Intrauterine Insemination (IUI) is a fertility treatment that involves placing processed sperm, with optimized concentration and motility, directly into the uterus.

IUI can be performed with or without administrating fertility medications. Compared to timed sexual intercourse, IUI has 2 times higher pregnancy rate.

Intrauterine Insemination (IUI) offers infertility patients a simple, less invasive and less expensive option to enhance fertility.

Before offering IUI, women should have at least one patent fallopian tube as diagnosed during hysterosalpingography (radiographic contrast dye is injected into the uterus through the cervix and runs through the fallopian tubes).

According to the American Society of Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) a couple needs to be evaluated for infertility after 1 year of regular, unprotected intercourse with not being able to get pregnant.

Male infertility is involved in 40% of infertility cases, female infertility in 40% and unexplained infertility in 20%. Infertility is defined as unexplained if its cause remains unknown even after an infertility testing.

In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm outside the body, in vitro (“in glass”). The process involves monitoring and stimulating a woman’s ovulatory process, removing an egg or eggs from the woman’s ovaries and letting sperm fertilise them in the IVF laboratory. After the fertilised egg (zygote) undergoes embryo culture for 2–6 days, it is implanted in the same or another woman’s uterus, with the intention of establishing a successful pregnancy.

Spermatozoa sometimes fail to fertilize even when they are artificially placed in close proximity of eggs during conventional IVF. In most cases gamete micromanipulation (ICSI, intra-cytoplasmic sperm injection) is the only way to overcome this problem.

The embryologist using micromanipulation techniques and microscopic laboratory facilities, deposits a single spermatozoon directly into the cytoplasm of the oocyte.

The therapeutic possibilities of ICSI have made it possible for men with severe sperm defects (low concentration, low motility and poor morphology or ejaculation disorders) to become fathers. In the past, these men would have no hope of experiencing fatherhood.

Practically, a single motile spermatozoon is needed per mature oocyte.

Until today, thousands of babies have been born from ICSI. There is no evidence that micromanipulation affects embryo quality or children safety and wellbeing.

Blastocyst is the embryonic development stage 5-6 days after fertilization and it is a sign of normal development and high degree potency. Only a few and not all embryos are capable of reaching the blastocyst stage under in vitro culture. Blastocyst culture requires the use of specialized culture media and a state-of-the-art laboratory with experienced embryologists and optimum culture conditions.

At this stage the embryo consists of 60-120 cells, forming two distinct groups. The outer layer of the blastocyst consists of cells collectively called the trophoblast that will give rise to the placenta and the inner cell mass (embryoblast) which subsequently forms the embryo. The next stage is blastocyst hatching out of its shell (zona pellucida).

Embryo cryopreservation has become a routine procedure for IVF clinics. If a woman doesn’t conceive during her stimulated cycle and she has cryopreserved embryos available, then she can proceed with her treatment having a frozen-thawed embryo transfer.

Frozen-thawed embryos may be transferred to the uterus around the 18th day of the frozen-thawed cycle. In most cases, the clinical management of frozen embryo transfer cycles involves estrogen administration from day 1 of cycle and then an estrogen – progesterone combination, taken orally, to achieve optimum endometrial thickness and quality.

The success rates of frozen embryo transfer are lower compared to “fresh” cycles. It should be taken into account that some embryos may not survive the thawing procedure “shock”.

It is well-known, that every month the female’s body recruits around 20 oocytes to reach their final stage of maturation, just prior to ovulation. Even though, only one oocyte will finally reach ovulation, the remaining oocytes are also capable of achieving maturation and fertilization. However, after ovulation, these remaining oocytes will become atretic and will fail to ovulate.

It has been observed, since the mid 20th-century, that human oocytes can resume their final stages of maturation in vitro. The incidence of in vitro oocyte maturation together with their ability to fertilize in vitro, set the basis to introduce a new technique in assisted reproduction technology, known as In Vitro Maturation (IVM).

To date, very few children have been born through IVM worldwide. However, IVM children are healthy and show normal development compared to children conceived naturally.

As with every new assisted reproductive technology, IVM should only be offered to a suitable group of women and only after counseling on the pros and cons of the method.

Assisted hatching is a technique where a gap is made in the zona, surrounding the embryo. Early stage embryos are surrounded by an outer shell, zona pellucida, which protects embryonic cells. When the developing embryo reaches the uterus, it has to break out or “hatch” out of its zona pellucida in order to successfully implant and continue its development. In some IVF cases it is necessary to improve the ability of the embryo to hatch out of its shell by reducing the thickness of the zona pellucida (assisted hatching).

Assisted hatching is performed, using laser technology, just before embryo transfer when the number of embryos to be transferred has been determined and should be perform from high experienced embryologists.