25 years of RTD (reproductive technology development)

The interview with the Honored Doctor of Ukraine, the Head of the clinical department of the ICSI Clinic: Reproductive Health Clinic, Aleksandr Darii.

Hello, Aleksandr Semenovich! Tell us please, how did you come to the field of reproductive medicine?

Hello! When I worked as the head of a women’s consultation clinic, I was not satisfied with the level of medicine and the technical equipment that was presented in the early ’90s. So, when the opportunity to move to a completely different level of technology and engage in programs of artificial insemination appeared, I immediately changed the post of head of the female consultation clinic to the ordinary work of the doctor in a clinic of human reproduction.

Was it the ICSI Clinic?

No, it was a clinic of a very famous person, my teacher Fedor Vlasovich Dakhno, who showed me the way to reproductive medicine. And then, after 5 years of working with him, my team and I realized that we can do something more powerful. And so, twenty–one years ago, the ICSI clinic was founded.

Has the problem, you have been working on, changed for the last 20 years?

We meet couples who have difficulties with the onset of pregnancy. Then and now our task is to achieve the birth of a child for the couple. Another thing is, that over these 20 years, technology has changed, the success of programs has grown significantly. What earlier was thought to be fantastic and very hard to resolve, is achieved quite simply now. So, of course, the progress was tremendous in this area. And we were at the origin of this progress.

What is the percentage of cases of male and female infertility?

In the end, everything is divided into approximately three equal parts. The first part is female infertility, the second part is male, and the third part is when both partners have issues.

Who usually comes and brings his couple to a fertility specialist men or women?

It depends on who’s in charge of the family. (laughs)

Usually a man, right?

You know, in fact, far from it. In my opinion, in recent times, this question concerned more women than men. And I would even say that it is about 70 percent of women and 30 — men.

Is the Ukrainian reality still the same now?

Yes. For example, a clear understanding of this, let’s say, the leading role of women or men gives me the following fact: look who mostly attends the Orthodox churches! More often it is — women.

Yes.

And who goes to synagogue? Who goes to the mosque?

Men?

Mostly men. Here is the answer: in such societies the decisions usually make men, and in ours — women. And, despite the fact that we call our society patriarchal, according to my observations, a woman has a pretty loaded word in the family. And this is deserved since women are “burdened with” more family issues than a man. These are my observations.

When is the moment when the couple still decides to go to the doctor and understands that something is wrong?

Often this is even an initiative of future grandparents who want grandchildren, see that the couple has been living together for quite a long time, and there are no children. And they find it strange. Especially if these are grandparents who provide serious assistance to their children.

Sometimes this is a sober assessment on the part of the spouses themselves, the understanding that if you can’t get pregnant for six months or a year, then it’s time to sort it out. It happens that couples come in the second marriage, in whom the birth of the child did not work out even in the first, and frankly say that there were problems and we need to be examined.

When can we expect a positive outcome of the treatment?

The statement “nothing can be done” is not about modern reproductive medicine. Nowadays, everything has moved so far forward, such a wide range of different options for help has appeared that it’s impossible not to help. 

What is the most effective way to combat infertility?

I consider in vitro fertilization with ICSI as the most effective way — sperm injection into the cytoplasm of the egg. This technique allows you to select the best and the highest quality sperm and enter it directly into the selected egg.

We evaluate the external data of the egg and sperm and select the highest quality samples, thereby repeatedly increasing the chances of fertilization. Then we monitor the development of the embryos in the laboratory for several days. With their normal development, we transfer the embryos to the uterus.

And, by the way, our clinic — ICSI Clinic, is named after this technique, which was first perfected and implemented by our specialists in Ukraine.

Please tell us about your innovative method of treating male infertility in situations where spermatozoids are absent in sperm?

We developed this technique on the basis of our clinic. Our doctors, urologists, and our chief embryologist, Miroslav Ivanovich Kononenko, deal with it. On a special Japanese machine, like a blacksmith, he makes unique glass tubes that are 20 times thinner than a human hair and can only be seen under a microscope. Miroslav Ivanovich has developed this technique (TESA), which allows, directly, from the male testicle, to take very little material and find single spermatozoa for subsequent fertilization.

What other ways are there to combat non–pregnancy?

Every time a married couple comes to us, we evaluate the health status of both spouses. There are five reasons why pregnancy may not occur. It is these factors that are the main. The first thing is to find out if there are problems with sperm or not. The second thing that should be done is to find problems with the uterus if there are any. The third thing that we should know is if there are problems with ovulation. Fourth, the not less important thing is the condition of the fallopian tubes, (patency and functionality). And the last, the fifth factor is the condition around the fallopian tubes: if is there an adhesion process, endometriosis, that is, something that prevents the egg from meeting the sperm.

Only by analyzing all these five factors, we understand what the reason is and what technological approach this reason can be eliminated or circumvented with. And, if such an opportunity is present, we will definitely use it and prescribe treatment. We are not fixated on the IVF option, in any case! If there is any chance to achieve pregnancy naturally or with minimal reproductive care, then we will do our best for this! 

What other features make your clinic stand out?

Another feature I would point out is that we have great experience of working with patients of older reproductive age. We help women of this age category to give birth to their own children without the involvement of donor eggs.

What is the oldest age of a woman who has become a mother with your help?

Forty–eight years old. But, more recently, a woman delivered a baby at 45. Pregnancy has occurred after the first program on their own oocytes.

What do you do to control the development and birth of a healthy baby?

In cases when parents of older reproductive age participate in the program, as well as in a number of other cases, in order to avoid the birth of an unhealthy child, we do a chorionic villus biopsy at 9–12 weeks of pregnancy. Doctors do not enter the fetal membrane of the fetus but work on its periphery. In the process, we pinch off part of the “root system” (chorionic villi), which the fetus attaches to the uterus, analyze and get the result on the same day, approximately in a few hours. Thus, a man gets information about the sex of the child and whether he is healthy in the evening of the same day. It is very easy and simple to determine the chromosome set of the fetus and find out if it has pathology in the early stages of pregnancy.

Alexander Semenovich, what would you like to wish your patients?

It is very important to understand what you really want. And after it becomes your true desire and your life–important dream — go straight forward to victory, ignoring the fact that there can be difficulties sometimes. They are temporary, but the result will definitely be positive!