Indications, preparation process, and target population for first-generation IVF: Artificial insemination technology

Artificial insemination is a treatment method that involves injecting semen obtained from masturbation into the woman's reproductive tract to allow the sperm and egg to combine and induce pregnancy. Artificial insemination has a history of over a hundred years, but its clinical application and successful implementation only began in the 1950s. Artificial insemination includes: husband's sperm insemination (using the husband's semen) and donor sperm insemination (using a donor's semen).

Artificial insemination is suitable for the following patients:

(1) Male infertility due to oligospermia, asthenospermia, abnormal liquefaction, sexual dysfunction, genital malformation, etc.

(2) Cervical factor infertility.

(3) Infertility caused by reproductive tract malformations and psychological factors leading to inability to have sexual intercourse.

(4) Immunological infertility.

(5) Unexplained infertility.

Before undergoing artificial insemination, you must first prepare the following documents: ID card and marriage certificate. Secondly, you need to undergo pre-operative examinations. For the woman: fasting blood routine, urine routine, coagulation series, liver and kidney function, blood sugar, hepatitis B five items, hepatitis C, HIV, syphilis antibody, and blood type; on the 2nd-3rd day of menstruation, fasting endocrine hormone levels should be checked; 3-7 days after menstruation ends, without intercourse, a hysterosalpingography (HSG) should be performed, and the results must show that at least one fallopian tube is patent. For the man: two semen analysis reports from within the past year; hepatitis B five items, hepatitis C, HIV, syphilis antibody, and blood type, etc.

Female preparation: ① Natural cycle IUI. Women with regular menstrual cycles can undergo natural cycle IUI. Patients should begin monitoring follicle growth on days 10-11 of their menstrual cycle. ② Ovulation induction cycle IUI. For women with ovulation disorders, ovulation induction is necessary. Patients should return for a check-up on days 2-3 of their menstrual cycle to rule out pregnancy and ovarian cysts via ultrasound. Ovulation induction drugs can then be administered. ③ When the dominant follicle reaches 1.4cm, establish an IUI ultrasound monitoring form, complete the form completely, and clearly state the indications for IUI. Verify the patient's ID card and marriage certificate. ④ Timing of IUI. IUI should be performed one day after the LH surge; IUI should be performed on the day of ovulation; when at least one follicle reaches a diameter of 18-20mm, inject HCG, and perform IUI 24-36 hours after HCG injection. ⑤ If there are >3 dominant follicles in the ovulation induction cycle, IUI for that cycle should be discontinued. ⑥ Lutein support. Starting on the third day after ovulation, oral dydrogesterone 10mg twice daily can be administered for 14 days. Sixteen days after the surgery, urine and blood HCG tests were performed to confirm pregnancy.

Male preparation: On the 8th day of the female's menstrual cycle, the male ejaculates once through masturbation. On the day of IUI, the male collects semen through masturbation.

First-generation IVF involves retrieving eggs using a needle and fertilizing them with sperm outside the body. The resulting embryo is then transferred to the uterus, bypassing the natural process of sperm and egg fertilization in the fallopian tubes. Second-generation IVF uses a microsurgical needle to inject sperm into the egg to facilitate fertilization, and the resulting embryo is then transferred to the uterus. Third-generation IVF, a new technology derived from the first and second generations, is called preimplantation genetic diagnosis (PGD). It adds a diagnostic step to IVF, obtaining multiple embryos through ovulation induction and in-vitro fertilization. Before transferring these embryos to the mother's uterus, a small number of cells are taken from each embryo for testing, screening for chromosomes or genes. Only qualified embryos are transferred, while unqualified embryos are discarded. Therefore, the main difference between third-generation IVF and the first and second generations is the additional diagnostic process, providing a safety guarantee for patients with chromosomal abnormalities or other genetic diseases, preventing the birth of defective offspring. Babies conceived using in-vitro fertilization technology are called test-tube babies, and these children develop in the mother's uterus. It is clear that "in vitro fertilization" does not actually produce babies that grow in test tubes. Instead, several eggs are retrieved from the ovaries, and in a laboratory, they are combined with the male's sperm to form embryos. These embryos are then transferred to the uterus, where they implant and cause pregnancy.

Indications for IVF:

(1) Gamete transport disorder caused by various factors in the female, such as bilateral tubal obstruction, absence of fallopian tubes, severe pelvic adhesions or history of fallopian tube surgery, resulting in loss of fallopian tube function.

(2) Ovulation disorders, who have not become pregnant despite repeated conventional treatments, such as repeated ovulation induction or intrauterine artificial insemination.

(3) Infertility caused by endometriosis, and those who have not been able to conceive despite taking medication or undergoing surgery.

(4) The male partner has oligospermia, asthenospermia, or teratospermia and has not conceived after intrauterine insemination, or the male partner's condition is not suitable for intrauterine insemination.

(5) Patients with immunologic infertility or unexplained infertility who have failed to conceive through intrauterine insemination.

(1) Severe oligospermia, asthenospermia, and teratospermia.

(2) Irreversible obstructive azoospermia.

(3) Spermatogenesis dysfunction (excluding genetic defects and diseases).

(4) Immunological infertility.

(5) In vitro fertilization-embryo transfer failure.

(6) Abnormal sperm acrosome.