Intrauterine Insemination (IUI)
This is the simplest method of assisted reproduction, in which sperm is placed directly into the woman’s uterus around the time of ovulation, with the aim of increasing the chances of fertilization. The cycle is monitored (either in a natural cycle or following ovarian stimulation with medication), sperm is collected and processed in the laboratory, and then introduced into the uterus using a specialized, thin catheter. It is a short, simple, painless, and minimally invasive procedure. It is recommended in cases of mild sperm abnormalities, unexplained infertility, ovulation disorders, cervical factor infertility, as well as in cases where donor sperm is used. Its success depends on several factors, including the woman’s age, sperm quality, and the underlying cause of infertility.
In Vitro Fertilization (IVF/ICSI/PICSI)
Stimulation Cycle
For in vitro fertilization (IVF) using a stimulated cycle, hormones are administered with the aim of producing multiple oocytes within a single cycle. Treatment usually lasts 8–12 days. During this period, the woman is monitored through ultrasound examinations and blood tests to assess hormone levels and response to treatment. Unlike the natural cycle (where one oocyte is produced), in a stimulated cycle the woman receives medication to stimulate the ovaries to produce multiple oocytes simultaneously. At the end of the treatment, oocyte retrieval is performed. This procedure is carried out transvaginally using a fine needle while the woman is under sedation (light anesthesia). The retrieved oocytes are then fertilized, and the resulting embryos are monitored and cultured in the laboratory. The final step involves transferring the embryo(s) into the uterus and/or cryopreserving any additional embryos for future use. The number of embryos transferred into the uterus is determined by the applicable legal framework and is primarily related to the woman’s age. A pregnancy test is performed 9–12 days after embryo transfer. Stimulated-cycle IVF is preferred for women with adequate ovarian reserve. Its advantage is that the retrieval of a greater number of oocytes may lead to the development of more embryos, increasing the chances of success while also providing the opportunity for embryo cryopreservation for future use.
Mild Ovarian Stimulation
This is a milder approach to in vitro fertilization, in which lower doses of medication are used with the aim of producing 2–7 oocytes. Monitoring and the remaining steps of the procedure are the same as in a stimulated cycle. It is recommended for women of advanced reproductive age, as well as for those with reduced ovarian reserve. It is important to emphasize that the choice between mild and conventional stimulation is not a matter of one being “better” or “worse”; rather, it depends on the woman’s age, hormonal profile (AMH, FSH), medical history, and treatment goals (e.g., embryo cryopreservation).
Natural Cycle
Natural cycle IVF is a more “natural” approach to in vitro fertilization, in which no hormonal stimulation is used (or only minimal hormonal stimulation is administered). More specifically, during each natural menstrual cycle, a woman’s body produces a single oocyte. In natural cycle IVF, the developing oocyte is monitored through ultrasound examinations and hormonal assessments, and then retrieved through the oocyte retrieval procedure. This is followed by fertilization of the oocyte and embryo transfer, or alternatively, the collection of oocytes or embryos over multiple cycles followed by embryo transfer once the collection process has been completed. The advantages of natural cycle IVF include the fact that the woman receives no or minimal medication and undergoes a more “natural” treatment process. However, it has a lower chance of success per cycle due to the availability of only one oocyte and a higher likelihood of cycle cancellation if no oocyte is retrieved or if fertilization does not occur. Multiple cycles are often required to achieve a successful outcome. Natural cycle IVF is recommended for women with reduced ovarian reserve, those with a previous history of poor response to ovarian stimulation medications, or when there are medical reasons to avoid hormonal treatments.
In vitro fertilization with donor gametes (oocytes / sperm).
In in vitro fertilization using donor oocytes and/or sperm, reproductive cells from donors are used instead of those from the couple.
– Oocyte donation: Oocytes from an egg donor are used and fertilized with the partner’s sperm or with donor sperm. The resulting embryo is transferred into the uterus of the woman who will carry the pregnancy. It is recommended for women with premature ovarian insufficiency, women of advanced reproductive age, women with a history of poor oocyte quality, or those with previous unsuccessful IVF attempts.
– Sperm donation: Donor sperm is used in cases of severe male infertility/azoospermia, in situations involving genetic disorders, or for single-parent families
– Combination of both donor oocytes and donor sperm: When both donor oocytes and donor sperm are used, the process includes the following stages: selection of the donor(s) – ovarian stimulation of the donor (for oocyte production) – oocyte retrieval – fertilization in the laboratory – preparation of the recipient’s endometrium – embryo transfer. This approach has very high success rates. It is a legal and anonymous procedure, performed through licensed assisted reproduction units, and there is an age limit for the woman undergoing treatment (54 years).