Infertility affects almost every 6^th to 10^th couple worldwide. It is estimated that there could be over 70 million infertile couples across the globe. To help infertile couples assisted reproductive technologies have been developed. Already more than 7 million babies have been born with the help of in vitro fertilization procedures.

Infertility is defined as the failure to achieve a clinical pregnancy after at least 12 months of regular unprotected sexual intercourse. As infertility is a very personal and delicate matter it is difficult to estimate how many couples exactly suffer from this problem, but it has been estimated to affect between 8 and 12% of reproductive-aged couples worldwide (1). The causes of the infertility can be very different. Approximately 20-30% of couple`s infertility cases are explained by male problems, 20-35% by female problems, and 25-40% of infertility cases are caused by the problems in both partners. In 10-20% of the cases, the cause of infertility remains unexplained (2). Numerous factors from both female and male side have been associated with the couples’ infertility, including ovulation defects, spermatogenic failure, parental age, endometrial dysfunction, obesity, and infections, in addition to specific genetic problems (3).

Assisted reproductive technologies (ART), especially in vitro fertilization (IVF), provide solutions to overcome infertility. The first report of establishing full-term pregnancy using in vitro fertilization (IVF), embryo culture and transfer happened in 1978 and is still the most striking and inspiring landmark in development of assisted reproductive technologies (ART) (4). Today the estimated number of IVF children born worldwide has already crossed seven million. According to Estonian Birth Register 355 children were born as a result of IVF on 2014, which makes 2.6 % of all births (5).

The general success rate of IVF procedures has remained around 30% for the past nearly 40 years. At Nova Vita clinic 55.5% of women under 34 years (included) achieved clinical pregnancy from June to December 2016. IVF was originally developed to help women who suffered from infertility due to damaged fallopian tubes. During the in vitro fertilization procedure, the egg and sperm are fertilized in laboratory conditions and the development of embryos monitored 2-6 days. Thereafter one or two (seldom three) good quality embryos are transferred to the uterus.

The first IVF child in Estonia was born in 1995 the procedure was led by Dr Andrei Sõritsa in Tartu. Nova Vita clinic was established on 1995 and first children born on 1996.

The microinjection of a single sperm (intracytoplasmic sperm injection, ICSI) revolutionized the treatment of male infertility (6, 7). The treatment involves injecting a single sperm directly into an egg. ICSI is an appropriate treatment for couples suffering from infertility due to the reduced quality of the man’s sperm cells. Reduced quality may refer to low sperm count or poor motility. If the ejaculate contains no sperm, an egg can be fertilized also with sperm retrieved from the epididymis, testicle or deferent duct. Pregnancy success rates from ICSI per treatment cycle are similar to IVF rates. The first child fertilized using ICSI technique was born in Baltic States with the help of Nova Vita Clinic on 1997.

Frozen embryo transfer (FET) enables to use all good quality embryos achieved after one ovarian stimulation treatment cycle and egg retrieval. In Estonia embryos can be stored in deep freeze for 7 years and they can be thawed when the parents want a second or third child. This means that the same family can have children who were conceived on the same day but born in different years. FET results have shown increasing tendency at Nova Vita and resulted in 31,5% clinical pregnancies on second half of the 2016 year which is similar to the results of fresh embryo transfer. The first successful FET in Estonia was done at Nova Vita Clinic and the child was born on 1997.

Advances in laboratory technology also play an important part in the improved treatment results. The fertility treatment sector is continuously progressing thanks to new technology and laboratory innovations. Nova Vita laboratory has continuously participated in research projects of Competence Centre on Health Technologies since 2009. Our aim is to help to understand the causes of infertility and develop new methods for treating both male and female infertility.

Using donated eggs is a good treatment method for women whose ovaries have ceased to function at a young age, or whose ovaries’ ability to produce eggs that can be fertilized is reduced. Also, in some cases, where both partners have poor quality gametes both donated sperm and eggs can be used. Nova Vita has own egg and sperm bank.

The health of children born through fertility treatments has also been monitored, and the treatments have not been found to increase their likelihood of illnesses or birth defects. In 80-85% of cases, modern fertility treatments can provide help for childless couples. There are more than 2100 children born with the help of Nova Vita Clinic.

Literature

1. Ombelet, W., Cooke, I., Dyer, S., Serour, G., and Devroey, P. (2008). Infertility and the provision of infertility medical services in developing countries. Hum Reprod Update 14, 605-621.
2. ESHRE ”ART fact sheet 2014”: https://www.eshre.eu/guidelines-and-legal/artfact-sheet.aspx
3. Venkatesh, T., Suresh, P.S., and Tsutsumi, R. (2014). New insights into the genetic basis of infertility. Appl Clin Genet 7, 235-243.
4. Steptoe, P.C., and Edwards, R.G. (1978). Birth after the reimplantation of a human embryo. Lancet 2, 366.
5. Report of National Institute for Health Development 201
6. Palermo, G., Devroey, P., Joris, H., van Steirteghem, A. C. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet 1992; 340: 17-8.
7. Hovatta, O., Reima, I., Lähteenmäki, A. Siittiön mikroinjektio munasoluun (Microinjection of Sperm into the Egg). Duodecim 1995; 111: 1542-5.

Keywords

IVF = In vitro fertilization is a treatment where a woman’s egg is fertilized with a man’s sperm outside the body. The fertilized eggs are grown into embryos, after which normally one or two embryos are transferred to the womb. Successful treatment requires an egg that can be fertilized, the availability of sperm and a womb that is able to support pregnancy.

ICSI = Intracytoplasmic sperm injection is a fertility treatment that involves injecting a single sperm directly into an egg, after which the treatment progresses similarly to IVF treatments.

FET = frozen embryo transfer. Good-quality embryos achieved through in vitro fertilization can be frozen and transferred to the womb later. This method enables several embryo transfers, thus increasing the likelihood of success.

IUI = intrauterine insemination refers to artificial insemination inside the womb and involves injecting sperm into the womb.

Clinical pregnancy = A pregnancy diagnosed by clinical signs; for example, a gestational sac observed with an ultrasound scan, or signs of pregnancy (e.g. an embryo, fetus, gestational sac or placenta) observed during a curettage.

IVF clinics in Estonia- Nova Vita, Tallinn East-Central Hospital, Tallinn West-Central Hospital, Hospital of University of Tartu, Elite, Fertility Clinic Nordic.