Center of Reproductive Medicine
Last updated: 17/01/2020
The Reproductive Medicine Unit at Aboujaoudé Hospital treats male and female infertility using the most recent techniques implemented by highly skilled professionals.
The Main ART Techniques
The term “ART” (Assisted Reproductive Technology) refers to all of the techniques employed to treat infertility in couples.
The three main ART techniques are artificial insemination (AI), conventional in vitro fertilization (IV-FET), in vitro fertilization by microinjection (ICSI or IMSI).
Artificial Insemination (AI)
AIH : artificial insemination with sperm from the husband or male partner.
AID : artificial insemination with sperm from a donor.
After the ovulatory period has been evaluated, artificial insemination can be performed.
This procedure consists in introducing, via a catheter, a minimum number of motile sperm into the neck of the cervix or, in most cases, directly into the uterus (intrauterine insemination: IUI).
The sperm is prepared beforehand at the laboratory (the male partner must provide a semen sample approximately two hours before insemination takes place). The most motile sperm are then isolated and selected.
In vitro fertilization and embryo transfer (IVF-ET)
The aim of IVF-ET is to allow male and female reproductive cells, or gametes, to interact outside of the woman’s body, in vitro.
This step takes place in a laboratory, in the appropriate culture medium where the woman’s oocytes and the man’s sperm spontaneously interact.
Fertilization can be detected after about twenty hours (formation of male and female pronuclei) and cellular division (two to four cells) occurs after two days.
The gynecologist then transfers the embryo(s) into the uterus by inserting a thin, flexible catheter into the cervix, via the natural passages.
IntraCytoplasmic Sperm Injection (ICSI)
IntraCytoplasmic Sperm Injection is a modified IVF technique.
In cases of low sperm count or poor motility, conventional IVF is useless because fertilization will not occur. The only way to obtain embryos is through ICSI, a technique developed in 1992 that involves injecting a single sperm into each oocyte using a micro-needle.
This procedure is performed in a laboratory under a microscope and requires the use of micromanipulation devices due to the cells’ extremely small size
After the micro-injection, the culture, fertilization verification and embryo transfer procedures are all identical to conventional IVF.
Intracytoplasmic Morphologically Selected sperm Injection (IMSI)
With ICSI, sperm is selected at 400x magnification. Some anomalies, such as vacuoles, cannot be detected at this level of magnification.
A technique combining an optical system with image analysis makes these anomalies visible, enabling a more informed decision about which sperm to inject.
This is not useful as a first-line treatment but may be indicated in certain cases, such as previous ICSI failures.
This technique is currently undergoing evaluation and its indications need to be more precisely defined.
Embryo freezing for later transfer
When a large number of embryos remaining following a conventional IVF or ICSI procedure, the laboratory can freeze part or all of the untransferred embryos. They are frozen the day of the transfer, following oocyte retrieval (D2, D3 or D5), and cryopreserved at the lab in liquid nitrogen (-196 °C).
In the event of a failed IVF attempt or when another pregnancy is desired, these embryos can be thawed and transferred into the female patient.
This technique eliminates the need to repeat the entire IVF cycle (oocyte retrieval, semen collection, fertilization, embryo culture, and so on).
However, the success rate for frozen embryo transfer is not 100%, since around 20% of embryos do not survive the freezing-thawing process.