IVF (In vitro fertilization) and ICSI (Intracytoplasmic Sperm Injection)

During the classic IVF procedure (In Vitro Fertilization) in laboratory conditions, we allow the best sperm to fertilize the egg. 50,000 processed sperm are added to each oocyte. That is, if the semen after processing contains a sufficient number of regular and motile sperm, their insemination is carried out in the wells with egg cells, and the sperm are allowed to fertilize the egg spontaneously. Under optimal conditions, fertilization can be confirmed as early as 16 to 20 hours after insemination of the sperm (success rate 65-85%).

ICSI, or microinjection of sperm into the cytoplasm of an egg cell, is a microsurgical procedure that allows fertilization of an oocyte that would not occur with standard IVF technology. It is primarily a method in the treatment of male infertility. Individual sperm insertion bypasses some well-known barriers to fertilization (with some additional advantages):

• abnormalities: zona pellucida
• defective sperm count and kinetics
• presence of antibodies to sperms
• teratozoospermia
• dysfunction of the sperm acrosome prevents polyspermic fertilization

This method requires the knowledge and experience of an embryologist, and fertilization control is performed after 16-20 hours and has a 70-85% success rate. ICSI is a complex microsurgical procedure that takes an average of 5 to 10 minutes per oocyte.

What determines IVF success?

In the early stages, 35-40 years ago, the success rate of IVF was less than 5%. Today, the success rate of the IVF/ICSI method in young patients is between 40% and 60% per fresh attempt. The success rate is the same after freezing and vitrification of embryos and even oocytes.

How the results are presented is essential for evaluating success. According to ET (embryo transfer), they are 12 to 15% higher than the presentation according the IVF cycle started, so the failure rate must be taken into account during the procedure.

The dropout rate for younger women is between 2 and 5%, while for women over 41 years of age, the rate is between 30 and 50%. Patients with poor response (poor ovarian response - POR) have more discontinuations, approximately 20-30% of cycles. Patients with fewer than 4 oocytes in the procedure (POR) have a significantly lower success rate - approximately an LBR of 10-12%.

Temporary abandonment of ET is now more common in patients with an exaggerated response to stimulation (PCOS patients), where all embryos are frozen due to the risk of hyperstimulation (freeze all technology), so there is no fresh ET. IVF outcomes are also affected by the incidence of spontaneous abortion, which is low in young people (8-10%) and high in patients over 40 (20-40%).