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Reproductive Medicine


Reproductive medicine: From science to practice

Scientific article by Sunya A. Levine, MD

Today, reproductive medicine has a solid body of knowledge in the treatment of infertility of all types and forms.

For more than three decades, in vitro fertilization (IVF) has been the main procedure for treating infertility. The IVF procedure is well established by doctors around the world. It consists of several stages: stimulation of ovulation in a woman, control of follicle maturation, subsequent collection of eggs and sperm, fertilization in the laboratory, monitoring the growth of embryos, transfer of the highest quality embryos to the uterus in an amount of no more than 3.

The stages of treatment are standard, but the characteristics of the body and indications for IVF require an individual approach, both in prescribing special medications and in setting the timing of each stage of treatment.

These methods are offered by almost all reproductive medicine clinics, and their effectiveness in treating infertility has been proven by tens and hundreds of thousands of children born. However, the effectiveness of IVF alone is no more than 40%. Therefore, the main task of reproductive specialists around the world is to increase the number of successful artificial insemination cycles. So, recently, in reproductive medicine clinics, the implantation of five-day embryos (blastocysts) instead of younger, three-day embryos has been practiced. Blastocysts are optimal for transfer because at this stage it is easier to determine the prospects of such an embryo for further development in the mother's body.

Other methods of assisted reproductive technologies, the list of which may vary from one fertility clinic to another, can help improve the statistics of successful fertilizations.

A common method for treating infertility is ICSI, which means direct sperm injection into an egg. Usually, ICSI is indicated for male infertility of the secretory type, and is often combined with IVF. However, ICSI, which aims to increase by 200-400, allows you to assess the condition of sperm only superficially, and in particularly severe sperm pathologies, this is not enough. Therefore, in 1999, scientists proposed a more innovative method of IMSI (IMSI). It provides for a 6600-fold increase and allows you to assess the smallest deviations in the structure of male germ cells.

Preimplantation genetic diagnosis (PGD) and comparative genomic hybridization (CGH) are used to assess the risk of genetic abnormalities in the embryo. Both methods involve examining the embryo for pathological changes in the embryo's genome before it is transferred to the woman's uterus. These methods not only increase the effectiveness of in vitro fertilization and are indicated in case of genetic disorders in the genotype of the couple, but also reduce the risk of self-abortion and the birth of children with genetic abnormalities.

The IRIDOMED Medical Center has developed several effective programs that in one way or another increase the effectiveness of infertility treatment while minimizing the couple's financial risks. The choice of treatment method depends on the cause of infertility, the duration of infertility, and the age of the couple.

Methods of infertility treatment
More than 30 years have passed since the first child was conceived using in vitro fertilization (IVF). Over these three decades, medicine has made a real breakthrough in the development of assisted reproductive technologies (ART). Since 1978, the year of birth of Louise Brown, the first child born after IVF, more than 2 million children have been born worldwide thanks to revolutionary reproductive technologies. Today, ART helps to conceive and give birth to healthy children even in the most difficult cases of infertility. At the same time, the risks to patients' health have been significantly reduced, and the effectiveness of infertility treatment has been increased.

So what is ART? Assisted reproductive technologies are methods of overcoming infertility, in which either some or all stages of conception and early development of embryos are carried out outside the woman's body.

We believe that regulating the licensing of reproductive medicine clinics is extremely important and necessary for proper state control over the legality of their activities. Thus, the draft law No. 6475-1 proposes to introduce separate licensing for medical practice, which includes the use of assisted reproductive technologies through surrogacy, accompanied by the addition of the relevant paragraph 15-1 to part one of Article 7 of the Law of Ukraine "On Licensing of Economic Activities".

Instead, the draft law No. 6475-2 does not provide for any requirements for obtaining separate licensing for such institutions. In contrast, the draft law focuses on the prohibition of economic activity in the field of assisted reproductive technologies by intermediaries (agencies).

It is worth noting that the legislator does not define the concept of "intermediary (agency)" in the context of this Law, and therefore the consequences of such a provision may be unpredictable. This is due to the fact that intermediary agencies may have a "shadow character" in the market for the provision of services in the field of assisted reproductive technologies, which does not protect the rights and legitimate interests of persons for whom the assistance of special agencies may be extremely important.

This may facilitate the activities of a number of intermediary firms whose main intention is to make a profit rather than to ensure the rights of the parties to the agreement on the provision of services in the field of assisted reproductive technologies.

We believe that restricting the possibility of financial gain from intermediary activities will help prevent the transformation of the use of assisted reproductive technologies into commercial entrepreneurship.

In addition, state control over organizations that provide intermediary services in the field of assisted reproductive technologies may also be considered acceptable.

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February 9, 2023
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