CredoWeb interview with Dr. Ing. Julian Marschalek, Specialist in Gynecology & Obstetrics and Deputy Head of the IVF Outpatient Clinic at the Department of Gynecological Endocrinology and Reproductive Medicine at Meduni Vienna

About 10 to 15 percent of all couples are faced with an unfulfilled desire to have children - and this percentage is rising: on one hand because of a higher maternal age, on the other hand because sperm quality in recent years has increasingly decreased and continues to decline.

In the case of many couples with unfulfilled desire to have a baby, it turns out in the course of the gynecological examination that natural conception is very unlikely or even impossible. These couples can often be helped with artificial insemination - called in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

In general, artificial insemination is preceded by hormonal stimulation of the ovaries. This injection treatment results in the formation of several follicles in the woman's ovary which, when they reach a certain size, are removed as part of the follicular puncture. This egg retrieval is done ultrasonically over the vagina, and can be done on request also under general anesthesia, in most cases, only a slight sedation is found to be completely sufficient.

A few days after fertilization of the egg cell embryo transfer takes place. Here, one to two, in very rare cases, three embryos are introduced into the uterus. In principle - the higher the number of transferred embryos, the higher the pregnancy rate. The recommendation on the number of embryos to be transferred is determined by additional prognostic factors (age of the patient, quality of embryo, number of previous unsuccessful attempts, etc.).

For which couples is ICSI method recommended?

An indication for ICSI exists when the semen quality is significantly reduced, that is, when not expected, or there is doubt that the seed can reach or penetrate the oocyte shell. This is the case when the seed has a variety of morphological disorders. These are, for example, external changes in the shape of the head or tail of the spermatozoa, or even if the semen has clear limitations in its mobility or quantity.

However, we also apply the ICSI method for other reasons: for example, if it was not possible to obtain fertilization of the eggs during preliminary trials and despite sufficient semen quality, or in certain diseases such as advanced endometriosis.

Is there any new insights in the repository options?

Reproductive medicine is a very young field in medicine - we generally know very little about the extremely complex mechanisms involved in fertilization or implantation of the embryo. There is a great deal of research in this area, in many directions: some researchers focus primarily on the embryo, its development and genetics, others focus on the lining of the uterus, others investigate modified stimulation protocols or new drugs. 

In this context, of course, an attempt is made to make the treatment process more comfortable for patients. You have to imagine that as part of a sterility treatment women have to inject several times a day at certain times. For some time now, there are active ingredients on the market that, after a single injection, build up an effective level that lasts for a week. Although these drugs may not be well suited for every woman, research is naturally in the right direction.

Studies on another active ingredient - orally administered one, not an injection, is something we reproductive medicine specialists expect eagerly ...