Laboratory methods

There is a wide range of laboratory methods that can be used in your fertility treatment, these are very often called add-ons by the Human Fertilisation & Embryology Authority (HFEA). The add-ons are certain techniques that may have shown some promising results in studies or have been around for a number of years, but have not necessarily been proven to improve pregnancy or birth rates. 

The HFEA have come up with a system of traffic lights to list these add-ons and indicated whether certain techniques are supported by any evidence or research on improving pregnancy or live birth rates. For more details follow this link

We XX listed below the most common ones with further details.  

ICSI 

ICSI (Intra-Cytoplasmic Sperm Injection) is a micromanipulation technique where an individual sperm is injected into an individual egg. Before ICSI, men with a very low sperm count had a poor chance of fathering a child even with other reproductive technologies. With ICSI, only one motile sperm for each egg retrieved is needed. This enables men with very poor sperm counts to achieve fertilisation, produce embryos suitable for transfer, pregnancy and the birth of healthy children. ICSI can be performed using sperm retrieved by testicular sperm extraction in men with azoospermia (lack of sperm ejaculate).

ICSI can be carried out on eggs retrieved through stimulated or natural cycles and is often recommended in those who have experienced failed fertilisation using standard IVF.

 


PICSI

PICSI is a method of sperm selection which is in addition to ICSI. It copies the process where mature sperm bind to shell surrounding the egg.

PICSI helps embryologists in sperm selection. It is based on research documenting that mature and structurally sound sperm will bind to hyaluronan, and is a reliable alternative to more expensive DNA integrity assays.

PICSI indication

  • Low sperm count or morphology
  • Previously low number of fertilised eggs or not fertilised after ICSI
  • Repeated miscarriage and/or repeated embryo transfer without implantation

Scientific studies do not show that this technique adds risks to the ICSI procedure and PICSI may not increase your chance of having a baby, but using this technique will help the embryology team when selecting the sperm for injection.


IMSI 

IMSI is a method of sperm selection which is used in addition to ICSI. The magnification on the ICSI microscope is increased by 6,000 times to allow the embryologists to see the detailed structure of each sperm. Sperm with a good shape (morphology) are selected for the ICSI procedure.

IMSI indication

  • Low sperm count or morphology
  • Previously low number of fertilised eggs or not fertilised after ICSI
  • Repeated miscarriage and/or repeated embryo transfer without implantation

Scientific studies do not show that this technique adds risks to the IMSI procedure and IMSI may not increase your chance of having a baby, but using this technique will help the embryology team when selecting the sperm for injection. Some studies have shown higher fertilisation rates and an increase in chance of pregnancy where poor ICSI fertilisation has been seen in previous treatment cycles.


Extended Cultivation

A blastocyst is the embryo stage typically seen five days after fertilisation. A blastocyst has two areas that the embryologists assess, the outer surface of the blastocyst called the trophectoderm which becomes the placenta and an inner group of cells called the inner cell mass which develops into a baby.

If embryos look similar at earlier stages, keeping the embryos until they reach this stage allows the embryologist to choose the best quality embryo(s) for transfer and can improve the chances of pregnancy. Not all embryos will reach the blastocyst stage and it may only be recommended when enough eggs have been fertilised. In addition to using extended culture as a selection tool, we know that in a natural pregnancy, a 3 day old embryo resides in the tubes and reaches the uterus on day 5 or 6. By transferring the embryo to the uterus on day five, the embryo is being returned to a more natural environment mimicking natural pregnancy. Blastocysts are suitable for genetic testing and can be successfully cryopreserved.


Time-lapse imaging of embryos

EmbryoScope™ from Vitrolife or Geri™ from Merck Serono

Using a time-lapse incubator is the latest technology for continuous assessment and culture of embryos. Until recently, embryo monitoring has involved the removal of embryos from an incubator for microscopic assessment at a specific moment in time. GENNET City Fertility offers time-lapse imaging of embryos utilising both the EmbryoScope™ or GERI™ incubator system – with a microscope and camera system integrated within the incubator your embryos are monitored 24 hours a day whilst they are in culture allowing embryo development to be assessed and observed as a time-lapse movie.

In addition, there is reduced disturbance to your embryos compared to using traditional incubation methods as the embryos remain in the incubator in a stable environment throughout the culture process without the need to remove them for daily checks.

Time-lapse incubators provide our team of embryologists additional morphological and developmental information about your embryos, including the assessment of morphology, multinucleation, cell division patterns and the time of embryo divisions – all contributing to the selection of a better quality embryo(s) to transfer.

Key Benefits of time-lapse imaging

  • Selection of “highest potential” embryos for embryo transfer giving you your optimal chance of having a baby
  • More stable environment for your embryos during culture
  • Time-lapse developmental video of your embryos for you to keep

There are scientific studies that have shown an increase in the chance of a live birth when using this technology to grow embryos. Embryologists feel that the use of these incubators improves the culture environment and helps in selecting good embryos and ignoring embryos with poor development.


EmbryoGlue

EmbryoGlue imitates the environment of the womb at the time of the implantation. It is not glue in the true sense of the word, but its function is similar to the function of glue because it increases the chance of implanting the embryo in the womb.

EmbryoGlue contains sugars and amino acids that support the embryo during the transfer and implantation period. EmbryoGlue contains hyaluronan which is a natural substance commonly found in all tissues in the human body. Its concentration in the uterus at the time of the implantation increases and the uterine wall and embryo contain receptors for its molecule. It is believed that hyaluronan in EmbryoGlue establishes a connection between the embryo and the uterus.

Who should use EmbryoGlue?

EmbryoGlue® brings along benefits for all patients who undergo the embryo transfer in the course of assisted reproduction. Scientific studies have shown that the use of an increased level of hyaluronan in embryo transfer media improves the chance of implantation after the embryo transfer. The results are better than those for transfers without hyaluronan. EmbryoGlue® is the only available product that is enriched with hyaluronan.