One of the most burning problems of today is that of childless marriage. From report of World Health Organisation: about 8% of couples experience some form of infertility problem during their reproductive lives. 50 to 80 million people probably have a problem with fertility around the world. There are about 2 million new infertile couples per year and numbers are increasing. The most common and most important cause of acquired infertility has been shown to be pelvic infection resulting from sexually transmitted diseases, unsafe abortion, or puerperal infection.
The total number of women in reproductive age in Estonia is about 300 000. And at the present time there are probably over 10 thousand married couples in our Republic who would like to have children but can’t because of health reasons.
Childlessness is accompanied by several medical and social problems like constant stress, unsuccessful marriages, alcoholism and so one. It’s a lot more complicated than the usual issues middle-aged people go through, such as work-related stress, inability to get life insurance quotes (much less get an actual plan), non-existent savings, etc. The main medical problems are: negative population growth, high rate of abortion, especially for primigravida, increasing rate of abortion and pregnancies among teenagers, decreasing fertility among women and men, relatively high neonatal mortality , high rate of prematurity and perinatal morbidity, sexual transmitted diseases.
After laparoscopic investigation in our Clinic we can took about high rate of tubal infertility in Estonia. Our date demonstrated that in 68,6% cases the pathological changes in fallopian tube’s were found. Most of them related to previous urogenital infections, spontaneous or artificial abortions and abdominal surgery.
The laparoscopic surgery is quite effective if the damage of tube’s not strongly pronounced. The artificial fertilization technique obtain more and more recognition. In the year 1993 we started to establish the first centre of in-vitro fertilization on the base of Tartu University Women’s Clinic (in 1998 same group move to Tähe Private Clinic).
The law “Assisted fertilization and Protection of the embryo” was ratified in Estonia in July 1997. The law includes 5 parts and 36 paragraphs and regulates artificial insemination, IVF, connected with those procedures manipulations with the embryos and all legislative problems.
Main positions of the law :
- artificial fertilization is voluntary (written agreement of both sides);
- culture of embryos is allowed – up to 14 days;
- storage of cryopreserved embryos in liquid nitrogen – up to 7 years;
- donation of sperm, eggs and embryos – are allowed and they are anonymous;
- from one sperm donor is allowed to have no more than 6 children in Estonia (population – 1.5 mln);
- for Embryo Transfer – no more than 3 embryos allowed.
- usage of fresh donor sperm – only cryopreserved after control of the donor for sexually transmitted diseases after 6 month;
- usage of sperm after husband’s death;
- cloning of the human;
- research of the embryos – are allowed only with the permission of Committee of Bioethics.
Steps of assisted reproductive technology in our group:
- first IVF cycle was performed: in September 1993;
- cryopreservation of the embryos: from February 1995;
- first IVF cycle with donated eggs: in July 1995;
- donor’s sperm bank: from October 1995;
- ICSI procedure: from 1997;
- TESA/MESA: from 1999;
- Assisted hatching: from 2000.
For the ovarian induction we used all types of protocols, most of them included pituitary down-regulation by GnRH-agonists.
In our work we use different media (products of Medi Cult (Denmark) or Scandinavian IVF medium (Sweden)).
We incubate embryos up to 5-6 days (mostly 2-3 days).
Sperm preparation technique include centrifugation in SupraSperm gradients or swim-up procedure.
Cryopreservation of embryos we perform usually on day 2-3.
Our achieved results in IVF:
- the first child after IVF performed in Estonia by our workgroup was born: in August 1995 ;
- the first child from donated eggs was born: in July 1996 ;
- the first child from donated embryos was born: in September 1996;
- the first child from IVF with cryopreserved donor’s sperm was born: in March 1997 ;
- the first child after freezing-thawing of embryos in our IVF laboratory was born: in June 1997;
- the first child after ICSI in our IVF laboratory was born: in 1998.
- the first child after using Assisted Hatching procedure before embryo transfer was born: in May 2000.