“How to get successful IVF?” is a question that worries every woman suffering from infertility. The process of artificial insemination is quite labor-intensive; it requires a lot of effort from future parents and often significant investments of money.

To increase the chances of successful IVF, you must strictly follow all the doctor’s recommendations and the rules of the procedure. If the doctor or future parents make a mistake, the likelihood of successful conception may be greatly reduced. Let's look at the effectiveness of IVF and how to increase it.

First of all, you need to understand how effective the in vitro fertilization method is. Currently, this ART method is the most effective, especially with additional procedures such as ICSI and PIXI.

But, unfortunately, IVF does not guarantee a 100% result, since the implantation of the fetus in the uterus is influenced by a large number of different factors. And even if the doctor creates the best quality embryos, they still may not implant in the uterus.

According to statistics, pregnancy occurs in approximately 50% of cases during IVF for women under 30 years of age. If a woman is 35 years old, then the probability of success does not exceed 30%, and after 40 years, the chance of having a child using her own egg is 10-20%.

The result is also influenced by the fact on what day IVF and embryo transfer is carried out, how healthy the woman is and how high-quality the man’s sperm are. The age of the spouses definitely has a great influence, since the reproductive cells change after 35-38 years and their quality deteriorates.

The process of fetal implantation has a great influence on the effectiveness of IVF. Superovulation, puncture and fertilization end favorably in 99% of cases, but after embryo transfer they can still die for the following reasons:

• due to hormonal imbalance;
• the cause may be too thin endometrium;
• inflammatory diseases;
• implantation does not occur in the presence of scars and polyps in the uterus.

To avoid difficulties during implantation, it is recommended to familiarize yourself with the rules for preparing and conducting IVF and follow them.

IVF rules

“How to increase the chances of implantation with IVF?” is a question that patients ask their doctors every time. It’s such a shame to waste a lot of money and time, and at the same time not get the long-awaited pregnancy. If a woman agrees to IVF, she must understand that there may not be a result. If a patient wants to be sure that the clinic will help her, she has the right to undergo IVF with a guarantee.

Let's consider what rules need to be followed in order to ultimately achieve successful IVF:

• Before entering into the protocol, a man and a woman must undergo examination and cure all diseases.
• To conduct IVF, you need to be responsible when choosing a clinic. Important role As a result of the procedure, the work of the embryologist plays a role. If the doctor is inexperienced, then there is a high probability that poor-quality embryos will be used for transfer.
• During the IVF process, it is recommended to use the ICSI method, which increases the chance of obtaining high-quality embryos. And high-quality embryos are easier to implant into the uterus.
• It would also be a good idea to conduct preimplantation genetic diagnostics in order to select good blastocysts for transfer. If a doctor accidentally implants an embryo with a genetic abnormality, it will die.
• It is recommended to resort to maintenance therapy after replantation. As a rule, doctors prescribe progesterone, which improves the endometrium and relieves the tone of the uterus so that the embryo attaches normally.
• It is necessary to exclude increased blood clotting in the mother. This problem often causes disruption of blood flow between the uterus and the fetus, which leads to early miscarriage.

It is recommended to carry out IVF using five-day-old blastocysts. Only the strongest embryos survive to the blastocyst, and cells with abnormalities die, so the chance of pregnancy is higher. But it is worth noting that if the transfer of five-day embryos does not produce results, the doctor may prescribe the transfer of three-day embryos in the next protocol. Under natural conditions, the cell can develop better and still take root.

You need to understand that embryo cultivation is carried out under artificial conditions. Although the importance and temperature in the incubator is close to the environment inside fallopian tubes, but it has not yet been possible to create the same ideal conditions. Therefore, there is a chance that more embryos will survive to reach the blastocyst inside the uterus, and they will eventually implant successfully.

It is also very important during the period of preparation for IVF and after the transfer to maintain correct image life. It is imperative to normalize your weight, eat right, lead healthy image life. A woman should regularly engage in light sports. It is better for a man to follow the same recommendations to improve sperm quality.

Of course, nutrition and physical activity do not affect embryo implantation. But doctors still recommend leading a correct lifestyle after embryo transfer, so as not to harm the unborn baby.

How to increase your chances of successful IVF (Video)

The IVF method or in vitro fertilization after its discovery has given millions of infertile couples around the world a real chance to become real parents. It is effective for a variety of forms, and in the case of childlessness due to, IVF is sometimes the only way to conceive a child.

The term “in vitro” literally means “fertilization outside the body” or in vitro, that is, conception occurs outside the body - as many say, “in vitro.” They resort to this method of treating infertility if the meeting of the sex cells of a man and a woman “in the natural environment” (in the female genital tract) is physically impossible. An important point in this regard remains the woman’s ability to bear and give birth to a baby.

The IVF method is the organization of fertilization of an egg with a sperm, as a result of which an embryo is formed, which is planted in the uterus in its “natural environment”. It has been proven that children born as a result of in vitro fertilization are no different from babies conceived naturally: in vitro conception does not in any way affect their health or intellectual abilities.

Note:It should be taken into account that this procedure has a list of indications and a whole list of contraindications. IVF is not carried out only at the request of the couple; This is a very complex procedure, which is indicated in cases of severe infertility that does not respond to conservative and surgical treatment.

Indications for IVF for infertility

The presence of certain reproductive pathologies and conditions in a woman or man may be an indication for an IVF program.

These include:

Infertility for unknown reasons. In approximately every 10th infertile couple, the cause cannot be determined. If other infertility treatment methods are ineffective, IVF is also indicated.

Contraindications to IVF

Despite high tech and the wide possibilities of modern reproductology, unfortunately, there are also contraindications to the IVF procedure for infertility.

They are classified into:

• absolute
• relative

Absolute contraindications to IVF include:

• pathologies of uterine development (absence, bicornuate uterus, “baby uterus”, double uterus);
• cervical cancer, uterine anomalies, ovarian cancer;
• systemic diseases - leukemia, heart defects, hyperparathyroidism, multiple sclerosis, aplastic anemia, cardiomyopathy, diabetes mellitus with complications, renal failure, lymphogranulomatosis, history of stroke;

If there are absolute contraindications, IVF is not advisable, because there is a direct threat to the life of the mother, since her disease may begin to progress or the procedure itself will be ineffective.

The list of relative contraindications includes:

• benign uterine tumors;
• hepatitis, syphilis, active tuberculosis, etc.;
• infectious diseases in the acute stage;
• exacerbation of chronic pathologies.

In case of relative contraindications, IVF is possible after completed therapy, or the disease has entered the remission stage.

Important: only a doctor has the right to decide whether IVF is suitable for a childless couple or should be considered alternative options(surrogacy, adoption). The conclusion is given by several specialists who jointly make a decision in the case of each individual couple.

Preparing for IVF

The stage of preparing women and men for this procedure begins 3-6 months in advance. A woman must undergo an infertility examination before IVF, which includes the following procedures:

The man is prescribed the following diagnostic procedures:

• spermogram (a very informative study that gives a complete picture of the state of the partner’s sperm and allows you to assess his level of fertility);
• Ultrasound of the scrotum, prostate gland;
• microscopy of urethral discharge;
• karyotyping;
• sperm DNA fragmentation;
• andrologist consultation;
• genetic consultation;
• consultation with a urologist.

General tests for infertility for men and women are studies for the presence of urogenital infections.

• antibodies to Treponema pallidum;
• M, G antibodies to HIV, hepatitis, herpes, cytomegalovirus;
• tests for Trichomonas, Candida fungi, mycoplasma, gonococcus, chlamydia, ureaplasma.

note: After a full examination program, the woman undergoes hormonal stimulation with drugs. Their task is to ensure the growth and maturation of follicles in the ovaries. At the same time, several of them ripen at the same time, and not just 1, as in the physiological cycle. This is necessary to fertilize several embryos, since the success rate of IVF is not 100%. The duration of such stimulation is up to 14 days, and it can be carried out on the basis of 3 protocols (long, short, super-long).

IVF procedure

In vitro fertilization itself occurs in several stages:

• Receiving eggs. After hormonal stimulation, follicles are collected from the woman under ultrasound guidance. This is done through transvaginal or laparoscopic access in the form of ovarian puncture. The egg along with the follicular fluid is extracted from each follicle using a puncture needle.
• Obtaining sperm from a man and carefully preparing them.
• Embryo cultivation. The sperm is specially processed and combined with an egg (up to 300,000 male cells per 1 egg). The material is placed in an incubator for up to 6 days, where there is a nutrient medium that ensures fertilization and development of future embryos.
• Transplantation of embryos into the uterine cavity. The finished embryo is implanted into the fundus of the uterus using a sterile catheter through the cervical canal. The procedure is completely painless and is carried out under ultrasound control.
• Embryo support. The woman is given drugs to create optimal conditions for implantation and development of the embryo.
• Diagnosis of pregnancy. 12 days after the transfer stage, it is advisable to conduct a blood test for hCG, which is considered the most reliable in terms of early diagnosis of pregnancy.

Allowable number of IVF attempts

IVF has only about 33% success rate, so the question about the number of attempts arises for every couple who decides to do it, because the procedure itself is not cheap. This issue is within the competence of only the doctor to resolve individually in each case, taking into account a reasonable limit on the number of procedures. There are cases where pregnancy occurred only after the 10th IVF attempt. Moreover, the procedure is completely safe for the body and can be repeated many times.

Medicines for IVF

Without them, pregnancy during infertility treatment with IVF is unlikely, because medications are used to create the necessary hormonal levels. The latter is the basis for the maturation and production of normal follicles, as well as the key to the next physiological implantation of the embryo and its further development.

The purpose of all medications used is to optimally prepare a woman’s body for pregnancy.

The following are used:

• Gonadotropin-releasing hormone agonists. These are the means for preparing the ovaries for stimulation (Zoladex, Decapeptyl, Lucrin, Diferelin).
• Medicines gonadotropic hormones. They stimulate and regulate the growth of follicles (Puregon, Pergoveris, Menopur).
• Gonadotropin-releasing hormone antagonists. They suppress the secretion of luteinizing hormone, thereby preventing premature ovulation (Cetrorelix, Orgalutran, Cetrotide).
• Estrogen preparations. Their task is to stimulate endometrial growth by improving blood supply to the uterus (Divigel, Proginova).
• Progesterone drugs. These agents activate the secretory transformation of the endometrium, thereby optimally preparing it for future embryo transfer (Lutein, Utrozhestan, Crinon).

Problematic points after IVF

There are some questions that arise after conception using IVF in case of infertility.

Reduction of unnecessary embryos

If a woman decides to keep 1 or 2 fetuses, but more have taken root, then the excess ones are removed under ultrasound control. They do not resort to removal directly, but to a special procedure. During this procedure, special substances are introduced into the fetus, which stop its growth and development and it gradually dissolves.

IVF in women after 45

It has been proven that the success of IVF decreases with age, and after 45 years of age its effectiveness is 1.5%, although before 40 this figure is still about 25%. In this case, the problem lies more not in the age category of the woman, but in the age of her egg. This is why patients over 45 are recommended to use a donor egg. But the decision is always made by the woman: to use her own material, but with a low probability of conception, or someone else’s, but with a higher IVF success rate.

note: In this case, one should take into account the fact that as a woman ages, the risk of chromosomal abnormalities in the embryo increases.

Multiple pregnancy

Doctors note the fact that after IVF the likelihood of conceiving twins, triplets and even quadruplets increases by 50%. It is worth remembering that multiple births are always a high risk for the mother, as well as for the future babies themselves. It can provoke premature birth, fading of pregnancy, etc.

How to behave after IVF

You shouldn’t limit your life too much after embryo transfer. But it is important to avoid certain things that can cause stress to the body, especially in the first 12 days.

In particular, it is better for a woman after IVF to temporarily give up such physical activity and habits as:

• fitness;
• power training;
• smoking.

It is worth leading a calm and measured life, walking more in the fresh air, spending less time in rooms where there are crowds of people. It is important to eat well and regularly, to adhere to the drinking regime, but you do not need to go on a diet or eat a lot. At the request of a woman, sex life can be limited.

Important:completely switching to bed rest after IVF is wrong, since the immobility of the body impairs blood circulation in the pelvis, i.e. the uterus and embryo will not receive the required amount of oxygen. As a result, this can negatively affect the implantation process.

You will receive more information about the in vitro fertilization technique by watching this video review:

Yulia Viktorova, obstetrician-gynecologist

IVF is a step-by-step procedure that gives hope and the opportunity to infertile couples to have children.

The protocol is regulated by day, the number of days taken depends on the type of implementation, duration for:

• ultra-short Temamoto protocol – 26-31 days;
• short protocol - 29-35 days;
• long protocol - 40-45 days;
• crypto protocol – up to 2 months.

In each specific case, the number of days may vary, it all depends on the health problems of the couple themselves and the type of protocol. Basically, the stages of the protocol are important for women, but a man will have to take part in only some of them.

The main stages following each other in the exact order specified.

In order for pregnancy to occur quickly, on the first try, the couple needs to carefully prepare, reconsider their lifestyle, and give up bad habits:

• alcohol abuse, under the influence of which most sperm become less mobile and their production sharply decreases. For a woman, the harmful toxins of alcohol are harmful during implantation, on early pregnancy inevitably lead to pathological development of the fetus;
• smoking, tobacco tar negatively affects both sperm and eggs; in a woman who smokes, stimulation of the ovaries and the likelihood of fertilization decrease;
• overweight or underweight. Drug therapy may not be helpful if your weight does not match your body mass index. With an index not within the range of 19 kg to 30 kg per m2, eco treatment may simply become ineffective.

Important! Gain weight to normal or lose it overweight. Overweight is possible with diabetes mellitus, endocrine diseases, so you first need to be examined by an endocrinologist; some cases are simply not compatible with pregnancy. A woman needs healthy eating, it is worth reviewing your diet, including more vitamins and protein in your diet. From strict diets, monotonous food must be given up urgently.

Food additives E and genetically modified products inevitably lead to allergies and infertility, keep this in mind! Women undergoing IVF treatment should not visit hot baths, saunas, baths, lift weights or play strenuous sports. An active lifestyle is necessary, but exercise should be moderate, light, and without much stress on the body.

2. Preliminary examination before eco

The examination consists of taking a blood test for both men and women to determine hormonal levels and the quality of seminal fluid. If deviations from the norm are detected, as well as if there are serious chronic diseases, you must first undergo a course of treatment so that the chances of pregnancy are higher.
Also subject to verification:

• ovarian reserve of eggs in a woman, possible pathophysiological changes in the reproductive system. As the reserve decreases, the number of eggs decreases and their quality deteriorates. The reserve sharply decreases with age, after ovarian surgery, chemo-radiotherapy;
• the uterine cavity, if there are pathological changes in it such as polyps, synechea, they must first be removed before IVF. The procedure may not be effective if the fallopian tubes are clogged, obstructed, infected with toxins, or have fluid in them. Damaged pipes require removal before eco;
• spermogram check. Sperm is analyzed for possible deviations in composition from the norm, genetic defects in the Y chromosome, congenital absence of seminal canals, which is often diagnosed in case of infertility in men. Please note that the problems are serious; a full genetic examination is possible.

3. Negative regulation

With increased ovarian activity, early superovulation is possible. Thanks to regulation, that is, reception hormonal drugs, it is possible to slow down the natural processes in the body, thereby establishing control over the subsequent process of fertilization. If, after a hormonal course, an ultrasound scan showed that the epithelium is undeveloped and the activity of the ovaries is suppressed, then the stage has been completed successfully and you can proceed directly to the IVF itself.

4. Growing eggs

While the egg is grown artificially for 10-14 days, the woman is prescribed:

• hormone therapy to stimulate the ovaries, ripening and growth of follicles. Important! Through hormone therapy, it is possible to obtain eggs suitable for fertilization in one menstrual cycle, and also to prepare the endometrium for embryo implantation;
• daily ultrasound to monitor endometrial growth and egg maturation;
• a blood test for ovarian cysts, which can sharply increase estrogen levels. With ovarian hyperstimulation, the IVF procedure is, unfortunately, impossible;
• injection of hCG to simulate the release of luteinizing hormone. It is important to administer the injection in a timely manner. If it is placed prematurely, a cyst may form in the follicles, making it impossible to obtain healthy eggs.

5. Egg retrieval

After the injection, at least 3 days must pass; ultrasound monitoring is carried out continuously. Next, mature eggs are collected by puncture, puncturing the peritoneum with a thin needle, and separated from the membrane under a microscope. The procedure is painstaking and is carried out under the guidance of only an experienced embryologist.

If it was possible to obtain a large number of eggs, then it becomes possible to preserve them and use them in the future if necessary. If the first procedure is unsuccessful, the previous stages of eco will no longer be needed in subsequent times.

Egg retrieval is similar to a minor operation; a woman may experience pain in the lower abdomen and cramps. But there is no need to worry, the discomfort will soon pass.

Interesting video:

6. Fertilization

The extracted eggs and sperm are placed in a sterile container with a nutrient medium, where fertilization should occur within 6 hours. In a container or incubator, the conditions are the same as in the fallopian tubes; when the egg and sperm unite, the embryos begin their development, after which healthy ones will be implanted, that is, transferred again into the uterine cavity.
At this stage, the woman is under the complete control of the embryologist; pathological development of the embryos cannot be allowed. The woman is given 5-6 days to rest and recuperate before subsequent, no less responsible IVF procedures.

7. ICSI method

The method is standard and is prescribed to all women for the treatment of infertility. 1 ml of sperm is taken from a man, in which 1/3 of the sperm must be active. If the number does not correspond to the norm, then using the ICSI method, healthy sperm are introduced into the extracted egg by injection. The only method for treating infertility in men and for the normal development of pregnancy usually gives positive results.

8. Embryo transfer

After 5 days, the embryo is transferred again to the uterus. It is on the fifth day that the endometrium should finally prepare for the birth of a new life, the survival rate of the implant increases, healthy embryos will not allow multiple pregnancies to develop, which is dangerous not only for the woman, but also for the fetus. The transfer of the embryo into the uterine cavity is controlled by ultrasound, the selected material is loaded into a catheter and introduced into the cervical canal of the fallopian tube.

9. Maintenance therapy

When the natural cycle is suppressed, hormones are poorly produced by the body, so you need to help it by administering the drug progesterone, which is prescribed to the woman by the doctor. The dosage and method of administration of the drug are prescribed; failure to comply with the conditions can lead to serious consequences, especially in the second phase of the menstrual cycle, so the woman must strictly follow all the doctor’s instructions. The drug is taken until the placenta matures, usually up to 12-13 weeks. It is also necessary to stop hormone therapy gradually, otherwise there is a risk of miscarriage, which should be taken into account by the woman.

From this moment until 2 weeks, sexual intercourse, heavy lifting, and hot baths are excluded. On the 14th day after embryo transfer, you can check your pregnancy using a test at home. Also come to the clinic again and donate blood for hCG, a pregnancy indicator. If the result is positive, we can safely say that pregnancy has occurred and a rapid increase in hCG. At the 3rd week, the woman is again given an ultrasound; if there is a fertilized egg in the uterus, it means pregnancy has occurred. If the test for hCG is negative and there is no fertilized egg, there is no need to talk about pregnancy. But don’t despair, this is just an attempt. It takes a little treatment and the chances of successful conception will increase significantly.

Carrying out the IV procedure in accordance with the days of the menstrual cycle is identical to the natural cycle, each stage of the procedure is strictly monitored by doctors, so IV is by far the best program for infertile couples. The main thing is not to despair of achieving what you want, not to neglect the advice of doctors, and to follow all instructions and treatment appointments.

In vitro fertilization is the main method of treating tubal infertility. IVF treatment is carried out in stages. The main stages of the IVF procedure include:

Ovarian reserve can be checked by the level of the hormone FSH and inhibin B in the blood serum or by counting the number of antral follicles at the beginning of the menstrual cycle. Increased FSH levels are associated with decreased ovarian reserve.

• Carrying out the necessary operations to prepare the uterine cavity for the IVF procedure - according to indications.

Pathologies of the uterine cavity, such as synechiae or polyps, must be removed before the IVF process begins. A hydrosalpinx, a fluid-filled blocked fallopian tube, reduces the success rate of IVF because the fluid in the tube is embryotoxic, and many doctors advise removing the damaged tube before IVF.

• Taking a spermogram

Before IVF, a spermogram (sperm analysis) is performed. If abnormalities are detected in the spermogram, a consultation with an andrologist is necessary to determine whether these abnormalities can be corrected and whether they are associated with other medical problems. For example, genetic defects in the Y chromosome are associated with some cases of male infertility, and men with a congenital absence of the vas deferens (the tubes that carry sperm from the testicles) often carry the genetic defect responsible for the disease cystic fibrosis. In such situations, genetic testing may be required. Infertility is often caused by various abnormalities of male reproductive cells, which include teratozoospermia. Teratozoospermia is characterized by a violation of the structure of sperm. The diagnosis of teratozoospermia is made to a man when half or more of his ejaculate consists of pathologically altered sperm, and the teratozoospermia index exceeds 1.6. The experience of reproductive doctors shows that with teratozoospermia, IVF the best way conceiving a child

• Taking blood tests

Undergoing IVF requires taking blood tests for HIV, syphilis, hepatitis B and C, and for the presence of antibodies to rubella. It is also necessary to make a smear of mucus from the vagina and cervical canal for bacterial flora to ensure the absence of infections. According to indications, the doctor may prescribe a hormonal examination (If the patient has previously undergone treatment for infertility, there have been miscarriages or medical abortions, in this case, a TSH test is one of the first to be done before planning a pregnancy under the IVF protocol. For a favorable pregnancy, the TSH indicator during IVF should be normal be no more than 2.5 mU/l.) and examination for sexually transmitted infections, as well as progesterone if it is normal. A complete examination will help identify problems that should be corrected before starting an IVF program.

Stimulation of superovulation

Stimulation of superovulation is carried out to obtain several eggs in an IVF cycle - from 10 to 20 (the exact number of eggs during IVF depends on the patient’s body) suitable for fertilization. This number of eggs during IVF is necessary in order to increase the likelihood of pregnancy in one IVF attempt, because not all eggs can be good quality, some may not be fertilized, and the embryos may stop developing.

To stimulate superovulation in an IVF cycle, hormonal drugs are used and a scheme for their use, called a “stimulation protocol,” is determined. The process of stimulating ovulation is of great importance for the IVF procedure.

Ovarian stimulation drugs

To stimulate superovulation, drugs containing follicle-stimulating hormone (FSH), which is responsible for the maturation of follicles, are used. Human menopausal gonadotropin (HMG) preparations are obtained from the urine of menopausal women. HMG drugs are somewhat cheaper than recombinant drugs, and contain, in addition to the FSH hormone, also the LH hormone. Recombinant FSH preparations are synthesized using biotechnological methods; they provide maximum precision of injection thanks to the injector pen and can be used by the patient independently. Drugs to stimulate superovulation are selected strictly individually.

Follicle puncture is carried out 36 hours after the injection of human chorionic gonadotropin (hCG), which activates ovulation of mature follicles. The use of hCG allows you to obtain a mature egg ready for fertilization.

Human menopausal gonadotropin (HMG) (menopur)
. Follicle-stimulating hormone (FSH) (gonal-F, puregon)
. Human chorionic gonadotropin (hCG) (choragon, rotten, ovidrel)
. Clomiphene citrate (Clomid, Clostilbegit)

Premature ovulation with IVF

Premature rupture of the follicle can negate IVF. Therefore, to prevent a woman’s own hormones from interfering with the stimulation of superovulation and to control the process of superovulation, the production of her own hormones is blocked by agonists and antagonists. Also prescribed by a doctor individually.

GnRH agonists (decapeptyl, diferelin, buserelin, zoladex, suprefact)
. GnRH antagonists (orgalutran, cetrotide)

Ultrasound monitoring

When stimulating superovulation, it is necessary to regularly monitor follicular growth using transvaginal ultrasound. Control of follicle growth is carried out every other day, starting from the fifth day of stimulation. It is also possible to adjust the dose of prescribed medications. Some patients may have blood tests to measure estradiol levels. Normally, the level of estradiol in the blood increases as the follicles mature, and the level of progesterone remains low until ovulation.

Using ultrasound and studying blood hormones, the doctor determines when the follicles are ready for puncture. Follicles typically grow 1-2mm per day, and mature follicles have a diameter of 16-20mm. When the follicles are ripe, they can be punctured, as a result of which follicular fluid (corpus luteum in IVF) containing eggs will be obtained. During an ultrasound, the thickness and structure of the endometrium is also necessarily examined. By the time the puncture is prescribed, the endometrium should be thicker than 7 mm and have a three-layer structure.

When the follicles have reached the desired size (usually on days 10-14 of the cycle), hCG is injected. The introduction of hCG allows you to control the exact time of ovulation - usually it occurs 36-40 hours after the injection. Ovarian puncture is performed before ovulation occurs, usually 34-36 hours after the hCG injection. Before GnRH agonists and antagonists were used in IVF cycles, doctors had to abort nearly a quarter of treatment cycles due to premature ovulation. If this happened, the follicles burst even before the puncture, and the eggs fell into the abdominal cavity, from where they could no longer be removed for fertilization in the laboratory.

The use of GnRH agonists or antagonists prevents the release of LH and FSH by the pituitary gland, thereby reducing the risk of premature ovulation. However, even today about 10% of cycles are interrupted, even before the injection of hCG. The most common reason for cycle cancellation is a poor response of the patient's ovaries to stimulation. If less than three follicles mature in the ovaries and the level of estradiol is not high enough, the likelihood of pregnancy is extremely low, then, with the consent of the patient, the IVF cycle is interrupted. The problem of poor ovarian response to stimulation is more common in women over 35 years of age and women with operated ovaries, i.e. in those patients who have a reduced ovarian reserve (the supply of follicles in the ovaries). As a result of a decrease in the number of follicles, the level of FSH in the blood increases. It is possible to adjust the dose of the drug to stimulate the ovaries, or prescribe stronger stimulating drugs, such as recombinant ones.

When a very large number of follicles (more than 25) mature, or when the level of estradiol in the blood is high, the IVF cycle has to be canceled due to the threat of developing polycystic ovary syndrome (PCOS). In this case, the ovaries are punctured and all embryos obtained are frozen. Interruption of an IVF cycle at this stage occurs due to the risk of severe ovarian hyperstimulation syndrome, since the impetus for the development of severe OHSS is usually the onset of pregnancy. Embryos can later be thawed and used in another IVF cycle without inducing superovulation.

Follicle puncture

Follicular puncture is performed to obtain eggs. It is carried out during transvaginal puncture of the ovaries for IVF by pumping out follicular fluid through a thin aspiration needle under ultrasound control.

Puncture of follicles is carried out under local or short-term (10-20 minutes) general anesthesia. A transvaginal ultrasound probe is placed in the vagina to visualize mature follicles and a thin needle is inserted into the follicles through the vaginal wall. The eggs are sucked out from the follicles one by one through a needle attached to a suction pump. Follicle puncture usually takes no more than 30 minutes. Follicle puncture is a minor surgical operation and does not require hospitalization. After the puncture, it is advisable to rest in the room for 2-3 hours. After the puncture, driving is prohibited. Some women experience painful cramps after the puncture. A feeling of fullness or pressure in the abdomen may persist for several days after the procedure.

Fertilization of eggs in vitro. Embryo cultivation

After puncture of the follicles, the follicular fluid (corpus luteum) containing the eggs is immediately transferred to the embryology laboratory, where it is examined by an embryologist under a microscope, selecting the eggs. The eggs are washed in a special medium and their maturity is then assessed. Next, the eggs are placed in a special nutrient medium and transferred to an incubator, where they await fertilization by sperm. Cups with eggs, sperm and embryos must be signed.

During a puncture of a woman's follicles, her husband donates sperm into a special non-toxic sterile container. Some men have great difficulty collecting sperm to order. They must notify the doctor about this in advance.

Such men can resort to preliminary cryopreservation (freezing) of sperm, which will then be thawed on the day of puncture of the woman’s follicles and used in the IVF cycle. After collecting the sperm, the sperm are washed from the seminal fluid using a special technology, which makes it possible to select the most motile and morphologically normal sperm. A specified number of motile sperm (usually 100,000 sperm/ml) are mixed with the eggs (called in vitro fertilization or in vitro insemination) and placed in an incubator. Penetration of a sperm into an egg usually occurs within a few hours. Fertilization is usually carried out 2-6 hours after puncture of the follicles; this procedure is also typical for the IVF donor program.

The incubator maintains a constant level of carbon dioxide, temperature and humidity. The conditions in the incubator and the composition of the nutrient medium imitate the conditions in the fallopian tubes, creating the most favorable conditions for the embryo in vitro. The nutrient medium is highly purified from heavy metals and contains ingredients such as proteins, amino acids, salts, sugars, and a special acidity buffer, which create optimal conditions for the growth and development of the embryo.

Intracytoplasmic sperm injection - ICSI

When, for various reasons, it is expected low percentage fertilization during the IVF procedure (for example, with a small number of motile sperm in the semen or a low percentage of fertilization in a previous IVF attempt), special micromanipulation methods are used. Intracytoplasmic sperm injection (ICSI) is a procedure in which a single sperm is injected directly into an egg to fertilize it. Pregnancy rates and birth rates after ICSI are comparable to results after traditional IVF. If a man has hereditary pathologies that cause infertility, which can be transmitted from father to son, medical genetic counseling is recommended before ICSI.

After adding sperm to eggs or performing ICSI, the embryologist checks how many eggs are fertilized normally. A normally fertilized egg (zygote) at this moment is one cell with two pronuclei. Pronuclei are like small transparent vesicles inside the cell, one of them carries the genetic material of the father, and the second - the mother. When they merge, it forms new life with a unique genetic makeup. Eggs with abnormal fertilization (for example, containing three pronuclei instead of two), as well as unfertilized eggs, are not used further.

Typically, 50% to 90% of mature eggs are fertilized normally after in vitro insemination or ICSI. A lower percentage of fertilization is observed when the sperm or egg is morphologically Bad quality, and the complete lack of fertilization may be associated with a pathology of the fertilizing ability of sperm or with a pathology of eggs.

Normally fertilized eggs (zygotes) continue to be cultured; they begin to crush, and their quality is assessed after another 24 hours. Embryos are assessed based on their appearance and crushing speed. Good quality embryos divide fairly quickly: two days after fertilization, normal embryos have 2-4 cells of approximately equal size with clear cytoplasm and no cell fragmentation.

By the third day, the embryo contains an average of 6 to 10 cells. By the fifth day, a cavity with fluid has formed inside the embryo, and the cells are divided into two types: those from which the fetus will subsequently form, and those from which the placenta will form. At this stage, the embryo is called a blastocyst. Embryos can be transferred into the uterus at any time from the first to the sixth day after the puncture. If normal development continues in the uterus, the embryo “hatches” from the surrounding membrane (zona pellucida) and implants into the endometrium of the uterus approximately 6 to 10 days after fertilization.

Embryo transfer at the blastocyte stage

It is now possible to culture embryos in the laboratory until they reach the blastocyst stage (usually day 5 after egg retrieval). The eco blastocysts can then be transferred to the uterus. Some researchers note that transfer of embryos at the blastocyst stage more often leads to pregnancy. There can be two explanations for this. Firstly, transfer of the blastocyst to the uterus is more natural, since in nature the embryo passes from the fallopian tube to the uterus at this stage. In addition, culture to the blastocyst stage allows the embryologist to select the “best” embryos, since weak embryos or embryos with genetic abnormalities are arrested before they develop into a blastocyst.

Blastocyst transfer also reduces the likelihood of potentially dangerous multiple pregnancies. The high implantation rate of blastocysts allows for the transfer of fewer embryos into the uterus (usually one or two), reducing the risk of multiple pregnancies and associated complications.

While blastocyst transfer is very promising for patients who have many eggs maturing, its benefit for patients with poor ovarian response to stimulation and a small number of eggs retrieved is still questionable. If few eggs are retrieved from a patient, there is a very high risk that none will reach the blastocyst stage. All of them can stop developing, and there will be nothing to transfer to the uterus. Since artificial cultivation conditions, despite all the latest developments in this area, are still far from natural, many embryologists believe that transferring embryos into the uterus at an earlier stage is more favorable for them than being in artificial conditions. Embryos that would not reach the blastocyst stage in vitro can safely continue embryo development after IVF transfer in the uterus and implant successfully.

Transfer of embryos into the uterine cavity

The embryo transfer procedure is usually painless as it does not require dilatation of the cervix. Using a regular vaginal speculum, the doctor gains access to the cervix. The embryo transfer catheter is a long, thin, sterile silicone tube with a syringe at one end. The diameter of the catheter is 1-2 mm. The catheter is filled with a nutrient medium containing one or more embryos. The doctor gently guides the tip of the catheter through the cervix into the uterine cavity and uses a syringe to squeeze out the medium containing the embryos from the catheter. As a rule, embryo transfer is performed under ultrasound guidance, and the doctor can see on the monitor how the medium with the embryos moves into the uterine cavity.

Women may experience various symptoms after eco-replantation, such as: Feeling of nausea, discomfort in the epigastric region, and sometimes vomiting may occur. These conditions must be differentiated from food poisoning, ovarian hyperstimulation syndrome, and various gastropathy. If the sensations worsen after the transfer of IVF embryos, you should consult your doctor.

Numerous foreign studies have shown that there is no need to remain in a horizontal position after embryo transfer for more than 10 minutes, because this does not affect pregnancy. Once the embryo has entered the uterus, it can no longer “fall out” from there. Despite its apparent simplicity, embryo transfer into the uterine cavity is one of the most critical stages of the IVF cycle. Data have been published in the literature indicating that up to 30% of embryos may be lost during transfer. The presence and consistency of cervical mucus has a great influence on success. For example, the embryo may stick to the catheter inside or outside, or may be carried along with the catheter into the cervix. Much depends on the qualifications of the doctor, special equipment and the developed embryo transfer scheme to prevent such situations.

Timing of ovulation after IVF when pregnancy occurs

Do not try to independently determine pregnancy using tests earlier than the 14th day after embryo transfer, since at this time the embryo cannot yet produce sufficient amounts of the hCG hormone. The answer may also be unreliable due to the use of hormonal drugs. 14 days after embryo transfer, contact the IVF clinic for a blood test for hCG, which is an indicator of pregnancy. If the test result is positive, then pregnancy has occurred. From this moment on, the amount of hCG will grow rapidly. Starting from the 3rd week after embryo transfer, pregnancy must be confirmed by ultrasound, which allows you to see the fertilized egg. You should be under constant supervision of an obstetrician-gynecologist, since you are yet to carry the pregnancy to term. If you experience abdominal pain or bleeding, consult a doctor immediately. A negative test result for hCG, the absence of a fertilized egg according to ultrasound, and the onset of menstruation indicate that pregnancy has not occurred. In this case, you should not despair: you need to take a break, wait for ovulation to occur after IVF, in some cases, carry out the necessary treatment and return to the IVF procedure again.

A negative result from an IVF procedure does not mean that this method is not suitable for you. With each attempt at IVF, your chances of successful conception increase and can reach 90% per year of treatment. Among the people there are signs for eco. It is necessary to take a break of about 2 - 3 months between attempts.

Assisted reproductive technologies – a method of providing medical care in which some or all stages of conception and (or) early development of an embryo (embryos) before transferring it (them) to the uterus are carried out in a laboratory setting.

The center can provide a photograph of the embryo on the day of the transfer!

The effectiveness of the IVF procedure

Time and age are insurmountable factors that significantly reduce the effectiveness of IVF.

The most desired outcome is, of course, pregnancy and the birth of a healthy child. However, there may be obstacles on the way to this goal. Each stage is of great importance for the effectiveness of the procedure.

IVF stages:

1. Complete clinical examination of the married couple.

2. Stimulation of superovulation in order to obtain a large number of eggs. (The stimulation scheme is selected individually by the doctor, taking into account the preliminary examination).

3. Ultrasound and hormonal monitoring of follicle growth and development.

4. Follicle puncture and oocyte retrieval. (The puncture is performed under intravenous anesthesia, under ultrasound control).

5. Fertilization with the sperm of the husband or donor. (On the day of the puncture, the patient’s husband donates sperm, which undergoes special treatment before fertilization of the eggs).

6. Transfer of the resulting embryos into the uterine cavity. (Usually 2-3 embryos are transferred, the remaining embryos are cryopreserved and, if unsuccessful, are used for subsequent transfer).

7. Support of the luteal phase, determination of pregnancy and development of further pregnancy management tactics.

8. Prevention of hyperstimulation syndrome and miscarriage.

If there is a history genetic diseases Pre-implantation diagnostics (FISH method) is carried out - a cytogenetic study of embryos at the stage before they are transferred into the uterine cavity.

The effectiveness of the procedure and the presence of complications are negatively affected by:

Age;

Late treatment, duration of previous treatments;

Surgical interventions on the appendages and uterus;

Inadequacy of examination and correction of identified violations;

Poor nutrition;

Unhealthy lifestyle, smoking, alcohol, bathhouse, solarium, long-term use of medications;

Electromagnetic vibrations (computers, mobile phones);

Sexual infections;

Failure to comply with all doctor's instructions;

Negative emotions;

Occupational hazards;

Excess weight, physical inactivity.

Remember: Infertility examination should be no more than 2 months, conservative treatment - no more than a year, surgical treatment to restore pipe patency - no more than 1 time.