Artificial insemination – types and description of methods (IV, IV, artificial insemination), indications (infertility, diseases), contraindications and complications, requirements for a sperm donor. reviews and prices of procedures in clinics. In Vitro Fertilization

Central Clinical Hospital, Baku, Azerbaijan

Relevance. In recent decades, in vitro fertilization (IVF) and intrauterine embryo transfer (ET) have become more widely available for the treatment of infertile couples. The number of pregnancies and births following IVF increases every year. The course of pregnancy after IVF and PE has some peculiarities. According to various studies, the frequency of spontaneous abortions reaches 44%, and premature births 37%. According to a global report, only 73% of pregnancies after the use of assisted reproductive technologies end in the birth of live children, the proportion of premature births is 33.6%, and the frequency of spontaneous abortions before 20 weeks of pregnancy is 21%. About 75-88% of cases of termination of pregnancy both in the population and after IVF and PE occur in the first trimester. According to the literature, up to 60% of early miscarriages are associated with chromosomal abnormalities. One type of early embryonic loss associated with a heterogenetic anomaly of both maternal and paternal chromosomes is anembryony.

Stimulation of superovulation, which is a mandatory stage of IVF, can also be considered as a risk factor for miscarriage due to the resulting relative hyperestrogenism, which disrupts the secretory transformation of the endometrium. Of course, we cannot exclude the influence of factors that increase the frequency of miscarriage, such as increasing age of patients, a history of gynecological diseases, the presence of various somatic pathologies, thrombophilic mutations, antiphospholipid antibodies, and a psycho-emotional factor, which certainly causes a decrease in the compensatory capabilities of pregnant women. One of the causes of pregnancy complications after the use of IVF and ET is multiple pregnancy, which occurs more often after assisted reproductive technologies than in the population. The average incidence of twin births is 20-30%, triplets 3-6%, while in the general population, cases of multiple pregnancies account for 0.7-1.5% of all births, and the frequency of triplets during natural conception is 1:7928.

Thus, based on modern literature data, we can conclude that patients whose conception was achieved through IVF and ET, based on a combination of factors associated with the etiology and pathogenesis of lesions in their reproductive system, age and somatic status, should be classified into the group risk of miscarriage, gestosis, placental insufficiency.

Taking into account the above, we set in our work target study the features of the course of pregnancy and childbirth after IVF.

Material and research methods. To achieve this goal, a comprehensive dynamic study of the course of pregnancy, childbirth, the postpartum period and the condition of newborns was carried out in 75 women whose pregnancy resulted from IVF (main group). The comparison group consisted of 75 women without a history of infertility with spontaneous pregnancy. General clinical and special research methods were used to examine pregnant women. All examined pregnant women underwent a general and biochemical blood test, determination of intrauterine infections and sexually transmitted infections, coagulograms (activated recalcification time, activated partial thromboplastin time, prothrombin index, thrombin time, fibrinogen), detection of cardiolipins, antiphospholipid antibodies, lupus anticoagulant in the blood , thrombophilic mutations, glucose tolerance test, general urinalysis. If necessary, specialists were consulted: urologists, nephrologists, therapists, neurologists, ophthalmologists, hematologists, cardiologists. All pregnant women underwent electrocardiography at the beginning and in the 3rd trimester, and echocardiography if necessary. The condition of the vaginal flora was assessed by bacteriological and bacterioscopic methods.

During the first 8-12 weeks of pregnancy, patients were periodically (once every 7-10 days) determined in the blood serum, the concentration of human chorionic gonadotropin (HCG), which allowed us to assess the function of the corpus luteum and trophoblast and determine the indication for hormonal correction.

The echographic examination was carried out using a Voluson 730 ultrasound device, which is equipped with a 4-dimensional sensor and color Doppler.

In order to identify genetic diseases, at 12-13 weeks, an ultrasound determination of the thickness of the collar zone, the length of the nasal bone was carried out, and based on the data, a double test was performed; at 16-17 weeks, a detailed ultrasound examination (ultrasound) and a triple test; at 20-22 weeks, a fetal test was performed. fetal echocardiography.

In order to assess the uteroplacental-fetal blood flow, a Doppler study of blood flow in the fetal umbilical cord artery, middle cerebral artery, and uterine arteries was performed. After the 30th week, fetal cardiotocography was performed weekly. Starting from the 12th week, the length of the cervix was measured monthly to exclude isthmic-cervical insufficiency.

When assessing perinatal outcomes in pregnant women of the main and comparative groups, complications from the mother (anomalies of labor, premature placental abruption, gestosis, etc.) and from the fetus (hypoxia, fetal asphyxia) were taken into account.

Newborns were assessed using Apgar scores at 1 and 5 minutes of life. Together with the neonatologist, a daily clinical assessment of the condition of the newborns, their somatic and neurological status was carried out.

The information obtained in the work was analyzed using specially developed computer programs based on standard products Microsoft Word 7.0, Excel 7.0, Access 7.0, as well as using methods adopted by sanitary statistics. In each clinical group, to evaluate certain indicators, variation series were compiled with their subsequent processing, calculation of structure indicators (in percentage), determination of the arithmetic mean (M), square deviation (σ), and root mean square error (m). The reliability of the results was assessed using the Student's t test (t).

Research results. The average age of patients in the IVF group was 33±0.4 years. In women with spontaneous pregnancy, the average age was significantly lower and amounted to 26.9±0.8 years (p<0,05).

An analysis of concomitant extragenital pathology was carried out (Table 1).

Thus, it was established that extragenital pathology was quite widespread in the IVF group. The dominant extragenital pathology was endocrinopathies (hypothyroidism, hyperthyroidism, obesity, polycystic ovary syndrome). Data characterizing the structure of gynecological morbidity in the main and comparative groups are presented in Table. 2.

The duration of infertility in patients of the main group ranges from 11 to 15 years in 22 patients, from 6 to 10 years in 42, up to 5 years in 11. The structure of the causes of infertility in the main group is shown in Table. 3.

As a result of treatment under the IVF program, 75 patients entered the first trimester. In 7 pregnant women this period proceeded without deviations, in 64 the threat of interruption was diagnosed. In assessing the development of pregnancy in the early stages, the determination of hCG in the blood serum has great diagnostic value (Table 4).

As can be seen from table. 4, the average value of the hCG peak in women of the main groups was significantly lower than in the comparison group. This appears to reflect inadequate hormonal function of the trophoblast in patients whose infertility was treated using IVF.

It can be assumed that luteal insufficiency, often caused by prolonged desensitization of the pituitary gland and aspiration of follicular fluid along with granulosa cells, leads to endometrial inferiority and reduces the functional activity of the trophoblast in IVF patients.

Periodic ultrasound of the uterus and ovaries in the early stages of pregnancy also helped us to timely detect increased myometrial tone, as well as assess the condition of the corpus luteum.

Studies have shown that after IVF, the threat of spontaneous abortion most often occurred at gestational ages of 7, 8 and 12 weeks, and the probable cause of this was hormonal deficiency.

Prematurity, bleeding during pregnancy, childbirth and the puerperium, placenta previa, perinatal mortality caused by the immaturity of fetuses in multiple pregnancies are observed much more often. Therefore, multiple births can be considered as a factor posing a threat to the normal course of pregnancy.

The incidence of multiple pregnancies after IVF in our observation was quite high (27 out of 75), with 6 identical pregnancies and 21 fraternal pregnancies. The number of pregnancies with twins was 24, and 3 with triplets.

All multiple pregnancies were complicated by the threat of miscarriage in the first trimester. According to the literature, the frequency of this complication in multiple pregnancy is 30-60%. One of the serious complications of the IVF method is ovarian hyperstimulation syndrome (OHSS). In our study, this pathology was recorded in 3 pregnant patients. Patients were aged 28-33 years. In 2 patients OHSS developed in a mild form, in 1 patient in a severe form. Thanks to timely initiation of adequate therapy, pregnancy was maintained in all cases.

We also studied the nature and frequency of complications during pregnancies in the second and third trimesters in a comparative manner in group studies (Tables 5, 6).

Comparing the data given in table. 5 and 6, it can be noted that such complications of the II-III trimester as the threat of spontaneous abortion, late gestosis, fetoplacental insufficiency, fetal hypoxia were recorded by us more often in the main group than in the comparative group, where these indicators did not exceed the general population frequency. Miscarriage (premature termination in the period from 28 to 37 weeks, that is, premature birth) was observed in our study in every fifth patient in the IVF group).

In 5 cases, birth occurred through the vaginal birth canal. 70 pregnant women were delivered by Caesarean section (including 44 singletons, 23 twins, 3 triplets). Forty-six pregnant women had a cesarean section performed as planned, and 24 as an emergency. Indications for emergency caesarean section were premature rupture of amniotic fluid, the onset of acute fetal hypoxia, deterioration in fetal condition according to Dopplerography, cardiotocography, severe form of late gestosis, premature placental abruption.

The course of the subsequent and early postpartum periods in the patients of the main group was uneventful. We observed hypogalactia in 17 patients; no purulent-septic complications were registered in postpartum women.

Conclusions. Characteristic features of pregnant women after IVF are: age over 30 years, complicated somatic and gynecological history, long-term and unsuccessful treatment for infertility (on average more than 8 years), high frequency of chronic genital infections, endocrinopathies, induction of superovulation preceding pregnancy, transfer into cavities the uterus of several embryos. In this group, the frequency of miscarriage is 1.5 times, ectopic pregnancy is 3-4 times, multiple pregnancy is 10-15 times higher than in spontaneous pregnancy. Taking into account the above, pregnant IVF groups should be assigned to a separate dispensary group due to the high risk of miscarriage, the development of chronic placental insufficiency, intrauterine infection and fetal malnutrition.

List of sources used:

1. Assessment of hemorheology indicators in pregnant women with placental insufficiency after in vitro fertilization using plasmapheresis / F.B. Buranova, T.A. Fedorova, P.A. Kiryushchenkov // Obstetrics and gynecology. - 2012. - No. 3. - P. 37-44.

2. Vityazeva I.I. IVF method: Complication of pregnancy with late gestosis // Problems of reproduction. - 1997. - No. 2. - P. 60.

3. Principles of individual hormonal preparation of the endometrium in patients with ineffective IVF attempts / E.V. Dyuzheva, E.A. Kalinina, L.N. Kuzmichev // Obstetrics and gynecology. - 2011. - No. 7. - P. 39-46.

4. Korsak V.S. In vitro fertilization in infertility therapy: dis. ...Dr. med. Sci. - M., 1999. - 300 p.

5. Assessment of endometrial receptivity in patients with a history of unsuccessful in vitro fertilization programs / M.M. Leviashvili, T.A. Demura, N.G. Mishieva and others // Obstetrics and gynecology. - 2012. - No. 4. - P. 65-70.

6. Pregravid disturbances of uterine blood flow in patients with a history of premature birth/ G.M. Savelyeva, E.Yu. Bugerenko, O.B. Panina // Obstetrics and gynecology. - 2012. - No. 4. - P. 42-48.

7. Investigation of systemic inflammatory in first trimester pregnancy failure/ J. Calleja-Agius, E. Jauniaux, A.R. Pizzey, S. Muttukrishna // Human Reproduct. - 2012. - Vol. 27. - P. 349-358.

The concept of ectopic pregnancy is familiar to many. This deviation is observed mainly during traditional conception, but it turns out that ectopic pregnancy is often detected during IVF. But why does this happen, because during the process of in vitro fertilization, embryos are implanted into the uterine cavity. How does it happen that the fetal buds leave the uterus and end up in the tubal or abdominal cavity? What to do in such a situation and is it possible to somehow avoid it?

The latest advances in medicine have helped many find the joy of motherhood

Nature provides that the fertilization process takes place in the fallopian tube, after which the cell is sent to the uterine cavity, where it is fixed in the endometrial layer. If the embryo does not have time to reach the uterus, attaching itself outside its cavity, then an ectopic pregnancy develops. This happens during natural conception. But with in vitro fertilization, the meeting of the sperm with the egg occurs in the laboratory and the finished embryo is implanted inside the uterus, where it should take hold, after which the development of pregnancy begins. It would seem that in such a situation an ectopic pregnancy cannot develop. However, practice shows that this is far from the case.

Before final fixation in the endometrial layer, the embryo floats for some time inside the uterine body, so it is quite capable of fixing itself somewhere nearby, for example, in the fallopian tubes (if they have not been removed). According to statistics, the frequency of ectopic pregnancies during IVF reaches 10%. Many patients are interested in whether there can be an ectopic pregnancy if the tubes are removed. Experts say this is quite likely. Even if the fallopian tubes have been removed, there remains a small section where the tube enters the uterine cavity. The implanted embryo can become fixed there, leading to the development of an ectopic pregnancy.

Where can the embryo be located?

Ectopic gestation can have a variety of localizations.

1. If the egg implants on the surface of the ovary, an ovarian pregnancy is diagnosed;
2. When the embryo is attached to the final segment of the removed tube, interstitial localization is revealed;
3. When located in the uterine cervix, cervical pregnancy develops;
4. In the abdominal cavity, the fertilized egg is located during abdominal pregnancy;
5. Most often, the embryo is attached to the fallopian wall, i.e., tubal gestation is diagnosed. A similar type of ectopic conception after IVF is detected in 96% of cases.

There are many reasons for such abnormal implantations and they may vary in each clinical situation.

Why does the embryo implant outside the uterus after IVF?

Routine medical examination using ultrasound

Embryonic implantation outside the uterus can occur for a variety of reasons. One of the main ones is considered to be insufficient quality of the endometrial layer. The internal layer of the uterine body must be almost ideal and maximally mature at the time of the fertilized egg transfer procedure, otherwise the embryo will not be able to fully implant. Insufficiently mature endometrium is observed when the patient is incorrectly and ineptly prepared for in vitro fertilization.

Female infertility can develop against the background of various factors. For example, due to previous infections such as gonorrhea or ureaplasmosis, gardnerellosis or chlamydia, mycoplasmosis and trichomoniasis, adhesions and chronic endometritis, the presence of polyps and fibroids, endometriosis, etc. Such pathological factors can develop and occur latently, asymptomatically. But before the IVF procedure, the patient must undergo a full examination for the presence of such diseases, so laparoscopic or hysteroscopic diagnosis is prescribed. If these studies are not performed, then the likelihood of an ectopic pregnancy increases.

Also, insufficient maturity of the endometrial layer can be caused by stimulation of egg maturation by Clostilbegit. This medication belongs to the group of outdated ovulatory inducers; it slows down the processes of endometrial growth. Therefore, when using it, the patient needs additional estrogen support. If the thickness of the endometrial layer is less than 8 mm, then the embryo is not transferred into the uterine cavity. In addition, the cause of ectopic conception during IVF can be ovarian hyperstimulation syndrome, in which there is a significant increase and displacement of the ovaries in size, leading to damage to the fallopian tubes. As a result, the direction of movement of the villi in the tubes changes in the opposite direction, that is, from the uterus to the tube. This condition develops as a result of powerful hormonal stimulation of a woman’s gonads.

Ectopic gestation can also be provoked by congenital reproductive anomalies or non-compliance with the ban on physical activity after embryo transfer. After implantation of embryos, the patient must eliminate stressful situations and conditions and ensure complete peace. When dragging heavy objects or other physical activity, the embryo may move into the tube. If a woman experiences any stress, the production of corticosteroids is activated, which provoke an increase in the production of progesterone and estrogen hormonal substances, and this somewhat negatively affects the thickness of the endometrial layer.

How to recognize an ectopic

Ectopic pregnancy after in vitro fertilization is detected much earlier than during normal conception. A reproductive specialist will determine this condition if the patient has clinical manifestations such as:

• Reduced levels of human chorionic gonadotropic hormone and its slow growth, which normally should occur quickly.
• A variety of bloody discharge, which can be represented by brownish smear, scarlet blood or brown watery masses. Blood present in the discharge may indicate a threat of spontaneous interruption, which occurs with uterine hematomas, bleeding pathologies, progesterone hormone deficiency, etc.
• Severe sweating, weakness and dizziness.
• In the area of ​​the uterus and tubes, a woman experiences pronounced painful sensations that radiate to the anus, thigh and lower back and only intensify over time. If the pain is insignificant, then this may indicate normal implantation and development of the embryo.
• Ultrasound examinations do not detect a fertilized egg in the uterine cavity.

Ultrasound is best performed using a transvaginal sensor; such an ultrasound examination is more informative and allows you to detect the embryo inside the uterus within a week after implantation.

Features of hCG indicators

Movement of sperm through the fallopian tube

During any pregnancy, the active release of the hormone gonadotropin occurs, so the test for detecting pregnancy, even with an ectopic one, will be positive. Therefore, it is impossible to identify possible variants of ectopic pregnancy based on the results of hCG at an early stage. Only two weeks after the transplantation, based on tests for gonadotropic chorionic hormone, can an ectopic be suspected. From about 2-3 weeks, the content of this hormone begins to double every two days.

To determine such an increase in hCG, several studies are necessary. If such growth dynamics are absent, then the analysis is repeated again after two days and only based on the data of several studies can certain conclusions be drawn.

Features of ectopic

One of the problems of ectopic conception with in vitro fertilization is the high probability of heterotopic pregnancy. In this condition, one embryo develops inside the uterus, as expected, and the other develops outside the uterine body. This is observed when several embryos are transferred; in search of a place to attach, one fetus may move into the tube.

In such a situation, specialists are faced with a difficult task - they need to remove the fallopian tube with the embryo attached to it, while preserving the fertilized egg inside the uterus. But this is not always possible. Fortunately, the frequency of such cases is one in 30 thousand. It is to prevent such a situation that in some countries, removal of the fallopian tubes is considered one of the mandatory points of the IVF protocol.

What to do, how to treat

Outside the uterine body, normal development of the fetus is impossible, so the abnormally located embryo must be removed from the patient’s body. Such removal can be carried out medically or surgically. Medical removal certainly does not have the same risks as surgery, but it cannot provide a 100% guarantee of successful termination of an ectopic pregnancy. For such an interruption, Methotrexate is usually used, which leads to hormonal imbalance, which provokes a miscarriage. As a result, the fetus should resolve or come out naturally.

A long-awaited baby is happiness for the whole family

But at the stage of detachment of the fertilized egg, many questions arise, such as where the embryo will go next and what to do if it does not resolve, but begins to decompose inside. In such a scenario, a woman will develop conditions that are dangerous to her health, and in case of sepsis, life-threatening. Due to the high risk of complications, drug treatment is used quite rarely.

The most guaranteed and uncomplicated result is provided by surgical intervention. To avoid recurrence of the ectopic, it is recommended to remove the entire tubal tissue along with the embryo located inside. Although doctors can also offer laparoscopic surgery, during which the egg is simply sucked out of the tube. Sometimes such an operation is necessary to preserve another embryo that is successfully developing in the uterus.

Prevention

To minimize the likelihood of ectopic conception during in vitro fertilization, it is advisable for patients to follow these recommendations:

• To stimulate ovulatory processes, choose only modern drugs of the latest generation, which have the most gentle effect on the endometrial layer;
• Follow exactly all the recommendations and instructions of the reproductologist after the transfer of fertilized eggs;
• Even before IVF, it is necessary to undergo a comprehensive examination, which should reveal hidden pathologies of the reproductive system, if any;
• Responsibly and seriously approach the selection of a clinic where IVF is expected to be performed and further observation of the patient.

When is the next conception allowed?

The patient will be able to become pregnant and carry a baby to term even after an ectopic pregnancy. How high the chances of successful motherhood are depends on the location of the embryonic tissues and the traumatic nature of the manipulations to remove them. But while the structures of the reproductive system are preserved, female fertility after such conception decreases. Therefore, planning the next conception must be approached as carefully as possible. Pregnancy is prohibited for the next six months.

First, you need to be treated for possible hidden infections, undergo a course of complete restoration of hormonal levels and the body as a whole. At this time, the patient is prescribed COCs. The patient undergoes a comprehensive examination and only after about six months the couple can again try to conceive using in vitro fertilization.

Only timely detection of an ectopic will help save the patient’s life and give her the opportunity to become a mother in the future. Ectopic conception is a dangerous condition, so at the first suspicious symptom you should seek medical help. In this case, the main task is to save the mother; saving the fetus is impossible.

Fertilization is the very first stage in the birth of a new life. It begins with the meeting and union of two sex cells: male and female - sperm and egg. At the site of their fusion, a zygote is formed - a cell that combines a complete set of 46 chromosomes with genetic information obtained from the parent cells. At the stage of fertilization, the sex of the future person has already been determined. It is chosen randomly, like a lottery. It is known that both the egg and the sperm contain 23 chromosomes, one of which is the sex chromosome. Moreover, the egg can contain only the X sex chromosome, and the sperm can contain both the X and Y sex chromosomes (approximately 50% each). If a sperm with an X-sex chromosome connects with an egg, the child will be female, and with a Y-chromosome, the child will be male.

How does the fertilization process occur?

Approximately in the middle of the monthly cycle, a woman ovulates - a mature egg capable of fertilization is released from the follicle located in the ovary into the abdominal cavity. It is immediately picked up by the cilia-villi of the fallopian tubes, which contract and push the egg inside. From this moment, the woman’s body is ready for fertilization, and for about a day a viable egg in the fallopian tubes will wait to meet a sperm. For it to happen, he will have to go through a long, thorny path. Having entered the vagina with a portion of seminal fluid during sexual intercourse, almost half a billion sperm, wagging their tails to speed up, rush upward.

Before the cherished meeting, you need to walk a distance of about 20 centimeters, which will take several hours. On the way of the sperm there will be many obstacles, overcoming which, the majority of the tailed animals will die. The hardiest sperm will reach the goal. For fertilization to take place, at least 10 million must enter the uterus and help pave the way for each other. Only a few thousand will reach the finish line, and only one of them will get inside. Not necessarily the strongest, but rather the lucky one who will be closest to the hole-entrance, which everyone worked to dig in order to break through the protective shell of the egg.

As soon as the sperm is inside the egg, their fusion occurs, i.e. fertilization. Now it is no longer a sperm and an egg separately, but a single cell - a zygote. Soon it will begin its first division, forming two cells. Then they will further divide into four, eight cells, etc. Gradually, the dividing cells will turn into an embryo, which the fallopian tubes, contracting, will push towards the uterus. He needs to leave this place as soon as possible, because... if it is delayed, implantation will occur directly in the oviduct, which will lead to an ectopic pregnancy. Around the fifth or sixth day, the embryo reaches its goal: it enters the uterus, where it will float freely for a couple of days, looking for a place to attach. Embryo implantation occurs on average on the seventh to tenth day after fertilization, sometimes a little earlier or later. Having found a convenient place, it will spend almost two days, like a gimlet, biting into the lush endometrium in order to gain a stronger foothold. Plunging deeper, it touches the blood vessels located in the wall of the uterus, so small hemorrhages occur at the site of implantation. At this time, a woman may notice slight spotting, which is called implantation bleeding and is considered an early symptom of pregnancy. The implanted embryo begins to release hCG into the mother’s blood, the pregnancy hormone, which pregnancy tests respond to. Therefore, ten days after ovulation, you can try taking the first test. If pregnancy is confirmed and its development is successful, the embryo will continue to grow and form, and after 9 months a new person will be born.

Artificial insemination

Artificial insemination helps couples conceive a long-awaited baby in case of male or female infertility. Depending on the cause of infertility, one or another method of artificial insemination is prescribed. Pregnancies resulting from any of these are completely natural and do not require further special monitoring. There are three main methods of artificial insemination:
— AI (artificial insemination);
— IVF (in vitro fertilization);
— ICSI (intracytoplasmic sperm injection).

The simplest and most accessible is artificial insemination. In this procedure, the male seminal fluid is injected directly into the woman's uterus through a catheter, then the sperm independently move into the fallopian tubes to meet the egg, where fertilization occurs naturally. Before injection, the sperm is specially prepared: weak sperm are rejected, the most active and mobile ones capable of fertilization are left.
Before AI, the couple undergoes a medical examination, tests for sexually transmitted infections, the man has a spermogram (sperm analysis), and the woman’s fallopian tubes are checked for patency in order to avoid ectopic pregnancy. Often, for greater effectiveness of the procedure, ovulation is additionally stimulated with medications.

Artificial insemination is prescribed for:
- lack of ovulation;
- vaginismus, when due to spasms and involuntary contractions of the pubococcygeus muscle in a woman, penetration of the penis is extremely difficult;
- cervical factor of infertility, when sperm cannot penetrate the uterus and die in the vagina;
- partner’s sexual disorder and inability to have full sexual intercourse;
- poor sperm analysis;
- infertility in young couples. AI is being chosen as the first option to combat unexplained infertility.

The effectiveness of this method is on average 20-25%. This percentage may be higher or lower depending on the age of the couple, sperm quality and other factors.

IVF is in vitro fertilization, the procedure is quite lengthy and labor-intensive. It is prescribed when all methods of treating infertility have been tried, but there are no results. Initially, the couple undergoes a full medical examination and examination, urine and blood tests, tests for sexually transmitted infections, hormones, women undergo a pelvic ultrasound, check the patency of the fallopian tubes, and men have a spermogram. Then they proceed directly to the IVF procedure. It consists of several stages. First, a woman undergoes ovarian hyperstimulation by injecting certain hormones into her body so that several full-fledged eggs, ready for fertilization, mature. Then these eggs are removed: under general anesthesia, punctures are made in the lower abdomen on the side of the ovary, or under local anesthesia, a needle is inserted through the vagina.

Before fertilization, a selected portion of male semen undergoes preparation: sperm are separated from seminal fluid, transferred to an incubator and placed in a nutrient medium. Next, the most active and complete sperm (about 100 thousand) are mixed in a glass bowl with eggs removed from the woman. In a day it will be possible to see whether fertilization has occurred. If this has happened, then the most viable zygotes are selected to grow into embryos. After another 24 hours, it can be determined whether embryo development is occurring. They are given another 2-3 days to grow and are transplanted using a thin catheter through the vagina into the uterus.

Usually two or three embryos (sometimes more) are transferred so that at least one of them takes root. The remaining high-quality embryos are frozen and stored at a temperature of -196C. In the future, if the couple wants to have more children, there will be no need to re-fertilize; it will be enough to use ready-made embryos. If the transplantation was successful, the embryos took root and implanted in the uterus, and a normal pregnancy then develops. If menstruation begins after 10-14 days, then the attempt was unsuccessful. The probability of pregnancy using IVF is 20% when transferring two embryos, and 30% when transferring three embryos.

In those rare cases when 3 or more embryos implant during the IVF procedure, reduction can be performed for medical reasons or the desire of the woman. Excess embryos are removed without posing a threat to the remaining ones. Depending on the reduction method chosen, the procedure is carried out between 5 and 10 weeks of pregnancy.
Just a few decades ago, in vitro conception seemed like a fantasy, but now it is a reality.

ICSI – intraplasmic sperm injection, is prescribed for male factor infertility, when for some reason the sperm cannot penetrate the egg. Most often this happens due to a small number of motile sperm, the absence of sperm themselves in the seminal fluid, teratospermia and other sperm pathologies.

In this procedure, the sperm is inserted into the egg using a very thin needle. The egg is first removed from the woman's ovary. All manipulations are carried out under a microscope. First, the egg is treated with a special solution to dissolve the outer shell, then the sperm is injected with a needle.

During the ICSI procedure, the couple undergoes the same preparation and examination as during IVF. The difference is that with IVF, sperm are present with the eggs in a special solution and penetrate inside on their own, while with ICSI, one, the healthiest and most viable sperm is selected and placed inside the egg with a needle. Sperm selection occurs under a very powerful microscope, with four hundred times magnification. IMSI is considered a variation of the ICSI method, when sperm selection is performed under a more powerful microscope, with a magnification of 6000 times. The chance of pregnancy with ICSI is approximately 30%.

The IVF method is used by couples who have an obstacle to spontaneous conception that cannot be eliminated. This could be a woman’s fallopian tube removed, or various gynecological diseases of an inflammatory nature that cause ovulation disorders.

Sometimes the cause of infertility is a man's lack of sperm, low sperm count or low sperm count. In this case, the seminal fluid is obtained by puncture by an andrologist who deals with the reproductive health of men.

In vitro fertilization occurs in a test tube, then the embryo is implanted into the uterus. The IVF procedure is especially effective for male infertility. Of course, the resulting sperm can be injected directly into the patient's vagina. But this method gives less chance of successful fertilization than IVF.

How does artificial insemination work?

The artificial conception procedure is carried out by a highly qualified specialist in an embryology laboratory. After hormonal stimulation of the body, mature eggs are extracted by puncture of the follicles.

The fusion of sperm and egg occurs in solution. They are left for several days to produce many ready embryos.

Thanks to special procedures, various pathologies can be detected, including chromosomal diseases, congenital malformations, and hemophilia.

Having selected the highest quality embryos, specialists transfer them to the uterine cavity. A special elastic catheter is used to transfer the embryo. This procedure is absolutely painless. After it, the woman can continue to do her usual activities, avoiding only physical exertion and psychological stress.

IVF is a universal method of artificial insemination, suitable for all cases of infertility.

There are two types of IVF: routine (conventional) and (introcytoplasmic sperm injection). In the first case, eggs and sperm are placed in a container in which they are independently cultivated for 2-5 days. With the introcytoplasmic method, specialists select the most active sperm and inject it into the egg using a microdevice. Such fertilization is used even with minor sperm abnormalities.

If a woman is healthy and a man has problems with sperm quality, doctors suggest using the method of intrauterine insemination. After sperm collection, a series of manipulations are carried out to improve its quality and injected into the uterus. This method is suitable for couples who are incompatible. This problem occurs when a woman's cervical mucus kills sperm. The insemination method allows one to overcome this barrier. In case of unsuccessful attempts, you can resort to using donor sperm (DS).

The following method of artificial insemination is also effective in case of incompatibility of partners and male infertility. This method is known as GIFT. When used, gametes (sperm and eggs) are transferred to the fallopian tubes. The success of the procedure depends on the correct day of the cycle and the condition of the fallopian tubes.

ZIFT is a method similar to the previous one, consisting of transferring a zygote (embryo) into the fallopian tube.

Pros and cons of IVF

The main advantage, which outweighs all the disadvantages of IVF, is the birth of a healthy baby when the partner is completely infertile. According to statistics, IVF is successful in 35% of cases. It should be remembered that implanting an embryo into the uterus is not harmless to the patient’s health. Such fertilization can be fraught with the occurrence of ectopic pregnancy, allergic reactions of the body to certain drugs, disruption of the gastrointestinal tract and liver. Therefore, the procedure requires a complete preliminary examination of partners and confirmation of the diagnosis.

If the procedure is successful, there is a possibility of multiple pregnancy. Therefore, it is often necessary to reduce “extra” embryos, which can provoke a miscarriage. If more than 2 embryos are left to develop in the uterus, there is a risk of hypoxia (lack of oxygen) in the fetuses and the birth of premature babies.

Stimulation of superovulation can be repeated only after 2.5-3 years, when the body’s hormonal balance is completely restored. In order not to wait so long, the embryos can be frozen and the transfer can be repeated six months after the first unsuccessful attempt.

IVF cost

The main disadvantage of artificial conception is, perhaps, the cost of the procedure. Fertilization using assisted reproductive technologies (ART) requires quite significant financial costs. For in vitro fertilization you need to pay approximately 10 thousand dollars. Not every couple dreaming of a child can afford to spend that amount.

The price of the main methods of artificial insemination varies. The price formation is influenced by the level and location of the clinic, and the qualifications of the doctors. Without taking into account medications, artificial insemination costs 15,000 rubles, the cost of IVF is at least 55,000 rubles, and if the procedure is carried out in combination with the injection of sperm into the egg - from 70,000 rubles. The average price for artificial insemination in the capital and regions of the Russian Federation is approximately 120-150 thousand rubles.

The cost of the procedure can be reduced if tax is deducted from the final amount. To do this, citizens must submit certain documents.

The cost of in vitro fertilization does not include the price of drugs to stimulate superovulation; the woman buys them herself. It is impossible to name the exact cost, since needs and possibilities vary, but prices vary significantly if the protocol for stimulating superovulation includes modern recombinant drugs. The cost of the latest generation of medicines significantly exceeds the cost of their analogues.

Contraindications to the procedure

In vitro fertilization is prohibited in the following cases:

• if pregnancy and childbirth are contraindicated for a woman due to physical and mental illness;
• if a woman has congenital malformations of the genital organs that make implantation and gestation impossible;
• if a woman has malignant or benign tumors of the ovaries and uterus;
• if the woman mentioned a history of malignant tumors (information obtained by questioning the patient);
• if acute inflammatory processes of any localization are detected in the patient’s body.

After surgical removal of fibroids, the contraindication to IVF is removed.

Important nuances

If a woman resorts to this procedure for the first time, doctors try to carry it out with minimal stimulation, bringing it as close as possible to natural fertilization.

When ovarian hyperstimulation syndrome occurs, further actions taken by doctors depend on its severity. In this case, the patient is either transferred under closer monitoring, or the eggs are previously removed and transferred for fertilization, or the entire cycle is canceled.

After embryo transfer, constant monitoring of the growth of the hCG hormone is necessary. 14-18 days after the transfer, the woman should take a pregnancy test.

Free IVF

The established cost of the IVF procedure is 106 thousand rubles. These funds are allocated from the regional budget. If treatment requires large expenses, then patients cover the remaining amount on their own.

Since 2014, not only couples who have formalized their relationship, but also those living in a civil marriage can take part in this free program. In addition, government-funded in vitro fertilization has become available to single women, same-sex couples, and partners diagnosed with HIV. Since 2013, in vitro fertilization has been part of the compulsory health insurance (CHI) program, and citizens with appropriate indications can receive benefits under the policy.

Citizens also have the opportunity to choose a clinic for IVF. All private clinics that have entered into an agreement with the Compulsory Medical Insurance Fund participate in the state program.

The cost of this state program for 2014-2015. stimulation of superovulation with hormonal drugs, puncture of follicles, cultivation of embryos and their transportation are included. The program does not include egg donation, ICSI, surrogacy and other procedures.

In vitro fertilization is a relatively new method of treating infertility. It was first used in England in 1978. However, similar attempts were made 200 years ago.

The essence of IVF (in vitro fertilization): sperm meet eggs in a test tube, and then they are implanted in the uterus of an infertile woman or a surrogate mother. If the outcome of the procedure is favorable (pregnancy occurs), there are often cases when in vitro fertilization leads to multiple pregnancies: twins or triplets are conceived, because Several eggs are involved in an attempt at in vitro fertilization. At the request of the woman, reduction can be carried out (removal of excess embryos), but it happens that this leads to the death of the remaining ones and subsequent miscarriage.

The success rate of the IVF procedure is approximately 30-35%.

When is IVF (in vitro fertilization) used?

IVF assistance is effective in those forms of infertility when it is not possible to eliminate the cause that prevents conception. For example, after an ectopic pregnancy, when one or both fallopian tubes are removed; after inflammatory diseases, when the patency of the fallopian tubes is impaired and it is not possible to restore it.

In cases where there is not enough sperm or when there are few sperm in it, andrologists have developed methods for obtaining sperm artificially using a puncture or surgery. With male factor infertility, it is not necessary to conceive using IVF; you can simply introduce sperm obtained artificially into the uterine cavity. However, given that this method of obtaining sperm is complex, in this case, using the IVF procedure gives a greater chance of success.

How often is IVF used?

Unfortunately, the IVF procedure is rarely used. There are many reasons for this:

• firstly, this method of treatment is expensive and is not included in compulsory medical insurance programs, which means it is not available to all patients;
• secondly, IVF centers are poorly subsidized by the state and can only be found in large cities.

Survey

If an infertile couple contacts one of the IVF (in vitro fertilization) centers for infertility treatment, then the first stage will be an examination of both partners. A woman usually undergoes an ultrasound, blood tests for hormones, tests for AIDS, hepatitis, and syphilis. A man has a spermogram. If necessary, genetic tests are performed. The examination takes on average 2 weeks. After the examination, a decision is made which method of infertility treatment is indicated for each specific couple.

Hormonal drugs

Before conception using IVF, a woman is prescribed special hormonal drugs that stimulate the growth and maturation of not one or two (as in a normal cycle), but several follicles. This is necessary because to carry out the IVF procedure you need to have a certain supply of embryos. The woman injects herself with hormonal drugs every day. The duration of hormonal treatment is on average 2 weeks.

Then the woman undergoes follicle puncture. The procedure is performed on an outpatient basis. Using a needle through the vagina under ultrasound guidance, mature follicles are removed from the ovaries. In this way, several eggs are obtained. This procedure is low-traumatic and complications after it are unlikely.

Receiving sperm

If a man is healthy, there are usually no difficulties in obtaining the required amount of sperm. In cases where spermatogenesis is impaired, a man needs special treatment.

There are situations when sperm is produced, but it is not possible to obtain it naturally. Then the doctor performs a puncture. This manipulation is performed under anesthesia. It is possible for an egg to be fertilized by a single sperm.

In Vitro Fertilization

Direct conception through IVF is carried out by embryologists in an embryological laboratory. Using modern equipment, the sperm and egg are connected in special solutions. After 2-4 days the embryos are ready for the next stage.

Preimplantation diagnosis

Preimplantation diagnosis is a method of examining an embryo obtained as a result of IVF before it is transferred to the uterus. With the help of modern genetic technologies, it is possible to examine an embryo consisting of only 4-8 cells. Using this diagnostic method, gross malformations of the embryo and hereditary chromosomal diseases, such as Down's disease, hemophilia, etc. are detected. In addition, with the help of preimplantation diagnostics, the sex of the unborn child can be determined.

Transfer of embryos to the uterus

Transferring embryos to the uterus is the simplest procedure of the entire method. Using a special elastic catheter, 2-3 fertilized eggs are transferred into the uterine cavity. This does not require pain relief.

After the egg transfer, the woman can go home to work. No special mode is required. However, some IVF centers issue sick leave. Naturally, after the procedure, women are not recommended to undergo heavy physical and emotional stress.

Pregnancy

Pregnancy with IVF occurs in 30-35% of cases. Out of 20 pregnancies that occur, an average of 18 end in childbirth. After the embryos are introduced, the level of hormones in the blood must be monitored once every three days. After 12 days, a pregnancy test is performed. In case of multiple pregnancy, at the request of the woman, reduction is performed - removal of “extra” embryos.

Childbirth

Childbirth during pregnancy after IVF is no different from normal. In cases where the cause of infertility is a woman’s illness, childbirth is carried out taking into account the specific illness. This has nothing to do with the method of fertilization.

Children

According to doctors, in vitro fertilization does not affect the unborn child in any way and he is no different from other children born naturally. However, there is an opinion that such children study better, but get sick more often. Doctors believe that this may be due to excessive guardianship of the desired child.

Number of IVF attempts

As is known, pregnancy occurs only in 30-35% of artificial insemination attempts. The question arises: what about those 70 out of 100 women who do not become pregnant? How many times can IVF attempts be made?

In each individual case, this issue is resolved individually. The IVF procedure itself is quite safe and can be repeated many times. For some couples, pregnancy occurs after 8-10 attempts. There is a reasonable limit on the number of procedures; it is determined by the doctor depending on the specific situation. In repeated attempts, it is possible to use embryos that were not used the previous time. Unfortunately, no one can guarantee pregnancy with IVF.

Egg donation

By puncturing the follicles, more eggs than necessary may be obtained. In these cases, healthy women are offered to become donors. Their eggs will be used in cases where the patient does not have her own eggs - after removal of the ovaries, during menopause, with altered ovaries, etc.

To encourage donation, women who agree to donate their eggs pay less to attempt IVF. Naturally, egg donation is anonymous; the donor has no rights to the child born from her egg.

Donor eggs are fertilized with the sperm of the husband of the woman into whom they are implanted. In this case, hormonal preparation for IVF is not required. In most IVF centers, excess fertilized and unfertilized embryos are kept frozen, regardless of whether they will be used in other women or not. The shelf life is determined to be 55 years.

IVF in menopause and in women with ovaries removed

Pregnancy and its successful gestation are possible in almost all cases when a woman has a uterus.

Patients aged 40-50 years can also have children. Usually, women of this age are forced to turn to IVF - if a child dies, in late marriages, and so on. If pregnancy is not contraindicated for a woman for health reasons, then the IVF method can be used.

The first trimester of pregnancy is usually accompanied by hormone replacement therapy, then it is canceled and the pregnancy proceeds independently.

Complications during IVF

The main complication that doctors encounter is multiple pregnancy. In addition, sometimes a miscarriage may occur after embryo reduction. A complication of hormonal therapy carried out before IVF can be ovarian hyperstimulation syndrome. It manifests itself as abdominal pain and bloating. If diagnosed early, it can be corrected. It is important to immediately consult a doctor if you experience any unpleasant sensations during hormonal therapy. Ectopic pregnancy with IVF is rare.