In Vitro Fertilization (IVF) with Embryo Transfer
In vitro fertilization (IVF) with embryo transfer – in humans – emerged in 1978 in England. This huge breakthrough was born in the first child who was fertilized in vitro, whose name is Louise Brown. This revolutionary treatment earned its discoverer, Dr. Robert Edwards, the 2010 Nobel Prize in Medicine. In Brazil, the first child born of IVF was Ana Paula Caldeira on October 7, 1984.
In vitro fertilization finds its main indication in tubal disease and this is easily justified. A couple whose man has potential semen, the woman has regular and ovulatory cycles, has a uterus with a receptive and intact cavity, a normal cervix and cervical canal, but no functioning tubes, would be condemned to have no children at all.
Tubal disease, ie chronic adnexitis resulting from sexually transmitted diseases (STDs), almost always acquired at a young stage of life, is responsible for almost 25% of cases of marital infertility. For a long time, we tried to recover these tubes through unsuccessful surgical procedures.
Subsequently, in vitro fertilization was indicated in other clinical conditions (endometriosis, infertility without apparent cause).
Although it represents a major breakthrough in the treatment of marital infertility, not all couples can be treated with in vitro fertilization. There are limitations to the female and male sides.
The woman must have a good ovarian reserve, a fact that follows her age; the younger the larger the ovarian reserve. On the other hand, the ovarian reserve is a biological reflection of the age of the follicle-oocyte complex. A high FSH value (> 20 mIU / mL) or very low Anti-Müllerian Hormone (<0.16) represents a decreased ovarian capacity. Overall, the ovarian reserve is relatively good up to 37 years, from this point onwards it has a drop in its fertility potential.
Another very important aspect of this program is the integrity of the uterine cavity. It can be verified by following imaging methods:
Hysterosalpingography (HSG): Radiological examination performed between the 8th and 12th day of the cycle is an excellent diagnostic resource. HSG often alone is sufficient for uterine cavity evaluation.
Ultrasonography: Performed in the periovulatory period, when the development of the endometrium is maximal and there has not yet been the action of progesterone, this exam allows a good delineation of uterine structures, both endometrial cavity and the texture of the uterus.
Hysteroscopy: A little more invasive examination, sometimes requires sedation, also offers a great opportunity to know the inside of the uterine cavity.
These tests allow the diagnosis of: polyps, fibroids and intrauterine adhesions; uterine malformations such as bicornuate uterus, unicorn; uterine cavity filling failures.
From the male point of view, the male should have at least 3 million mobile sperm per ml after the separation process and the percentage of normal oval sperm not less than 4% by Kruger’s strict criteria.In summary, women with low ovarian reserve or men with significant changes in sperm should not be applied by the classical IVF technique.
In vitro fertilization treatments have success rates that are highly dependent on the cause of infertility, but fundamentally the woman’s age is the major factor for the good prognosis. Thus, for reproductively young women (under 35), we can expect pregnancy rates between 40 and 50% per treatment cycle (Source: CDC, Centers for Disease Control, 2009).