Artificial fertilization

Synonyms

• Reproductive medicine
• In vitro fertilization

introduction

If all therapeutic attempts to induce a pregnancy have failed (see: Unfulfilled desire to have children), reproductive medicine, also known as artificial insemination, is used.

Homologous insemination

This method for artificial insemination becomes male in some sperm-associated causes infertility applied (so.). These include too little ejaculate volume (Parvisemia), insufficient sperm concentration in the ejaculate (Oligozoospermia) and abnormal sperm motility (Asthenozoospermia). The partner's sperm are fed directly into the uterus the woman promoted. Since the cervix the woman is bypassed as a possible obstacle to passage, this procedure is also used in the case of cervical-associated infertility (so.) the woman to use. The sperm can be used directly after preparation or frozen beforehand over a longer period of time. Is the man an operation or irradiation of the genitals e.g. as part of a cancer operation (e.g. Prostate cancer) before, the couple can freeze the sperm in advance.

Note: artificial insemination

Prior to this, the couple must be given mandatory advice from an independent doctor who will provide information on medical, psychological and social issues and discuss the desire to have children with the couple.

Heterologous insemination

At this artificial insemination In contrast to homologous insemination, the sperm comes from an unknown donor. It is therefore used when the partner's sperm quality or quantity is insufficient for homologous insemination.

Note: Artificial insemination with donor sperm

With this procedure, the couple should note that the use of foreign sperm can also seriously impair the psyche and relationship of both partners. The man is then entitled to challenge the marriage and the child to get to know its genetic father.

In Vitro Fertilization (IVF)

This procedure is translated as "Fertilization in the test tube"because the artificial fertilization here, in contrast to insemination, takes place outside the womb. The process usually consists of four steps:

1. The first thing that happens is the hormonal stimulation of the ovary. Through the hormone GnRH, which affects the pituitary gland (Pituitary gland) acts, a synchronous maturation of egg cells in their envelope (follicle) in the ovary.

1. In addition, the hormone FSH (Follicle stimulating hormone), which promotes follicular maturation. If the ultrasound control shows that the follicles are of sufficient size, ovulation is triggered with the hormone HCG (human chorionic gonadotropin). If the woman refuses hormonal pre-treatment, this step can also be omitted. However, there is a risk that not enough mature egg cells can be obtained in the next step and the success rate drops rapidly.

1. The next step is the follicular puncture. The contents of several follicles, i.e. the egg cells, are aspirated by laparoscopy or vaginally under ultrasound control.

1. The last step is in-vitro cultivation. The man's prepared sperm are added to the egg cells in a culture medium. After about 17 hours it is examined microscopically whether fertilization has taken place in the culture medium. A maximum of three fertilized egg cells are now developed into embryos and transferred to the woman's uterus after a further two days. The remaining fertilized eggs can be frozen and used in another attempt. After the transfer, the woman receives a pregnancy-maintaining hormone (HCG or progesterone) to encourage the embryo to implant in the uterus.

This artificial insemination is used when the conditions for an insemination (so.) are inadequate or previous inseminations were unsuccessful. On the male side, this is again the case with sperm impairment, on the female side, when a meeting of sperm and egg cell, e.g. prevented by anatomical obstacles or adhesions in the fallopian tube.

Depending on the age of the patient, pregnancy can be achieved in one in ten to one in four women using this procedure.

Read more on this topic: Egg donation

Note: Problems with artificial insemination using in vitro fertilization

However, multiple pregnancies and miscarriages - such as premature births - are more common here.

As with any hormonal stimulation of the ovary, there is also the risk of overstimulation syndrome (see below).

Intracytoplasmic Sperm Injection (ICSI)

In this method of artificial insemination, the first two steps (hormonal stimulation of the ovary, follicle puncture) are identical to those of IVF. In the last step, however, individual sperm from the partner, which can be obtained directly from the testicles or epididymis, are introduced directly into the woman's egg cell with the help of a glass pipette. The procedure is therefore also suitable for the most severe impairments of male sperm or ejaculate, which have made all other reproductive medicine procedures unsuccessful. This also includes the complete absence of sperm in the ejaculate (Azoospermia) or ejaculation disorders.

Read more on the topic: Desire for children

Embryo Protection Act

This law has been in force since January 1, 1991 and should be known in some aspects in order not to illegally exceed the options available.

Overstimulation syndrome

With every hormonal stimulation of the Ovariessuch as those associated with ovarian infertility and if pretreatment is undertaken as part of in vitro fertilization and intracytoplasmic sperm injection, there is a risk of overstimulation of the ovary. The risk is particularly high with treatment with ovulation triggers (Antiestrogens how Tamoxifen, Clomiphene) as well as gonadotropins

(HMG, FSH) and HCG (Humanes C.horionGonadotropin).

The syndrome implies that instead of one dominant follicle (egg cell + envelope) several mature in the ovary. This in turn leads to multiple pregnancies, ovarian enlargement and stomach pain. In severe cases it can become large Ovarian cysts, Ascites and coagulation disorders that make hospitalization necessary.

There is a very low risk with therapy with Gonadotropin-releasing hormones.

adoption

Are all attempts one pregnancy by artificial fertilization failed to reach, there is still the possibility of adoption. However, very few children are given up for adoption and the legal conditions are strictly regulated. The couple initially gets the child for a year on probation.