IVF, Fertility Preservation

A. Long Protocol

From one month before beginning IVF, GnRH agonist is medicated. Hypodermic injections are provided 7-10 days before menstruation, and as menstruation begins, ultrasound and hormone exams are performed to check if the conditions are appropriate for inducing ovulation, and gonadotrophin is injected to induce hyperovulation. The state of ovulation is checked through ultrasound and blood tests every 2-3 days on average. The stage, though it is long due to injections, is characterized by its stability.

B. Short Protocol

From the third day from of menstruation, gonadotrophin is injected, and when follicle is grown to a certain size, GnRH antagonist is injected to prevent premature ovulation and retrieve egg. When compared to a long protocol, the growth of follicle may not sometimes be even, but the period for injections is relatively short, with the rates of pregnancy are similar.

C. Mild IVF

Mild IVF is used to prevent the side effects associated with high stimulation IVF and uses a lesser amount of injections for inducing ovarian hyperstimulation. In general, an ovulation inducing agent is also used to use a lesser amount of injections.

D. Natural Cycle IVF

In this method, no hyperstimulation-inducing injection is used to retrieve the egg on the day of natural menstruation. The process is simple and costs less, but exclusively used in the group that shows an extremely low egg retrieval rate.

Stage 2 : Egg Retrieval and Sperm Preparation

A. Egg Retrieval

As the mature follicle is monitored on ultrasound, gonadotrophinis injected and the egg is retrieved after about 34-36 hours later. In most cases, the eggs are retrieved from the patient using a transvaginal technique called transvaginal oocyte retrieval, involving an ultrasound-guided needle piercing the vaginal wall to reach the ovaries.

B. Sperm Preparation

Sperm is prepared for fertilization on the day of egg retrieval, andabstinence 2-3 ahead of sperm preparation is ecommended. Sperm is collected in the container through masturbation, and, depending on the situation, can be collected from the frozen sperm or through a surgical procedure.

Stage 3 : In-Vitro Fertilization and Culture

Upon retrieval of the egg and sperm, they are put on a culture dish containing culture medium for fertilization. In general, it is left for natural fertilization, otherwise intracytoplasmic sperm injection (ICSI) is also opted. The fertilized embryo is cultured for about 3-5 days.

Stage 4 : Embryo Transfer

The fertilized embryo is inserted to the endometrium using a catheter. The locations of the catheter and embryo are checked under abdominal ultrasound. Depending on the age of the patient, conditions of the embryo and number of days of culture, 1-3 embryos are transferred. No anesthesia is required, and the patient can return to normal daily life after taking a rest for about 10 minutes.

Stage 5: Luteal Support

Luteal support begins after egg retrieval. In most cases, progesterone agent or gonadotrophin agent is used, which can be injected, inserted through the vagina or orally administered. Luteal support contributes to the implantation of the embryo and embryogenesis.

IVF – Treatment Program

Price – KRW 8,000,000 ~ 9,000,000 ($6,800~7,600 1cycle)

*Average USA cost – 12,000
(1 cycle, according to Verywell family, 2019)
*Depending on individuals, a method of ovulation stimulation, dose of drugs, injections and test types may be different.

Duration – 25~30 days (1 cycle)

Tests before IVF procedure

Husband
Blood test (Hormone) | Semen test
Sperm strict morphology test | Ultrasound

Wife
Blood test (Hormone) | Hysterosalpingorgraphy
Ultrasound | Ovulation test
Endometrial biopsy | Hysteroscopy/Laparoscopy operation

How to Preserve Fertility

Embryo Freezing After IVF

Embryo freezing (embryo cryopreservation) after IVF is adopted in the women who cannot conceive at the moment due to cancer treatment, etc. and whose level of fertility is significantly lowered. This method of freezing the embryos that are fertilized with the spouse’s sperm has been showing high success rates (about 50- 60% of pregnancy after transfer of the frozen embryo) of pregnancy with extensive clinical experiences. However, this method cannot be adopted for unmarried women as their eggs cannot be fertilized.

Ovarian Tissue Freezing

Ovarian tissue freezing is mostly employed in young cancer patients for whom hormone hyperstimulation cannot be opted. In such patients, their ovarian tissues are surgically collected using laparoscopy, etc. before conducting cancer treatment that can cause diminished ovarian function and, upon completion of cancer treatment, the frozen tissues are transplanted upon subcutaneous tissues or inside the abdominal cavity. In the laboratory, the ovary’s outer layer (called ovarian cortex) is cut into small strips and frozen. Despite some advantages including no need for the period of hormone hyperstimulation and the recovery of fertility after transplant and endocrinal functions, its rate of successful pregnancy is still low.

Freezing Eggs After Egg Collection

In this method, a multiple number of eggs are collected in one menstrual cycle of the unmarried women through the minimum level of hormone stimulation and freeze them for preservation. This method is conducted in a similar manner to IVF, but the mature eggs are immediately frozen without fertilization for future use. This method is relatively simple and does not require surgical procedures, but the time for hormone hyperstimulation is required for those patients who have to undergo cancer treatment.

Fertility Preservation (Egg Freezing) – Treatment Program

Price – KRW 5,000,000 ~ 6,000,000 ($4,250~5,070)

*Average USA cost – 12,577 (1 cycle, according to Freeze , 2019)
*Depending on individuals, a method of treatment, dose of drugs, injections and test types may be different.

Duration – 12 days

Necessity of Examining Male Infertility

In general, at least 15% of married couples are said to be suffering from infertility. Infertility is the inability to conceive a baby for at least one year despite normal sex life without contraception. In these couples, husbands are said to be responsible for about 50% of the causes of infertility. Therefore, in infertility cases, male infertility should be checked.

Examination of Male Infertility

Physical Exam

Testicles and scrotum, seminal duct, varicocele, and etc. should be examined.

Medical History

Disease, past General Surgery, medication, genetic disease, intercourse, and etc. should be checked.

Semen Analysis

Maintain abstinence for 2-3 days. If normal, one occasion of semen analysis is sufficient, but if any abnormal sign is suspected, one or two more examinations may be recommended. In the examination of semen, it checks the quantity of sperm, sperm count, motility, leukocyte count, and etc. are checked.

Semen DNA Exam

If there is varicocele, or the assisted reproduction procedure continues to fail, semen DNA examination aimed at checking DNA damages is recommended.

Treatment of Male Infertility

Surgical Treatment

If diagnosed with varicocele, the enlarged blood vessel should be surgically removed. And in the case of obstructive azoospermia, vaso-epididymostomy should be performed to reconstruct the passageway of sperm. Those who received vasectomy in the past can receive vaso-epididymostomy.

Infection Treatment

Treatment of infections with antibiotics can also raise the possibility of pregnancy.

Hormone Treatment

This can be performed on the patient of infertility having hormone problems.

Alternatrive Drugs

Arginine, Carnitine, Coenzyme Q10, Folic acid, Glutathione, Omega fatty acids, Selenium, Vitamine A, Vitamine C, Vitamine E, Zinc

Good Habits for Healthy Pregnancy

– Quit smoking
– Reduce or quit alcohol consumption
– Maintain normal weight
– Avoid exposure to the environment in which the temperature of
testicles rise, including sauna
– Avoid exposure to the diverse environmental hormones

FAQ about Male Infertility

Q. What is varicocele?

A. Being one of the common causes of infertility visiting the hospital at the rates of 20-30%, varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum.

Q. How Does it Cause Infertility?

A. Testes are located outside the body to keep them at a lower temperature than the body. The major functions of testes are production of sperm and secretion of male hormone, and, if there is varicocele, the testes are put in a bad environment. It can cause raised temperature of testes, diminished supply of oxygen, reduced reproductive organ hormones, toxic substances to negatively affect the motility, shape, count, etc. of sperm, and can sometimes cause pain on the scrotum.

Q. How Is It Diagnosed?

A. Depending on the level of symptoms, it can be divided into three levels, with the most enlarged one being visible with the naked eye. It can also be diagnosed with simple digital exploration, and also sometime using ultrasound. In terms of anatomy, it mostly occurs on the left side of the scrotum, but can sometimes occur on both sides.

Q. Should This Always Be Treated?

A. General Surgery for varicocele is, in general, performed for pregnancy. Cases in which neither pregnancy is wanted nor pain is caused and no change in the sizes of testes are not considered as surgical implications.

Q. How Is It Treated?

A. While there are diverse methods of treatment, the surgical removal using the microscope is known to show the highest success rate and lowest complications. The patient can be discharged on the next day of the General Surgery.

What Are the Advantages of Surgical Treatment

After General Surgery, the symptoms of varicocele improve in 60-80% of the patients, raising the possibility of natural pregnancy to about 40-50% within a year and to about 70% within two years.