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Artificial insemination has been an established treatment for 40 years. More recently, research has ensured that the chances of achieving pregnancy have continued to improve. In some cases, however, it comes down to not just one major intervention, but rather the sum of many small measures that help you realise your dream of having a child. As part of our range of therapies, we offer various additional treatments that have been proven to help (e.g., acupuncture).
As part of our basic diagnostics, we also check your vitamin balance and your iron levels. Vitamins D, B12 and iron are particularly important for pregnancy. They support the formation of blood, cells and genetic material. We also recommend the additional intake of folic acid and iodine. These substances are important for the development of the embryo’s central nervous system.
Artificial insemination is a very intensive and burdensome treatment, which may come with a certain level of stress. We have the means to offer you acupuncture on the day of your embryo transfer. For this process, the attending practitioner can come to our centre and perform acupuncture approximately 1 hour before embryo transfer. This serves primarily as a relaxation measure before the procedure.
Assisted hatching is the process whereby the embryo is helped to hatch from the egg membrane. This is the prerequisite for pregnancy to occur. If hatching does not succeed, even a well developed embryo cannot implant in the lining of the uterus, meaning that pregnancy can’t occur. The embryo’s movement from the egg membrane can be disrupted by a thickening or microscopically undetectable hardening of the egg membrane. Such changes are found more frequently in patients over 35 years of age and in frozen (cryopreserved) egg cells. If multiple fertility treatments are repeatedly unsuccessful with healthy embryos, we deduct that there may be implantation difficulties as a result of a hatching disorder. In this case, we advise assisted hatching.
The following occurs during this process. On the day of embryo transfer, a small incision is made in the membrane of the fertilised egg with the help of a laser. This facilitates the embryo to “hatch” from the egg’s membrane. The process is quite comparable to a chick hatching from an egg. The embryo is not harmed during assisted hatching, and the chances of pregnancy occurring are significantly improved.
Using high-resolution microscopes, sperm cells are selected to be injected into an egg cell that shows little to no external abnormalities. This selection is usually not possible with the average 200x magnification, as abnormal microstructures in the sperm will not yet be recognisable. With IMSI, the sperm are screened with 400-600x magnification without real time staining. However, the influence of sperm micromorphology on the outcome of fertility treatment is contested. Therefore, a general recommendation cannot be made for IMSI.
Cryopreservation is a complex yet careful procedure of freezing reproductive cells (gametes). The cells are stored in liquid nitrogen, where the temperature is slowly lowered to -190 degrees by a computer system. The cells are stored in what is termed a “cold sleep”, enabling the cells to 59 be viable for several years. There is no evidence that freezing these cells increases the risk of child disabilities or genetic disorders.
PICSI refers to a method in which hyaluronic acid is used in sperm selection, in order to distinguish immature from mature sperm. This enables a higher quality of sperm to be selected for ICSI (injection of sperm into the egg cell). The heads of mature sperm carry a specific receptor for hyaluronic acid, while immature sperm do not. Mature, mobile sperm bind head-first to the hyaluronic acid spots in the tissue culture dish. This stimulates the binding of the sperm to 60 the egg, as hyaluronic acid is an essential component of the egg membrane. This hyaluronic acid binding test selects sperm that have reached a certain stage of maturity and which, according to study results, have a low proportion of changes in their chromosomes. Normally 96% of sperm have their chromosomes intact, while only 4% of sperm show changes that may negatively affect egg fertilisation. However, this overall still reduces the chances of fertilisation. PICSI increases the proportion of chromosomally healthy, mature sperm. We consider the PICSI method to be a more natural and effective form of fertilisation compared to the classic ICSI method. PICSI combines the advantages of spontaneous fertilisation, in which the mature sperm fertilises the egg, along with the advantages of the ICSI method, when the sperm is injected directly into the egg in a controlled environment. This method can be used for all patients and is recommended especially in the following cases: previously failed implantation, low fertilisation rate after ICSI, abnormalities in embryo quality or delay in their development, repeated miscarriages or patients with a largely increased proportion of abnormal sperm.
In examining polar bodies, we can draw conclusions of whether there are any chromosomal defects in the egg. Polar body diagnostics was developed to prevent eggs with chromosome maldistributions (for example trisomy 21) from being transferred into the uterine cavity. To carry out PKD, the polar bodies of the fertilised egg are removed and 6 of the chromosomes (13, 15, 16, 18, 21 and 22) are tested. Maldistributions of the chromosomes previously mentioned are responsible for the majority of miscarriages caused by genetic issues. Disturbances in the distribution of these chromosomes usually lead to a pregnancy not occurring after embryo transfer or to an early death of the embryo (abortion). However, this can also result in the child being ill when they are born. Specific hereditary genetic defects in the mother can also be detected with the help of polar body diagnostics. This method does not increase pregnancy rate but does however lower the miscarriage rate to a minimum in relation to the chromosomes examined.
These terms refer to the examination on a microscopic level, of the structure of the egg’s membrane (Polar Aide) or its spindle apparatus (Spindle View). The egg membrane’s structure is examined using a polarisation microscope, which assesses the inner layer of the membrane. This layer of membrane is extremely important for the developmental potential of the egg cell. Changes are often found here, particularly in patients over 35. The spindle apparatus plays a central role in the division of the human egg cell. It is responsible for the precise alignment and distribution of the chromosomes during cell division. The presence of a spindle, along with the 1st Polar body, is an accurate indicator of egg maturity. However, in 15-20% of all mature eggs, 61 the spindle is not present. The latest techniques make it possible to examine the shape and position of the apparatus in the egg cell without harming the cell itself. This makes it possible to assess the quality of the egg cell by looking at its spindle apparatus even before fertilisation. This process helps to determine which cells have the best developmental potential.
The culturing of embryos in the incubator is possible for up to six days. Health insurance companies will usually only cover costs until the third day. After the third day, the embryo begins to activate its own genetic material. At this point, further development depends upon its “potential”. It is only after the third day, that we are able to recognise that embryos which have developed well up to this point, show a limited capacity for further growth, or quite the opposite. The prolonged culture (up to six days) enables us in some cases to further optimise the therapy plan based on the morphological development of the embryos. However, not every case is improved by this process, which is why we are happy to advise you.
Not every single method available is helpful on an individual basis. Entrust your hope to have a child in us: in our diagnostics and counselling and let us find out which path is the right one for you.
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