% per cycle, depending on the woman's age, diagnosis and duration of infertility. Approximately 15% to 20% of gonadotropin-induced pregnancies will end in miscarriage, a proportion similar to that in the general population.

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  • Antibiotics to treat an infection of the urogenital system.
  • Hormones in cases where the testicle does not receive sufficient stimulation from pituitary hormones.
  • Surgical intervention for excretory azoospermia. When a man has this problem, the testicles produce sperm, but it is not present in the ejaculate because there is an obstruction somewhere along the way. Surgery is used to identify the obstruction, remove it and reconnect the segments.
  • Surgery may be attempted to cut the obstructed area and restore continuity of the two segments.
  • Intracytoplasmic Sperm Injection (ICSI): This is a treatment that is only performed in the context of in vitro fertilisation (IVF). It is used in severe cases of male infertility, when there are not enough sperm cells and they are not mobile enough to penetrate the egg. Using a sample of the spouse's sperm, the embryologist injects a spermatozoon captured with a glass needle with a microscopic diameter into each of the spouse's eggs.
  • Percutaneous Epididymal Sperm Aspiration (PESA): This is a treatment only performed in the context of in vitro fertilisation (IVF). Performed under local anaesthesia, this procedure is carried out in cases of obstruction of the vas deferens. Most often, this involves a puncture in the epididymis using a fine needle. However, a small incision in the epididymis is sometimes necessary. Sperm are then collected and the best of these are used for IVF with microinjection.
  • Testicular Sperm Extraction (TESE): This is a treatment only performed in the context of in vitro fertilisation (IVF) with ICSI. This procedure, performed under local anaesthetic, involves removing sperm directly from the testicles using a very fine needle. This technique is used when there is a complete absence of sperm in the ejaculate or epididymis, but the testicles are still producing sperm.
  • Artificial insemination with spousal sperm (IAC).
  • Artificial insemination with donor sperm (AID).
  • In vitro fertilisation with spouse's sperm.
  • In vitro fertilisation with donor sperm.

520.000 CFA


Artificial insemination

Without the drugs
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1.740.000 CFA

 

IN VITRO FECONDATION - IVF Classic
(without drugs)

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2.140.000 CFA

 

IN VITRO FECONDATION - IVF ICSI
(without drugs)

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More information on treatments

For an informed decision...

Assisted Reproduction consists of a series of fine techniques that integrate the whole process to obtain fertilization. The woman's eggs are obtained and fertilised with her partner's spermatozoa. The embryos obtained are then introduced into the woman's uterus. Due to their complexity, they must be performed in specialised centres with the appropriate infrastructure (operating theatre, laboratory).
 
ARTIFICIAL INSEMINATION
 

Artificial insemination is the most classic and also the simplest of the assisted reproduction techniques. It consists of introducing the man's sperm into the cervical canal or inside the woman's uterus on the day of ovulation. The first step is to monitor the menstrual cycle in order to know the day of ovulation. To do this, serial ultrasound scans and hormonal determinations are carried out.

For artificial insemination, sperm must also be prepared in advance. This involves obtaining the sperm in advance and carrying out capacitation (also known as enhancement) in the laboratory, in order to obtain the best possible quality sperm.

This technique can be repeated several times, but it has been shown that its effectiveness decreases considerably from approximately the fourth attempt onwards, so it is not cost-effective to continue in this way and other treatments should be offered.

IN VITROFERTILISATION

IVF involves the union of gametes (sperm and egg) by placing them in a culture medium. The resulting embryo is transferred immediately in utero or frozen. To give IVF the best chance of achieving pregnancy, several embryos are created. Laboratory technicians are responsible for selecting the embryos to be re-implanted. The embryos are classified according to their appearance, the progress of their cell division, etc. Thus, the 4a, four-cell, round-looking embryos are selected as a priority. When the mother is less than 38 years old, 2 to 3 embryos are re-implanted. When she is over this age, 3 to 4 embryos will be transferred into the maternal uterus.

IVF can be performed in a spontaneous cycle provided it is normal.

INTRACYTOPLASMIC SPERM INJECTION (ICSI)

This technique is in fact assisted in vitro fertilisation. The steps for collecting gametes are identical to those of IVF. It is the technique of "making" the embryo that differs. For ICSI, a micro-pipette loaded with a single spermatozoon is introduced into the egg using a retention pipette.

A single sperm is selected and transferred directly into an oocyte (obtained by means of a containment pipette). The embryo is then transferred to the uterus.

In general, the procedures used to treat infertility are aimed at achieving ovulation (in the case of women) or obtaining sperm of better fertile quality, in the case of men, in order to allow the union of the egg and the spermatozoon and thus achieve pregnancy.

The first step in treatment, in many cases, is pharmacological treatment to induce ovulation.

When indicated, artificial insemination is usually combined with ovulation induction and is often the first procedure used, because it is a simple and economical technique. It is also useful when a (small) alteration is detected in the semen sample, in some cases of female factor and in some mixed causes.

In vitro fertilisation (IVF) will be necessary when a fallopian tube blockage has been diagnosed (this is also why it is used when a child is desired after a tubal ligation), when there are very few sperm available from the man or when a pregnancy is not achieved after several attempts at artificial insemination

Insemination (of any kind) is absolutely painless and takes only a few minutes to perform. IVF is performed under anaesthesia and the woman is not aware of the oocyte extraction. Recovery takes no more than 1 hour.
No, because there are many conditioning factors, of an endocrinological type among others, that make the ovarian response different from one woman to another and from one cycle to another.

More than half of all couples with more than two years of infertility eventually achieve a pregnancy. With advances in research and greater availability of the latest techniques, the success rate of treatments is constantly increasing.

On a pu vérifier que leur emploi (logiquement sous contrôle du spécialiste) ne comporte pas de risques particuliers pour la femme.

Certainly not. The choice of donor is made on the basis of the phenotypic characteristics of the woman and her partner, if she has one.

Phenotypic traits considered are eye colour, hair colour and texture, skin colour, Rh factor, height and weight.

Donors cannot know the children and vice versa.
Grâce à ces analyses, on peut savoir si l’origine de la stérilité provient de l’homme.

De nombreux facteurs influent sur les résultats d’un spermogramme: le stress, la dernière éjaculation, la fièvre, les médicaments, etc. Il arrive parfois que ces circonstances masquent un résultat et il convient par conséquent de recommencer les analyses.

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