Introduction
In infertile patients with premature ovarian failure, menopause occurs already before the age of 40. The signs of menopause are: absence of menstruation periods (amenorrhoea), a lack of oestrogens (hypoestrogenism), elevated levels of gonadotropins (FSH-follicle stimulating hormone) and low ovarian reserve (low AMH-Anti-Müller’s hormone). In this case, there is no follicular growth nor ovulation in the ovaries and pregnancy is only possible if the donor’s oocytes are used. However, the use of donor’s oocytes is not acceptable to all families for various reasons (religious, social, family, psychological).
Method
In vitro activation of ovaries – methodology, used on women with premature ovarian failure where the growth of primary and secondary follicles are stimulated and as a result of that, these women are able to get ripe oocytes with IVF (in vitro fertilization) and after fertilization become pregnant and have a baby. There have been cases of natural conception after IVA.
Activation occurs in laboratory conditions after the removal of ovarian tissue during laparoscopy. The studies showed that when surgically removed ovarian tissue were split, then the ovarian growth pathways (Hippo signal route) activated and as a result of that the growth of “sleeping ” oocytes occurred.
Ovarian activation surgical method was presented for the first time by Japanese investigator Kazuhiro Kawamura in year 2010.
Following the use of this method, the world’s first child was born in 2013.
Since then, several countries have started to use this method (Japan, China, Spain, Poland, Mexico, Russia, India). Several children have already been born as a result of this method and there are different variations of the methodology in use.
The TIME magazine (USA) has nominated this method as one of the ten best medical achievements in the world.
Indications for ovarian activation:
- Different causes for ovarian failure. Decreased ovarian reserve.
- The absence of oocytes in IVF program.
- Empty follicles syndrome when in IVF program there has not been any egg cells to be extracted.
- If follicles do not grow during stimulation despite the use of high gonadotropins medications.
- If the ovaries do not work after a trauma due to surgery.
- High FSH levels (range 30-150 UI/L) and low AMH levels (zero or close to zero).
How IVA is performed at Elite Clinic
Dr. Andrei Sõritsa will perform the necessary examinations during the consultation, assess the possibility of the operation and discuss the expected effect and risks of IVA.
Foreign patients can send a description of their problem, hormone test results (FSH, E2 and AMH) and scan report (size and structure of the ovaries, size of all follicles, size and structure of the uterus, endometrium thickness) by e-mail: andrei@elitekliinik.ee.
In some cases, you might be asked to start a hormonal preparation already before the operation. You will be offered the time for laparoscopic surgery. You need to be healthy for the time of surgery. You should not have diseases that increase the risk of the surgery.
For the operation you will come in the morning to the Elite Clinic, thereafter the surgery will be performed and in the evening you can leave the clinic and drive home (you are allowed to fly the day after the operation).
The operation is performed under general anaesthesia and will take approximately 1,5 hours.
During the operation, the doctor removes a piece of the ovarian tissue size about up to 2 x 2 cm, splits it in IVF solution and puts small ovarian pieces sized about 1x1x1 mm with catheter into another ovary and under the peritoneum near the ovary and stitches it together.
After the operation, it is recommended to rest for 3 days at home. If necessary, you can ask the doctor for a sick leave verification letter.
Efficiency of the operation
The current world studies show that approximately 50% of women who has undertaken follicle activation surgery, indicate the activation of the ovaries which is sufficient for the formation of oocytes, for fertilization and embryo transfer. Some women start to have menstruations again.
Unfortunately, before the operation, there is no way to predict how many “sleeping” follicles there are left in woman’s ovaries and how they will react to the activation.
The IVA method makes it possible to obtain oocytes from women who have stopped the oocytes production naturally. However, this method cannot improve the quality of the egg cells, which means that this method is most suitable for women aged up to 41, especially aged up to 35 or when the menopause length is less than 4 years.
Even after the age of 41 years, the IVA method gives a higher likelihood of obtaining oocytes, but the quality of the egg cells still remains consistent with age. The quality of the egg cells drops dramatically after 43 years of age
When to expect an IVA effect
Based on the condition of the patient before the surgery, the doctor will give you after surgery a timeline to start with ovarian stimulation and IVF procedure either immediately after surgery, a month later or once AMH rises and FSH lowers, which can take up to 6 months.
It should be taken into account, that initially follicles need to be grown using high doses of medications, then retrieve the oocytes, to fertilize them and freeze embryos. Most likely such procedure needs to be performed repeatedly for as long as there are good embryos for transfer. Only then the frozen embryos transfer can be planned. If they wish, foreign patients can have an IVF procedure in their home country.
How long can it take to act
No precise data are available at the moment. The best effect of ovarian activation is expected in the first year after surgery.
Analyses required for laparoscopic surgery
- Bloodgroup and Rh factor,
- PAP test (valid for 24 months),
- T.pallidum Ab, HIV, HBsAg, HBcAb, anti-HCV, full blood count; Gonorrhoea, Trichomonas, Chlamydia (valid for 3 months).
The risks of laparoscopic surgery
The risk of operation is below 0.3%. You can read the description of laparoscopic surgery on the Elite Clinic’s website.
Dr. Andrei Sõritsa is an experienced surgeon who has performed over 1000 different laparoscopic surgeries during his lifetime.
Risks of IVA
There are no reported complications regarding IVA. There is no evidence that IVA raises the risk of cancer in women. But today, less than a thousand such procedures have been carried out in the world and it is too early to draw definitive conclusions on its effectiveness and potential risks.
Price of IVA
- With Estonian Health Insurance 3200 EUR
- Without Estonian Health Insurance 4200 EUR
The price does not include analyses nor consultations.
In order to assess your indications and contraindications for surgery, as well as to estimate the likelihood of becoming pregnant after surgery, please fill in the form, attach your (and your husband’s) the results, the scan report of the uterus and ovaries, and book a Skype/FaceTime, WhatApp or Viber consultation. The price for consultation is 150/170 EUR.
Could this method be effective in your case? You can make an inquiry by phoning to Dr. Andrei Sõritsa on + 372 5052295.