For some couples, assisted reproduction is the only way to have a child of their own. Generally speaking, there are two methods of assisted reproduction available: in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). In both procedures, fertilization does not take place inside the woman’s body but is artificially induced in a laboratory.
Here you will find all the important information as well as recommended clinics for assisted reproduction.
In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are also commonly referred to as artificial insemination (assisted reproduction).
With IVF and ICSI, fertilization does not take place inside the woman’s body, but rather artificially in a laboratory. Both techniques are part of reproductive medicine.
For some couples, after fertility testing, artificial insemination is the only option for having a child.
While IVF was primarily used in the early days of reproductive medicine, doctors now use ICSI in 75 percent of cases.
In IVF, egg and sperm cells are placed together in a laboratory dish, where they must find each other on their own.
In vitro fertilization (IVF) is a form of so-called assisted reproduction @ phonlamaiphoto /AdobeStock
With ICSI, on the other hand, doctors inject a single sperm cell directly into an egg. This is done using a very fine needle. Doctors usually use ICSI when a man’s sperm quality is not optimal.
Intracytoplasmic sperm injection (ICSI) is suitable for men with severely impaired sperm quality @ Tatiana Shepeleva /AdobeStock
In both procedures, the woman first undergoes hormone treatment. The goal of hormone treatment is to retrieve as many eggs as possible from the woman’s ovaries.
Doctors then bring the eggs and sperm together. After successful fertilization and once the fertilized egg has developed, doctors transfer it to the uterus.
Couples who wish to undergo fertility treatment must first undergo a number of tests.
The primary focus is on identifying the cause and determining why a fertility problem has arisen.
To do this, both the woman and the man must undergo testing.
Preliminary Examinations for Women
Preliminary examinations for men
Counseling on artificial insemination
In any case, couples should take sufficient time to consider their options after undergoing fertility tests and receiving counseling from their doctor. After all, artificial insemination represents a major intervention in the female body.
Additional Tests Before Artificial Insemination
In any case, both partners should undergo testing for HIV and hepatitis (B and C) before artificial insemination.
For the woman, it is also important to confirm immunity to rubella. Additional tests that may be advisable before artificial insemination include screening for toxoplasmosis and chlamydia.
ICSI is also suitable in cases of poor sperm quality, as only one sperm cell is needed per egg.
In vitro fertilization (IVF), on the other hand, requires multiple sperm cells that must find their way into the egg. Therefore, the man’s semen analysis is decisive in determining whether IVF or ICSI is used.
The semen analysis includes values and information on:
Doctors now use ICSI not only to treat male infertility but also following unsuccessful IVF attempts.
Hormone Treatment and Egg Retrieval
For artificial insemination (IVF and ICSI), the woman receives hormone preparations to stimulate the ovaries. This allows the ovaries to mature several follicles. This increases the chances of obtaining multiple viable eggs for in vitro fertilization.
The woman injects the hormones under her skin using a thin pen-like device or a standard syringe @ Suzi Media /AdobeStock
To prevent premature ovulation during hormonal stimulation, the woman is given medication to suppress her body’s natural hormone production. This procedure is also known as the agonist protocol with downregulation.
During the stimulation treatment, follow-up examinations are conducted, during which the doctor checks whether one or more eggs are present.
If there are sufficiently large eggs, the woman takes special medication to trigger ovulation. Thirty-six hours later, the doctors retrieve the eggs from the ovaries.
This is performed under light anesthesia or analgosedation. It is an outpatient procedure, and the woman can go home after about two hours.
Providing Sperm for Artificial Insemination
One or more sperm cells are required for the artificial insemination itself. These should be as fresh as possible, which means that the man must provide a semen sample on the day of egg fertilization.
He can do this either at the clinic itself or at home. If he brings the semen sample from home, he must use a special container for transport. He must also ensure that the semen is at body temperature.
If neither IVF nor ICSI is an option, you’ll need to work with your doctor to find another solution.
After the man has provided the semen sample, the semen is processed in the laboratory to increase its fertilization potential.
Sperm Donation for Artificial Insemination
In cases of male infertility or reduced fertility following unsuccessful artificial insemination attempts, the couple may consider sperm donation.
Both procedures (IVF, ICSI) can also be performed using donor sperm. Sperm donation is also a viable option if the man has a hereditary disease that he does not wish to pass on to the child.
In Germany, only men between the ages of eighteen and forty who are physically and mentally healthy are eligible to be sperm donors. All donors are screened for infectious diseases (e.g., HIV, hepatitis, chlamydia).
Donor sperm can also be used for intrauterine insemination. During intrauterine insemination, doctors insert a catheter into the woman’s uterus. The donor sperm is thus introduced into the woman’s body.
Using donor sperm for artificial insemination can be very stressful for the couple. Therefore, in addition to medical counseling, psychological counseling is also advisable. You should also consult a lawyer to ensure you are legally protected. It is recommended that you enter into a treatment agreement.
Artificial Insemination in the Laboratory
After doctors have retrieved the eggs and prepared the sperm, artificial insemination takes place. Doctors bring the eggs and sperm together via injection (ICSI) or place both in a laboratory dish, where they must find their way to each other on their own (IVF).
Laboratory staff then culture the treated eggs in an incubator, where optimal conditions prevail. Twenty-four hours later, experts examine the eggs under a microscope to determine whether fertilization has occurred.
If fertilization was successful, the fertilized egg is transferred back into the woman’s uterus after about 2–5 days.
On the day of egg retrieval, the doctor informs the couple of the following:
After two to five days, the doctor transfers the fertilized eggs into the uterus using a thin catheter. This is a painless procedure. Experts also refer to it as embryo transfer.
If there are any fertilized eggs left over, they can be frozen (cryopreserved). If the treatment is unsuccessful, these can be thawed and transferred the next time. The advantage: A cryopreservation attempt is significantly less invasive because the woman does not have to repeat the entire procedure.
Pregnancy Test and Ultrasound Examination
About fourteen days after the embryo transfer, a blood test is performed to determine whether a pregnancy has occurred. The key indicator here is the level of the pregnancy hormone (HCG) in the blood. Another two weeks later, an ultrasound can reveal how many babies are actually present.
The success rates of artificial insemination depend on various factors:
The average birth rates for IVF and ICSI per embryo transfer range between 22% and 24%.
The birth rate per treatment cycle is approximately 20%, as successful fertilization does not occur in one out of every ten treatments.
It’s important to keep in mind that the success rate—at 15 to 20 percent per attempt—is not particularly high. It may therefore take several cycles before artificial insemination is successful.
Since each attempt is very stressful, the couple needs a certain amount of perseverance. Sometimes it can be helpful to take a break after a few unsuccessful attempts to recharge.
For the embryo to successfully implant in the uterine lining, it must break out of its protective membrane (zona pellucida).
In reproductive medicine, this implantation process can be facilitated through assisted hatching. It acts as a kind of hatching aid for the embryo.
During assisted reproduction, the embryo’s exit from the zona pellucida is facilitated by thinning or perforating it. Assisted hatching is performed using a laser, a glass needle, or enzymatic thinning of the zona pellucida. In modern reproductive medicine, laser technology is the method of choice.
A careful risk-benefit assessment is necessary despite the low risk of injury to the embryo due to precise laser technology.
Assisted hatching is recommended for couples who have already undergone several unsuccessful treatment cycles with IVF or ICSI.
Due to the hormonal treatment involved in assisted reproduction, it is possible for multiple follicles to mature.
After follicular aspiration, all retrieved eggs are then used for intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF).
If more eggs are fertilized than are intended for transfer, cryopreservation is an option. This allows the patient to avoid another round of stimulation and egg retrieval (follicular aspiration).
Every physician listed in the Leading Medicine Guide has attained the highest level of training and certification within their respective medical specialty society. Furthermore, we contacted this physician based, among other factors, on their case volume (surgeries, treatments, and therapies), which we determined by cross-referencing various publicly available sources. Following discussions with the selected physicians and the directors of the medical facilities, as well as a subsequent internal review, they were admitted to the Leading Medicine Guide.
The quality assurance of the Leading Medicine Guide is further ensured by 8 admission criteria. Each member must meet at least 6 of them:
