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Couples facing infertility are well aware of what IVF is. According to global statistics, about 25% of spouses planning to have children experience difficulties conceiving. In vitro fertilization gives partners the opportunity to have children even in the most desperate situations.

IVF: what is it?

IVF is an abbreviation that stands for two words: in vitro fertilization, that is, artificial insemination in a test tube. This effective method infertility treatment in gynecology. Reproductive assistive technologies have been used relatively recently. for a woman was carried out about 40 years ago. As a result, the Englishwoman Louise Brown was born. Over these decades, more than four million IVF children have been born worldwide.

The IVF procedure involves the fusion of a sperm with an egg outside the woman’s body. Special preparation is carried out in advance, and the doctor selects a regimen based on existing health problems. Artificial insemination is considered a complex, high-tech medical procedure that requires the participation of doctors and compliance with all instructions of reproductive specialists.

"IVF Baby" Louise Brown recently became a mother herself.

Being a new breakthrough in the field of medicine, which now allows even those couples to whom nature has denied this happiness to have a child, in vitro fertilization has become firmly established in our lives over several decades, becoming one of the most vital and already understandable procedures.

But is IVF really necessary in the treatment of infertility, or are there any alternatives to it?

Let's try to understand this issue.

In vitro fertilization is the most effective method of treating infertility

Today no one doubts the enormous importance of in vitro fertilization in the field of infertility treatment for married couples. IVF treats many forms of female and male infertility, sometimes being the only option for spouses to have healthy children.

Since 1978, when this method was used in medical practice for the first time, in one of the clinics in England, IVF has come a long way in development, and now these methods have been worked out perfectly, guaranteeing a very high success rate for each procedure, for any diagnosis of the spouses.

The essence of the IVF procedure is to arrange a "meeting" eggs and sperm outside the woman's body , and then implant an already fertilized and developing embryo into her uterus . Typically, for this procedure, several eggs are grown from each woman and fertilized.

The strongest embryos are placed in the uterus - very often after IVF a woman gives birth to twins, and if there is a threat of miscarriage of these children, then at her request they can remove “extra” embryos from the uterus - however, this sometimes threatens complications for a future pregnancy and the death of the remaining ones embryos in the uterus.

IVF is successful in approximately 35% of procedures - this is a very high result, taking into account the great complexity of the methods performed.

IVF - all the pros and cons

A few years earlier, the in vitro fertilization procedure was not widely available, especially to residents of the Russian outback. In addition, this procedure was and remains paid, and this is quite a lot of money.

In addition to the fee for the procedure itself, there is a high cost to consider. Currently, the majority of infertile couples of childbearing age are allocated state quotas for the IVF procedure, this method infertility treatment is available to everyone who needs it.

Of course, those married couples who hope to become parents only through IVF ardently support this method of infertility treatment. Doctors - gynecologists, as well as geneticists - share the same opinion - in the IVF process the whole biological material undergoes very thorough medical examination , and the birth of babies with genetic disorders, hereditary diseases or other pathologies is excluded.

Pregnancy and childbirth of a woman who became pregnant as a result of an IVF procedure, no different from the pregnancy of a woman who became pregnant naturally.

However, the progressive direction of medicine - in vitro fertilization - also has opponents. For the most part, IVF procedures are opposed religious representatives of different faiths , including Orthodox activists. They consider this method of conception barbaric and unnatural.

In addition, as a result of growing embryos, some of them subsequently die - and this is unacceptable, in the opinion of church representatives, because it is the murder of already conceived children.

Be that as it may, the truth is always somewhere in the middle. To date IVF is necessary for treatment complex species infertility . Medical science is developing, and already now in the IVF process, doctors can use only one egg, growing only one single embryo , which does not contradict ethical principles and does not offend the feelings of IVF opponents.

Currently, a special method is being widely developed - "Modified natural cycle"(MNC), which consists of medicinal (hormonal) support for the growth of one follicle using small doses of follicle-stimulating hormone, and then maintaining its stability and preventing premature growth by another group of hormones - GnRH antagonists.

This is a more complex technique, but it pays off in every possible way in practice.

When is IVF not the only option?

Is there an alternative to in vitro fertilization?

In some cases, the usual IVF procedure cannot bring the couple the desired result in the form of a long-awaited pregnancy. This, for the most part, in couples where the woman does not have both fallopian tubes, or several attempts at IVF did not bring the desired result.

What is the alternative to in vitro fertilization in this case, and what are the chances of a couple getting a long-awaited child?

Let's consider the most discussed and well-known options .

Change of sexual partner

It is no secret that sometimes a man and a woman are well suited to each other spiritually and physically, but their reproductive cells may be antagonists to each other , not allowing to conceive a child. In such cases, people have only one piece of advice - to change their sexual partner, to conceive a child from another man. Let us keep silent about the moral side of this “alternative”; we will only note that changing a sexual partner may not lead to the desired result, but very often leads to problems in the family.

Egg donation.
If for one reason or another it is impossible to take an egg from a woman for the IVF procedure, then this procedure is performed using donor egg , taken, for example, from a close relative - sister, mother, daughter, or frozen material.

Otherwise, the procedure for fertilization with a donor egg is no different from the standard IVF procedure - it just involves the appearance of additional steps to collect eggs from a donor .

Intrauterine sperm insemination

This method of infertility treatment is as close as possible to natural fertilization, with the only difference being that not embryos grown outside her body are introduced into the woman’s uterus, but purified and specially prepared sperm husband

The exact same procedure is performed on a single woman who wants to have a child, by injecting her with donor sperm. As a rule, the method is used if a woman has natural ovulation and there is confirmation in.

A woman becomes pregnant as a result of the intrauterine insemination method in approximately 12% of cases.

GIFT method (intratubal gamete transfer)

This is newer than IVF, but has already been proven to be a more effective method of in vitro fertilization, which serves an excellent alternative, which has the right to further development and use in medicine.

With this method sexual gametes of partners, namely eggs and sperm, are introduced not into the uterine cavity, but into the fallopian tubes women. Fertilization that occurs as a result of this process is as close as possible to natural.

Moreover, this method has certain advantages over classic version IVF, because the uterus, while the fertilized egg moves towards it through the fallopian tubes, has the opportunity prepare as much as possible for embryo adoption , gain the ability to best implant it into your wall.

This method is most effective for women over 40 years of age with secondary infertility.

ZIFT method (intratubal zygote transfer)
The method of intratubal transfer of zygotes has been known since the same time as the GIFT method. At its core, ZIFT is transfer of eggs already fertilized outside the woman’s body, located at the very early stages divisions, not into the uterine cavity, but into the fallopian tubes.

This method is also close to natural fertilization, it allows the uterus fully prepare for your upcoming pregnancy and accept the fertilized egg onto your wall.

The ZIFT and GIFT methods are suitable only for those women who have preserved fallopian tubes, or at least one fallopian tube that has retained its functionality. This method is more effective for young women with secondary infertility.

The incidence of pregnancy as a result of the last two alternative methods IVF – ZIFT and GIFT – more often than with the conventional IVF procedure.

These methods are also good because their use almost completely eliminates ectopic pregnancy.

Accurately measuring a woman's body temperature to determine the moment of ovulation

IN last years the method became known precise definition moments of ovulation in a woman, and therefore the best moment to conceive a child naturally. This method was developed by New Zealand chemist Shamus Hashir. This new method is based on one technical invention - a special electronic device that is located in a woman’s body and sends signals about changes in her body temperature even half a degree.

As you know, the moment of ovulation is accompanied by a slight increase in the woman’s body temperature, and this can accurately tell spouses who want to have children when it is necessary to perform sexual intercourse to conceive. The device for measuring a woman's body temperature is inexpensive - about £500, which is significantly cheaper than a regular IVF procedure.

Couples who want to have a child should rely on the signal that the device gives in the event of ovulation.

This method guarantees a high percentage of pregnancy in couples where the woman has irregular cycles, or anovulatory cycles - but, unfortunately, it has not yet become widespread, is currently at the study stage and is promising, as alternative to in vitro fertilization .

^ It is important to remember that each patient has her own individual response to the medications received during treatment, and that each subsequent treatment cycle is different from the previous one. This means that in reality your response will be different from the response of other patients to the same drugs, but your body may also respond differently to each subsequent cycle of IVF treatment, i.e., not the same as in the previous cycle ECO. In this regard, your examination, treatment and, accordingly, its results may differ from those of other patients. The results of your examination and treatment, as well as planned future treatment, cannot be compared with the results of examination and treatment obtained in other patients. Although there are many similarities, it must be remembered that IVF and ICSI treatment is a personal matter and that most patients feel uncomfortable and embarrassed when discussing their personal problems in public.

^ If you are planning IVF treatment, it is recommended that you consult a doctor approximately 1-2 months before the start of the cycle you have chosen for IVF to resolve all your questions. At the appointment, the results of the preliminary examination are re-evaluated, including: examination on a chair, ultrasound, hormonal studies, identification of pathogens of sexually transmitted infections, i.e. standard examination for patients before IVF treatment. According to indications, additional examination methods are carried out. For review and subsequent registration, the patient is given an agreement for IVF treatment (including ICSI methods, assisted hatching, fragmentation removal). All forms of agreement between the parties for each procedure must be signed before the start of the treatment cycle. One of the main requirements for starting IVF treatment is protection from pregnancy in the cycle in which treatment begins using barrier methods of contraception (condom) rather than hormonal ones.

^ Activities that help increase the chances of success in a given treatment cycle

^ For women:

Avoid, if possible, taking any medications other than regular aspirin. If you are prescribed any medications by another doctor, you must inform your doctor before starting treatment. - Avoid smoking and drinking alcohol. - Limit your intake of coffee and caffeine-containing drinks as much as possible (no more than 2 cups per day). - Avoid changes in diet and weight loss diets during an IVF cycle. - Refrain from sexual intercourse for 3-4 days before follicle puncture, and subsequently after embryo transfer until the day of the pregnancy test (detailed recommendations will be given to you in the statement on the day of embryo transfer). Regular physical activity, like exercise physical exercise are not contraindicated until the ovaries enlarged as a result of treatment do not create some discomfort. - Avoid hot baths, baths and saunas. - Try to avoid communicating with patients with acute respiratory viral infections (ARVI), avoid hypothermia. If your body temperature rises or cold symptoms appear, tell your doctor.

^ For men:

An increase in body temperature above 38° C 1-2 months before the IVF / ICSI procedure can negatively affect sperm quality; If you are sick, please measure your body temperature and report any increase (any illness or illness accompanied by an increase in body temperature). Visiting baths and saunas is not recommended, as elevated temperature may adversely affect sperm quality; please refrain from visiting them for at least 3 months before you are due to start treatment. Taking medications, drinking alcohol and smoking cigarettes should be avoided before starting IVF/ICSI treatment. Do not start any new sports or strenuous activities. physical activity during the 3 months preceding the start of IVF/ICSI. If you run, please try to switch to walking without overload. Refrain from wearing tight underwear. Avoid sexual intercourse for at least 3 days, but no more than 7 days before sperm collection (on the day of follicular puncture).

^ For both spouses:

If you have a genital herpes infection, you must report the appearance of symptoms preceding the disease (general malaise, general weakness, unmotivated fatigue), acute manifestations of the disease or healing rashes. Regardless of whether a man or a woman suffers from genital herpes, any of the indicated stages of herpes infection will require immediate cessation of IVF/ICSI treatment.

^ Beginning of the IVF program (entry into the program)

^ On the eve of the start of the IVF program, 7-10 days before menstruation, you need to make an appointment with your attending physician to conduct an ultrasound of the pelvic organs and assess the condition of the ovaries and the thickness of the endometrium (uterine mucosa). After the doctor verifies the normal condition of the ovaries (absence of ovarian cysts) and endometrium, in the presence of the necessary official documents (a contract for the provision of medical services, an agreement for this method of treatment, signed by both partners) and the results necessary examinations, the doctor enters the patient into the program (IVF treatment cycle). The patient is given an individual prescription sheet, the rules for administering medications and the “lifestyle” during the IVF treatment cycle are explained in detail. The patient should come to each subsequent appointment with an appointment sheet. The prescription sheet indicates the patient’s name, her age, outpatient card number and describes in detail the entire treatment regimen: the name of the drugs, daily doses, frequency, route and sequence of their administration and the date of each subsequent appearance at the doctor’s appointment. During the treatment cycle, both spouses must strictly follow all prescriptions and recommendations of the attending physician and appear for examination at the appointed time. The patient is given directions (vouchers) to pay for each stage of IVF treatment. Before each stage of treatment begins, it must be paid in advance. Treatment may be stopped at any stage if, in the opinion of the doctor, the chances of successful completion and obtaining good results are extremely low. In this case, the patient will receive a refund for the stages of treatment not completed. The first stage is stimulation of superovulation Its goal is to increase the chances of pregnancy. To do this, a woman is prescribed hormonal drugs that cause the simultaneous maturation of several follicles in her ovaries. In each of the follicles, one egg matures, which is collected during puncture. After their fertilization, several embryos are obtained. The more embryos were obtained, the greater the chances of successful development of pregnancy after their transfer to the patient’s uterus.

^ Drugs to stimulate superovulation:

^ GnRH agonists (a-GnRH) – “ Diferelin" or " Decapeptyl"; GnRH antagonists (anti-GnRH) – “ Orgalutran », « Cetrotide"; Preparations of human menopausal gonadotropins (HMG) - « Menopur"; FSH preparations – “ Puregon », « Gonal-F"; Human chorionic gonadotropin (HCG) preparations – “ Decayed" All these drugs are prescribed according to developed treatment regimens or “protocols for stimulating superovulation.” Currently, several such “stimulation protocols” have been developed and successfully used all over the world, providing for the joint or sequential use of drugs from these groups to achieve the main goal of ovarian stimulation in IVF cycles - the growth of several follicles. Before the start of stimulation, the doctor discusses with you the stimulation protocol that is most suitable for you. As a rule, a GnRH agonist - Diferelin or Decapeptyl - is first prescribed for 10-14 days from the middle of the second phase of the previous cycle (21 days menstrual cycle ) to suppress spontaneous ovarian activity. This is not the stimulation itself, but only the preparation of the ovaries for its implementation with HMG or FSH drugs. It is very important because... increases the effectiveness of subsequent stimulation and allows you to reduce the dose of prescribed HMG (FSH) drugs and, accordingly, the cost of treatment. This is an important argument, since all stimulation protocols used in IVF are carried out exclusively with expensive hormonal drugs. The start of the administration of a - GHRH usually occurs on the 21st day in a 28-day cycle or the 23rd in a 30-day cycle and lasts, on average, 10 -14 days, but possibly longer if necessary. This scheme for stimulating superovulation is the most traditional, most widespread and effective of all those proposed today. It is called the “long” stimulation protocol. There are other stimulation schemes (“short” and “ultra-short” protocols), but they are used much less frequently and, mainly, when standard “long” modes are ineffective. For 10 - 14 days of ovarian preparation the patient needs to come to see the doctor only twice: before the start of the administration of a-GRG (1st appointment, that is, direct entry into the IVF program) and after this period (2nd appointment). Of course, if there are no unforeseen reasons for an additional visit to the doctor. After the necessary degree of ovarian suppression is achieved under the influence of a-GnH (as judged by the doctor at the 2nd appointment by reducing the concentration of estradiol in the blood and the characteristic ultrasound picture ), the doctor makes additional prescriptions for the patient. The dose of a-GnRH is halved and a new drug is prescribed directly to stimulate the “suppressed” ovaries - gonadotropic hormone preparations - Menopur or Puregon (Gonal-F) in addition to a-GrH for 12 - 14 days. Described above scheme - a-GRG + hMG (FSH) complex allows you to significantly increase the number of follicles in the ovaries. This, in turn, improves the quantity and quality of the resulting embryos and allows you to plan the treatment cycle taking into account the wishes and needs of the patient: “bring closer” or, conversely, “pushing back” the puncture of the follicles for several days to obtain the eggs that have matured in them without fear that this will worsen the results of treatment. This stimulation continues until a single appointment in the middle of the cycle of the drug hCG, which causes the maturation of eggs in the follicles, which allows them to be prepared for puncture at the second stage of treatment (the stage of puncture of the obtained follicles). To stimulate ovulation, as a rule, three types of gonadotropins are used: HMG - "Menopur" and FSH - "Puregon" or "Gonal-F". The first day of administration of gonadotropins is considered the first day of the cycle, and further counting is carried out from this day. This makes IVF treatment cycles different from other stimulated cycles used in assisted reproduction (intrauterine insemination or insemination with donor sperm), in which stimulation begins on the 3rd - 5th day of the menstrual cycle and without prior administration of a-GnRH. The drugs act on the ovaries and stimulate maturation of follicles. The dose of the administered drug to stimulate follicular growth is selected individually, taking into account the woman’s age, her weight and the initial state of the ovaries (their functional reserve) and depends on the response of the ovaries to the IVF treatment. This reaction is assessed periodically by the level of sex hormones in the blood serum (estradiol) and the ultrasound picture (the number and size of follicles in each of the ovaries, as well as the thickness of the endometrium). Carrying out an ultrasound and determining the concentration of estradiol during treatment with hormonal drugs is called “Ultrasonic and hormonal monitoring."

^ Ultrasound and hormonal monitoring

^ Organizational issues

^ Ultrasound monitoring is carried out by the attending physician at the appointment, and a blood test for estradiol is given upon the doctor’s direction in a diagnostic laboratory. Monitoring is not paid separately, since its cost is included in the cost of this stage of treatment. The frequency of monitoring is set by the doctor depending on the results obtained (ultrasonic picture and estradiol concentration). The date and time of each subsequent visit to the doctor for monitoring is entered on the appointment sheet held by the patient. As a rule, the number of visits does not exceed 4 or 5. The time must be chosen taking into account the wishes of the patient, because most of them continue to work. Typically, ultrasound is performed with a vaginal sensor (abdominal ultrasound), which is significantly more informative than conventional ultrasound through the abdominal wall. Before performing a abdominal ultrasound, you need to empty your bladder to improve the quality of the resulting image. Nurse invites you to the monitoring room. You will be asked to undress as if for a gynecological examination, after which you lie down on a prepared gynecological chair and your attending physician is invited. The sensor is inserted by the doctor into the patient’s vagina; a sterile condom is first put on it, which is discarded after use. The ultrasound procedure is completely painless and safe. Some patients may experience a feeling of discomfort or tightness, and there may be slight vaginal discharge after the end of the ultrasound procedure, mainly associated with the use of a special gel to improve the quality of the resulting image. What is assessed during monitoring? The first ultrasound monitoring is usually carried out on the 5th or 6th day of stimulation with gonadotropins to assess the response of the ovaries (dynamics of follicle growth) and endometrial thickness in order to select the most optimal dose of the drug and determine the date of the next visit. Before the active growth of follicles begins (until they reach sizes of 10 mm and above), an ultrasound scan is performed once every 4-5 days, then the ovaries are examined more often - once every 2-3 days. Blood tests for estradiol are taken either with the same frequency or slightly less frequently (depending on the specific situation). Depending on the dynamics of follicle growth and hormonal levels The attending physician determines the frequency of attendance for monitoring individually for each patient and selects the exact dose of drugs. At each monitoring, the doctor determines the number of follicles in each ovary, measures the diameter of each follicle, and assesses the thickness of the uterine mucosa. Finally, when your doctor decides that you are ready For puncture of the follicles (more precisely, the follicles are mature enough for puncture to collect oocytes), you will be given an injection of hCG. As a rule, this drug is prescribed 35 - 36 hours before the puncture itself for the final maturation of the eggs. If the puncture is not performed, ovulation occurs 42 - 48 hours after the time of injection. The main and mandatory conditions To prescribe hCG, a certain degree of follicular development according to ultrasound is required (at least 3 mature follicles). A potentially mature follicle against the background of stimulation is a follicle measuring 18-20 millimeters.

^ Second stage - puncture of follicles

^ The purpose of this stage is to obtain eggs from the follicles of stimulated ovaries by puncturing them with a hollow needle (puncture). This intervention is carried out under ultrasound control, in sterile conditions (operating room) and under intravenous anesthesia. The time for the puncture is scheduled by the doctor in advance and according to standard scheme: 35-36 hours after hCG administration. The date and time of the proposed puncture are recorded in the patient’s appointment sheet. The contents of the follicle (follicular fluid with eggs) are transported to the embryology laboratory in special sterile disposable plastic containers made of non-toxic polymer. The entire follicle puncture procedure lasts, on average, 15-20 minutes.

^ Memo for patients before follicle puncture

^ In order to avoid vomiting during and after anesthesia, it is necessary: ​​In the evening, on the eve of the puncture, refrain from eating after 18-00 and from taking any liquids after 24-00. On the day of the procedure, refrain from eating or drinking any liquids until the procedure begins. We strongly request that you come to the puncture without makeup, contact lenses, manicure or jewelry. You don't have to take off your wedding ring. By the time the puncture is completed, the spouse or donor must donate sperm for subsequent analysis, special processing and fertilization of the resulting eggs. Then the patient is invited to a special room for changing clothes: her body temperature and blood pressure are measured, her general well-being is determined, and she is asked to completely empty her bladder. She is escorted to the operating room, where she is prepared for the puncture: they are helped to lie down in a gynecological chair, the external genitalia are treated. An anesthesiologist and an attending physician are invited to the operating room. After the administration of drugs for anesthesia (that is, when you fall asleep), the procedure itself is carried out. After the puncture, you are under observation medical personnel hospital within 1.5-2 hours. Once the anesthesiologist is satisfied that your condition is satisfactory and you are feeling well, you will be allowed to stand up. The IVF laboratory nurse will accompany you and your husband to the attending physician.

^ Memo for patients after follicular puncture

^ The doctor informs you about the results of the puncture, makes new appointments, and sets the date and time for embryo transfer. After the puncture, you can eat and drink as you see fit, depending on how you feel. In order to prevent the occurrence of an infectious process after a puncture, you will be recommended to take antibiotics (a single loading dose of a broad-spectrum antibiotic - for example, 1 capsule of doxycycline).

After the procedure, you may experience some soreness in the pelvic area, a feeling of fatigue, or even drowsiness (the latter is associated with the use of anesthesia). Minor bloody issues from the genital tract after puncture, associated with puncture of the vaginal wall during puncture. As a rule, they are scanty and vary in color from red to dark brown.

^ Please tell your doctor if you experience the following symptoms after the puncture:

High temperature (over 37 degrees C).

Severe bleeding from the vagina.

Unusual or severe pain in the pelvic area.

Difficulty urinating or bowel movements.

Nausea, vomiting, or diarrhea.

Sharp or shooting pain.

Pain or sting when urinating.

Unusual back pain.

Increase in abdominal circumference.

^ Feature support corpus luteum

^ In place of the punctured follicles, yellow bodies are formed. Normally, at the site of a mature follicle that “bursts” during ovulation in a woman of reproductive age, a corpus luteum is also formed, the main function of which is the production of the hormone progesterone, which “prepares” the uterine mucosa for the attachment of the embryo. However, in IVF cycles, α-GnRH drugs are used to stimulate ovulation, which reduce the function of the corpus luteum. Moreover, levels of the hormone estradiol in stimulated cycles are disproportionately increased compared to progesterone. Therefore, drug support for the function of the corpus luteum and normalization of the ratio of estrogen and progesterone are necessary, starting from the day of follicle puncture. This improves the condition of the uterine mucosa - the endometrium and thereby increases the chances of successful implantation (attachment) of embryos. In most cases, a natural hormone is prescribed progesterone in the form of a pharmaceutical preparation Utrozhestan"or synthetic progesterone" Duphaston"Utrozhestan is available in the form of capsules for oral administration (oral) or vaginal administration. The vaginal method of administering the drug is preferable, since in this case it immediately goes to the uterus, bypassing the systemic (general) blood flow. “Duphaston” is available in tablet form and is taken only orally. In some cases, after follicular puncture, until the day of the pregnancy test, medications such as, for example, “ Proginova" or " Estrofem" Both drugs contain another female hormone, estradiol, which also takes part in preparing the uterine lining for implantation. The drugs are available in tablet form, but Proginova is taken orally, and Estrofem is inserted into the vagina. The type and dosage of the drug is selected individually. All prescriptions are recorded by your attending physician on the prescription sheet immediately after the puncture, and then after the embryo transfer the dosage of the drugs is adjusted.

^ The third stage is fertilization of eggs and cultivation of embryos

^ After the follicular fluid arrives at the laboratory, the embryologist conducts a “search” for eggs, which are then placed in an incubator. Fertilization is carried out with concentrated sperm 4-6 hours after receiving the eggs. For normal fertilization, approximately 50 thousand sperm are used for each egg. If sperm parameters do not meet the requirements of standard IVF or previous IVF attempts have been unsuccessful, further treatment tactics are discussed (possibly ICSI or IVF using donor sperm). The ICSI technique is used to fertilize mature eggs in the case of sperm abnormalities in the spouse (“ICSI”). If it is difficult to obtain sperm on the day of puncture or there are no sperm in the ejaculate, a special procedure is provided - testicular biopsy. The day of puncture is considered the zero day of embryo culture; The first day of cultivation is the day following the puncture. It is on this day that most eggs show the first signs of fertilization. They are already noticeable 16 - 18 hours after the union of eggs with sperm (insemination). Fertilization is re-evaluated 24-26 hours after insemination. Fertilization control is carried out by an embryologist when viewing dishes with cultured cells under a microscope. One of the reasons for failures in IVF is the lack of fertilization of eggs. Often the reason for this is not possible to establish, despite the extensive knowledge of scientists in this area. No one is immune from this, and such an outcome is often difficult to predict, but it must be remembered. If your couple did not have eggs fertilized using the standard IVF method, you and your husband need to visit a doctor to decide on further management tactics for your couple. Possible options: re-donation of sperm and performing the ICSI procedure or performing ICSI with sperm already obtained on the day of puncture (if it good quality). It is advisable from the very beginning, even before the puncture, to discuss the possibility of switching to ICSI if the standard IVF procedure fails.

^ Stages of embryo development

^ A fertilized egg is called a zygote - it is a one-cell embryo that already contains a double set of chromosomes, that is, from the paternal and maternal organism. However, the presence of zygotes is not yet sufficient to resolve the issue of the possibility of embryo transfer into the uterine cavity. First you need to make sure that the embryos are splitting and developing normally. This can only be judged based on the quantity and quality of the dividing cells of the embryo and not earlier than one day after fertilization, when the first signs of fragmentation appear. They appear most clearly only on the second day of cultivation. Every day, an embryologist evaluates the embryos, recording all parameters: the number and quality of embryonic cells (blastomeres), the rate of fragmentation, the presence of abnormalities, etc. Only good quality embryos can be transferred. Embryo transfer is carried out on the 2nd - 5th day of cultivation - depending on the pace of their development and the quality of the embryos. Until recently, embryos were cultured for three days and then transferred to the uterus and/or frozen. Nowadays, so-called extended culturing of embryos for five or six days until they reach the blastocyst stage is common. Blastocysts have a higher implantation success rate, allowing fewer embryos to be transferred and reducing the risk of multiple pregnancies while increasing pregnancy rates.

^ Stage four - embryo transfer

^ As mentioned above, embryo transfer is carried out on the 2nd - 5th day of cultivation, depending on the stage of their development. On the day of embryo transfer, you must arrive 30 minutes before the appointed time. The presence of the husband is possible, but not required. On the day of the transfer, we allow patients a light breakfast, but liquid intake should be limited. This will reduce the discomfort associated with a full bladder. Immediately before the embryo transfer, the doctor, embryologist and couple decide on the number of embryos to transfer. The embryologist demonstrates in the photograph the embryos selected for transfer and answers questions of interest to the couple. After receiving information about the doctor’s readiness to carry out the embryo transfer procedure, the embryologist collects the embryos into a transfer catheter, which is a thin plastic tube with an attached syringe, and hands it over to the doctor, carrying out the transfer. The embryo transfer procedure is technically simple. The patient lies down on the gynecological chair. The doctor exposes the cervix in the speculum, and then inserts a catheter through the cervical canal into the uterine cavity. The catheter contains embryos that enter the uterine cavity. Then the doctor passes the catheter to the embryologist, who examines its contents under a microscope for any embryos remaining in the catheter. Transferring embryos usually does not take much time (5-10 minutes). The procedure is painless, although sometimes the patient may experience slight discomfort. If, after embryo transfer, married couple There are “extra” embryos of good quality left, the couple is asked to freeze them for further storage and subsequent transfer after thawing in the event of no pregnancy after this IVF attempt (“Embryo Cryopreservation”). After embryo transfer, you are in a horizontal position for 40 - 45 minutes, after which you get dressed and are invited to your attending physician to discuss further features of treatment and lifestyle.

^ How to behave after embryo transfer?

^ Your attending physician will provide a detailed statement in 2 copies (to you and your attending physician at your place of residence) about the IVF treatment performed. The extract indicates: lifestyle recommendations, timing of pregnancy tests and ultrasound examinations, dosages and duration of medication use. In addition, if necessary (working patients), a certificate of incapacity for work (sick leave) is issued. Nonresident patients are given an open sick leave certificate, which they can extend at their place of residence. After embryo transfer, the dose of progesterone drugs (Utrozhestan or Duphaston) is usually doubled, and their use can last up to 12-14 weeks pregnancy, when the placenta (baby place) is formed and releases “its” progesterone in sufficient concentration. After the transfer, some patients note slight spotting or the release of air bubbles from the genital tract. Please don't worry about this. This does not mean that at this time your embryos are expelled from the uterine cavity. Immediately after the embryo transfer, it is very useful to come home, lie down and try to relax. From the moment of the transfer until the pregnancy test, you can safely return to most of your daily activities and responsibilities with the exception of excessive physical activity. It is considered absolutely normal that if the results of the pregnancy test are negative, you will blame yourself for something you did or , on the contrary, did not do during this period of time - the waiting time. In this regard, try not to do anything for which you will reproach yourself if pregnancy does not occur, and adhere to the recommendations below: - Do not take a bath or swim in the first day after the transfer. - Do not shower or douse yourself with water. - Don't use tampons. - Do not be sexually active until you receive your first pregnancy test. - Do not engage in jogging, aerobics, tennis, skiing, mountaineering or other similar sports. - Do not start playing other sports or physical education. - Don't lift heavy objects. You can return to "work" after 24 hours in bed and one or two days of moderate physical activity. Trying to keep yourself busy and distracted from waiting for your pregnancy test results will help you get through those 12 to 14 days. You may experience some spotting or spotting from your vagina before taking a pregnancy test. Approximately 50% of our pregnant patients after IVF had similar discharge before the test and even after receiving a positive result! Don't lose optimism! You should definitely get your blood tested, even if you think that this discharge is menstruation and pregnancy has not occurred. A quantitative pregnancy test must be done - determination of hCG in the blood. Diagnosis of pregnancy Quantitative hCG - a pregnancy test must be done 14 days after the embryo transfer. If this time falls on a “Sunday” day off, the test can be done on Monday. Non-resident patients are recommended to do an hCG test at their place of residence and inform us by phone about its results. A blood test for hCG determines the hormone (chorionic gonadotropin) secreted by the embryo if it is attached to the uterine cavity. As a rule, the concentration of this hormone is comparable to the result of IVF treatment: the presence of pregnancy, the number of embryos in the uterine cavity, etc. Most pregnancy tests give either positive or negative results. However, sometimes there are “weakly positive” results - a low concentration of hCG in the blood. If you were given exactly this result, it may indicate the following: - Late but normal implantation of the embryo. - Interrupted pregnancy. - Ectopic pregnancy. - Laboratory error. Further monitoring of hCG is extremely important in each of the above situations. 2-3 days after the weakly positive result, you need to repeat this study. Repeated blood testing for hCG will allow us to determine whether your pregnancy is progressing and developing normally. The first ultrasound is recommended to be performed one week after the day of the pregnancy test (or 3 weeks after the embryo transfer). This is an ultrasound like this early extremely important in terms of the possibility of termination of pregnancy (miscarriage), ectopic pregnancy and multiple pregnancies. Ectopic tubal pregnancy can occur in 2-3% of pregnancies after IVF. Timely, early diagnosis of ectopic pregnancy and laparoscopic surgery avoids serious complications that threaten the woman’s life. A second ultrasound examination is performed 10 days from the first to confirm the normal development of pregnancy - definitions fetal heartbeat. As soon as the doctor detects a fetal heartbeat, he recommends that you contact your obstetrician-gynecologist for early pregnancy registration. The approximate pregnancy period at the moment will be 6-7 weeks. If the pregnancy test is negative, you stop taking progesterone medications. It will take 3 or 5 days before your period arrives, if it has not arrived earlier. Your menstrual flow may be different from your usual periods (heavier, lighter, shorter or longer). If menstruation does not come within the next week, inform your doctor and repeat the blood test for hCG. Gonadotropin preparations The active principle of such medications are the two main gonadotropic hormones of the pituitary gland, which are necessary for normal operation woman's ovaries. FSH - follicle-stimulating hormone is responsible for the growth and development of the follicle in the ovary, and LH - luteinizing hormone ensures the final maturation of the egg and ovulation in the middle of the cycle (rupture of the leading follicle and release of the mature egg into the abdominal cavity). There are two types of gonadotropic hormone drugs: HMG drugs – contain both hormones – FSH and LH; FSH preparations contain only the FSH hormone. In our clinic, the most commonly used HMG drugs are Menopur (Ferring, Germany), and the FSH drugs are Puregon (Organon, Holland) and Gonal-F (Serono, Italy). . These medications differ not only in composition, but also in their production technology. “Menopur” is obtained from the urine of menopausal women using a special highly purified technology. The drugs "Puregon" and "Gonal-F" were created by genetic engineering– the drugs contain only a certain part of the FSH molecule, which directly ensures the growth of the follicle. The use of all drugs is safe from the point of view of the risk of developing an immune reaction against “foreign” hormones. Side effects of these drugs occur infrequently and include abdominal discomfort, flatulence (bloating ), mood changes, increased fatigue or anxiety, which in most cases weaken or completely disappear after follicular puncture. One of possible complications Therapy with gonadotropic hormone drugs is multiple growth of follicles and the development of ovarian hyperstimulation (“Ovarian hyperstimulation syndrome”). The drugs are available in the form of a dry substance (powder) and an attached solvent (in ampoules) and are administered intramuscularly once a day. In this case, 2-4 ampoules of dry substance are diluted with the contents of one ampoule of solvent. Usually patients give themselves injections, sometimes they involve their relatives or friends who know how to do intramuscular injections. It will be better if the first injection is given by a nurse in order to teach the patient or whoever will be injecting her how to administer the drug. It is important to administer the drugs in the dose prescribed by the doctor, at the same time of day, preferably in the 2nd half of the day. Instructions for IVF patients on administering the drugs “Menopur”, “Puregon” and “Gonal-F” Wash thoroughly and dry your hands. Prepare in advance: one sterile syringe with a needle for intramuscular injection, 2 cotton balls moistened with 70% alcohol, one ampoule of solvent and 3 or 4 ampoules of the drug (in accordance with the prescription sheet). Treat the index and thumb of your right hand with an alcohol ball and quickly (in one motion) uncork the ampoules. Remove the cap from the needle and draw 1 or 2 ml of water (the proposed sterile solvent) into a syringe and dissolve this amount of solvent alternately in each of 2 to 4 ampoules with a dry substance, sequentially transferring the contents of the previous ampoule (already dissolved) into the next ampoule (with the dry substance not yet dissolved). The substance dissolves almost instantly; the needle should be inserted into the ampoule as deeply as possible. Draw the dissolved contents of all ampoules into the syringe; Hold the syringe vertically and lightly press the plunger to remove all air bubbles from the syringe. Take the syringe and the new alcohol ball in your right hand. Select the injection site; preferably, it does not coincide with the site of the previous (yesterday) injection. Gently grab the skin in this area with your left hand. Take a comfortable position and, leaning on the leg opposite to the one where the injection is to be made, try to relax the muscles of the latter as much as possible. Apply an alcohol ball to the injection site and hold the ball under thumb left hand. Holding the drawn syringe like a “throwing spear,” pierce the skin with the needle (the depth of penetration should be at least 1/2 the length of the needle) and quickly insert the needle into the muscle. Smoothly press the plunger to squeeze out the contents of the syringe, then quickly remove the needle. Treat the injection site with an alcohol ball. All used material (cotton balls, used syringes, etc.) is thrown away (in ordinary waste containers - no special equipment is required). GnRH agonists To prevent a woman’s own pituitary hormones from interfering with the stimulation of superovulation, their production is blocked by analogues (agonists) hormone gonadoliberin (a - GnRH). The active principle of the drugs is the compound triptorelin, a synthetic analogue of GnRH. The latter causes the release of gonadotropic hormones in the female body, which, in turn, have a direct effect on the production of female sex hormones, the growth of follicles and the maturation of eggs in the ovaries. GnRH agonists prepare the ovaries and thereby “unify” the conditions for subsequent maturation of follicles during stimulation. In addition, these drugs prevent premature ovulation, that is, rupture of follicles before puncture. Of the agonists, the most commonly used are Decapeptyl-Daily (Ferring, Germany) and Diferelin-Daily (Ipsen, France). The drugs are available in the form of daily injections (daily - from English word“daily” - daily) and deposited forms (the drug is administered once every 4 weeks). In the IVF program, drugs with daily administration are most often used. Most drugs are produced for subcutaneous injection, some drugs are administered intramuscularly. "Decapeptyl-Daily" The drug is available in the form of ready-made syringes of 2 types: "Decapeptyl - Daily 0.5 mg" - and "Decapeptyl - Daily 0.1 mg". Each such syringe looks very similar to the insulin syringe that patients use diabetes mellitus– very thin (no thicker than a hair needle for painless subcutaneous administration of medicine). We usually prescribe Decapeptyl Daily 0.1 mg as a daily subcutaneous injection. One package contains 7 or 28 syringes with the drug. The drug is stored in the refrigerator. One syringe is enough for one injection (if prescribed in the first 10-14 days of treatment); when the doctor reduces the daily dosage (the next 12-14 days of administration of a-GRG - already together with gonadotropin preparations), it is enough to administer not the entire syringe, but only half of its contents per day, and it is recommended to store the remaining medicine in the syringe (0.5 ml) in refrigerator until the next dose (after putting the cap on the needle). Immediately before administering the drug, there is no need to warm it up further. Instructions for administering “Decapeptyl-Daily 0.1 mg” Open the package and take the syringe from the package. Remove the plastic cap from the syringe needle. Take the syringe into left hand and a cotton ball soaked in 95% alcohol in your right hand. Select a subcutaneous injection site (on the shoulder or on the anterior abdominal wall); It is advisable to change injection sites daily. Gently clean the injection site with a cotton ball moistened with alcohol. Holding the syringe in your right hand like a “throwing spear” at an angle relative to the surface of the skin, quickly insert the syringe needle under the skin. Smoothly, without jerking, squeeze out the entire contents of the syringe, then remove the needle, treat the injection site with a new cotton ball with alcohol and throw away the used syringe. When you start administering Menogon or Puregon, the dose of Decapeptyl-Daily is reduced by exactly half; the syringe is not thrown away, and the second half of the contents of the syringe remaining after injection is stored until the next injection in the refrigerator, for which the cap is put on the needle again. ampoules) and are administered subcutaneously once a day. In this case, the contents of an ampoule of dry substance are diluted with the contents of one ampoule of solvent. Instructions for administering Diferelin-Daily 0.1 mg Wash and dry your hands thoroughly. Prepare in advance: one sterile syringe with a needle for intramuscular injection, 2 cotton balls moistened with 70% alcohol, one ampoule of solvent and a bottle of dry substance. Treat the index and thumb of your right hand with an alcohol ball and quickly (in one motion) open the ampoule with the solvent. Spray the cap of the bottle with an alcohol ball and open it. Remove the cap from the needle and draw 1 or 2 ml of water (the proposed sterile solvent) into the syringe and dissolve this amount of solvent in the vial with the dry substance; The substance dissolves almost instantly; the needle should be inserted into the ampoule as deeply as possible. Draw the dissolved contents of the bottle into the syringe; Hold the syringe vertically and lightly press the plunger to remove all air bubbles from the syringe. Take the syringe and the new alcohol ball in your right hand. Select a subcutaneous injection site (on the shoulder or on the anterior abdominal wall); It is advisable to change injection sites daily. Gently clean the injection site with a cotton ball moistened with alcohol. Holding the syringe in your right hand like a “throwing spear” at an angle relative to the surface of the skin, quickly insert the syringe needle under the skin. Smoothly, without jerking, squeeze out the entire contents of the syringe, then remove the needle, treat the injection site with a new cotton ball with alcohol and throw away the used syringe. When you start administering Menogon or Puregon, the dose of Diferelin-Daily is reduced by exactly half; the syringe is not thrown away, and the second half of the contents of the syringe remaining after injection is stored in the refrigerator until the next injection, for which the cap is put on the needle again. GnRH agonists must be administered at the same time, preferably in the evening. If you change the time of administration of the drug (the difference is more than an hour), you must inform your doctor about this and discuss with him the time of the next injection. Each drug is accompanied by detailed instructions manufacturer about the features of use and storage of this drug, its side effects , which greatly facilitates their administration by the patients themselves. Side effects of agonists do not occur often and are associated mainly with a decrease in the level of sex hormones in the blood: a decrease in sexual desire, rapid changes in mood, hot flashes, and rarely depression are possible. But all of these manifestations are transient in nature and indicate the effectiveness of the drug, paradoxically, because they are associated with a temporary decrease in the level of sex hormones (estradiol) in the body. All of these symptoms associated with a decrease in estrogen saturation disappear after the start of gonadotropin administration due to increased production of estrogen in the woman’s stimulated ovaries. The drugs do not accumulate in the body, and all side symptoms disappear without a trace. Sometimes there is slight soreness, redness or, less commonly, itching at the injection site (injection site). This is a local allergic reaction, which usually does not require the prescription of additional medications and discontinuation of the drug, but it, like other possible side effects of the drug, should be reported to your doctor in a timely manner. GnRH antagonists GnRH antagonists (ant-GnH), like agonists, block the functioning of the pituitary gland, and thereby provide conditions for stimulating follicular growth. Antagonists are prescribed at the final stage of stimulating follicular growth to prevent premature ovulation (usually from the 6-7th day of stimulation, that is, the use of Menopur or Puregon). During the stimulation process, as a rule, no more than 4-5 injections are required. Drugs in this group include Organutran (Organon, Holland) and Cetrotide (Serono, Italy). Our company uses the drug “Orgalutran”. The drug is available in the form of ready-made syringes “Ogralutran 0.25 mg”. Each such syringe looks very much like an insulin syringe, which is used by patients with diabetes - a very thin needle (no thicker than a hair for painless subcutaneous administration of medication). The drugs are prescribed in the form of subcutaneous injections at the same time of day, which is indicated by your attending physician. Instructions for administration of the drug "Orgalutran 0.25 mg" Open the package and take the syringe from the package. Remove the plastic cap from the syringe needle. Take the syringe in your left hand and a cotton ball soaked in 95% alcohol in your right hand. Select a site for subcutaneous injection (on the shoulder or on the anterior abdominal wall); It is advisable to change injection sites daily. Gently clean the injection site with a cotton ball moistened with alcohol. Holding the syringe in your right hand like a “throwing spear” at an angle relative to the surface of the skin, quickly insert the syringe needle under the skin. Smoothly press the plunger to squeeze out the contents of the syringe, then quickly remove the needle. Treat the injection site with an alcohol ball. All used material (cotton balls, used syringes, etc.) is thrown away (in regular waste containers - no special equipment required). Human Chorionic Gonadotropin (HCG) Human Chorionic Gonadotropin is a hormone similar to luteinizing hormone (LH), which causes ovulation of the leading follicle in the middle of the menstrual cycle. HCG injection is intended to prepare the follicles for puncture and the final maturation of the eggs. Ovulation occurs 42-48 hours after hCG administration. Therefore, follicular puncture must be performed before ovulation, otherwise the follicles will be empty. HCG is prescribed 35 - 36 hours before the puncture. The time for prescribing the drug is recorded in the prescription sheet and is once again clarified by your doctor immediately before the puncture. Many patients experience discomfort in the lower abdomen after an injection of hCG due to an increase in the size of the ovaries and are sure that they are ovulating. In fact, careful monitoring of patients during treatment and the drugs used (a-GnRH or antagonists) almost completely eliminate the risk of premature ovulation, i.e., ovulation before follicle puncture. HCG is produced by different companies under different commercial names. The most commonly used drug is Pregnil (Organon, Holland). The drug looks like White powder. Each ampoule of dry substance is accompanied by 1 ampoule of solvent. The drug is administered intramuscularly. The hCG injection is carried out only once during the entire treatment cycle, the injection is painless and, as a rule, the patient gives it to herself. Before the appointed time of puncture (written down in the appointment sheet), the patient does not need to visit the doctor or take blood tests for hormones. Instructions for administering the drug “Pregnil” The time of administration of hCG is a decisive moment in treatment, so the drug must be administered exactly at the calculated time! Wash and dry your hands thoroughly. Prepare in advance: a disposable syringe with a needle, 2 cotton balls moistened with 70% alcohol, and medicine (ampule with dry substance). Take the ampoule with the dry substance from the package; remove all plastic protective coatings. Treat each ampoule with an alcohol ball. Remove the cap from the needle, insert the needle straight and firmly into the center of the rubber cap of the solvent ampoule. Turn the ampoule upside down. Lower the plunger of the syringe to withdraw sterile solvent (in an amount of 3 ml), and then disconnect the empty ampoule. Remove air bubbles from the syringe by lightly flicking it or shaking it with your fingers, then squeezing out the air with the syringe plunger. Select the site for the intramuscular injection. Stretch the skin in the selected area with your left hand. Take the ready-to-use syringe and a cotton ball soaked in alcohol in your right hand. Treat the skin with alcohol and hide the used ball under your left hand. Holding the syringe like a “throwing spear”, insert the needle into the muscle at an angle, then with sharp pressure on the piston, squeeze out the entire contents of the syringe, remove the needle, and treat the injection site with a new cotton ball with alcohol. Place used instruments and medications in a waste collection container.0Topic closedPage: 1" GOAL - PREGNANCY! » Articles (recommended reading) » Very detailed article about IVF (step by step)Forum rating | Create a forum for free © 2007–2016 “QuadroSystems” LLC

Women

WOMEN

First of all, you need to identify your ovarian reserve. This is a genetically stored supply of eggs in a woman’s ovaries in the absence of pathophysiological changes in her reproductive system. Unfortunately, ovarian reserve decreases with age. Also leading to its reduction are: ovarian surgeries, radiation exposure, antitumor chemotherapy. It is checked by the level of hormones AMH, inhibin B, FSH. Or, in the first days of the menstrual cycle, you can count the number of antral follicles.

It is important to prepare the uterine cavity. The operation is performed according to personal indications; if a woman has pathologies of the uterine cavity, such as synechiae or polyps, they must be removed before IVF. Also, hydrosalpinx, a fluid that accumulates in the fallopian tubes, negatively affects the effectiveness of the program, since this fluid has an embryotoxic effect. Treatment of this pathology must be carried out before the start of the IVF procedure.

You need to check the smear for infections. Give a smear for bacterial flora. Based on the results, the doctor may prescribe treatment and hormonal testing. IN best case scenario do a full examination so that if there are infections or hormonal imbalances, this can be corrected before the stages of in vitro fertilization begin.

HORMONES THAT A WOMAN SHOULD CHECK:

ULTRASOUND STUDIES MUST BE DONE TWO TIMES PER CYCLE TO DETECT PATHOLOGIES.

As soon as you have completed all the examinations and are fully prepared, you begin to enter the IVF procedure. 7-10 days before the start of your menstrual cycle, make an appointment with your doctor. You should perform an ultrasound of the pelvis, assess the condition of the ovaries, and the thickness of the uterine mucosa. Upon completion of all examinations, your treating doctor should have a complete picture of your health status, as well as the health status of your spouse. A personal card is created for each patient, which indicates the patient’s health status, the entire treatment regimen, medication dosages, and the dates of each subsequent visit.

On days 3-5 of the cycle:

FSH. This is very important indicator. The set of drugs for further stimulation of a woman depends on its level;

On day 3-4:

On any day of the cycle:

Prolactin

Days 3-8 of the cycle:

Estradiol

Androgens

On any day of the cycle:

thyroid hormones

For men

DESCRIPTION OF PREPARATION FOR IVF STAGES TO THE MAN

The man needs to pass spermogram is an analysis of seminal fluid that determines a man’s reproductive ability. It is also possible to take this test in our clinic. This analysis is done before the first stage of IVF, as the process of taking a spermogram is quite simple. Sperm is donated by ejaculation in the clinic on the day of the test. For this purpose, the clinic has a special comfortable room, and a special container is provided free of charge. If a man experiences discomfort and is not sure of the positive outcome of ejaculation in the clinic, it is allowed to do it at home. To do this, you need to buy a container specially designed for this at the pharmacy. After collecting the sperm, the seminal fluid must be submitted for analysis within two hours.

A spermogram allows you to establish a man’s fertility and identify existing diseases of the reproductive system. If the results of the analysis reveal deviations from the norm in the spermogram, then a consultation with an andrologist is necessary in order to understand whether the abnormalities can be corrected and what they are associated with. There may be other medical problems, such as genetic defects on the Y chromosome.

Such defects are sometimes the cause of male infertility. Men with a congenital absence of the channels through which sperm exit the testicles - the vas deferens - are often carriers of the disease cystic fibrosis. If this problem is detected, genetic testing should be performed.

The man must also undergo a urethral smear. This analysis identifies diseases such as prostatitis, urethritis, and sexually transmitted diseases. Full list You can find out about the tests in the article “Preparing for IVF: tests that need to be taken.” You should be tested for infections and latent infections (TORCH infections).

I WOULD LIKE TO REMIND THAT TO OBTAIN A CORRECT RESULT, YOU SHOULD FOLLOW THE FOLLOWING RULES:

Avoid sexual intercourse. Optimally - 4 days.

Avoid alcoholic drinks, sleeping pills and sedatives during this period.

Avoid visiting saunas, baths, hot baths.

BELOW IS A DECODING OF THE CONCLUSIONS SPERMOGRAMS

Ask a Question!

You have questions? Feel free to ask any questions! And our staff specialist will help you.

The in vitro fertilization (IVF) method allows childless couples to conceive and give birth to their own child genetically without endangering the mother's health. This method of conception is not effective for all couples. There are contraindications that make using the method impossible.

The decision on the possibility of extrauterine fertilization is made by the doctor after considering all the pros and cons of the procedure and taking all measures to treat diseases that prevent pregnancy.

The main indication for participation in the IVF program is the inability to cure the infertility of one of the spouses. Indications for the procedure are:

• obstruction of the fallopian tubes;
• ovulation disorder;
• endometriosis;
• anatomical features of the uterus that prevent conception.

For men, indications for IVF are sperm pathologies or disorders of seminal fluid excretion.

When can spouses be denied participation in the program?

The procedure is not prescribed if a woman is unable to carry a pregnancy to term due to health reasons. There are absolute and temporary (relative) contraindications.

Temporary obstacles to artificial insemination

Temporary contraindications are correctable, and after appropriate treatment a woman will be able to become pregnant and give birth to a baby. The artificial insemination procedure is postponed in the following cases:

• pronounced adhesions in the pelvis;
• accumulation of fluid in the fallopian tubes, preventing implantation of the embryo;
• chronic disease of the appendages, which has worsened this year;
• benign tumor in the uterus, ovaries.

After treatment, the doctor may authorize participation in the program. An obstacle to IVF is some congenital or acquired diseases of a woman, such as heart defects, brittle bones, and the absence of one kidney.

Extrauterine fertilization is not always possible due to genetic diseases of the woman. Such diseases include hemophilia and Duchenne muscular dystrophy. In this case, preimplantation genetic diagnosis is performed before the artificial insemination procedure.

Conditions that increase the chance of pregnancy

One of the conditions for the effectiveness of IVF is a woman’s body weight. It is desirable that the woman’s weight be more than 50 kg, but not exceed 100 kg.

Being underweight can lead to difficulties in inserting a fertilized egg into the uterus. Overweight can lead to premature birth, negatively affect the baby’s health.

Smoking is considered a relative contraindication for participation in the artificial insemination program. The pregnancy rate is lower in women who smoke. There is another contraindication that affects the effectiveness of the method: age. Although the procedure is carried out after 45 years, the chance of conceiving and carrying a child decreases with age.

In what cases is IVF not performed?

In vitro fertilization is contraindicated for women whose health condition does not allow them to bear a child without risk to their own health.

Absolute contraindications:

• tuberculosis, HIV, hepatitis, syphilis;
• malignant tumors of any location;
• blood diseases;
• diabetes;
• diseases of the heart, blood vessels;
• hypertension that cannot be controlled with medications;
• mental illness.

Don't resort to artificial insemination with congenital malformations of the uterus, deformations that can prevent the implantation of the embryo into the uterine wall, and childbirth. The use of in vitro fertilization is not indicated for chronic somatic diseases that cannot be treated, such as intestinal fistula or renal failure.

IVF is contraindicated for benign tumors in the genital organs. Reception hormonal drugs during the program can provoke the transition of a benign neoplasm to a malignant tumor.

The doctor makes the decision to conduct IVF for the treatment of infertility of a married couple after a comprehensive examination of the spouses. IVF is used when other methods of treating infertility are impossible.

Video from a specialist