Assisted reproduction techniques

Low-complexity techniques:

Intrauterine Insemination

A simple procedure performed in the consulting room. It consists in the insertion of a sperm sample previously enhanced in the laboratory into the uterus with a cannula. Insemination is performed so as to match ovulation timing accurately determined by ultrasound. It is painless and easy to perform. It is typically made for three cycles, and 40% of patients get pregnant. If pregnancy is not achieved, only an additional 10% will succeed if they try three further cycles. Accordingly, if pregnancy is not achieved in 3 or 4 cycles, it is time to try high-complexity techniques.

High-complexity techniques

IVF

Also known as the “test-tube baby” technique, IVF is a procedure intended to fertilize eggs to form embryos in the lab. This method was initially intended to solve problems of tubal obstruction but it is currently used to help cases of moderate male factor infertility. It consists in joining both gametes (sperms and ova) in a Petri dish with a specific culture as medium. Once fertilization takes place and the resulting embryo is formed, embryo transfer is performed. Embryo transfer consists in depositing embryos formed in the lab into the womb, and may be done within 48 hours after follicular aspiration and is performed in the aspiration room or the transfer room without anesthesia.

GIFT

This is a procedure with a high rate of success. It is performed in patients with healthy, viable fallopian tubes. This treatment is recommended and used in patients with infertility problems of unknown origin or when IVF embryo transfer is difficult through the vagina for a number of reasons, such as cervix narrowness or deviation. Unlike IVF, in GIFT both male and female gametes are transferred into the fallopian tubes, without fertilization having taken place. The purpose is placing the gametes in the very setting where fertilization occurs naturally, but for any reason was cannot take place spontaneously. This procedure is performed in the operating room either with epidural or general anesthesia. Gametes are transferred to the fallopian tubes with a laparoscopic procedure, which consists in practicing a 1-cm incision below the navel, distending the abdomen with carbon dioxide (CO2), passing a telescopic instrument with a video camera attached to it through the incision to manipulate the fallopian tubes, and make an additional 1-cm incision across the pubic hair to transfer the gametes. The procedure typically takes some 30 minutes.

ICSI

This procedure is applied in cases of severe male factor infertility, where sperm quantity and motility are very poor or when there are no sperms in the semen (in which case sperms are taken directly from testicles or epididymes.) Once the eggs are in the laboratory culture, and the semen sample has undergone a special treatment, one single sperm is microinjected into the egg cytoplasm. This technique overcomes any fertilization impediment, with the ensuing development of embryos in patients with very poor sperms. Once microinjected, the egg is placed in the same culture as IVF. Resulting embryos are then transferred also in the same way as in IVF.

TOMI: A technique created in Peru

While ICSI solved one of the problems of infertility that were hitherto considered insurmountable, namely male factor infertility, there sometimes were problems at the moment of embryo transfer. Compelled by need to get these patients to have successful results, the Instituto de Ginecología y Fertilidad (IGF – Institute of Gynecology and Fertility) developed a new treatment in Peru: TOMI. This technique combines two techniques that have proven very effective not only at IGF but worldwide: GIFT and ICSI. TOMI consists in transferring oocytes that have been microinjected right before embryo transfer.
Appropriate for severe male factor infertility, of the main advantages is that the microinjected oocyte is transferred into its natural setting. This procedure has proven extremely successful in the first year it has been applied. Today, there are many children in Peru who have been born thanks to this method. An important aspect of this technique is that it may be effective even in patients with bad pregnancy expectation even for ICSI, or those who have had numerous trials with high-complexity assisted reproduction techniques. We are proud to be the only institution in Peru that applies this technique –so far with such good results.