What is IVF treatment
Artificial insemination methods
There are many different methods of artificial insemination. Which procedure makes the most sense in the case of infertility depends on the individual situation. First of all, a careful diagnosis is carried out on both partners to determine the underlying cause of the infertility.
The legal conditions in Germany exclude some measures that are permitted in other European countries. This includes, for example, the genetic examination of artificially fertilized embryos before they are returned to the womb (pre-implantation diagnosis), which is only permitted in exceptional cases, within very narrow limits and after examination by an ethics committee. The implantation of more than three embryos or the freezing or further cultivation of already divided embryos (= two-cell cells) is also prohibited in Germany. Cloning, selection according to gender or changing the genetic information are expressly prohibited and made a punishable offense.
Insemination is usually used when the man has found that the amount of semen is too low or that the sperm is of poor quality. In women, for example, infertility due to a disorder in the cervix can be the reason for insemination. To enable pregnancy, the sperm cells are injected directly into the uterus (intrauterine), the cervix (intracervical) or the fallopian tubes (intratubar) using a syringe or a soft catheter. The sperm cells then have to find their own way to the fertilizable egg cell.
There are two types of insemination:
- Homologous insemination: In this form, the husband's semen is used.
- The heterologous insemination: Here the semen from an anonymous donor is used.
According to § 27a SGB V, only homologous insemination can be performed at the expense of the GKV.
In Vitro Fertilization (IVF)
In-Vitro-Fertilization (IVF) is fertilization that is carried out in a test tube ("in vitro" means "in the glass"). For this purpose, fertilizable egg cells are removed from the woman. These are placed in a nutrient solution and fertilized with the partner's sperm cells.
Statutory regulations apply particularly strictly to IVF. The number of egg cells that can be used for re-implantation is limited to three. If there is no sex-linked hereditary disease, the child's gender cannot be selected.
In order to get enough fertile eggs from the ovaries, hormone treatment is usually carried out before IVF. The ovaries are stimulated to such an extent that several fertilizable egg cells can be obtained. The measure of freezing surplus egg cells obtained in this way is prohibited in Germany.
The success rate of IVF, in which the birth of a healthy child occurs, is 25 to 30 percent.
Intracytoplasmic Sperm Injection (ICSI)
Microinjection, or intracytoplasmic sperm injection (ICSI), is also a modified method of in vitro fertilization. In the ICSI method, a sperm cell obtained from the ejaculate or surgically from the testes or epididymis is injected directly into the female egg. Reproductive medicine specialists use this technique, for example, when the male partner has too few sperm cells in their ejaculate or when the seminal ducts are blocked. In around 25 percent of cases, pregnancy can be brought about with this procedure.
Risks of IVF and ICSI
The G-BA checked the ICSI to see whether the use of this method would lead to an increased rate of malformations. The review showed that the malformation rates in both ICSI and IVF-conceived children are significantly higher than naturally conceived children. Significant differences in the increase in risk between IVF and ICSI, on the other hand, cannot be determined.
In the guidelines for artificial insemination, the obligation for doctors who offer reproductive medicine services was included to provide information about the increased risk of malformations with ICSI or IVF compared to natural conception.
Intratubar gamete transfer (GIFT)
With GIFT, egg cells are removed from women with the help of a laparoscopy (laparoscopy). These are then injected into one or both fallopian tubes together with the partner's prepared sperm cells. This can be done either through the abdominal wall or through the cervix using a catheter. The fertilization then takes place naturally. The fertilized egg should migrate into the uterus and implant itself there.
The GIFT method is used when the causes of infertility cannot be precisely determined. The application can also be useful in the presence of endometriosis. Since the success rates of this method are not higher than with IVF, but a laparoscopy under general anesthesia is associated with a higher risk of complications, intratubar gamete transfer is no longer often practiced today. The success rate is around 20 percent. There is an increased risk of an ectopic pregnancy.
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