Circular 12/2012/tt-Byt: Issued Technical Process Of Artificial Insemination And In Vitro

Original Language Title: Thông tư 12/2012/TT-BYT: Ban hành Quy trình kỹ thuật thụ tinh nhân tạo và trong ống nghiệm

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MINISTRY OF HEALTH
Number: 12 /2012/TT-BYT
THE SOCIALIST REPUBLIC OF VIETNAM.
Independence-Freedom-Happiness
Hanoi, July 5, 2012

IT ' S SMART

B an action Q Artificial insemination techniques And in vitro fertilization.

____________________________

Base of Decree One. 88 /2007/NĐ-CP December 21, 2007 by Ch I'm Functional, mission, rule. Okay. Limit and muscle All A socket function of the Ministry of Health;

Base of Protocol 12 /2003/ND-CP February 12, 2003 by Ch I'm I ' m going to cover you with the scientific method;

Your trial. Okay. The Secretary of the Health for the Health of the Children-Children of Health;

Minister of Medicine What? issue artificial insemination and passive insemination. i In vitro as follows:

M One.

GENERAL REGULATION

What? 1. Ph Yes. Micro-tuning

This information provides for the process of discovery, diagnosis, and artificial insemination techniques (pumping sperm into the uterus), fertilization in vitro fertilization and sperm retention, ovules, storage of the embryo, storage of the testes.

Go. 2. Explain Hold.

1. Pregnancy is the product of the fertilization process which is calculated starting in week 09 after fertilization until birth or when a miscarriage.

2. Fetal birth is the case with βhCG in the serum ( > 25 đv/L) or in urine with the non-use of hCG support.

3. Pregnancy l Negative. Oh, yeah. p ultrasound.

M Two.

EXAMINATION PROCEDURE, CH Move! INFERNO GUESS

What? 3. Explore and inferno exploration tests for married couples.

1. Principle: ask sick and visit parallel to both v. Your husband

2. To the wife:

a) Clinical examination:

- A full body.

- Internal examination;

- Medical exam, nanny.

b) Tests:

- A uterine scan, a supply of taps.

- The internal test works at the beginning of the menstrus cycle to evaluate the reserve of the ovaries (day 2-day 4): Estridiol (E2), FSH, LH and AMH (on any day of the period of the period) quantized Progesterone into the royal phase;

- Ultrasound: detection of abnormal uterine uterus and ovaries, count of first-cycle secondary follicles (2-day 4);

- Testing blood formula, blood biochemistry;

- Test of hepatitis B; syphilis, TB, HIV (mindful of consultation before the current prescribed trial of HIV/AIDS);

- Chlamydia test;

- Other special tests (depending on the individual): Cytomegalo virus, Anti-phosphoro lipid, breast imaging, cervical vaginal tissue, genetic testing.

3. To the husband:

a) Clinical examination:

- A full body.

- Internal examination;

- Explore the genitals;

b) Tests:

- Hepatitis B, syphilis, TB, HIV ( Save Counseling prior to the current regulation of HIV/AIDS.

- Test analysis of the World Health Organization.

What? 4. Discover and inferno probe tests for single women.

Single women make visits and tests like Clause 2 of these. For the donor sperm donor to the single, perform the test as a point b 3 Article 3 This message.

M Three.

ARTIFICIAL INSEMINATION TECHNIQUES

What? 5. Consulting case unborn inferno method artificial insemination

1. Request:

a) Advisory cadres are specialist doctors, students or nursing students with general knowledge of inferno, consulting skills, understanding the needs of the sick, understanding policy, law on childbirth according to the scientific method and related issues;

b) There is a private, discreet, private, photo-equipped, photo-assisted biking.

2. Consulting Content:

a) Explaining the treatment process for spouses includes visiting visits, doing tests, using an ovarian stimulative (if any), tracking during the stimulation of the ovaries, which handle sperm samples;

b) Anticipating the timing of sperm pumping into the uterus, the process of using sperm injection techniques into the uterine chamber;

c) Royal phase support after sperm pump infection in the uterus, following the injection of sperm into the uterus, the way to monitor if it is pregnant;

d) The success rate of the method, the development of children;

The ear can be met;

e) The cost of treatment.

3. For the application of a sperm sample: perform the prescribed consultation content at Clause 2 This.

What? 6. Process purification techniques for b Uh ... Sperm on the uterus.

1. Sperm: purification of sperm is the purpose of removing the dead sperm and the relative crystals in order to obtain a large sample of healthy sperm to pump into the uterus or fertilization of the vitro.

2. Specify:

a) The specified cases of injection of sperm into the uterine chamber;

b) Purization of sperm for the fertilization cases in vitro fertilization.

3. Prepare:

a) Preparation of the husband: sexual abstination of sexual relations between the ages of 02 and 07 days;

b) Prepare the tools: centrifugworks, microscopes with glass 10 And 40, the 10, the operation cabinet, the fridge to sample the semen.

c) Preparation of consumable supplies: pointed bottom tube, injection pump, pipete, blue glass, blue-glass, sample-sampling jar named wife, lips r The filter and the purification of the sperm.

4. Process:

a) Sample:

- The husband abidets sex between the ages of 02 and 07 days;

- Need to be prepared in front of the instruments used to process the sperm sample, each one with a separate set of names named wife and husband or numbering the number;

- Take the semen with the masturbation method, wash your hands and clean genitals before taking the sample.

b) Filter sperm filter:

- Fuck! Okay. The semen is fully solved in a 37-degree refrigerator. - or room temperature, 30 minutes average;

- Evaluation of the chart-based index: volume, quarantine time, pH, sperm density count;

- Selection of filtration method (scale or up scale);

- Remove the filtration section around 0.3-0.5 ml to pump sperm into the uterine chamber;

- Reassess the density, post-filtered sperm sample.

What? 7. Technical Process b Uh ... Sperm on the uterus.

1. Diamond: The sperm pump into the uterus is the technique in which the catheter is carried through the cervical tube that aims to pump directly the sperm sample directly into the uterus. The purpose of the sperm pump method into the uterus is to increase the c rate Boob Pregnant for married couples.

2. Specify:

a) Apply to the inferno couple for one of the following causes:

- Inferno due to the weak, abnormal sperm husband but still qualified for treatment by injection of sperm into the uterine chamber;

- Inferno due to the disturbance.

- Inferno is unknown.

- Inferno of endometriosis;

- Inferno due to the cervical factor;

- Unborn inferno, the need for sperm samples to perform sperm injection techniques into the wife's uterus;

- The cases keep sperm.

b) Applying for single-life women has the need to give birth by this method.

3. Condition: there must be at least one supply of a supply.

4. Prepare:

a) Preparing a single wife/woman who lives alone has a need to give birth: it is possible to stimulate the ovaries in the spouse/woman who lives alone has a need to give birth and monitor the development of the ovules until the release of the ovum or in the natural menagulation cycle. The ovaries, the husband abstain from sex with his wife between the ages of 2 and 07 days to sample the semen sample, the semen sample is filtered before the pump;

b) Prepare a tool for filtering the semen sample: as a point b 3 Article 6 This message. In addition, the need to prepare: the duck beak, 02 clamp of the sepsis, cup of physiological salt water for vaginal cleaning and cervix;

c) Preparation of consumable supplies: injection of 1 ml injection, catheter uses sperm injection into the uterus, antlers used for vaginal cleaning, cervix, and physiological saline.

5. Process (in case The wife or woman who lives alone has the need to give birth by this method):

a) Pump time: once in 36 hours or twice at 24 hours and 48 hours after hCG injection:

b) The woman is in the gyroworld, the world. What? Sterling in the abdomen and two thighs;

c) Wiping the pussy with a physiological salt water.

d) Place the beak, expose the cervore.

) Clean up the vagina and the cervix with the salt water, wiping it in dry gauze;

e) The sperm sample filtered into the injection pump was attached to the catheter;

g) The light of the catheter, as he passed through the hole in the neck of the uterus, stopped;

h) Pump from the sperm from the sperm to the uterus.

i) Remove the catheter from the womb chamber;

l) Remove the duck beak and let the patient lie down for 30 minutes;

l ) Imperial support: after the sperm injection into the progesteron supply chamber supports the royal phase;

m) A pregnancy assessment: a 14-day pregnancy test after sperm injection into the uterus.

M Four.

THE PROCESS OF FERTILIZATION IN VITRO FERTILIZATION.

What? 8. Consulting for a passive married couple ti In vitro.

1. Request: In accordance with Regulation 1 Article 5 This message.

2. Contents:

a) Explaining the treatment process for spouses including clinical visits, testing, regimen stimulation regimen of ovaries, medication time, tracking in the process of taking drugs;

b) The expected time to poke the ovules, explains the need for sperm at this time;

c) Embryo transfer time;

d) Body phase support, post-transfer tracking;

The success rate of the method of fertilization in vitro;

e) The accidents can happen;

g) The cost of treatment.

What? 9. Consulting special cases

1. Counseling for cases of fertilization in the test tube:

a) Fertilization cases to The wasp plumbing is the schools. Older people, who are sick with their ovaries, respond to poor ovaries, abnormal genetic abnormones.

b) In addition to the information content that needs to advise the couple prescribed at the 2 Article 8 of this Information, further consultation is required:

- There must be a written commitment of both the donor and the carpels;

- While the donor ovaries use the ovaries to stimulate the ovaries, the recipient needs to use the preparation of the uterus;

- The success rate depends on the age of the donor.

- The inheritance of the child is born.

- The ear of the ovule.

2. Counseling of the IVs in vitro-controlled vitrium:

a) The husband will be given a testor or a chimpanzer to determine whether the sperm or not, if any, can proceed as fertilization in vitro with the sperm of the husband;

b) Fake i likes the process of collecting sperm by the trick (the biopsy from the crests or the testis), performing a fertilization in vitro fertilization using the cytoplasm (ICSI).

c) Consulting with success rates, expenses;

d) The accident counseling may occur;

In case of a cell The sperm may be able to use the donor's sperm sample.

e) The genetic nature of the child was born in the school. You have to apply for sperm.

3. Consulting cases of fertilization in the embryo application tube: for married couples who wish to apply for embryos, executed by regulation at Clause 1 This.

What? 10. The fertilization process in vitro fertilization (IVF)

1. Diamond: In vitro fertilization (IVF) is a reproductive technique in which sperm fertilization with ovules in the petri dish. The resulting embryo is moved into the uterus to nest or will be frozen for later use.

2. Specify:

a) Unborn cases due to the clots of the shower.

b) Inferno of endometriosis;

c) Inferno due to the unusual birth of the ovule (not to release the ovules, the poor ovules, the cyst ovaries, the elderly and the elderly);

d) Inferno of the abnormal semen.

Unborn unknown causes;

e) Applied the sperm pump to the uterus but no results.

3. Anti-designation: Inferno Cases due to the cause of the chamber t Yeah. Bow.

4. Prepare:

a) Prepare the sick person (see, advise, stimulate the ovaries);

b) Prepare the sperm sample (see sperm sample filter filter);

c) Preparing the tools: the ultrasound machine has a vaginal probe, the operation cabinet, the CO closet. 2 ()

d) Preparation of attrition: needles smoking ovules, transplants, ovules, pipettes, types of environments.

5. Process:

a) Visiting the couple;

b) Do the necessary basic tests;

c) Evaluation of the reserve of the ovaries (internal testing, first-class follicle);

d) Stimulate the ovaries (sketchline of the agonist, the antagonist regimen, long regimen);

-Track of the prophecy. Okay. n cysts with ultrasound and the volume of hormon estradiol, progesteron, LH;

e) The HCG injection helps mature the ovules when qualified;

g) Poke the carpel through the vaginal road under the ultrasound of the ultrasound after a hCG injection of 34 to 36 hours;

h) The use of progesteron supports the royal phase immediately following the smoking.

i) At the same time sampling sperm samples, preparing sperm samples by filtration method;

l) For fertilization of fertilization with ovules in classical vitro fertilization (IVF) or by means of deforestation p The cytoplasm (ICSI).

l ) Cultured in a 37 ° implant. - and 5% C O. 2 or 6% CO 2 depending on the type of environment required;

m) Check out the fertilization after 16 to 18 hours;

n) Continue to feed the embryo in the implant until 2, day 3 or day 5;

o) embryo transfer day 2, day 3 or embryo transfer date 5 (embryos embryo);

p) Continue to use progesterons supporting the royal phase;

q) A 14-day βhCG test after embryo transfer or 12 days after the blastocyte embryo transfer, having a biological pregnancy when βhCG > Twenty-five.

r) The vaginal ultrasound after 28 days of embryo transfer if pregnant.

What? 11. The sperm purification process for fertilization in vitro

1. It is an order of Article 6 of this article.

2. Designation: The cases need to filter sperm samples to make fertilization in vitro.

3. Prepare:

a) Preparation of the husband: husband abstintion of sex from 02 to 07 days, taking the sperm sample of the day to tease the ovule;

b) Preparation of equipment: microscopes, glasses, refrigerators, operations cabinets, Count.

c) Preparation of consumable supplies: sharp bottoms, glass, filter environments, pipettes, injection pumps.

4. Process:

a) Take a sample of the semen: in accordance with the regulation at Point 4 Article 6 This message.

b) Filter sperm filter:

- Fuck! Okay. It ' s a complete glass of glass in a 30-minute refrigerator, recording a complete quarantine period.

- Take a few semen that evaluate the indicators: sperm density, pH measurement, sperm stain according to the WHO recommendation to evaluate the abnormal rate, the survival rate; and

- Filter the sperm with a "concentration and swim scale" method;

- The residue is used for fertilization in vitro fertilization (for sperm culture, or used for ICSI).

What? 12. The process of smoking the ovules is fertilization in vitro

1. The urination is an ovule technique that is taken out through the vaginal pathway by poking under the ultrasound guide, then giving fertilization to the sperm in the implant.

2. Designation: all after detonation Like The ovaries are eligible for the ovule.

3. Prepare:

a) Prepare the wife/woman alone: excited the ovaries until the capsule is grown.

b) Prepare the instrument: the ultrasound machine has a vaginal probe, a microscopic microscope, a implant;

c) Preparation of consumable supplies: vaginal cleaning water, tuberous antlers, cups, duplicate clams, duck beak, gloves, vitro, needles, pumps (or machine suction), carrot plate, disc 2 l The four-well disc, the environment of sorts.

4. Process:

a) Point of attraction: after a hCG injection of 34 to 36 hours;

b) Decreased pain by self-induced anesthesia or in-place anesthesia, can be concluded p in the coma;

c) Woman/woman Stain. They eat themselves before poking the ovules, and go to the ground before they do the trick.

d) Cleaning up the vulgate, the vagina, the cervix with the brine of physiological salt;

And in the bowels of the sick and the belly of the sick;

The injection of injection, the needle and the ovule. Yes. The environment is used for smoking before poking.

g) Start teasing the ovules under the direction of the ultrasound, which in turn teasing each of the ovules one and every one side of the ovaries, the entire process. Oh. The youngest needs to be gentle, in the light of light.

h) Chuy Okay. You can use the capsule to get into the lab. Okay. searching and picking up ovules:

i) Enlarge the injection and the needle to avoid the ovules in the needle and pump.

5. Following the following teasing:

a) A single woman who lives alone in the back room is a great deal.

b) Pulse, blood pressure, breathing rhythm. Oh, abdominal pain, vaginal bleeding from 01 to 2 hours after poking;

c) Guide your wife/woman who lives alone after poking: taking drugs, dating the embryo transfer date.

6. Accident:

a) Bleeding in due to poking in large blood vessels in the abdomen, due to the damage to the ovary;

b) Infection caused by an infection in the bowels, colon;

c) The blood of the bladder is caused by needles into the bladder.

What? 13. embryo transfer process

1. The embryo: embryo transfer is the technique in which one or more embryos are transferred into the recipient ' s uterus for the embryo to nest.

2. Designation: all cases of insemination in vitro fertilization when an embryo transfer will proceed to transfer the embryo on 2, 3 or 5 after poking the ovule.

3. Anti-designation: no anti-designation but can delay embryo transfer in some cases: egg-chamber process, unprepared cases of uterine mucosa.

4. Prepare:

a) Prepare the wife/woman to live single: use progesterone after poach or prepare to seal up with estrogen and progesterone if moving ph cell Frozen or begging for an embryo.

b) Preparation of vehicles, tools: ultrasound machines to transfer embryos under ultrasonic instructions, duck beak, duplicate clamp, cervical clamp, cervical nong (when necessary), water cups, microscopic microscope;

c) Preparation of consumerate supplies: vaginal cleaning gauze, cervical wipes, cervical cleaning environment, embryo transfer catheter, embryo transfer disc.

5. Process:

a) Embryo transfer point: day 2, day 3 or 5;

b) Prepare the embryo to be ready in the disk, which requires the name of the name, the number of files carefully;

c) A single woman who lives alone needs to give up the bladder to the bladder;

d) In the position of a master.

"Sanitation of Hygiene";

e) Open the beak, wipe out the cervix with an embryo transfer environment;

g) Gently thread the shell casing through the tube socket The uterus reached the waist of the uterus, just passing through the ultrasound through the belly.

h) Inform the embryonic tissue doctor that prepares to suck the embryo into the heart of the inside after having the outer shell casing through the arc of the uterus;

i) Gently thread the heart of the inside of the uterus into the uterus, the head of the catheter, about two centimeters from the bottom of the uterus.

l) gently put the embryo into the uterus, not transmusing five embryos;

l ) Gently draw the catheter out of the womb chamber;

m) Check out the cleaners, the remaining embryos.

n) Remove the platypus;

o) Men and women who lived alone lie at least 30 minutes before their departure;

p) Support the royal phase.

What? 14. The process of injection of sperm into the fetus Uh ... (ICSI)

1. Diamond: The injection of sperm into the cytoplasm is the micromanipulation of the injection directly into the cytoplasm to fertilization.

2. Specify:

a) Inferno cases due to unusually heavy semen semen (singular, weak, irregular);

b) Reverse ejacostar;

c) M There. The sperm from the crests, the testis.

d) The history of fertilization is poor at times of fertilization in the previous test.

) The growth cycles in vitro (IVM);

e) The cycles use the ovules after the decaying.

g) Older women (> 40).

3. Prepare:

a) Prepare the ovum and sperm.

b) Preparation of tooling: glasses and microprocessors, needles and needles, radiators, lockers;

c) Preparation of consumable supplies: the volume of ICSI, the environment, oil to cover above.

4. Process:

a) Prepare the sperm sample to make ICSI using a "concentration-up" or "concentration scale" method;

b) After poking, brew in the closet. All Between 01 and 03 hours before the execution of engineering;

c) Preparation of the ICSI.

d) Ch Only. Glasses and parts. differential. operation;

Let ' s separate the particle cells out of the ovule, incubate one hour.

e) Start the injection of sperm in the cytoplasm. ()

g) sleep The ovules have been injected with sperm in the 37 ° implant. - , 5% C O. 2 ()

h) Check the fertilization after 16 to 18 hours.

What? 15. Process Take it It ' s a trick.

1. The trick: taking the sperm by the trick is the technique of making sperm from the crests or testis to get sperm for fertilization with the ovules with a sperm injection technique into the cytoplasm.

2. Designation: inferno cases due to the absence of sperm due to congestion (Azoospermia), ejaculartic disorder.

3. Anti-designation: cases with no sperm after the biopsy biopsy.

4. Consulting: implementing provisions at paragraph 2 Article 9 of this.

5. Visit K They were

a) Ask for history.

b) A full body.

c) Explore the genitals: the testes of the testis, the crests, the testis.

6. Test:

a) The volume of sexual hormones.

b) Basic tests: blood, blood clots, hepatitis B, syphilis, TB, HIV.

7. Prepare:

a) Prepare the sick: examine the counsel of the husband;

b) Preparation of tooling: duplicate clams, larva gauze, septic solution, physiological salt water, cup of septic solution, centrifugworks, microscopes;

c) Preparation of consumable supplies: needles and injection pumps used to tease, environmental types used for filtering, petri dishes.

8. Process:

a) Anesthesia or anesthesia in place;

b) Wiping out the genital organs and surrounding areas with physiological salt water;

c) Fixed the crests (if poking the crests), or fixed the testes;

d) Poking up the crests or testis (which may have to be poking several times or more can get sperm samples);

Kill the poking, check if there's bleeding, clots.

e) Finding sperm in the sample of the pathology (for a sample that is easy to find from the crests is easier to find than the testes from the testis);

g) Filtering sperm from the sample to use the injection of sperm into the cytoplasm;

h) Post-procedure care guidance.

What? 16. The cold storage process

1. Sperm: sperm storage is the technique in which the sperm sample is frozen and stored in a cold preservation environment. When you need to be able to break up, you can use it.

2. Specify:

a) Cases of people with cancer before radiation therapy, Okay. avoiding the effects of sperm quality;

b) Pre-austerity cases Stain. The satellite, the case in case you want to have a child.

c) Cases of non-self-ejacrotic spinal cord injury can be able to obtain sperm by electrical stimulation then frozen to sperm samples;

d) Sperm samples from the crests, the testes can be frozen to avoid having to biopsy several times;

So, the preparation is for reproductive support, but the husband has to be gone.

e) Hard husband. All Sperm: sperm-refrigeration will be specified to avoid the case of the wife who has provoked the ovule, or has prepared the ovules without sperm for use;

g) The sperm donation cases will be frozen in the sperm bank to provide for the high school hours. p has a need for sperm.

3. Prepare:

a) Preparing the sick: taking samples of the sperm from the husband to the planet;

b) Preparation of tooling: sperm sample storage, storage; refrigerated machines (in case of machine-based temperature);

c) Preparation of consumable supplies: liquid nitrogen, environmental types.

4. Slow storage process:

a) Assessing the quality of the pre-frozen sperm by the World Health Organization standard;

b) Balanced with a cold preservation environment by giving semen into the back-control tube for a certain rate of cold storage (01 ml of semen mixed with 0.5-5). 1 lml, mixing (avoiding the bubbles), to stay at room temperature 12-15 minutes;

c) Packaging: packaging the preserved pipe, the name of the sick person, code and date of the cold storage;

d) Lower the temperature according to the program of the machine or lower the temperature according to the experience (lowering the temperature by hand);

Save in liquid nitrogen: after hypothermia, attach the tube to the aluminum foil and keep in the liquid nitrogen container.

What? 17. The process of decaying.

1. The sperm is a technique in which the frozen sperm sample and stored in the storage will be decaying, then filtered to use.

2. Specify:

a) Decaying sperm to pump sperm into the uterine chamber;

b) Decaying sperm for fertilization in vitro fertilization.

3. Prepare:

a) Prepare the sperm sample. Oh, -

b) Prepare the vehicle: a cup of 37 ° water. - , the instruments used to filter sperm samples (see sperm lashes filter);

c) Preparation of consumable supplies: the means of filtering the sperm sample.

4. Process:

a) Remove the sperm sample from the liquid nitrogen, so that in the room temperature of 01 to 03 seconds, the layers of the ice cover outside the storage.

b) Put the pipe into the 37 ° water. - in the ring from 10 to 20 minutes;

c) Assessing the amount of sperm after the decor by the standards of the World Health Organization;

d) M There. Post-decaying sperm tumor will be filtered to b Uh ... The sperm enters the uterine chamber (IUI) or as a fertilization in vitro.

What? 18. The modular refrigeration process is complete

1. The diamond: the frozen tissue is the technique in which the testes are biopsy and winter. Yes. , save in the l-preserved environment Yes. Yeah. When it is necessary to break down the sperm for use.

2. Designation: Inferno Cases with no sperm, the biopsy of a sperm-made sperm that is conducted in cold storage for the following times to avoid having to biopsy several times.

3. Prepare:

a) Preparation of the disease: discovery, counseling;

b) Prepare the instrument vehicle: duplicate clamp, cup of septic solution, machete, scissors, frozen machine, testable tissue duct, tissue storage;

c) Preparation of consumable supplies: petri disk, frozen environment, liquid nitrogen, and an infection.

4. Process:

a) Proceed to the exam. l examination and counseling for the same disease the case for sperm-based sperm;

b) Conduct the biopsy biopsy, put into a disk that contains the environment to wash it clean;

c) A small tear of the dedicated tweezers, which determines the presence of sperm, evaluate the mobility under the reverse microscope;

d) Separating each of the chimes in order to proceed frozen.

Small and mixed all the cold preservation into the tubes that have been separated, shaken, and put into the cold storage tube;

e) Fuck! Okay. the test tube at room temperature, then lowered the temperature according to the program;

g) Sample the sample in the jar of liquid silk and the preservation.

What? 19. The process of decaying

1. It is a complete technique in which a frozen chimpanzer and stored in storage will be frozen to separate the sperm.

2. Designation: Cold-tissue cold storage fields to obtain sperm as an ICSI.

3. Prepare:

a) Prepare the testes.

b) Prepare the instrument: the microscope.

c) Preparation of consummate supplies: the environment of sorts for filtration of sperm, petri dishes.

4. Process:

a) Remove the finished model tube from the liquid nitrogen jar, to stay at room temperature for the duration of 15 to 30 minutes;

b) Wash the chimpanzers with the washing environment;

c) For the sample sample of the petri dish containing the IVF environment, the tissue is torn down. Okay. searching for sperm;

d) Assessing the mobility of sperm;

The sperm culture is at 37 degrees. - , C O. 2 5% in the 24-hour period;

e) Reassess the mobility of sperm and use to make ICSI.

What? 20.

1. The cold storage is the technique in which the ovules are removed from the ovaries, frozen, and stored in a cold preservation environment. When the woman is ready to get pregnant, the ovules will be decaying, giving fertilization to the sperm by the ICSI method and transferring the embryo into the uterus.

2. Specify:

a) The pathology cases should be treated with ovarian-cutting surgery;

b) Schools p does not get the sperm sample after teasing the ovules;

3. Prepare:

a) Preparation of the disease: stimulation of ovaries, poking the ovules, separating the seed cell;

b) Prepare the instrument vehicle: the petri dish, the liquid nitrogen box, the ovules, the ovens, the microscope, the microscope.

c) Preparation of consumable supplies: pipet, injection pump, liquid nitrogen, the types of environment used in the clover.

4. Process:

Similar to embryonic refrigeration, there are many different types of refrigerated storage, but there is now a large hydrogenation method that has many advantages and most of the breeding support centers are currently applied.

The ovules should be stored in the water from 02 to 06 hours after poking and immediately after. i All right, separate the cells from the ovules. Evaluate the quality of the ovules, recording all the parameters prior to the process of being overcrowded. Depending on the specific environment, the specific steps of the process vary from the standard process.

a) Prepare:

- Environment t Waxing Solution, the Vigilant Solution, the Equilibrium Solution (Equilibrium Solution), at a temperature of 25 ° - -27. - ()

- The stock of the ovule has been named, the age of the sick, the day, the month, the cold year;

- The porous box contains liquid nitrogen;

- Evaluate the quality of the ovules in the east;

- Prepare the disk: small a drop of WS and 3 drops ES to the lid of the Petri disk. Drip VS on Petri.

b) Cold storage:

- Balance: use the pipet to put the ovules on the WS, then move the ovules from the drop of WS to the ES drop by using the pipet that merge the droplets, the average time is 3 minutes. Smoking the ovens from the drops on the last drop of ES, the ovules will open in about the original shape in the period of about 09 minutes, there is th Okay. Wait, wait, wait, wait, wait. What? The original.

- Hydrogenation: using pateur peteur from the environment ES to the environment VS, smoking down to wash up the ES solution, then use the pipet to the stock. It ' s embedded in the liquid nitrogen, putting the stored-down storage to achieve the fast cooling speed. Put a plastic pipe in the stock.

(Note: the time of action should be within 1 minutes and the maximum reduction of the environment when smoking the ovules).

What? 21.

1. The caricary is the technique in which the ovules are frozen and stored in storage are taken to decaying and give fertilization to the sperm by the ICSI method. It will be frozen to the east by the means of the cold.

2. Designation: h p has to be frozen to allow fertilization of the fertilization of the ovules after preparing the mucosa of the uterus for the recipient.

3. Prepare:

a) Preparing the sick: preparing the lining for the embryo recipient, the sperm sample to do ICSI after the disintegration of the ovules, the preparation of the ovules will be decaying;

b) Prepare the instrument: the microscope.

c) Preparation of consummate supplies: environmental types, petri dishes, pipets.

4. Process:

a) Prepare:

- Thawing Solution in the petri dish to enter the 37 ° implant. - At least 30 minutes.

- The disks contain the DS environment (Dilution Solution), the WS1 and WS2 environments, which names the sick to the frozen disk, the types of the environment on the tiles on the disk.

b) Decor:

- Check your name, file number, favour Hold, the name of the sick is on the store.

- The petri disk has a TS environment that was prepared for the floating glass, the storage of the ovules after it was removed from the liquid nitrogen that was embedded directly into the S environmental disc for 60 seconds;

- Suction on the pepet with a few TS environments and switch to the DS environment disk in 03 minutes;

- Continue to smoke to transfer the embryo to a WS 1 environment volume in 5 minutes;

- Switching to WS2 environment disk in 5 minutes;

- Eventually switching the ovules into a disk containing the cultured environment were prepared, evaluating the morphology and the quality of the ovules. It is possible to proceed as ICSI after 2 hours.

What? 22.

1. An embryo: the cold storage is the technique in which the embryo is frozen and stored in a cold preservation environment. When the woman is ready to get pregnant, the embryo is decaying and moved into the uterus.

2. Specify:

a) The cases have excess embryos after embryo transfer;

b) Cases of risk of an omelet attack or omelet attack;

c) The cases of the ovule are not prepared for the mucosa of the uterus.

d) Cases of uterine mucosa are not favorable.

3. Anti-designation: unconventional but bad quality embryos are usually non-populated because the degeneration rates after the large number of these embryos are usually high.

4. Prepare:

a) Preparing for cold embryos;

b) Prepare a tool: embryo storage, vp. Hold. Embryos, pipets, injections, microscopes,

c) Preparation of consumerate supplies: petri dishes, liquid nitrogen canisters, liquid nitrogen, types of environments used in the eastern embryo.

5. Process:

There are many different types of embryonic storage, but cold storage by hydrogenation has many advantages and currently most reproductive support centers apply this method.

Evaluate the quality of the embryo, recording all the parameters before the process of the cold storage.

a) Prepare:

- VS Hydrogenation Environment (Vitri to cations Solution), the Equilibrium Solution (Equilibration Solution) environment at room 25 ° - -Twenty-seven.

- Cryotop has been named, the age of the sick, the date, the month, the year of the embryo.

- The porous box contains liquid nitrogen;

- Assessing the quality of the embryo to the east;

- Prepare disk: 300 µ m l ES in the first cell of the four well, 300 µ m. l VS in the second cell.

b) Embryonic storage:

- Balance: use the embryo to suck the embryo from the cultured environment on the drop of the ES environment within 15 minutes, observed under the microscope to see if the embryo size returns as originally;

- Hydrogenation: using the pipet pasteur transfer the embryo from ES environment to the VS environment, smoking up to change the ph location cell i, then use the pipet pasteur to put the embryos in the stock and then suck b. Oh. The environment and the dip in the liquid nitrogen. This process performs within 30 seconds, a maximum of no more than 01 minutes.

What? 23. What? It's an embryo.

1. The lion: cryogenesis is the technique in which the embryo is frozen and stored in the storage area will be removed for deconation, then transfers into the recipient's uterus. The embryo is frozen in a way that will be decayed by that method.

2. Designation: h p transfer frozen embryo after the preparation of the uterine mucosa is eligible.

3. Prepare:

a) Preparing the sick: preparing the lining of the uterus for the embryo recipient;

b) Preparation of tooling: microscopes, implants;

c) Preparation of attrition: the petri dish, disc 4 well, pipet the types of environments that use to split the embryo.

4. Process:

a) Prepare:

- The TS (Thawing Solution) in the petri dish is stored in a 37 ° implant. - At least 30 minutes.

- The DS Environment (Diluen Solution) entered the first cell of the 4-well disc, the WS1 (Washing Solution) environment into the second cell and WS2 in the third cell, the person's name on the frozen disk, the environmental types on the plates on the disk.

b) Decor:

- Check the patient's name, file number, log date on the storage.

- Taking the Petri disk with a TS environment is prepared for floating lenses, embryo storage or ovules after taking out of nitrogen embedded directly into the TS 01 ph environment. A t;

- Convert the embryo to the 3-minute DS environment;

- Convert embryo to model i WS1 05 minutes;

- Convert the embryo to the WS2 environment;

- Convert the embryo to a culture environment disk I VF is prepared, set in C implants O. 2 , at 37 ° C, the quality of the embryo is to be evaluated.

c) Yes. Okay. transfer of the embryo from 2 to 03 hours after the breakup of the embryo or feed the embryo overnight and transfer the embryo the next day.

What? 24. The frozen embryo transfer process (FET)

1. Diamond: The frozen embryo transfer is the technique in which one or more of the frozen frozen embryo is transferred into the recipient ' s uterine chamber that has been prepared to seal the uterus.

2. Designation: cases with frozen embryos.

3. Anti-designation: no anti-designation, however it can destroy the embryo transfer cycle if the uterus seal is not well prepared.

4. Prepare:

a) Prepare the sick, prepare for the lining of the womb.

b) Preparation of vehicles, instruments and supplies of attriation: executed by regulation at Point b, c Article 4 Article 13 This message.

5. Process:

a) The internal test and some other tests need the men’ s cycle.

b) Ultrasound assessment of the uterus and two ovaries;

c) Prepare to seal the uterus with estrogen at the beginning of the cycle cycle;

d) Tracking the release to The seal of the uterus with ultrasound;

When eligible for transfer of the embryo will begin to use more progesteron from 48 to 72 hours before the embryo transfer;

e) Notify the ph doctor. cell Broken down. cell The next day.

g) Embryonic decays, depending on the anticoagological method, to choose the method of decaying.

h) Post-life embryo culture in the culture environment and the implant;

i) Assessing the development of the embryo, the pre-transfer of the embryo;

l) transfer the frozen embryo after 3 hours or the next day;

l ) Embryo transfer under ultrasonic instructions;

m) Continue to use the same dose estrogen and progesterone before embryo transfer;

n) 14-day βhCG quantitative after embryo transfer;

o) ultrasound 28 days after embryo transfer if pregnant is biochemical;

p) If there is a pregnancy, continue to use estrogen and progesterone for up to 12 weeks.

What? 25. Repository in into the ovule in vitro fertilization (IVM-Invitro Matulation)

1. Magic: adult ovulation in vitro fertilization is the technique in which the ovules are removed from the ovaries from early stage, then grown into the implant and for fertilization with sperm by injection of sperm into the cell. I mean, The embryo will be transferred to the recipient's uterus or cold storage.

2. Designation: cases of people who are at risk of ovarian attack (multifolic ovaries, egg-attack history) c And n mature to avoid oversize of the ovaries.

3. Prepare: same as in school hours p fertilization in vitro but different from a number of points:

a) The needle is an IVM.

b) The environment to raise the ovule;

c) The filter grid to filter the ovules.

4. Process:

a) The patients were added FSH;

b) Monitoring the development of the ovary;

c) Use hCG ()

d) I'm gonna have to do it.

Mature in vitro to the IVM environment for an average of 24 to 26 hours;

e) Execute Oh. The cells are removed from the ovule.

g) The sperm is fertilized.

) sleep It ' s in the implant after fertilization.

i) Check the fertilization after 16 to 18 hours;

l) embryo transfer day 2, day 3 or day 5;

l ) The βhCG volume of 14 after embryo transfer;

m) ultrasound on the 28th after embryo transfer if there is a biochemical pregnancy.

What? 26. The fertilization process in the applied test tube

1. Diamond: The fertilization of the ovule is the technique in which the sperm gives the fertilization to the ovules of the donor ovules in the implant. The embryo will be transferred to the recipient ' s uterus chamber that has been prepared to seal the uterus for nest.

2. Specify:

a) For the recipient of the ovary:

- The incubation of the ovaries;

- The quality of the poor.

- The ovaries respond poorly (FSSH concentration of growth cycles, secondary follicles);

- Older women (over 40 years old);

- Abnormal genetics.

b) For the donor:

- Degree i By statute;

- There was at least one healthy child;

- If you are raising a child, you must at least 12 months without breastfeeding.

- No chronic pathology, d. i Yeah,

3. Counseling for the couple: executed by regulation at 1 Article 9 of this.

4. Preparation: executed by regulation at paragraph 4 Article 10 This message but needs to prepare the donor and prepare to seal the uterus for the recipient.

5. Process:

a) Examine the body, the gyroology, the donor test;

b) Signed a pledge between the couple who donate the ovule and receive the ovule;

c) Adjust the cycle between the donor and the receiving of the ovule;

d) The stimulation of the ovary donor ovaries and the standard of the uterus to be sealed with estrogen;

Tracking the development of the ovules of the donor ovules with the ultrasound and the volume of hormon;

e) Tracking the seal of the uterus with ultrasound;

g) When the capsule grows to mature, the hCG injection is given to the donor.

h) Smoking the donor ovules, and using progesteron for the recipient;

i) Remove the sperm from the recipient's sperm;

l) For the sperm husband fertilization of a donor ovule with a fertilization method in classical vitro fertilization (IVF) or by using a sperm injection into the cytoplasm (ICSI) depending on the quality of the sperm;

l) Check the fertilization after 16 to 18. Now ()

m) embryo transfer day 2, day 3 or 5 for the recipient (wife);

n) Use estrogen and progesteron after embryo transfer;

o) The amount of βhCG following a 14-day embryo transfer;

p) Supernegative after a 28-day embryo transfer if pregnant pregnancies;

q) Continue to use estrogen and progesteron to 12 weeks.

What? 27. The fertilization process in the sperm application tube

1. Magic: fertilization in a sperm cell is a technique in which the sperm donor sperm fertilization with the recipient's ovules in the implant. The embryo will be transferred to the uterus to nest or will be frozen for later use.

2. Specify:

a) The husband has no sperm;

b) Abnormal genetics.

3. Sperm donor condition:

a) No infectious diseases.

b) No mental illness, genetic disease;

c) M There. Normal sperm according to WHO standards.

4. Counseling for the couple applying for sperm: follow the rules Shit. This is at Section 9 This News.

5. Preparation: prepare to be the same as in vitro fertilization but the sperm sample in this case will be taken from the donor.

6. Process:

a) Examine and examine sperm donors;

b) M There. The semen has been removed from the front to the planet.

c) Stimulate the ovaries according to an aphrodized ovaries regimen;

d) Monitoring of the development of the ovules, the lining of the uterus with ultrasound and the volume of hormon;

When the capsule grows to adulthood, injections hCG;

e) Smoking the ovule, using progesteron to support the prince;

g) Filter the donor sperm sample;

h) For sperm donor sperm with ovules using a fertilization method in the classical vitro (IVF) or by using a sperm injection polymerogen (ICSI) depending on the sperm sample quality;

i) Fuck! Okay. the ovules and the sperm or the following ovules are the ICSI in the implant;

l) Check the fertilization after 16 to 18 hours;

l) Embryo 2, day 3 or 5;

m) Use progesteron after embryo transfer;

o) The amount of βhCG following a 14-day embryo transfer;

p) Supernegative after a 28-day embryo transfer if pregnant pregnancies;

q) Continue to use progesteron support for the prince for up to 12 weeks.

What? 28. Preselective embryo reduction process

1. The trick: selective embryo reduction is the procedure that uses needles to poke through the vaginal path under the ultrasound guide to cancel the pregnancy in the case of a polyphonic.

2. Index:

a) The cases where the term 03-gestation becomes after the embryo transfer, the number of embryos left are usually 2 embryos or one embryo depending on the particular case;

b) For fetal cases, minimize a child depending on the specific case.

3. Age of embryo reduction: the ideal reduction period is 07 weeks + 03 days.

4. Consulting:

a) Reason to reduce the embryo;

b) The process of reducing the embryo;

c) The ear can have.

5. The method of reducing pain: anesthesia or anesthesia at the site, which can combine the anaesthesia.

6. Preparing:

a) Preparation of a pregnant woman: a test of the blood formula, the blood group, and the factors of the blood; the child fasting, urinate before the procedure;

b) Preparing the instrument: clamp grip, ultrasonic machine;

c) Preparation of consumable supplies; cups of septic solutions, duplicate solutions, needles, and injections.

7. Process:

a) Discover before making tricks and anesthesia;

b) Clean up the vulgid, vagina, cervix with a physiological salt water;

c) Experiencing Steric Stomach and Abdominal Stomach;

d) The ultrasound reevalues the number of pregnancies, embryonic and embryonic conditions will be minimable. The reduced embryo is the embryo located near the needle line and is located near the cervix;

So, the needle in the right position, the needle in the right position, will minimize the needle in the right direction, after the needle hits the embryo, and then it ' s going to suck up the embryo.

e) For small embryos that can suck up the embryo, for large embryos that do not drain the need for a suspended cardiac arrest;

g) In the large case of pregnancy you can use potassium chloride to pump into the heart chamber;

h) antibiotics in the defense.

8. Following the following embryo reduction:

a) and a pregnant woman in the bed;

b) According to the circuit, blood pressure, breathing, abdominal pain, vaginal bleeding 2 hours after poking;

c) Date back 2 days.

9. Tai Tai:

a) bleeding.

b) In the blood vessels, the bladder;

c) Infection;

d) She was pregnant, she died.

Section 5

EXECUTION CLAUSE

What? 29.

It has been in effect since 20 August 2012.

What? 30. organizational responsibility

The Health of the Child-Child is responsible for presiding, in coordination with the Bureau of Management, Healing, the Legal Affairs and related units that organize the instruction, direction, inspection, inspection of this information.

In the course of execution, if there is difficulty, the entanging of the agencies, the organization, the individual report to the Ministry of Health (Child-Child Health) to study and solve.

KT. MINISTER.
Chief.

(signed)

Nguyen Write