MACS (MAGNETIC-ACTIVATED CELL SORTING) -METHOD OF SPERM SELECTION.

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(MACS) is an effective way to select functional sperm and increase pregnancy rates.

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The MACS® ART Annexin V System was designed to selectively remove defective, albeit morphologically indistinguishable, cells from a patient's sample. The process begins with magnetic labeling of the defective spermatozoa, which are then passed through a separation column where they are selectively captured. Intact surviving sperm that do not show signs of fragmented DNA pass through the column and are collected for further use (ICSI or cryopreservation).

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The direct retrieval of sperm ready for fertilization represents a key advantage over traditional DNA fragmentation tests, in which the patient receives only impractical information about the percentage of damaged cells.

IVM - in vitro oocyte maturation

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It is the collection of immature oocytes from unstimulated or minimally stimulated ovaries. Maturation of the oocyte and acquisition of its fertilisation capacity is achieved under laboratory conditions.

Indications:

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• in patients where it is not possible to obtain mature oocytes by conventional stimulation
• in patients at high risk of hyperstimulation syndrome
• in patients with polycystic ovary syndrome (PCOS)
• in patients with highly differentiated follicular growth within a single stimulation
• in patients after ovarian surgery

ME - Embryo monitoring

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Non-invasive continuous embryo monitoring is a method in in vitro embryo culture that allows monitoring the development of embryos without the need to check their development under a microscope outside the incubator. It allows their continuous monitoring on a monitor. Selection of the most suitable embryo for transfer is more efficient and thus increases the chance of a successful pregnancy.

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The main advantages of the ME are:

• minimising the handling of embryos, which reduces the risk of embryo damage
• a constant overview of the status of all embryos
• precise_CO2, _O2 and temperature control during embryo culture
• accurate documentation of embryo status

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This relatively new method, introduced in assisted reproduction, brings a better selection of embryos suitable for transfer into the uterus and increases the percentage of pregnancies after treatment. We use the EmbryoScope device for permanent embryo monitoring.

Culturing of embryos in laboratory conditions is most often 2 to 5 days after ovarian puncture.

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For larger numbers of embryos, a standard five-day culture is used to select the morphologically best developing embryo, which allows for the control and subsequent selection of the most suitable embryos for transfer (= transfer to the uterus).

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If the number of embryos is low (2-3 embryos) and they already show different development at the beginning of the culture, it is possible to transfer the embryos into the uterus on the second or third day of culture.

Embryotransfer - the transfer of embryos into the uterus is an easy and painless procedure for the patient, similar to a normal gynaecological examination. The embryos are introduced into the uterine cavity through a thin transfer catheter.

KET or thawed embryo transfer is the same as embryo transfer. The preparation of the patient for KET consists of hormonal stimulation of the uterine lining, controlled by ultrasound. The embryos are thawed, their quality is assessed and after a short culture they are inserted into the uterine cavity through a thin transfer catheter.

AZH - assisted zonal hatching

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A micromanipulation technique in which the envelope (zona pellucida) of the embryo is disrupted in a small area. For the embryo to nest in the uterine lining, it is necessary to travel out of the zona pellucida, which protects the embryo throughout the culture period. In some cases, embryo implantation may fail because the zona pellucida is too hard. The laser beam is used to gently disrupt the envelope and clear the way for the embryo. With AZH, it is not possible to damage the embryo.

EmbryoGlue® is a medium used for the transfer of embryos into the uterus that contains, in addition to all the important nutrients needed for optimal embryo development, a substance called hyaluronan in a higher concentration. Hyaluronan occurs naturally in higher concentrations in the follicular fluid as well as in the fluid in the fallopian tubes and in the uterus, where it creates an environment of increased viscosity. Independent research has shown higher chances of pregnancy when EmbryoGlue® culture medium is used for embryo transfer to the uterus compared to low-concentration or no-hyaluronan medium. EmbryoGlue® is applicable for the transfer of embryos of all developmental stages, from two-day-old embryos to blastocysts, irrespective of whether fresh or frozen embryos are transferred.

PGS - preimplantation genetic screening

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PGS is the search for any change in the genetic makeup of the embryo. Using this method, we check the whole DNA in large sections. PGS uses the technique of Fluorescence In Situ Hybridisation (FISH), which allows us to analyse a limited number of chromosomes 5 or 8, most often those whose variations in number lead to spontaneous abortion or to the birth of a child with a serious genetic disability (for example, Down's, Patau's and Edwards syndrome). The FISH method is largely being replaced by the array CGH method (so-called microchips), which makes it possible to analyse all chromosomes while the fertilisation itself occurs naturally (i.e. the sperm and egg fuse spontaneously).

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‍Indications:

• age of the patient over 37 years
• repeated unsuccessful IVF cycles
• repeated spontaneous abortions
• a partner with a severe spermiogram disorder
• previous cancer treatment in one of the partners

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PGD - Preimplantation Genetic Diagnosis

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In the case of PGD, it is a search for a specific genetic change. That is, it is intended for parents who are carriers of rearrangements of genetic material between chromosomes (translocations, deletions, etc.). This technique allows the selection of an embryo that does not carry the alteration.

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Preimplantation genetic diagnosis of monogenic diseases

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Genetic testing of embryos that is designed for couples who have a known genetic variation and an increased risk of having a child with a genetic burden. The prerequisite for using this method is that the disease is testable at the gene level, in other words, the specific gene change (mutation) responsible for the disease must be known in the family (cystic fibrosis, spinal muscular atrophy, Duchenne muscular dystrophy, Huntington's disease).