IVF is an extremely complex and lengthy procedure that requires considerable effort and patience from both parents and doctors. It’s not a fact that it will work out and be successful from the very first time, but it’s worth trying, and you will succeed. IVF stages always follow in strict order one after another. And at every stage, the woman's health is strictly monitored so that an accidental failure does not jeopardize the success of the entire protocol.

This is the blueprint for the entire process. there are quite a few, in each case, the reproductive specialist selects it individually for each woman. Even the same protocol may differ in the number of certain drugs, the duration of their administration, and so on. And it is always a difficult task for a doctor, in which it is important to choose an adequate treatment and not make a mistake.

All protocols differ only up to the moment of receiving eggs, then they are almost identical.

Protocols are short, long, ultra-short and hyper-long. There is a protocol - when a woman still has ovulation and menopause has not occurred.

You should also keep in mind that during the process of embryo transfer, you may receive several embryos for greater security. They can all take root, then a multiple pregnancy will occur. On the one hand, this will be a pleasant surprise, on the other hand, an increased risk for gestation. But given that all IVF mothers are under the constant attention of doctors, the risk in this case is minimal.

Indications and contraindications

IVF is a complex operation that requires some effort from a woman. And in any case, she has her own testimony and.

Indications

There are many indications for IVF.

• Pipe factor - with their obstruction, developmental pathology, or absence.
• Severe forms of endometriosis, in case of failure of surgical treatment
• Immunological incompatibility, when a woman develops antibodies to sperm
• The age of the spouses is over 35 years old, if, during a normal sexual life of more than 12 months, the marriage remains infertile
• Just unexplained infertility

Contraindications

They can be both absolute and irresistible, and temporary. Temporary - the name speaks for itself, they only need some time to solve the problem, they do not put a complete barrier in front of a married couple in the hope of giving birth to a baby. Contraindications can be both on the part of a woman and on the part of a man.

Temporary

• First of all, these are various inflammations in the body - a cold, flu, a toothache or barley popped out on the eye. After the inflammation has passed, it is necessary to give the body time to fully recover and strengthen the immune system.
• Any exacerbated chronic diseases - in this state, the body simply will not be able to accept and cope with the additional load. In addition, it is almost always some kind of inflammation in the body, in which IVF is not performed.
• Detected benign tumors - any tumor must be removed, and this is a priority.
• Recent surgical interventions, even dental ones, after which the immune system is weakened, the body must be given time to recover.
• Insufficient or excessively overweight - these factors make it difficult for the embryo to engraft in the uterus and bear the baby. However, after the normalization of body weight, it is worth trying to go through the IVF protocol.

Absolute

• conditions of a woman in which there is a threat to her life - liver and / or kidney failure, heart defects, severe forms of diabetes, critically low vision
• anomalies in the development of the genital organs, in which it is impossible to bear a baby, for example, Rokitansky-Küstner-Hoser syndrome
• any history of cancer
• mental disorders

On the part of a man, there may also be contraindications for the IVF protocol, but they are mostly relative, temporary. They can most often be dealt with by slightly correcting the state of health of a man.

If oncology is detected in the future father and he is to be treated with chemotherapy or radiation therapy, the sperm is taken from him before the start of treatment.

Preparation for IVF

When the IVF procedure has already been decided, the stages of its implementation remain unchanged for each couple, or for each expectant mother. But first you need to properly prepare for it, as this is a very difficult process.

Getting directions

This is the very first step, not even the introduction to the program. The period when you choose a clinic, you get a consultation with a reproductologist and a referral for tests.

To join the protocol, you will have to pass a large number of tests, and both parents. Please note that many of the tests have an extremely limited expiration date and will need to be retaken if delayed.
But there are also those whose validity period is unlimited in time. This, for example, blood type and Rh factor.

You will be required to take a hormone test - this is very important for prescribing the amount of the drug for hormonal stimulation to obtain an egg.

At this stage of IVF, indications and contraindications are also identified, and initial consultations are given. You will learn about IVF stages, how many days it takes, how long the whole procedure takes. The reproductologist will tell you about all IVF stages in detail, you should not worry about anything, just follow his instructions.

The first stage seems quite simple and almost unimportant - after all, no manipulations are being carried out at this time. However, it is impossible to diminish its importance for the entire subsequent process.

IVF stages are calculated according to the days of the cycle of each woman.

Stage 1 – Inspection of specialists

For your baby to be born healthy, his parents must be healthy. And both, this concerns the father no less than the mother.

First of all, both parents pass the generally accepted tests - a complete blood count, AIDS, RW, hepatitis, for the presence of other infections. Further specific tests will be assigned.

You may also need to adjust your weight slightly.

What will interest the doctor

Cardiology

Both of you will check the state of the cardiovascular system, take a cardiogram. It is important for the expectant mother that everything is in order in order to know whether the heart will cope with the upcoming stresses.

Detection of latent infections

Many infections "live" in the body for years without revealing themselves, including the "gentle killer" hepatitis C, and many others. It also happens that after identifying and treating these infections, pregnancy occurs naturally.

Mammologist and gynecologist

It is necessary to know the state of the gynecosphere, the mammary glands - whether there is any pathology in them. And if so, get the appropriate treatment. This includes holding

Andrologist

You will also need to consult an andrologist for pathologies of the male genital area.

Next, you will need to determine if you have sufficient ovarian reserve. This is the number of eggs that can be fertilized. This reserve is laid down at the moment of conception of the woman herself and cannot be increased in any way. But it quickly decreases with age and with various effects on the ovaries - with radiological exposure, chemotherapy, ovarian surgery.

Tests for hormones

During IVF, you will be prescribed hormone therapy. To accurately calculate the amount of medication needed, you will need to take tests for hormone levels. They are handed over on clearly marked days of the cycle.

Analysis that does not depend on this - for hormones thyroid gland.

• FSH - It is taken on day 3-5 of the cycle. The whole further procedure and prescribed medications depend on the level of its indicators.
• On day 3-4 - LH (), it is produced by the pituitary gland and regulates the production of progesterone in women. At its peak, it stimulates ovulation, and then its level drops sharply.
• On any day of the cycle - Prolactin;
• 3-8 day of the cycle - Estradiol;
• analysis for androgens;
• thyroid hormones can be taken on any day of the cycle.

You will also need to undergo an ultrasound examination twice per cycle - at the very beginning and at the end. It will be necessary to examine the small pelvis, the condition of the ovaries, the mucous membrane of the uterus and its thickness.

And only after all these examinations, if no contraindications have been identified, does the IVF procedure begin. The beginning of the input should be calculated in such a way that it falls on the second half of the cycle, approximately 5-7 days before the start of a new cycle. At this time, the doctor will have a complete picture of your health and the health of the future father in his hands. At the same time, the issue of assigning you an IVF protocol and the date of the next visit is decided.

Preparing a man

The father must also be prepared for the sacrament of the conception of the baby.

• He must also undergo a full medical examination.
• The man will have to analyze the seminal fluid. It will determine the reproductive capacity of a man. If necessary, sperm sampling is carried out surgically.
• You will need a smear from the urethra - to identify possible purely male diseases. A smear will also rule out the presence of sexually transmitted diseases.
• The man also takes tests for hormones. It is easier for him to do this, since he is not “tied” to the days of the cycle and can pass them on any convenient day.

If necessary, additional treatment will be prescribed, which will increase the chances of success of the entire protocol.

For more correct test results, you should refrain from sexual intercourse, visiting baths and saunas, drinking any alcohol (including beer) at least a week before the test. You should also eat as properly as possible and avoid stress and lack of sleep.

From the submitted spermogram, it will become clear whether the PICSI procedure or its modification is required - when suitable spermatozoa are placed directly into the egg with the thinnest needle.

Stage 2 - Stimulation of superovulation

At this stage, the expectant mother will have to go through a "hormonal attack" in order for her body to mature as many oocytes as possible - in order to take as many of them as possible at the next stage. Usually it is from 10 to 20 oocytes.

V female body hormonal preparations are introduced that stimulate the hormonal system, all organs.

This is the longest stage of IVF by days - depending on the prescribed protocol, it can last from 10 days (super short) to 2-3 months (super long) protocols. But usually this stage takes 2-3 weeks, during which several eggs mature in a woman. It is often prescribed so as not to create a prolonged load on a woman's ovaries.

The natural cycle IVF protocol can also be prescribed - with it, the woman is not injected with any stimulating hormones.

When entering this stage, doctors also look to see if the woman has gone through menopause. In this case, it will no longer be possible to obtain her own oocytes and will have to use a donor egg.

Stage 3 - puncture

At this stage, mature eggs are collected. The whole process takes place under constant ultrasound monitoring. For this, the patient is given a short-term general anesthesia. Mature follicles are taken from the ovaries with a special aspirator. The whole process lasts from 30 minutes to an hour. After that, in a special container, they are transferred to the laboratory, where other doctors will perform their rites over them.

For the woman herself, this stage of IVF is painless. Since a puncture is still a small surgical intervention, the expectant mother is given 2-3 hours to rest and, after examining the gynecologist, she is released for now.

On the same day that the puncture is performed, the man must submit his sperm to the laboratory. In some cases, this also requires the use of testicular puncture.

There are situations when it is impossible for a man to donate seminal fluid on the same day. In this case, he hands her over the day before and she is subjected.

Stage 4 - fertilization

The most mysterious and sacred stage, which is carried out in the laboratory. Only embryologists can enter it, it is absolutely sterile, so that nothing would prevent the birth of a new life.

Sperm also undergoes a certain preparation, during which the spermatozoa are separated from the seminal fluid. This is done in order to select the most suitable, mature and mobile from the total number.

The highest quality eggs are also selected.

The egg then joins with the sperm. Most often, this process is carried out 4-6 hours after the puncture of the follicles. In a test tube with a nutrient medium, eggs are mixed with spermatozoa so that in vitro conception occurs.

This can happen in the usual way - when the sperm penetrates the wall of the egg itself - this process can take about an hour, or through. In this case, the doctor, using the thinnest needle, places it directly into the egg. Then the resulting embryo is placed in an incubator for 5-6 days to form a zygote.

Stage 5 - cultivation of embryos

After fertilization has occurred and the embryo has grown to 50-100 cells, it is checked for the presence of pathologies and genetic diseases, such as Down syndrome, hemophilia and others. Embryologists carefully monitor the quality of the resulting embryos, to ensure that proper conditions are maintained in the laboratory.

The most viable embryos are selected for implantation. Doctors are well aware of what a healthy embryo should look like, which is suitable for further development and will not “freeze” at any stage of pregnancy.

Stage 6 - transfer to the uterus

Healthy embryos are implanted in the woman's uterus. Although it is officially allowed to implant several embryos, in most of the leading clinics in the world, 1-2 embryos are transferred into the uterus, and the rest are frozen so that in case of failure, a second attempt can be made. The same embryos can be implanted in the mother even after several years, without resorting to IVF.

After implantation, the woman again undergoes hormonal therapy, already in order for the embryo to take root better. This course of hormone therapy helps in maintaining pregnancy.

If the embryo was transferred and implanted in a woman in a natural cycle, there may not be a need for hormone treatment, and such a pregnancy will in fact be no different from a natural one.

The times when obstruction of the fallopian tubes, the absence of ovulation in a woman, too few viable sperm in a man or age over 40 became a sentence of childlessness are long gone. Invented in the 70s of the 20th century, the technology of in vitro fertilization (IVF) is currently the most improved. It allows you to get pregnant and give birth to a healthy child (the absence of gene abnormalities is controlled) after certain stages of preparation.

In some cases, an extracorporeal technique can be performed not with your own, but with a donor egg. It can also be performed with donor sperm, if there are indications for this. This method makes it possible to become parents, even if the woman herself is unable to bear the child for some reason (surrogate motherhood program).

IVF cost varies. On average, without the state program, in 2016 it exceeds 107 thousand rubles and depends on which protocol (that is, the stages of drug and instrumental support) will be chosen, what additional methods will be needed. Under the CHI policy, it is free of charge, but only:

1. according to strict indications;
2. up to 39 years of age women;
3. the policy covers only 2 in vitro conception attempts.

Although IVF bypasses the obstacles that nature has placed in the way of pregnancy for a particular couple, its effectiveness is not close to 100, but only to 50%. In some cases, it is necessary to repeat it, and it is usually performed by methods (ICSI IMSI, ICSI PICSI) that increase the chances of success.

What is IVF

This technique is called "in vitro conception". It consists in isolating an egg and then introducing a male cell outside the female body into it. The development of the embryos is then monitored under a microscope. When they reach the required stage of development, they are introduced into the uterus of a woman who has been prepared in advance and is at the most fertile stage. For some time, careful ultrasonic monitoring of developing embryos is carried out: their engraftment is monitored, and their number can be regulated, in agreement with the woman.

In the 2nd and 3rd trimesters, pregnancy obtained using this reproductive technique is carefully protected from possible negative influences.

IVF is carried out when there is no possibility of fusion of the egg and sperm in vivo. Children born in this way do not differ physiologically from those conceived; in vitro fertilization does not affect either health or mental or intellectual qualities. On the contrary, with the help of this technique, it is possible to avoid the birth of a child with a disability or with a severe genetic pathology.

Statistics

The method of in vitro fertilization began to be developed back in the 70s of the 20th century. The first child in the USSR, conceived by this method, was born in 1986. The manipulation technique has been gradually improved, and since 2010, more than 4 million children have been born from extracorporeally obtained embryos in the world, of which one in 160 appeared in Russia.

The effectiveness of IVF depends on many factors. Among them are the number of attempts to introduce embryos (the more transfers, the higher the likelihood of success), the hormonal and structural characteristics of a particular woman. One of the factors affecting efficiency is age:

• up to 25 years, the chance of engraftment of the embryo is 48%;
• at 27-35 years old - about 33%;
• at 35-40 years old - about 25%;
• 40-45 years old - 9%;
• over 45 years old - 3%.

If the embryo has taken root (more often several of them take root), the pregnancy ends in term birth or caesarean section in 70-76% of cases.

Indications for manipulation

IVF is carried out according to medical and social indications, if a woman wants to have children under such circumstances when:

1. violation of the patency of the fallopian tubes;
2. absence of fallopian tubes - congenital or during surgery, for example, in the treatment of tubal (ectopic) pregnancy;
3. a severe stage of endometriosis, when a combination of hormonal and surgical treatment did not make it possible to become pregnant within a year;
4. conditions in which ovulation does not occur (a donor egg is used);
5. genetic diseases transmitted through the egg or sperm (with X- or Y-chromosome);
6. desire to give birth after the age of 40: IVF provides more opportunity to protect yourself from the birth of a child with genetic abnormalities (for example, with Down syndrome): before replanting, the embryo undergoes genetic diagnosis;
7. poor quality of the seminal fluid of a man (few active spermatozoa or they are completely absent), not amenable to treatment;
8. when infertility occurred due to endocrine diseases of a woman: thyroid, pancreas, pituitary gland, and, despite their treatment, it was not possible to get pregnant;
9. antibodies against spermatozoa in a woman: in a test tube it is possible to introduce a male cell directly into a female one, avoiding immune reactions;
10. infertility of unknown cause. This condition is detected in every tenth couple who cannot conceive a child within a year.

If there are no contraindications, the procedure can be performed:

• unmarried women who wish to have a child;
• women of non-traditional sexual orientation;
• men who want to have a child without having sexual intercourse, using the service of surrogacy;
• women suffering from vaginismus - a condition when any penetration into the vagina (even a tampon or speculum for gynecological examination) is accompanied by a spasm of its muscles (this can be compared with a spasm of the muscles of the eyelid when trying to introduce a foreign body into the eye).

How many attempts can be

Positive eco results are rarely obtained the first time. It often takes several attempts before at least one of the introduced embryos can gain a foothold in the uterine mucosa. Cases of successful implantation are known only after 6 or 9 attempts. There is no limit on in vitro fertilization attempts as such. It is believed that after 10 attempts there is no point in continuing to try further.

Fertility doctors are doing everything possible to make this happen as soon as possible. To do this, they tell what kind of preparation for IVF should be carried out, what examinations should be carried out within its framework, so that the necessary manipulation protocol is selected based on their results.

What reduces the chances of successful IVF

The price paid for the procedure can become "wasted" money if a woman has any of the following situations:

Pelvic inflammatory disease frequently observed

That is, the appendages of the uterus, blind, sigmoid or rectum, Bladder. In this case, adhesions form in the pelvis, which impede the normal movements of the female reproductive organs. There is a second complication of frequent inflammatory processes of the small pelvis. Changes in pH, which are necessarily present in such conditions, modify the structure of the uterus and its appendages (in particular, the endometrium becomes thinner). As a result, it will be difficult for the implanted embryo to implant (embed) and take root in the mucous membrane of the uterus (endometrium).

Have had abortions or curettage of the uterine cavity

Interventions that imply a violation of the integrity of the endometrium and the underlying layers of the uterus are very dangerous for planning conception in the future.

When a pregnancy that has begun to develop is artificially interrupted, this produces a “blow” on the hypothalamus, the main endocrine organ:

• firstly, due to a sharp change in the balance of sex hormones;
• secondly, due to stress, which is any surgical intervention.

The negative effect on the hypothalamus leads to the fact that it stops giving “completely correct” commands, and this may affect the preservation of the pregnancy obtained with the help of IVF, the preparation for which includes not quite physiological doses of hormones.

In addition, abortion and curettage lead to the formation of adhesions in the pelvis, can cause either the formation of polyps in the uterine cavity, or non-closure of the cervix. Both of these lead to the formation of isthmic-cervical insufficiency, which can cause miscarriage during pregnancy.

Violation of sperm formation partner

Decreases the chances of successful IVF by deteriorating seminal fluid quality, which can be caused by one of the following conditions:

• long-term toxic effect on the body of industrial, medicinal toxins, cigarette tar, alcohol;
• low testosterone;
• insufficient levels of vitamins E, A, B, C, affecting spermatogenesis (formation of spermatozoa) of a man;
• the cells that make sperm are very sensitive to the effects of sexually transmitted infections.

Low follicular reserve

The eggs (oocytes) of a woman are laid when the future woman herself is in utero. Before birth, their number decreases, if the birth was difficult, then quite strongly. Further, oocytes should be consumed gradually, maturing almost every menstrual cycle. If a woman suffers inflammation of the ovaries, the peritoneum in the small pelvis, she develops endometriosis, or she often has to be influenced by industrial or food poisons, the eggs are consumed faster. How older age, the fewer normal follicles remain, from which a full-fledged cell can develop. This means that the chance of IVF with your own egg decreases, and by the age of 40, you may have to use a donor oocyte.

Preparation for IVF for a woman necessarily evaluates the follicular reserve. For this, the following is carried out:

• folliculometry - transvaginal ultrasound performed in certain days cycle, designed to visually assess the state of the follicles - "vesicles" from which the eggs develop;
• determination of AMH (anti-Müllerian hormone) in the blood. If it is low, this means that there are few “decent” follicles that are less than 8 mm in diameter;
• determination of FSH (follicle-stimulating hormone) in the blood. It is produced in the pituitary gland, located in the cranial cavity. Its main function is to “turn on” the maturation of the follicle for pregnancy. High level FSH means that the pituitary gland does not receive a sufficient response from the ovaries, that is, there are few follicles in them.

Chronic diseases of a woman

Diseases of the gastrointestinal tract, blood vessels and heart, lungs and brain have a toxic effect on the ovaries, and also worsen their blood circulation. And the more damaged the ovaries (this is not always possible to assess by ultrasound or other studies), the more difficult it is to get a healthy egg for IVF.

Who will not be able to get a chance to conceive "in vitro"

We can name the following contraindications to the IVF procedure, when no reproductive specialist will undertake to carry it out: the underlying disease may begin to progress, threatening the life of the mother, or the manipulation will be ineffective. These are absolute contraindications:

1. anomalies in the structure of the uterus or its acquired deformations (bicornuate, infantile uterus, its absence or doubling), when either the embryo cannot be implanted, or there is no guarantee that the uterus will be able to bear it;
2. cancer of the body or cervix, ovaries, fallopian tubes;
3. severe pathologies of internal organs:
   • heart defects;
   • malignant blood diseases: leukemia, lymphoma, lymphogranulomatosis, aplastic anemia;
   • severe stage of schizophrenia;
   • suffered a stroke;
   • increased work of the parathyroid glands;
   • severe course of diabetes;
   • cardiomyopathy;
   • multiple sclerosis;
   • kidney failure;
   • mental illness that can pose a threat to the bearing of the fetus;
   • tumor pathologies of the ovaries.

There are also relative contraindications when manipulation can be performed after some preparation. This:

• tuberculosis in the active stage;
• benign tumors of the uterus. If such a formation does not exceed 30 mm in diameter, IVF can be performed, and the tumor is removed after childbirth. Embryo replanting in this case should be carried out taking into account the location of the tumor focus so that it does not become an obstacle to carrying a pregnancy;
• hepatitis;
• syphilis;
• exacerbation of chronic diseases, which can be corrected medically or surgically;
• transferred cancer (sarcoma) of any localization;
• acute inflammatory pathologies of any organ.

HIV is a relative contraindication to IVF. There are separate protocols for manipulating women who maintain a sufficient amount of the desired immune cells on antiretroviral therapy.

In any case, the decision on the possibility of carrying out a "test-tube" conception is made by a council of doctors, who can offer a childless couple alternative options: adoption of a child, surrogate motherhood.

Contraindications exist only on the part of women. Men will only have to delay IVF:

• for a year - if radiation or chemotherapy was performed to treat any cancer;
• 2-3 months after the complete cure of an inflammatory disease of any reproductive organ (testicles, prostate, urethra, cavernous bodies);
• for 2-3 months if the man who has to donate his own seminal fluid has been ill infectious disease: chicken pox or herpes zoster, leptospirosis, tonsillitis, measles, rubella. After hepatitis B or C, the period when you need to refrain from donating sperm is determined by the infectious disease specialist based on the tests. Usually this time interval takes more than a year.

Types of in vitro fertilization

In essence, IVF is the creation of conditions in a test tube for the fusion of a sperm and an egg. If there are problems with the seminal fluid of a man, as well as men after 40 years, auxiliary methods are used. This:

1. IVF ICSI (Intra Cytoplasmic Sperm Injection): The injection of sperm directly into the egg using a special needle.
2. ICSI IMSI is a subspecies of the previous method. In this case, a morphologically mature spermatozoon is selected under a 6000x magnifying microscope (“simply ICSI” implies only a 400x zoom), and it will be introduced into the oocyte. “Morphologically mature” means that its ability and readiness for fertilization is assessed under a microscope, through the eyes of a doctor, only by its structure (without any tests). The word "morphologically mature" is ciphered in the abbreviation "IMSI": "Intracytoplasmic Injection of Morphologically Mature Sperm".
3. ICSI PICSI. In this case, the maturity of the spermatozoon is determined using a protein test (the protein that gives the letter "p" in the abbreviation "PIXI"). The male cell is placed in a solution where the protein is hyaluronic acid. This substance is contained inside the human skin, in the vitreous body of his eye, and also surrounds the egg, creating a protective layer around it. If the spermatozoon is ready for fertilization, it will easily pass through the layer with hyaluronic acid and will not be damaged. When it is immature, it will be damaged by this substance.

Advantages of in vitro fertilization

In vitro fertilization procedure:

• makes it possible to conceive with any infertility;
• allows you to check the embryo for the presence of genetic diseases and viruses before its introduction into the uterine cavity;
• you can "order" the gender of the unborn child;
• as a result of IVF, children are born who are mentally and mentally indistinguishable from their peers.

Why is in vitro fertilization bad?

IVF has its drawbacks. This:

• more often twins and triplets are born this way than one child. This is due to the fact that in order to increase the chance of engraftment of the embryo, they are introduced into the uterus in the amount of several pieces;
• stimulation of the maturation of several eggs at once, which is mandatory during IVF, can cause complications, for example, ovarian hyperstimulation and some other pathologies;
• as with natural conception, the embryo can be fixed not in the uterus, but in the fallopian tube.

Preparation for IVF

Since in vitro fertilization is an extremely responsible and expensive procedure, it is carried out after the preparatory stage, which is mandatory for both the woman and the future father of the child. The IVF preparation time is determined individually - in case of presence or identification of temporary contraindications to the procedure. In the absence of such, it takes from 3 months to six months for both partners.

Preparing for IVF: where to start? Both spouses simultaneously adjust their own lifestyle and pass the prescribed tests. If it turns out that treatment of the identified disease is required, or the ovarian reserve of the woman does not allow the use of her own egg, the forced maintenance of a healthy lifestyle is extended. How long it will take depends on the situation and is negotiated with the treating reproductologist.

Laboratory and instrumental diagnostics

A woman takes the following tests before IVF:

1. general blood and urine tests;
2. determination of liver samples, kidney waste, glucose, glycosylated hemoglobin, protein and fat fractions in venous blood;
3. coagulogram (blood clotting test);
4. blood on RW;
5. determination of progesterone and estrogens in the blood;
6. a smear with the definition of trichomonas, candidal fungi, mycoplasma, gonococcus, chlamydia, ureaplasma, which is carried out by the bacteriological method and using PCR reaction;
7. determination of antibodies (serological diagnostics of blood) to:
   • rubella;
   • hepatitis E, A, B, C;
   • HIV virus;
   • herpetic viruses that are transmitted through the placenta and can cause congenital infections of the fetus: herpes simplex viruses 1.2 types, cytomegalovirus, Epstein-Barr virus;
8. determination of the microflora of the vagina, cervix and urethra by bacteriological and cytological methods;
9. detection of atypical (cancerous, precancerous) cells by examining smears from the urethra, cervix and vagina in a cytological laboratory.

She undergoes the following instrumental studies:

• fluorography of the lungs;
• electrocardiogram;
• transvaginal ultrasound of the uterus and ovaries;
• ultrasound (up to 35 years) or x-ray mammography;
• colposcopy (examination of the cervix using a special microscope);
• if necessary - hysterosalpingography (X-ray after the introduction of contrast into the uterine cavity, used to assess the patency of the fallopian tubes), laparoscopy, endometrial biopsy (if the cytological study gave the result "atypical cells" or transvaginal ultrasound found an incomprehensible node);
• Ultrasound of those organs that can affect the course of pregnancy: adrenal glands, thyroid and parathyroid glands.

If necessary - the presence of miscarriages in the family, cases of congenital malformations or gene diseases - the couple is consulted by a geneticist, who also prescribes an analysis for karyotyping (study of the quality and quantity of chromosomes of each spouse). This will reveal the discrepancy between their chromosomes, calculate what is the probability of having a baby with a genetic disease or malformations.

Preparing a man for IVF includes passing tests such as:

• blood for antibodies to syphilis;
• spermogram;
• blood for antibodies to HIV, hepatitis B and C, herpes group viruses;
• sowing a smear from the urethra for the growth of trichomonas, myco- and ureaplasmas, chlamydia, candida, gonococci;
• cytological examination of a smear from the urethra for atypical and tuberculous cells;
• Ultrasound of the scrotum;
• transrectal ultrasound of the prostate;
• study of sperm DNA fragmentation;
• consultation of a geneticist, urologist, andrologist.

• Find out how much which analysis is good, write down on the sheet the order in which you will take them;
• Find out where it will be cheaper to take tests and whether you need to sign up there in advance;
• Ask where you can take free tests.

Lifestyle Correction

Before IVF, it is important not only to take tests, but also to fine-tune your own daily routine and diet, give up bad habits, treat those diseases that a person knew about or that were identified as a result of the examination.

Lifestyle

To reduce the risk of possible negative consequences of IVF, both spouses need 2-3 months before entering the protocol:

1. give up alcohol;
2. quit smoking;
3. drink no more than 1 cup of coffee per day;
4. stop testing temperature differences on your own vessels (baths, saunas);
5. cure chronic diseases, including carious teeth;
6. sleep 8-9 hours a day;
7. prepare mentally by creating a comfortable and harmonious environment for yourself: communicate more with friends and relatives, take time for yourself, your hobby, your favorite business. You should not spend all the time looking for information and thinking about IVF: this reduces the chances of a successful engraftment of the embryo.

Diet

Both a woman and a man, as a preparation for IVF, need to switch to healthy eating. This means avoiding fried and fatty, foods with preservatives, chemical additives, too spicy or sweet. It is worth switching to 5-6 meals a day in small portions.

The diet also implies the normalization of weight, on which the hormonal background directly depends. Therefore, it is worth consulting with a nutritionist and therapist, what should be included more in the diet: fatty acids, proteins, slow carbohydrates.

Drink

Even at the stage of testing, a woman should try to get used to drinking 2-3 liters of liquid (this implies that her kidneys and heart are healthy). This will cleanse the body of toxins, and when stimulating ovulation with drugs (one of the stages of IVF), it will prevent ovarian hyperstimulation syndrome. It consists in increasing the density of the blood, the release of fluid from the vessels into the tissues (associated with the maturation of a large number of eggs).

Medications

It is not advisable to load both the female body, which is preparing to become an egg donor, and the male body, in which healthy spermatozoa should mature, with extra medicines. You need to consult with the doctor who prescribed you medications for permanent (long-term) intake to see if they can be canceled, if not, then how this can affect the pregnancy. If there is no such obstacle, you can proceed to the implementation of the IVF protocol.

As a preparation for the procedure, medications are often prescribed, the task of which is to facilitate the body's perception of the drugs with which the protocol is carried out. They are the following:

1. Tykveol. It is an antioxidant derived from pumpkin oil. It will protect the liver, which will receive a significant drug load in preparation for receiving the egg.
2. Folic acid. This is a vitamin that, taken before the start of the IVF protocol, is very useful for normalizing hematopoiesis and the immunity of the expectant mother. It is also used after embryo replanting, reducing the likelihood of developing malformations in it.

Sport

At the stage of preparation for IVF, sports, especially oriental dances, in which there is an active movement of the stomach, are an indispensable thing. With its help, the blood circulation in the small pelvis improves in a physiological way, which will further improve the implantation and bearing of children.

Vaccination

To protect yourself and your child from serious diseases, consult an infectious disease doctor about vaccinations against:

• rubella;
• hepatitis B;
• poliomyelitis;
• flu;
• tetanus;
• diphtheria.

They need to be completed 2-3 months before entering the IVF protocol.

If ICSI, IMSI, PICSI is planned

In this case, a man is being prepared, whose task is to repeatedly donate seminal fluid so that the doctor can find in it some of the best cells for fertilization. Therefore, before donating sperm, he will have to refrain from sex for 7-8 days, quit smoking, do not drink alcohol and caffeine-containing drinks, and do not eat foods with preservatives.

If, despite all efforts, there are still few viable forms in the sperm, the man will have to undergo one or more testicular punctures. If this does not lead to finding the right cells, donor sperm can be used.

Preparation of discordant couples for IVF

The risk of having an HIV-infected child in a discordant couple (where only one spouse is infected with HIV) is 1-2% for natural conception. In the case of IVF, it is possible to test the embryo for this virus before introducing it into the uterus.

The safest situation is when a woman is infected. She can become pregnant without risk to her HIV-negative husband, but only not at the subclinical (when there are no symptoms yet) stage of the disease and only after specific therapy that suppresses the immunodeficiency virus (it is called antiretroviral).

If the man is HIV-positive, more preparation is needed, but it is carried out by medical workers. After a course of antiretroviral therapy, the man donates sperm, which is centrifuged in the laboratory. This reduces the risk of infection of a woman, since the virus will go into the layer that will be separated from the sperm by a film. Next, the spermatozoa are cleaned many times, and then they are tested for HIV. Only one male cell is taken to fertilize an egg.

Stages of in vitro fertilization

There are various protocols for the procedure, which differ in the number of stages: short, long, super-long. The longer the protocol, the more physiological it is. However, in each case, the number of stages is assigned by the reproductive specialist individually; it is negotiated with a woman who wants to become a mother.

Consider how the IVF procedure goes step by step based on the long and short protocols. The super-long protocol differs in the duration of the first stage - more than 2 weeks, while with the long one it lasts less than 2 weeks

Long protocol

It lasts 4-6 months; ends with the introduction of the embryo into the uterine cavity. It consists of several stages:

1. Ovarian suppression

This is necessary so that further preparation for the introduction of embryos now takes place under the full control of doctors. To "turn off" the work of the ovaries, it is necessary to introduce drugs into the woman's body that will block the production of luteinizing (LH) and follicle-stimulating hormones (FSH) by the pituitary gland. If there is no command from the pituitary gland, the ovaries will turn off.

FSH and LH blockers are prescribed 7 days before the expected menstruation. You need to drink them for 2-3 weeks, until natural ovulation is completely suppressed (this is judged by the maximum decrease in estrogen in the blood).

2. Ovarian stimulation

After the suppression of the natural work of the ovaries, the function of the pituitary gland will be taken over by a preparation of laboratory-created (recombinant) FSH. It is taken for 8-12 days, while every 1-3 days an ultrasound is performed, where they look at the size of the follicle. In the same time intervals, the level of estradiol in the blood is monitored.

3. Inclusion of the follicle

This is the final stage in the formation of the egg, which will be used to inject the sperm into it. The "launch" of the follicle is made when at least 2 follicles are mature in the ovary (their size has reached 5-8 mm). This is done with the help of a preparation of chorionic gonadotropin, which can:

• induce ovulation;
• form the corpus luteum - the gland that the follicle becomes after a mature egg has left it. It produces progesterone, which is necessary for the onset and formation of pregnancy;
• HCG is also needed for the formation of a normal placenta.

During a long protocol, doses of drugs are used that will be commensurate with the abilities of the ovaries.

4. Puncture

36 hours after the launch of the follicle, its puncture (puncture) is performed in order to obtain an egg. An IVF puncture is performed on the 12-15th day of the menstrual cycle. The procedure is carried out as follows:

• the woman is in the operating room, on the operating table;
• she is placed a catheter in a vein, through which drugs are injected for anesthesia;
• an ultrasound probe is placed over the abdomen;
• a device equipped with a needle is inserted into the vagina;
• under the control of ultrasound, the follicle is pierced, the egg is sucked through the needle, enters a special reservoir;
• after that, the anesthesia immediately ends.

The procedure lasts about 10 minutes

5. Transfer of punctate from the reservoir to the nutrient medium

From a sterile reservoir, the contents obtained as a result of a puncture are first transferred under a microscope, where eggs are isolated from it. They are transferred to a nutrient substrate, which is placed in an incubator. There, the oocytes do not last long, usually a few hours, before merging with the spermatozoon.

6. Getting sperm

Seminal fluid is obtained by masturbation. If conception is not from a husband or sexual partner, sperm from the Sperm Bank can be used. The husband's consent to this procedure is recorded by a special protocol.

7. Fertilization

There are two main options here:

1. eggs and spermatozoa are placed on a nutrient medium, where they independently find each other;
2. a spermatozoon is injected into the egg (ICSI, IMSI) after a preliminary test (PICSI).

8. Embryo maturation

Having penetrated into the oocyte, the spermatozoon begins to form a single organism with it, called the zygote. She, placed on a medium rich in trace elements, vitamins and nutrients, begins to actively divide. The incubator where this happens has strict temperature, CO2, pH control equipment.

9. Pre-implantation diagnosis

When the zygote contains from 4 to 10 identical (this is the 5th day of development) cells, you can take one of them and study it for gene, chromosomal abnormalities, as well as viral load. The gender of the child can also be determined, but his choice is prohibited. federal law No. 323-FZ of November 21, 2011 "On the basics of protecting the health of citizens in Russian Federation". You can only “order” what gender the child will be in the event that diseases (for example, hemophilia) can be transmitted with X or Y chromosomes.

Pre-implantation diagnosis is possible only if IVF ICSI or ICSI IMSI is planned later.

10. Transfer of the embryo to the uterus

Before the procedure, blood is taken for estradiol.

With the help of a long and thin elastic catheter, without anesthesia, 1-3 embryos are introduced into the uterine cavity. A woman needs to lie down for several hours, after which she can go home.

Even in the operating room, they can administer a drug that improves blood flow - Fragmin or Clexane. It is performed to prevent complications associated with increased clotting, if ovarian hyperstimulation syndrome suddenly develops.

Fragmin / Clexane is administered for at least another 5 days, under the control of blood clotting.

11. Supportive care

In order for the embryos to take root, doctors prescribe progesterone preparations, the main “pregnancy hormone”. Usually it is "Utrozhestan" in candlelight. You need to enter candles lying on your back, putting a pillow under the buttocks, as deep as possible.

12. Engraftment control

IVF results are assessed by the level of hCG in the blood, as well as by ultrasound. An ultrasound examination is performed 2-3 weeks after the transfer; the results of hCG after IVF should be evaluated 4-6 days after implantation. At first, the hormone grows slowly, after 2-3 weeks it begins to increase every day by 1.5-2 times.

On average, the hCG table looks like this:

Day after puncture	If a 3-day embryo was transferred, hCG	If a 5-day-old embryo was transferred, the hCG level	Variation of hCG
7	4	2	2-10
8	5	3	3-18
9	6	4	3-18
10	7	5	8-26
11	8	6	11-45
12	9	7	17-65
13	10	8	22-105
14	11	9	29-170
15	12	10	39-270
16	13	11	68-400
17	14	12	120-580
18	15	13	220-840
19	16	14	370-1300
20	17	15	520-2000
21	18	16	750-3100
22	19	17	1050-4900
23	20	18	1400-6200
24	21	19	1830-7800
25	22	20	2400-9800
26	23	21	4200-15600
27	24	22	5400-19500
28	25	23	7100-27300
29	26	24	8800-33000
30	27	25	10500-40000
31	28	26	11500-60000
32	29	27	12800-63000
33	30	28	14000-68000
34	31	29	15500-70000
35	32	30	17100-74000
36	33	31	19000-78000
37	34	32	20500-83000

Short protocol IVF

It is applied if the woman has responded poorly to the first stage of a long protocol, and also if she is over 35 years old. The short protocol lasts less than 4 weeks.

A short protocol begins not with ovarian suppression, but with stimulation of follicle growth with FSH and LH preparations. These drugs are taken on the 3rd day of the menstrual cycle. And although the short protocol is not so physiological, it also has advantages:

the duration of the course is less;

the price is lower.

IVF cryo protocol

This term refers to the replanting of embryos previously frozen to the temperature of liquid nitrogen. They are kept when fertilization of more than necessary number of eggs occurs. Freezing of embryos is coordinated with a married couple.

Frozen embryos are implanted in a woman 2-3 days after ovulation. This is usually possible for women who are under 35 and whose menstrual cycles are regular. Replanting can be done both after a short and after a long IVF protocol.

Donor eggs

If obtaining own oocytes is not possible due to:

• absence of ovaries - congenital or during surgery, for example, to treat purulent fusion of their tissue;
• women's entry into menopause.

Any healthy woman can act as an egg donor: either a relative or friend of a woman, or a donor on a paid basis. To obtain a donor oocyte, it is necessary to synchronize the menstrual cycles of both women, and then puncture the donor follicle.

Complications and consequences of in vitro fertilization

Usually, IVF has no consequences for a woman: she has a pregnancy similar to a natural one, which early dates support hormonal medications in doses that mimic physiological levels of hormones. But in some cases, complications of the procedure can occur. This:

• multiple pregnancy. Diagnosed in time, it can be corrected: a puncture of "extra" embryos is performed, a drug is injected through the puncture, which contributes to their independent death;
• ectopic pregnancy;
• bleeding from the ovary after its puncture;
• ovarian torsion;
• ovarian hyperstimulation syndrome. It is associated with the maturation of many follicles instead of one, under the influence of drugs. This increases the production of estradiol many times over, which increases clotting, microthrombi are formed in the vessels, and the liquid part of the blood sweats into the pleural, abdominal cavity, and heart sac. It is formed in women with a tendency to allergic reactions, those who have polycystic ovaries, those who have increased estradiol activity, and those who used hCG to support the second phase of the menstrual cycle. The syndrome manifests itself a few hours or days after the puncture of the follicles. Symptoms: heaviness in the lower abdomen, nausea, frequent urination, shortness of breath, interruptions in the work of the heart. It is treated by the introduction of protein preparations into the vein, by eating animal proteins.

As for the health consequences in the future, scientists are divided. Some believe that IVF can cause tumors in the ovaries and mammary glands. The opinion of others is that these are unrelated things, that those problems that initially force a woman to go for in vitro fertilization are factors in the development of cancer.

The effect of the procedure on the child

The consequences of IVF for children are also a subject of controversy among scientists. Some believe that they can be like this:

• increased risk of fetal hypoxia;
• disruption of the cardiovascular system;
• neurological disorders;
• developmental defects.

A pregnancy that develops by in vitro fertilization can, like a natural one, proceed with placental abruption, premature birth, or “fading” of the fetus.

To ensure a normal pregnancy after IVF

It is very important in the first 12 days very strictly, then - a little less strictly follow the following rules:

1. To avoid physical activity: fitness, strength training, running.
2. No smoking.
3. Walk more outdoors.
4. Limit your sex life.
5. Less likely to be in a room where there are a lot of people.
6. Drink at least 30 ml/kg of liquid per day.

The modern world is rich in innovation and technology development. Changes in medicine, especially in the field of reproduction, have not bypassed. Medicine has stepped far forward pushing the boundaries of the impossible. Now doctors have the opportunity to help infertile couples. Assisted reproductive technology came to their aid, which develops every year and increases the percentage of positive results. The most used technology is in vitro fertilization. Married couples, and especially women, are preoccupied and anxious, worrying about every little thing. And, of course, the first thing that worries couples who decide to turn to drastic methods for help is the statistics of in vitro fertilization protocols. They are worried about what success awaits them, with what attempt they will be able to feel that very long-awaited joy from motherhood and fatherhood.

Probably, the decisive moment in choosing a clinic is the statistics of IVF clinics on successful pregnancies. Only after studying the existing information about the results, many couples opt for one or another clinic. In addition, if a couple goes to the IVF protocol according to the quota received by the state, this will not affect the choice of the clinic. Thus, a fertility clinic provides you with its services free of charge on the basis that your treatment will be funded by a mandatory health insurance policy.

Statistics of successful IVF and factors influencing it

It should be noted that in vitro fertilization is the most effective method infertility treatment.

When taking into account IVF success statistics, the following factors that affect the results should be taken into account:

• age limits of women and men;
• the reason why the couple is infertile, the duration of infertility;
• the results of the ovarian puncture, i.e. what eggs were obtained and in what quantity;
• with a male factor, the characteristics of the received spermatozoa and the quantity affect;
• how many embryos were obtained that are capable of development;
• the longer the barren experience, the harder it is to treat;
• the state of the endometrium during the period of transplantation and implantation of embryos;
• number of previous in vitro fertilization treatment attempts;
• the level of qualification of doctors in the selected clinic;
• individual selection of the protocol in each individual case;
• the right choice of hormonal drugs with an adequate dosage;
• hereditary diseases that affect the course of treatment;
• embryo transfer after cryoprotocol;
• a significant impact is exerted by the lifestyle of patients (alcohol consumption and smoking);
• the presence of diseases in the acute stage or not fully cured at the time of the protocol.

IVF statistics around the world are different from the statistics in our country. The reason for this is more modern equipment. For example, in the United States over the past year, about 200 thousand IVF protocols have been carried out, 130 thousand of them were carried out for the first time. According to the data among these thousands, 38% turned out to be successful and ended in term birth with absolutely normal healthy children.

Countries where IVF is performed with a positive result

Japan is famous for its technology. It is worth noting that for a large number of the population (127 million people) there are about 500 clinics that deal with infertility treatment. While, for example, in the Russian Federation with a large population of clinics, there are much fewer clinics. Also, do not forget that it is from Japan that the protocol with the most gentle effect of hormonal drugs during stimulation comes from. So in 2016, 424 thousand IVF protocols were carried out, of which 12% were successful.

In the first place among the countries in which in vitro fertilization is carried out is Israel. A high percentage, namely 47-50%, is explained by the fact that this method of treatment has been carried out in this country since 1980. And clinics conduct trainings on preparation for in vitro fertilization.

Good results after IVF are observed in clinics in Spain. Every year, about 5,000 IVF protocols are performed in Barcelona clinics. The percentage result in Barcelona exceeds 45%, and in the country in general 43-44%, of which almost 20% pregnancy occurred the first time.

Along with Israeli clinics, there are clinics in Poland. So in Poland, the percentage of successful IVF reaches 55-60%, and this is worth noting the highest result among all European countries.

Sweden has also established itself as a country with efficient protocols. In addition, another of the positive aspects in this country is that each clinic has a certain type of contract that provides for an agreement on the number of attempts. In the event that for some reason IVF was not successful, part of the amount spent will be returned to you.

Turkey and Cyprus are also famous for their great successes. About 3,000-4,000 married couples visit these countries every year, some of them are single. In percentage terms, we can say that after the cryoprotocol, success is noted in 48.5%, and after intrauterine insemination - 17.9%.

In Belarus, the rules for IVF are stricter, only couples who are officially married have the right to receive treatment using assisted reproductive technology. With regards to efficiency, the percentage of positive results is also high.

If we talk about indications in Ukraine, it is worth noting that the statistics of successful IVF are also at the proper level. That is, about 35% of the protocols carried out end in a normal pregnancy and, accordingly, childbirth.

In Russia, over the past year, the percentage of children born as a result of IVF was slightly more than 1% of all babies. Statistics on successful IVF are maintained by each clinic separately, but if taken in total, then after the first attempt, 35% were successful, and 40% were successful after a second attempt at treatment. But on average, statistics for the country at the world level, that is, about 55-60%.

Do not forget that the success of the procedure depends on the clinic itself. For example, clinics in the capital have more modern and high-tech equipment, unlike peripheral clinics.

Having an idea of ​​the average results of IVF procedures performed, you can decide on the choice of a clinic, as well as prepare for various options for the outcome of treatment.

IVF success rate

The statistics of IVF attempts, depending on the selected protocol, is as follows:

• conducted in vitro fertilization in the natural cycle has not very encouraging figures, 8-11% of cases. The probability is reduced due to the fact that one, maximum, two eggs are punctured. So, they fertilize such a cell, which they received and only one.
• the use of cryoprotocols has a more rosy picture of successful attempts. In 23-25% of procedures are successful. These figures are affected by the method of storage of the received embryos and their subsequent thawing. Compliance with all the rules of this protocol.
• IVF with donor material has a fairly high efficiency. About 46-47% of women become pregnant and carry a healthy child. Most likely, a high percentage is obtained as a result of careful selection of a “worthy” egg. This method is usually used in the treatment of patients over 35 years of age, when their reserve is sharply limited or exhausted.
• the use of IVF + ICSI gives a result of 32-35% on the first attempt, with repeated use the result is already higher - 40-42%. With each procedure performed, the result increases, for example, after the fifth attempt, a successful result is obtained in almost 70% of cases.

Depending on the experience of infertility:

• infertility for three years and a less successful result at the first attempt of about 30%;
• infertility treatment lasts from 3 to 6 years for each case, the probability of a positive result is reduced to 27.5%;
• with infertility for 6-9 years, the success rate drops to 27%;
• indecision to resort to IVF for 10-12 years leads to a decrease in pregnancy by 20%;
• if infertility has not been treated for 15 years, percentage success for each cycle is only 14-15%.

IVF results depending on the infertility factor:

• tubal-peritoneal infertility factor success is observed in 53% of couples;
• infertility of endocrine origin as a result of treatment 45.5% successful development of pregnancy;
• 47% of successful cases in severe forms of endometriosis;
• with polycystic ovary syndrome, with a correctly selected protocol, a positive result after IVF is noted in 55% of cases;
• in the case of the male factor, the use of IVF + ICSI methods gives a result of about 50% success;
• in the presence of any other cause, treatment gives a result of 25.5%;
• favorable treatment of infertility of unknown origin in 30%;
• combined factor in a woman, the result is 22.5%;
• combined male and female factors lead to a positive result after IVF treatment in 26%.

Given the age, it should be noted that:

• with IVF in women who are under 34 years old, 38.6% have a positive result;
• in patients aged 34 to 38 years, successful IVF occurs in 30.3% of cases;
• in women who are over 40 years of age, the success rate for positive completion of the protocol is reduced to 16.8%.

Statistics of results after IVF

The results of statistical data can be improved by following the recommendations of the attending physician, observing healthy lifestyle life, eat right, give up alcohol and nicotine. If these rules are followed, it turns out to achieve successful results of the IVF protocol. Over the past ten years, it has been possible to increase the effectiveness of this method from 10% to 40%. And all this is due to the development of science and technology, the emergence of new, more accurate and modern equipment. As well as the annual advanced training of doctors in the field of assisted reproductive technologies.

Undoubtedly, everyone knows that it is not always possible to get pregnant on the first attempt, but with each attempt, the chance of a successful completion of the program increases. So in the case after repeated attempts, the percentage increases from 35% to 74%.

The incidence of complications after IVF protocols.

The most common complication is ovarian hyperstimulation syndrome. But as statistics show, about 2% of cases are allocated to its frequency of occurrence.

The development of an ectopic pregnancy is quite rare, and most importantly, the doctor can prevent the occurrence of this pathology in time. So according to statistics, this is possible in 8% of cases.

IVF statistics provide data that in 0.0001% of cases, the development of an oncological process is a possible complication. This may be due to aggressive hormonal therapy. But the percentage is so small that cases of such complications can be said to be practically non-existent.

Multiple pregnancy among doctors is also considered a complication after the IVF program. Such a pregnancy can occur if two embryos are implanted after transplantation and both are viable. It is considered a complication because, in general, multiple pregnancy is very difficult to bear and has its own characteristics of management. This occurs in about 25-30% of cases.

Spontaneous interruption of IVF pregnancy can occur for completely different reasons and happens with any pregnancy. Such cases occur in 10% of all pregnancies.

What is ECO?

In vitro fertilization (IVF) is a form of assisted reproductive technology used in cases of infertility by combining a woman's egg and a man's sperm in a laboratory test tube. The term "in vitro" means outside the body, and the fertilization process itself means that the sperm has safely entered the egg. Most often, the IVF method is used in cases where other, less expensive fertility methods have failed, since IVF is quite an expensive procedure.

The cost of one IVF cycle includes the cost of medicines, surgery, pain relief, ultrasound, blood tests, egg and sperm processing, embryo storage and transfer. The exact amount of one IVF cycle varies, and can cost over $12,000 - $17,000.

Brief anatomy

In most cases, the main cause of infertility is the inability to physically meet the female and male reproductive cells in their "natural environment", namely in the female genital tract. At the same time, the female body is quite capable of bearing and giving birth to a child. Thus, medical workers are faced with the issue of organizing a “date” between the egg and sperm. After that, the finished embryo must be returned to its rightful place - in the uterus of the expectant mother, where pregnancy after the IVF procedure develops in the usual natural way. If the fertilized egg attaches to the lining of the uterus and continues to grow, a baby is born after 9 months. This process is called natural or the concept of outside help. It should be noted that children resulting from IVF are absolutely no different from children conceived in a natural way.

Indications for IVF

Reasons for infertility treatment by IVF can be as follows:

Damage or blockage of the fallopian tubes (may be caused by pelvic inflammatory disease or previous reproductive surgery);
- endometriosis;
- male factor of infertility, including a decrease in the number of spermatozoa;
- unexplained infertility;
- woman's age;
- premature ovarian failure, inability of the patient to produce eggs.

IVF efficiency

In vitro fertilization is by far the most effective procedure that allows you to achieve a long-awaited pregnancy without long-term treatment. The chances of conception with various types of infertility are 40-45%, which, you see, is quite a lot.

IVF treatment is often successful, but one attempt may not be enough to achieve a positive result. Studies show that the chances of IVF success are mostly after the fourth cycle of attempts. The success of an IVF procedure depends on a number of factors, including the characteristics of the patient and the treatment approaches themselves. The average percentage of conception in all patients is 30-35%, but, for example, if the problem is only in the obstruction of the tubes, then the probability of pregnancy rises to 40-45%, and, for example, with endometriosis and the absence of one ovary, it decreases to 10%. So you need to make predictions strictly individually.

However, with all the effectiveness of the method, not all pregnancies lead to a live birth.

Successful IVF results may vary depending on various kinds treatments needed for different patients according to their specific problems. Various parameters that govern the level of success include:

The age of the woman producing the eggs;
- The number of eggs that are produced after stimulation;
- The quality of sperm;
- Number of embryos resulting from processing;
- Number of implanted embryos.

According to the Society for Assisted Reproductive Technology (USA), the chance of having a baby after IVF is as follows:

In 41 - 43% of women under the age of 35;
- in 33 - 36% of women aged 35 - 37 years;
- in 23 - 27% of women aged 38 - 40 years;
- in 13 - 18% of women aged 41 years and older.

Preparation for IVF

Prior to the planned start of IVF treatment, your doctor may recommend taking birth control pills. This may seem strange, because on the contrary, you want to get pregnant. In fact, the use of birth control pills before a treatment cycle has been shown to significantly reduce the risk of hyperstimulation syndrome and ovarian cysts, and may even increase the chances of success.

Also, your doctor may ask you to record the days of your ovulation by plotting your basal body temperature or using special ovulation tests. As soon as you detect ovulation, tell your doctor right away. Since some time after this you will be prescribed GnRH antagonist or GnRH agonist fertility drugs such as Lupron. These drugs can have complete control over ovulation. In other cases, with rare ovulation cycles, progesterone may be prescribed. Always follow your doctor's instructions.

Before starting an IVF treatment cycle, patients need to do the following tests and examinations:

Women:

Complete hemogram, blood sugar, urea, ALT;
- Hepatitis B (HBs Ag);
- HIV.

For men:

Semen test within 6 months;
- Hepatitis B (HBs Ag)
- HIV.

Your doctor will also ask you for a complete blood count and an ultrasound. This is called your original work of blood and ultrasound. In the blood work, the doctor will look at your estrogen levels, specifically E2 or estradiol. This is done to make sure your ovaries are "sleeping" and the expected effects of taking Lupron or a GnRH antagonist are present. An ultrasound is done to check the size of your ovaries and look for ovarian cysts. If there are cysts, your doctor will decide how to deal with them. Sometimes their treatment can be delayed for a certain period, since most cysts can resolve on their own over time from the use of already prescribed devices. In other cases, a doctor may remove cysts by draining fluid with a needle.
As a rule, if all the indicated tests and examinations are good, then the next stage of treatment begins, namely the preparation and conduct of the IVF procedure itself.

Stages of IVF

The entire IVF treatment procedure consists of eight main phases, each of which is described in detail below.

1. Regulation phase. It is a process of suppressing a woman's natural production of luteinizing hormone (LH). This hormone triggers ovulation and contributes to the final stage in the maturation of the egg. IVF medications allow a woman's cycles to be regulated by stimulating the follicles on the ovaries and several of their eggs, which will be collected during oocyte retrieval. Unlike collection in a natural cycle, the collection of a single oocyte of an IVF procedure increases the success rate by collecting several eggs at the same time.

You will be prescribed oral contraceptives for a certain period of time before the start of oocyte collection. About five days before your last pill, you can use a nasal spray called Synarel. Within four to seven days after taking the last tablet on the due date, stimulation of the injection will begin.

2. Superovulation stimulation phase. Fertility drugs are given to a woman to increase her egg production. Typically, a woman produces one egg per month. However, during IVF treatment, taking certain medications makes it possible to gently stimulate the development of several follicles in the ovaries at once. For these purposes, low doses of follicle-stimulating hormone (FSH) are used, which reduces the likelihood of large stimulation. Under the influence of these hormones, not one or two eggs grow in the ovaries, as usual, but 8-10, or even more. This is necessary to increase the chances of conception. The first stage lasts 12-14 days. During this phase of treatment, the woman will have regular transvaginal ultrasounds for a detailed examination of the ovaries, as well as blood tests to check hormone levels, which may lead to the doctor changing the amount of medication.

3. Monitoring phase. Every woman reacts differently to stimulation from cycle to cycle. Therefore, it is very important for physicians to monitor how a patient responds to their treatments. For these purposes, all the same blood tests and ultrasound are used, which should always be in the clinic. Ultrasounds are performed regularly by trained nurses to detect mature follicles.

Once your ultrasound confirms the presence of a number of mature follicles, there is a final step to take before collecting oocytes. Its essence involves the introduction of a single injection of human chorionic gonadotropin (hCG) alpha, which is almost identical to LH and therefore leads to ovulation, as in the natural cycle. If there is insufficient follicle growth or if you are at risk of developing severe ovarian hyperstimulation syndrome, your further preparation cycle may be canceled and no human chorionic gonadotropin (hCG) injection will be given. If treatment is stopped because your ovaries are not responding to medication, your doctor may recommend other medications and wait for your next cycle. The cycle can also be canceled if ovulation in the woman's body occurred before the search for follicles, since if the ovulation eggs are independent, they cannot be restored.

4. The oocyte retrieval phase. When, according to the results of the ultrasound, it is clear that the follicles in which the eggs are contained and grow are mature, the patient is punctured. This procedure is done under light anesthesia (some clinics use only modern sedation anesthesia technique, which allows you to endure most unpleasant medical procedures as comfortably as possible) and under the control of transvaginal ultrasound. A long, thin probe needle runs along the vagina and can be seen on the screen of the device. The needle pierces the wall of the vagina, within the ovarian follicles, after which the contents of each follicle are removed along with the egg and carefully transferred to heated test tubes. The follicular fluid is then examined under a microscope to identify oocytes in the aspiration. The procedure is repeated for the other ovary. This process usually takes from a few minutes to half an hour depending on the number of follicles present. After the medical staff completes the examination, you can return home. After the procedure, some cramps may occur during the day. In rare cases, if a woman is unwilling or unable to produce eggs, a pelvic laparoscopy may be used to remove the ovaries.

5. Fertilization phase "in vitro". When each resulting egg is processed and placed in a test tube with a nutrient solution, it is ready to be fertilized by the husband's sperm. Semen samples must be delivered to the clinic immediately after the oocyte (egg) retrieval procedure. Good quality sperm will then be isolated directly for fertilization using a density gradient centrifugation process. This male sperm is placed with the best quality eggs. The mixing of sperm and egg is actually called fertilization. The eggs and sperm are then stored in an environmentally controlled incubator where, at a certain temperature, the eggs begin to multiply. The sperm usually fertilizes the egg within a few hours after insemination. If the doctor thinks that the chance of conception is low, the sperm can be injected directly into the egg. This is called intracytoplasmic sperm injection (ICSI).

The next day (16-20 hours after insemination), the oocytes (eggs) are carefully examined under a microscope to determine the fertilization rate. Approximately 60% of oocytes are expected to be fertilized by IVF, while approximately 70% of mature oocytes are to be fertilized by ICSI. If fertilization is successful, then the egg will have two identifiable central disks called pronuclei (PNs). One pronucleus is a set of chromosomes from a male, and the other from a female. The developing embryos are then returned back to the incubator. The embryos will remain in the incubator until your embryo transfer, usually 2-3 days after oocyte collection.

6. Embryo growth phase. When a fertilized egg divides, it becomes an embryo. The lab staff regularly checks the embryo to make sure it grows and develops properly. Within about 5 days, a normal embryo has several cells that are actively dividing.

For couples who are at high risk of passing on a genetic (hereditary) disorder to their child, pre-implantation genetic diagnosis (PGD) may be used. The procedure is carried out for 3-4 days after fertilization. Laboratory scientists take one cell from each embryo as material to test for specific genetic disorders.

According to the American Society for Reproductive Medicine, PGD can help parents decide which embryos are best for an implant. This reduces the risk of congenital malformations in the child. However, this technique is controversial and is not offered in all centers.

7. Embryo transfer phase. When the embryos reach the required stage of development, the two best ones are selected and transferred to the patient's uterus. Embryos are placed in the woman's uterus within 3 to 5 days after egg retrieval and fertilization. The transfer process itself is similar to taking a smear. A speculum is placed in the vagina so that the cervix is ​​clearly visible. A thin tube is inserted through the cervix into the lower part of the uterus itself. After that, using an even smaller tube (catheter) with a small amount of liquid, the embryo itself will be introduced, which is pushed out of the transfer catheter into the uterine cavity.

Specialists monitor the transfer of the embryo into the uterus using ultrasound to make sure the procedure was successful. After that, the mirror is also removed, which means that the IVF procedure is completed. Embryo transfer is a painless procedure, done without anesthesia, and usually takes 2-3 minutes.

If the embryo attaches to the uterus and grows, the result is considered positive and means pregnancy. At the request of the parents, more than one embryo can be placed in the uterus, which can lead to twins and more children. The exact number of possible embryos that can be implanted in the uterus is a complex issue that depends on many factors, most notably the age of the woman.

After the embryo transfer, the woman should rest for the rest of the day. Complete bed rest is usually not prescribed unless there is an increased risk. Most women return to their normal activities the very next day.

8. Phase support on early stage pregnancy after IVF. Women undergoing IVF must take progesterone hormone tablets daily for 8 to 10 weeks after embryo transfer. The hormone progesterone, produced naturally by the ovaries, helps improve the surface of the uterus to support pregnancy. Having too little progesterone in the first weeks of pregnancy can lead to miscarriage.

12-14 days after the embryo transfer, the woman can return to the clinic to take a pregnancy test and find out her result. If the test is positive (yes!), you may need to continue taking progesterone for a few more weeks. Your doctor will also carefully monitor your blood tests and ultrasound results to prevent the possibility of a miscarriage or an ectopic pregnancy. During IVF treatment, miscarriage occurs in 15% of women under the age of 35, in 25% of women at the age of 40 and up to 35% of women after the age of 42.
Your doctor will also monitor if IVF treatment has resulted in multiple pregnancies. If this pregnancy has four or more embryos, then you can discuss with your doctor the possibility of reducing the number of fetuses through a procedure called "embryo reduction". Sometimes this is done in order to increase the chances of a successful pregnancy and the birth of a healthy child.

Multiple pregnancy with IVF

The most common IVF problem is multiple pregnancy. Often twins are born, rarely triplets. The risk of multiple pregnancy occurs when more than one embryo is placed in the uterus, which increases the risk of preterm birth and low birth weight. (However, even a single baby born after IVF is also at high risk for preterm birth and low birth weight.) Whether IVF increases the risk of birth defects is still unclear.

The number of embryos that must be created or transferred during one IVF cycle is subject to debate. Some sources of medical literature state that transferring no more than four embryos in one IVF cycle will give optimal results. Transmission of more than four, thought to result from an excess number of multiple pregnancies, increases the possibility of additional complications.

Transferring four embryos instead of one or two increases the patient's chances of getting pregnant. However, it is important to understand that all four of these embryos could implant. Some people have serious concerns about what happens to the remaining embryos. In any case, couples should carefully discuss such issues with their doctor.

Complications and risks of IVF

Like most medical procedures, IVF treatment can also carry certain complications and potential risks. Fertilization risks correspond to each specific step of the procedure.

Depression. IVF involves a large expenditure of physical and emotional energy, as well as time and money. Many couples undergoing fertility treatment suffer from stress and depression, especially if IVF fails.

Lack of response to hormone therapy. One problem is that the ovaries may not respond to gonadotropins and the follicles still do not develop. This is usually seen in older women.

Ectopic pregnancy. Although embryos are transferred directly into the uterine cavity, in very rare cases, they can migrate into the fallopian tubes and develop there, resulting in an ectopic pregnancy.

Internal bleeding. There is a very small risk of internal bleeding after egg retrieval.

Side effects from medications taken. A woman taking fertility drugs may experience bloating and abdominal pain, mood swings, headaches, and more. side effects. This condition results in the accumulation of fluid in the abdominal cavity and chest. Symptoms include pain and bloating, rapid weight gain (4-5 kg ​​over 3-5 days), decreased urination despite adequate fluid intake, dark urine, nausea, vomiting, and difficulty breathing. Some cases can be treated with bed rest. More serious cases require pumping out the fluid with a special needle.

Ovarian hyperstimulation syndrome. Sometimes during the stimulation of ovulation, many follicles develop. After the embryo transfer, the ovaries continue to grow and can grow to become very large, resulting in a buildup of fluid in the abdomen and chest. This condition is known as ovarian hyperstimulation syndrome. Patients may experience abdominal pain, bloating, nausea and vomiting, thirst, pain and bloating, rapid weight gain (4-5 kg ​​over 3-5 days), decreased urination despite adequate fluid intake, dark urine, nausea, vomiting and difficulty breathing. This happens in less than 5% of cases. Some cases can be treated with bed rest. In rare cases, patients must be hospitalized for rehydration of intravenous fluids.

Tissue damage. Many IVF medications are given by injection, often several times a day. Repeated injections may cause bruising. medical research showed that fertility drugs are not associated with the development of ovarian cancer. The risks of egg retrieval include reactions to anesthesia, bleeding, infections, and damage to structures surrounding the ovaries, including the intestines and bladder. Approximately one in 1,000 patients will need surgery to repair the damage caused during the egg retrieval process.

Be sure to call your doctor right away if you experience:

Temperature above 38 C;
- severe pelvic pain;
- heavy bleeding from the vagina;
- blood in the urine.

If the pregnancy test is still negative for 12 to 14 days after the transfer, then your doctor will ask you to stop taking progesterone and wait for the next appropriate period to start a new phase of treatment. Having failed, you do not need to give up, you must definitely try again, perhaps just the next cycle will be successful!

How is childbirth going after IVF?

According to most experts in the field of assisted reproductive technologies, the method of fertilization does not affect the course of childbirth, and patients are quite able to give birth naturally. However, in vitro fertilization, as a rule, is performed for women after many years of infertility, especially if this is not the first IVF attempt, and most likely, the condition of the pregnant woman is an indication for a caesarean section, since it can significantly minimize the risks for the child due to possible complications of the birth process . The same applies to the situation when there are any other pathologies on the part of the mother and child, or complications occur during childbirth, as well as in the case of multiple pregnancies.

Well, if, apart from the method of fertilization, nothing aggravates the condition of a woman, then childbirth is carried out through the natural birth canal.

Are children conceived through IVF different from normal children?

In some cases, embryos obtained as a result of in vitro fertilization undergo pre-implantation genetic diagnosis. This study, made possible by the advances in modern genetic technology, is carried out before the embryo is transferred into the uterine cavity. It allows you to identify gross malformations, chromosomal diseases, such as Down's disease; You can also determine the gender of the child. Thus, even before entering the uterine cavity, the baby is insured against genetic diseases, which is a definite plus in favor of IVF.

As you know, the abilities and skills of children are determined not only by the genes received by the child from the parents, but also by how much the parents strive to develop the baby's abilities.
Since children born after IVF, as a rule, are long-awaited, parents often comprehensively take care of the baby, do everything possible to raise and educate their long-awaited child. Perhaps this determines the fact that children after IVF usually show top scores academically compared to "normal" children. Although the influence of some kind of "genetic selection" cannot be ruled out here - after all, parents resorting to IVF, probably, on average, themselves have a higher educational level than the average population.

Every married couple sooner or later comes to the conclusion that they want to have a baby. If earlier women became mothers already at the age of 20-23, now this age is greatly increasing. Representatives of the weaker sex decide to have offspring after 30 years. However, things don't always go as planned at this point. This article will tell you about how IVF is done (in detail). You will learn the main steps of this procedure. It is also worth mentioning the indications and limitations of this manipulation.

What it is?

Before you find out how IVF is done (in stages), it is worth saying a few words about the manipulation itself. In vitro fertilization is a way to conceive a child outside the female body. Babies born subsequently are called "test-tube babies." The procedure was first performed several decades ago. It took a lot of effort and expense.

Now it is no longer something unnatural. You can do it for a fee or on a special quota. For this, a man and a woman must have certain indications.

When is IVF done?

There are many indications for this procedure. However, only some of them involve free manipulation. In this case, the couple is allocated a quota, and all expenses are covered by the state and the insurance company.

Pipe factor

One of the most common reasons for in vitro fertilization is tubal infertility. In this case, a woman may not have a fallopian canal at all. More often it is a consequence of surgical interventions. Also, obstruction can be attributed to the tubal factor. Before IVF is done, such channels are removed.

male infertility

The indication will be poor-quality partner sperm. Find out the state of the material during the spermogram. In this case, the main factor will be that sperm reduces its quality in vivo (in the female genital organs).

endometriosis

When is IVF done? One of the indications for manipulation is the growth of the endometrium outside the uterus. This pathology affects mainly women of reproductive age. In this case, treatment can be long and include surgical methods, as well as hormonal drugs. In the absence of a positive effect, experts advise not to delay, but to resort to the procedure of artificial insemination.

Age changes

Many women are interested in the question of up to what age they do IVF. In fact, there are no specific limits. Many couples, on the contrary, turn to assisted reproduction methods only because they cannot conceive a child on their own due to their age (usually after 40 years).

Problems with ovulation

Every woman may have two or three anovulatory cycles during the year. This is not some kind of pathology. When less than 5-6 ovulations are carried out within 12 months, then this is already a deviation. Usually this problem is easily eliminated by hormonal drugs. However, if this method is ineffective, doctors advise IVF.

Contraindications to be aware of

Before IVF is done, a woman must be carefully examined. If any contraindications to manipulation are revealed, then it must be abandoned. These include the following situations:

• therapeutic and psychological pathologies incompatible with pregnancy;
• deformation of the uterine cavity, in which the attachment of embryos is unlikely;
• tumors of the uterus and ovaries, which can grow with hormonal preparation;
• malignant diseases even in the stage of regression;
• inflammatory processes in the genitals of a woman or a man.

In each situation, the couple is considered individually. If contraindications are determined, then the specialist will definitely inform about this.

How is IVF done?

The fertilization process itself takes quite a long time. Depending on the length of the protocol, the couple may need from one to three months. During the procedure, a woman has to take many drugs. Some of them have unpleasant side effects.

The in vitro fertilization procedure consists of several stages. The doctor will definitely tell you about them at the first visit. Many couples wonder how quickly they do it. With a free procedure, spouses have to wait for a quota for some time. Usually this issue is resolved within a few months. When carrying out artificial insemination in a private clinic, it is possible to start the protocol within a few weeks after treatment.

Preparation and analyzes

Before IVF is done, a woman must be examined. Her partner must also pass certain tests. Standard tests are tests for hepatitis, HIV, syphilis. A man must pass a spermogram. It determines by what method artificial insemination will be carried out.

Also, the representative of the weaker sex must visit some doctors. This is a neurologist, cardiologist, ophthalmologist, therapist. A conversation is being held with a psychologist.

Prescribing drugs: choosing a protocol

Before IVF is done, experts determine the length of the protocol. It may be short. In this case, stimulation begins immediately after the next menstruation. A woman is prescribed hormonal drugs, which she must take daily according to a strict scheme. Often the drugs are in the form of injections. Medicines can be administered in a hospital or self-administered. The doctor will definitely tell you all the subtleties of manipulation.

With a long protocol, before the start of stimulation, the woman is introduced into the so-called menopause. This is often done in the presence of hormonal pathologies, including endometriosis. After a break that lasts from two weeks to a month, stimulation begins. Further actions will be the same in both protocols.

Follicle Growth Tracking

So how is IVF done? In the process of receiving hormonal drugs a woman must visit the ultrasound diagnostic room. Typically, such a study is scheduled for the 5th, 9th and 12th day. However, if necessary, the doctor may recommend additional days. During an ultrasound, a specialist evaluates the growth of follicles and the condition of the uterus with the endometrium. The reproductive organ should be as ready as possible to receive the embryo.

At the last study, the date and time of the puncture is assigned. At this stage, stimulation ends.

Egg selection

We continue to explore the topic of how the IVF procedure is done. For a puncture, a woman must be placed in a hospital. Here she is given a separate place and all the conditions. The puncture can be made through the abdominal wall or by the vaginal method. The second option is chosen more often. It is considered more natural and less traumatic.

A disposable sharp needle pierces the back wall of the vagina and is brought under the sensor to the ovary. I must say that the doctor must be extremely careful so that there are no complications. After egg collection, the patient must remain under close medical supervision for at least two hours. During this period, the condition of the woman is monitored and intra-abdominal bleeding is excluded.

Fertilization

You already know that before IVF is done, a man's sperm must be examined. The course of the next stage will depend on the quality of the seminal fluid. At normal rates, normal fertilization is performed. Required amount sperm are simply combined with selected eggs.

If there are pathologies of spermatozoa or there are very few of them, then they resort to the ICSI method. In this situation, embryologists select the best and highest quality spermatozoa, after which they combine them with eggs.

in vitro

After fertilization, each zygote is placed in a separate container. There, conditions are created that are as close as possible to those that are in the body of a woman. It is worth noting that at this stage (immediately after the extraction of the follicles), the woman continues to take hormonal drugs. Usually these are drugs based on progesterone. They help maintain the work of the corpus luteum and prepare the uterus for pregnancy as much as possible.

The time period for growing embryos may vary. Usually it is from 2 to 5 days. Many blanks die already on the third day. Only the strongest survive. Reproductologists are trying to bring the embryos to the point where they will have from 4 to 8 cells. After that, they move on to the next stage.

Cell transfer

If you are interested in how IVF is done, the photo of the procedure is presented to your attention. Embryo transfer is carried out within the walls of the hospital. This does not require anesthesia. The woman is located on a thin silicone tube is inserted into the cervical canal. Through it, the embryos move into the cavity of the reproductive organ.

In recent years, experts have tried not to implant more than two embryos. However, according to some indications, this number can be increased. Note that in this case a special contract is concluded that informs the patient of her rights and obligations. If viable embryos remain after the transfer, they can be frozen. You can use them at any time. This procedure does not affect the quality and genetic condition.

Expectation

Perhaps the most exciting and painful moment is two weeks after the transfer. It is after this period that the outcome of the procedure will be determined. All this time, the woman receives progesterone and human chorionic gonadotropin preparations.

You can find out the result 10-14 days after the transplant. The patient is offered to take a blood test to determine the amount of chorionic gonadotropin. It is this hormone that is secreted during pregnancy, increasing in quantity every day.

Result of manipulation

If the amount of chorionic gonadotropin increases, then this indicates pregnancy. After reaching the mark of 1000 IU, it is necessary to do an ultrasound examination. It will show the number of attached embryos. If there are more than two fetal eggs in the uterus, a woman is offered to use a procedure called reduction. During it, the doctor removes excess embryos. It is worth noting that this manipulation is very dangerous. It can lead to miscarriage or miscarriage. Therefore, many couples refuse it. However, carrying more than two babies at once is also unwise. After all, premature birth may begin or pathologies of the development of babies can be detected. In any case, the final decision remains with the couple.

If the result was disappointing and pregnancy did not occur, the woman should stop taking all drugs. In this case, the first question that interests patients is formulated as follows: how often is IVF done? Most couples want to try to become parents again as soon as possible. However, doctors do not advise to rush. In preparation for artificial insemination The body of a woman endures the strongest loads. He needs time to recover. Reproductologists usually recommend refraining from trying to conceive for up to six months. Also, the couple is assigned additional examinations that can find out the cause of the failure.

The final stage of the procedure

How IVF is done is described in detail in this article. If the procedure ended positively, then the woman is offered to register at the place of residence. In some cases, the clinic takes responsibility for the management of pregnancy until a certain period. This is usually required in multiple pregnancies.

Hormonal support is provided for up to 15-20 weeks. After that, all drugs are gradually canceled. At this time, the placenta, which supplies the fetus with everything it needs, is already formed and works in full force.

Delivery: what determines the choice of method

You already know how IVF is done. The procedure is quite complicated and requires the patient to follow all the rules. You can talk about the successful outcome of the manipulation after the birth of the child. Often this issue is dealt with by specialists from the same clinic in which artificial insemination was performed.

In the normal course of pregnancy and the absence of contraindications, a woman can give birth on her own. Natural childbirth is welcome in singleton pregnancies. If there are two or more babies, then doctors insist on a caesarean section. In this case, you will be sure that the kids will not get a birth injury when passing through the birth canal, which often happens with multiple pregnancies. Doctors will help the children in time.

Results

From the article, you learned how the in vitro fertilization procedure takes place. If you are interested in additional details, please contact a specialist. The doctor will tell you how and what you need to do for a positive outcome. In each individual case, individual recommendations are possible.

An important role in this process is played by the mood of the couple. Think positive, eat right, spend more time outdoors. Follow all specialist instructions. Have a good result!