WE CAN OVERCOME DIFFICULTIES AND BECOME PARENTS
Today, 15%-20% of couples worldwide face fertility problems. Dealing with this ever-exacerbating problem is facilitated by the methods of medically assisted reproduction. This field of medicine has yielded revolutionary achievements in the procreation process thereby guaranteeing new possibilities and offering tremendous joy to thousands of couples.
At the moment more than 250,000 couples in Greece are sub-fertile. Meanwhile recent studies have upset long-standing beliefs by establishing that in 40% of the cases the cause of sub-fertility has to do with the woman, another 40% with the man and the remaining 20% is attributed to unexplained factors concerning the couple.
In vitro fertilisation has been applied worldwide for the last 35 years and has resulted to millions of births around the globe. The great variety of in vitro fertilisation methods enable us to treat each couple’s problem individually while quality upgrades means we can achieve better gestation percentages than before. Success percentages have exceeded 40% while 15 years ago they ranged between 10-15%. This means that today, one in every two women attempting in vitro fertilisation becomes pregnant.
Reliable in vitro fertilisation centers in Greece have been getting these results for a few years now thereby rendering our country a popular destination for sub-fertile couples around the globe.
CAUSES OF SUB-FERTILITY
18% of couples are unsuccessful in getting pregnant after 12 months of trying unprotected sexual intercourse. At this point, they refer to a medical practitioner.
The most common causes of sub-fertility in women are blocked fallopian tubes (usually as a result of inflammation) and hormonal disorders causing abnormal ovulation or ovulation of a lesser quality.
Endometriosis is another cause of sub-fertility as is age. In men, corruption of sperm factors leads to sub-fertility.
Such corruption can be caused by inflammation (occurring when standard hygiene rules are not observed), accidents affecting the genitals, hormonal disorders, genetic chromosomal abnormalities, varicocele, immunity factors and occasionally exposure to high temperatures as an occupational norm.
In vitro fertilisation comprises certain phases. Before the whole process starts, certain necessary medical and blood tests are performed to the couple aiming to increase as much as possible the method’s chances of success.
What is required from the man is the sperm. The woman, after the ovarian stimulation brought about by drugs, is subjected to egg retrieval. Afterwards, the eggs are fertilised with the partner’s sperm and then transferred into the uterus.
Embryo transfer is usually done on the second day. Now though, it can also be done during the blastocyst phase, namely when the embryo reaches the 6th day of its life. In this case, it is easier to implant the embryo thereby increasing the chances of successful implantation.
The aim is to transfer as few embryos as possible without reducing the method’s chances of success. That is to prevent multiple gestations with all obstetric and perinatal complications these entail as well as the emotional, financial and family cost they incur.
Should there be surplus embryos, they can be frozen to be used by the couple in the future. This aims at increasing the gestation percentage from a single treatment cycle since it enables the woman to conduct repeated embryo transfers with the least possible financial and emotional cost and pharmaceutical intervention.
A woman attempting in vitro fertilisation can produce up to 10-15 eggs, 10-12 of which will be fertilised. Not all of them will be implanted. Leftover embryos are frozen in liquid hydrogen to be used in two cases.
Either to repeat the process without new egg retrieval in case the attempt fails or if the woman wishes to have a second child after a number of years.
Embryos can be frozen for entire decades. Under the new legislation passed in 2005 however, the maximum limit is set to five years which can be extended for another five with the couple’s consent.
This method has produced “twins” born even 10 years apart from one another.
Until a few years ago there was no way to help couples where the man suffered from serious problems in terms of sperm number or mobility or even azoospermia ie, complete lack of sperm cells in their sperm. In these cases there was nothing to be done and foreign sperm had to be used (from a sperm bank).
The development of microfertilisation however enables us to retrieve a sperm cell using a micropipette under a very powerful microscope. Then, having opened up the egg’s casing, the sperm cell is placed in the egg’s cytuloplasm. This way, the egg is fertilised!
Sperm cells are taken by means of a small needle even from men suffering from azoospermia. Subsequently, a sperm cell is used to fertilise the egg which is then painlessly transferred into the uterus. This method has a 95% success rate in couples with sperm problems.
PRE-IMPLANTATION GENETIC DIAGNOSIS
To prevent pregnancies where the embryo suffers from serious genetic diseases, such as thalassemia, cystic fibrosis and others, for the last few years pre-implantation genetic diagnosis has been performed to embryos.
A cell is taken from the developing embryo and is subjected to tests. This way, diseases can be identified (genetic diseases) as early as the third day of fertlisation. The parents are thus certain that their baby will be healthy.
This method is only applied to in vitro fertilisation on the 3rd day of the embryo’s life in order to check for genetic anomalies before the embryos are transferred into the uterus.
Pre-implantation genetic diagnosis for all genetic diseases whose pathological mutation is known can be combined with CGH-array. This way, by conducting a biopsy on a very small sample of the fertilised eggs, we can gather all necessary information before transferring them into the uterus. This enables us to only implant the embryos which are free from chromosomal and genetic diseases.
CGH-array is a method examining all 23 pairs of chromosomes and is usually performed to women with repeated failed attempts at in vitro fertilisation, multiple miscarriages and at an older age. In June 2011, the first twins were born in Greece using this method, with dozens of children following.
During the last few years, the use of pre-implantation genetic diagnosis has been extended beyond simply preventing genetic diseases from being passed down to also ensuring that the children born are not only healthy but also histo-compatible to other afflicted children of the same family.
Pre-implantation diagnosis with histo-compatibility check was first used in Greece in three families with children suffering from thalassemia and chronic granulomatus disease. After transplanting germ cells from their histo-compatible siblings born by means of in vitro fertilisation using this method, the suffering children are completely cured.
This method can also be applied to exclude genes affecting our quality of life or reducing life expectancy, such as diabetes and cancer.
Pre-implantation genetic diagnosis has already been successfully applied to exclude genes related to neoplastic diseases, such as neurofibromatosis or retinoblastoma, thereby producing healthy children.
Apart from the scientific achievements made in this field, Greece also enjoys certain comparative advantages in relation to other countries.
The great climate, archaeological treasures and nearby destinations available for short breaks can help the sub-fertile couple be relieved of the stress and emotionally anxiety which they are bound to experience during this difficult time in their life.