Stages of IVF - steps towards the desired pregnancy. How does IVF proceed from start to finish: how is the artificial insemination procedure done? On what day of your period do you do IVF?

In vitro fertilization provides a real opportunity for infertile couples to become parents. The procedure is not as simple as it seems, and the woman often has to undergo ovarian stimulation to induce superovulation. What it is and how it happens, we will tell you in this article.

What is it?

Stimulation of the ovaries before IVF is carried out only in a stimulated cycle. With normal ovarian function without the use of any medications, a woman matures one egg in one menstrual cycle, or less often - two.

Stimulation of the ovaries allows you to obtain several eggs in one cycle, which significantly increases the chances of selecting the highest quality oocytes, their fertilization and subsequent transfer to the uterine cavity of the expectant mother. Ultimately, the likelihood of pregnancy increases.

After the couple contacts a reproductive specialist, taking into account the true cause of infertility, an individual scheme is prescribed - an “action plan” for the next month. This plan, tailored to a specific woman, provides detailed description stages, their order, as well as hormonal drugs to stimulate ovulation and their dosage is called a protocol.

Starting the next menstrual cycle, in which IVF is planned, the woman “enters the protocol.” This introduction begins precisely with stimulating the increased work of the ovaries, so that by the middle of the cycle the doctor can obtain not one, but several oocytes suitable for fertilization.

Stimulation of the ovaries completely changes the biological rhythm of life of the female body. The ovaries do not work as usual, but in emergency mode. Stimulation before IVF is most often required during the first protocol. If you manage to obtain a large number of eggs, then in the next protocol (provided that the first does not bring a positive result) you can do without drug “shock” hormone stimulation; the doctor will be able to use cryopreserved (frozen) eggs or embryos.

You can, of course, try to get pregnant in a natural cycle, without stimulation. In this case, an embryo obtained from a single egg is transferred to a woman without drug support, but the predicted effectiveness of such IVF is several times lower than with the stimulated protocol.

The state of the female body that the doctor strives for when prescribing ovarian stimulation is called superovulation. This term means multiple ovulation, in which 3-4-5 or even more follicles mature.

Sources:

1. Losos, Jonathan B.; Raven, Peter H.; Johnson, George B.; Singer, Susan R. Biology. New York: McGraw-Hill. pp. 1207-1209.
2. Campbell N. A., Reece J. B., Urry L. A. e. a. Biology. 9th ed. - Benjamin Cummings, 2011. - p. 1263
3. Tkachenko B. I., Brin V. B., Zakharov Yu. M., Nedospasov V. O., Pyatin V. F. Human physiology. Compendium / Ed. B. I. Tkachenko. - M.: GEOTAR-Media, 2009. - 496 p.
4. https://ru.wikipedia.org/wiki/Ovulation

How is stimulation carried out?

Usually the stimulation process begins on the 3rd or 5th day of the menstrual cycle. The countdown is from the first day of the next menstruation. Therapy lasts until approximately the middle of the cycle, when, according to ultrasound estimates, the size of the follicles reaches a sufficient size. Then the procedure of “ovarian puncture” is prescribed. It is carried out in a hospital setting under general or local anesthesia. A thin and long hollow needle is inserted into the woman’s ovary through the back wall of the vagina, which “pumps out” the contents of the dominant follicles along with the eggs.

The eggs undergo microscopic examination, and the best of them are considered suitable for fertilization. The oocytes are placed in a nutrient medium, and the sperm of the husband or donor is added there.

Fertilized eggs remain to “ripen” in the laboratory for several more days, after which they are again subjected to strict selection. Placed in the uterine cavity to the expectant mother There will be only the most viable and strong embryos.

The more eggs were obtained, the more of them successfully passed the fertilization stage and were found suitable for transfer, the higher the likelihood of a successful IVF outcome. If after transfer there are “extra” embryos remaining, in agreement with the attending physician, they can be frozen and will be stored in a cryobank until required. The woman will be able to use them in the next protocol or in a few years, when she wants to give birth to another baby.

From the moment the hormones are prescribed, which in the first phase of the cycle should ideally lead to superovulation, control over the growth of the endometrium of the uterus and follicles begins. Normally, the endometrium should “grow” by 1 mm, and the follicles by 2 mm every day.

If growth exceeds these normative values, the regimen is revised to adjust for the likelihood of developing a dangerous complication - ovarian hyperstimulation syndrome. If the growth rate of the endometrium and follicles is not up to normal, the doctor may increase the dosage of hormones or change one drug to another. The ovarian response may vary.

Shock doses of hormones, which are completely unusual for the female body outside of IVF, can have quite noticeable negative consequences for the whole body, and therefore stimulation with minimal hormonal support is sometimes recommended in order to minimize the harmful effects. However, in such protocols, for the most part, only follicles grow, the endometrium grows slightly, and its thickness is very important so that fertilized eggs can implant and take root.

In protocols with minimal stimulation, doctors often set the goal only to collect biomaterial - eggs and freeze them until the next protocol, when the endometrium is ready to accept the fertilized egg.

Stimulation in a short protocol lasts approximately ten days. The entire protocol takes one menstrual cycle. In a long protocol, stimulation can last more than 30 days.

When choosing the type of protocol, the doctor focuses on the cause of infertility and related problems. So, with endometriosis, it will take quite a long time to “build up” the endometrium, so a long protocol is chosen. In particularly difficult cases, the duration of stimulation can reach up to six months.

Feelings during stimulation

A woman usually begins to feel the consequences of hormonal stimulation during the stimulation process itself. The hormonal background changes, natural hormones are replaced by an excessive concentration of those introduced from the outside, and the state of health noticeably worsens. A woman can literally be plagued by severe headaches, nausea, dizziness, nagging pain in the lower back and lower abdomen.

Due to changes in the hormonal balance, a woman’s psycho-emotional state is disturbed, she becomes nervous, intolerant, whiny, irritable, she is overcome by attacks of severe anxiety, disturbed night sleep, bloating and appetite disturbances may occur.

If, during the period of stimulation, transparent, rather abundant discharge appears from the genital organs, this is good sign, indicating that the endometrium is growing at a fairly rapid pace, and the chances of implantation of embryos into the functional layer of the uterus after embryo transfer increases.

Drugs

To stimulate superovulation, exclusively synthetic hormonal drugs are used. The doctor chooses the dosage based on the patient’s own hormone levels, the state of the reproductive system, the cause of infertility, the woman’s age and a host of other factors, including the response of the ovaries to stimulation.

In the first phase, follicle-stimulating hormone (FSH) drugs are taken; when the follicles enlarge and ovulation approaches, the woman is given drugs based on LH, which helps the egg to mature quickly. After about 36 hours, a puncture is scheduled - and the eggs, ready to meet the sperm, are removed from the ovaries.

If a woman is planning to undergo insemination (not to be confused with IVF), then when the follicles mature, drugs based on human chorionic gonadotropin (hCG) are administered, which provokes rupture of the follicle membranes and the release of a mature egg. After which the woman’s sperm is injected into the uterine cavity from her husband or donor. Conception, unlike IVF, does not take place in a test tube, but in the body of the expectant mother.

At the final stage after embryo transfer, the woman is prescribed drugs containing synthetic progesterone. It is this hormone that prevents the onset of the next menstruation, and also creates the most comfortable conditions for the developing embryo - it thickens and makes the endometrium of the uterus more loose, improves metabolic processes, partially suppresses maternal immunity so that embryo rejection does not occur, and also maintains the smooth muscles of the uterus in a calm state , preventing hypertension and possible miscarriage.

The most popular and common drugs used during ovarian stimulation include the following.

"Orgalutran". This remedy allows you to suppress the production of follicle-stimulating and luteinizing hormones, which is very important for controlled superovulation in the IVF protocol. The drug exists in the form of syringes with an injection solution. At the recommended dose, it is injected subcutaneously into the thigh area. It is important not to forget to take the drug at certain time intervals, otherwise the pituitary gland will quickly restore its ability to synthesize FSH and LH. Usually the drug is taken for five days.

• "Pugeron." This is a drug with a follicle-stimulating effect. It promotes the maturation of not one, but several follicles in the first phase of the menstrual cycle. Puregon therapy is prescribed not only in the IVF protocol, but also before intrauterine insemination, as well as in IVF + ICSI protocols. The drug is administered from 2-3 days of the menstrual cycle, duration from 7 to 12 days, until the preovulation stage is detected by ultrasound results. Stimulation with Puregon is considered effective over four protocols. Then the effect decreases and the drug needs to be changed.

• "Gonal-F". This drug exists both in the form of a lyophysilate for preparing injections after dissolution, and in the form of a ready-made solution for subcutaneous injections in the so-called “syringe pen”. The dose of the drug per day should not exceed 450 IU. Every day, from day 2-3 of the cycle, the drug is injected subcutaneously into different places. It is strongly not recommended to inject the product into the same place. Usually, 12-13 days after the start of use, the follicles reach adequate size and can be extracted by puncture.

• "Menopur." Reviews of stimulation with this drug are mostly positive. The product is obtained from the urine of women in a state of natural age-related menopause. The drug affects the activity of the pituitary gland to suppress all follicles except the dominant one, and therefore it becomes possible to obtain several eggs that are mature and suitable for fertilization. The drug also increases the thickness of the endometrium.
• "Meriofert". This drug also has a pronounced follicle-stimulating effect, promotes endometrial growth, and also increases estrogen levels. The drug can be administered subcutaneously and intramuscularly.

• "Klostilbegit." This drug is usually used in “soft” IVF schemes. With its help, the ovaries quickly cope with the growth of several follicles, which will be fertilized not in this cycle, but a little later. The dosage of the drug is purely individual. The ovarian response to the drug is not always adequate.

How to give injections yourself?

Usually, doctors do not object to a woman doing the necessary daily injections on her own; before that, she will receive detailed instructions on where and how to administer the drug. General requirements to independently carry out doctor’s orders are as follows:

• subcutaneous injections are best done with special injector pens;
• any hormonal drug should be administered extremely slowly and deliberately;
• injections should be given at the same time every day;
• if one injection is missed for some reason, you should call the doctor and get further recommendations;
• It is strictly prohibited to increase or decrease the recommended doses.

If a woman falls ill with a cold, flu or acute respiratory viral infection during stimulation, or if she has been prescribed antibiotics, she should definitely contact her doctor to decide on the advisability of continuing stimulation or postponing the egg retrieval procedure to another menstrual cycle.

Possible complications

One of the most dangerous complications stimulation as a stage of IVF is considered ovarian hyperstimulation syndrome. With this syndrome, the ovaries increase in size due to the growth of a large number of follicles.

Symptoms of hyperstimulation most often manifest as ascites (accumulation of fluid in the abdominal cavity), in which a woman feels bloated. Pain in the lower abdomen can have varying intensity; it directly depends on how much the woman’s ovaries have enlarged relative to the normal size.

Breathing becomes heavier and more difficult, and nausea, vomiting and diarrhea may occur. Severe swelling of fingers, legs, lower abdomen, blood pressure decreases, the woman’s well-being noticeably worsens. The volume of urine excreted by the kidneys decreases markedly. In a state of hyperstimulation, embryo transfer is highly undesirable, since the likelihood of carrying a pregnancy to term, even if it occurs, will be minimal.

The most at risk of hyperstimulation of the gonads are fair-haired women under the age of 35, women suffering from polycystic disease, as well as women who are prone to allergies and receive hormonal support with hCG in the second phase of the cycle.

The danger of hyperstimulation lies in the possibility of death, the development of cardiac and renal failure, and the likelihood of rapid depletion of the gonads.

Avoiding ovarian hyperstimulation will be helped by the high qualifications of the doctor who conducts the protocol, his readiness to quickly respond to changes in the woman’s well-being and the response of the ovaries. If the follicles grow too slowly, the dose of the hormonal drug should not be increased sharply; after identifying the cause of the unsatisfactory growth of the follicles, sometimes it is necessary to change the drug altogether. During puncture, in order to avoid the development of hyperstimulation in the second phase, it is important to aspirate all accessible large follicles.

In most cases, such an unpleasant complication can be avoided, so do not panic. A trusting relationship with the doctor will ensure that the process of stimulating follicle growth will proceed without dangerous complications and the remaining stages of IVF will proceed similarly, ending in complete success.

Other possible complications of ovarian stimulation before IVF include the possibility of multiple pregnancies, as well as the possibility of ectopic pregnancy after embryo transfer, but this is extremely rare. During stimulation, especially if it is carried out over several protocols, a woman can gain a lot of weight. Also, some sources indicate the likelihood of early menopause after pregnancy, which became possible thanks to IVF precisely because of the previous hormonal stimulation of the ovaries.

How to behave during the stimulation period?

Of course, it is quite difficult for a woman to remain calm and measured, because hormones leave their mark on almost everything - well-being changes (not for the better), libido decreases, the woman experiences not only emotional instability, but is also in a state of severe stress due to fears that the attempt may fail. Nevertheless, doctors strongly recommend trying to pull yourself together and cope with your negative emotions, because stress clearly does not contribute to the successful implantation of embryos and the onset of such a long-awaited pregnancy.

It is important for a woman to walk in the fresh air and eat well. Trying to stick dietary nutrition or vegetarianism should remain a thing of the past. Diet and successful IVF are incompatible. A woman’s diet should contain many vitamins and minerals. The menu must contain animal proteins - meat, fish, dairy products.

The amount of fat in the menu should be somewhat limited. Proteins are extremely important because consuming them in sufficient quantities somewhat reduces the likelihood of such an unpleasant complication as hyperstimulation syndrome.

It is important for a woman who has entered into the protocol and started stimulation to change her lifestyle. She should get a good night's sleep and take care of her health. Immunity, which inappropriately can be undermined and weakened viral infection, flu, high fever, it is now necessary to female body was able to cope with a more important task. Therefore, it is important to stay away from sick people; during epidemic seasons, it is better to take several days off or part of a vacation and save yourself from the need to meet sneezing and coughing people on the bus, subway, or at work.

Smoking and drinking alcoholic beverages during ovarian stimulation, as well as drinking coffee, cocoa, and strong tea can have a negative impact on hormonal levels. It is better to refuse all this.

A woman should not go to a bathhouse or sauna, visit a solarium, or be exposed to direct sunlight for a long time. You should not take any medications without the knowledge and approval of your fertility specialist.

If you have a headache, do not immediately grab painkillers, and if you are vomiting, take antiemetics. It is better to endure some unpleasant sensations and symptoms - they are temporary.

If during the stimulation process unusual discharge appears, for example, bleeding or “smearing”, you should definitely consult a doctor without delay. If your joints hurt, and many women, according to reviews, note that this also happens, you should also consult a doctor.

On the way to acquiring the highest and most unique gift of nature - childbearing, many infertile couples have to go through the procedure of in vitro fertilization. The topic of IVF is the subject of frequent discussions, both among reproductive medicine specialists and in public circles.

But married couples who long time fought for the possibility of having a child, as a rule, stand aside from any controversy regarding IVF. Indeed, often this procedure becomes their only way out.

Therefore, reliable information about how everything happens and how many days it takes is a real value for them, which will allow them to correctly assess all opportunities and risks, plan upcoming actions and choose medical institution, where the in vitro fertilization procedure will be performed. Key information aspects of this issue are covered in this article.

IVF is a strictly regulated procedure

No matter where in the world the in vitro fertilization procedure is carried out, for each specific infertile couple it follows the same scheme. This is due to the clear standardization and unification of clinical treatment regimens, concluded in the form of clearly regulated IVF protocols. This means that all fertility centers perform certain medical procedures at a certain stage of the procedure for certain types of infertility.

But such a standardized approach is not without individualism. Indeed, without observing the principles of an individual approach, it is unlikely that success will be achieved due to the uniqueness of each case of infertility. Therefore, several types of in vitro fertilization protocols have been developed that can be used to treat infertility. Protocols could be:

• Ultrashort (Japanese or Teramoto protocol);
• Short;
• Long;
• Cryoprotocol;

Important to remember! Any IVF protocol consists of identical sequential stages. The difference between treatment regimens of the same type lies only in the types and names of some of the drugs used, the methods of manipulation and the time required to complete the immediate IVF cycle. Therefore, how long this procedure will take directly depends on the specific case of infertility and the type of protocol chosen that corresponds to it!

General scheme and characteristics of IVF stages

Whatever the reason for the persistent infertility of a married couple, the emergence of indications for IVF unites them into several groups, according to the stage of this procedure. This means that each woman will have to undergo almost identical studies and manipulations, the scope of which can be expanded if indicated. The stages of in vitro fertilization are more relevant for a woman, but for a man, who participates only in some stages. It is presented like this:

1. Preparatory activities;
2. Stimulation of ovulatory activity of the ovaries;
3. Obtaining biological material in the form of eggs and sperm;
4. The procedure for in vitro fertilization of eggs (in vitro conception) and cultivation of embryos;
5. Transfer of embryos into the uterine cavity;
6. Monitoring the onset and progress of pregnancy.

Characteristics of IVF protocols by day and preparation

A general visual description of the basic IVF protocols by day of the menstrual cycle and the time of each stage is given in the form of a table.

Protocol name	Long		Short	Ultra-short
Duration of treatment	Total duration 40-45 days		Duration 28-35 days	Duration 25-31 days
Stimulation of superovulation	Phase	Timing and duration	Timing and duration	Timing and duration
	Pituitary suppression	7 days before menstruation (day 20-25 of the cycle). Duration 12-22 days	Suppression of pituitary activity and stimulation of the ovaries are carried out simultaneously, starting from the first days after menstruation (2-5 days). The duration of the stage is 12-17 days.	Suppression of the activity of the pituitary gland and stimulation of the ovaries are carried out simultaneously starting from the first days after menstruation (days 2-5 of the cycle). The duration of the stage is 8-12 days.
	Ovarian stimulation	The first days after menstruation (usually 2-5). Duration of the phase is 12-17 days
Follicle puncture	It is carried out under the control of follicle growth using ultrasound monitoring on days 12-22 after the administration of the first dose of stimulating drugs.		Under ultrasound control on days 14-20 after the first administration of drugs and the start of hormone stimulation	Monitoring follicle growth according to ultrasound with puncture on days 10-14 after the start of the first stage of IVF
Embryo transfer	Carried out 3-5 days after receiving biological material for any type of IVF protocol
Pregnancy support and control	It is carried out for 2-3 weeks after embryo implantation by introducing progesterone. During this stage, no earlier than 10-12 days later, ultrasound control and a test for hCG levels are performed for any type of protocol.

Preparatory activities. There is not a single medical procedure in medicine that does not require appropriate preparation. If we're talking about For such a complex procedure as IVF, the importance of the preparatory stage increases hundreds of times. Any unrepaired breakdown in the body will certainly affect subsequent stages of the procedure and may cause its failure.

The main task of the preparatory stage is a comprehensive examination of the married couple in order to identify and subsequently correct pathological conditions posing a potential threat to the possibility of performing IVF or carrying a pregnancy.

Preparatory measures should consist of general ones aimed at eliminating somatic pathology (acute and chronic diseases of internal organs, infections) and special ones intended for correcting pathology of the female genital organs (drug treatment, laparoscopy). Particular attention is paid to the need to bring the lifestyle, regime physical activity and nutrition in accordance with what is required.

The body of future parents should be as limited as possible from any harmful influences. This will allow you to obtain the most complete and viable germ cells (sperm and eggs). The total preparation time may take from one to three months. The couple spends most of this time at home. Staying in the clinic may only be required while taking tests or performing medical procedures.

Important to remember! You should not begin preparations for IVF before consulting with a specialist at the reproductive medicine center where the procedure is planned. Some studies and measures may not be necessary due to their previous conduct during examination and other infertility treatment methods!

How superovulation is stimulated

The transition of the preparatory stage directly to the IVF procedure begins after the administration of drugs that affect the ovulatory activity of the ovaries.

This stage is called stimulation of superovulation. It consists of three phases.

Phase one - blockade of the natural activity of the pituitary gland. The physiological rationale for this measure lies in the artificial enrichment of the body with hypothalamic and pituitary hormones that regulate the hormonal activity of the pituitary gland in relation to the synthesis of gonadotropins.

This is necessary in order to turn off the natural production of follicle-stimulating and luteinizing hormones by the endocrine cells of the adenohypophysis. They can be either agonists of gonadotropin releasing hormone - GnRH (diferelin, decapeptyl, buserelin, suprefact, zoladex), or its antagonists (blockers): cetrotide, orhalutran. Such drug stimulation will prevent the premature maturation of one of the eggs. The result will be uniform maturation of their entire colony.

Phase two – acceleration of follicle maturation. During the second phase of the first stage of in vitro fertilization, simultaneous active growth and achievement of maturity of all follicles that responded to stimulation with hormonal drugs are achieved. Instead, high doses of medications containing a large dose of pituitary hormones (luteinizing and follicle-stimulating) are administered:

• Preparations based on human menopausal gonadotropin (HMG) (one of the main drugs is menopur);
• Recombinant preparations of follicle-stimulating hormone (FSH): puregon, gonal;
• Medicines with an antiestrogenic effect based on clomiphene (clostilbegit, Clomid).

This is not possible in the natural ovarian-menstrual cycle. Therefore, such drug stimulation is called superovulation stimulation, which will make it possible to obtain several high-quality eggs at further stages of IVF.

Phase three - delay of premature ovulation. To ensure that the most mature ovarian follicles do not ovulate prematurely at the end of the stage of superovulation stimulation, 36 hours before their puncture, preparations of human chorionic gonadotropin (hCG hormone) are administered: pregnin, choragon, ovidrel. Their role is not only in delaying the ovulatory activity of the ovaries, but also in a beneficial preparatory effect on the endometrium for the subsequent implantation of the embryo into it.

The drugs used for stimulation can be short-acting or long-acting (depot drugs). During their administration, the patient does not have to be in the clinic, since injections can be performed independently using a special syringe pen containing a solution with a hormonal substance. But stimulation control must be carried out systematically according to an individual program. The regime and lifestyle at this time corresponds to that in preparation for IVF.

Important to remember! The first stage of the IVF cycle, during which the superovulatory activity of the ovaries is stimulated, determines the duration of the entire treatment procedure. This is due to the need for an individual approach, which is the basis of existing IVF protocols. The total duration of treatment can range from 25-31, 28-35 days for ultra-short and short types to 40-45 days for long ones. Half of this time is spent on the first stage!

How and when eggs are obtained

Stimulated artificially the ovaries increase their size and volume due to the simultaneous maturation of many follicles. This process is monitored using ultrasound monitoring and determination of the hormonal spectrum of the blood (estrogen, FSH). A daily increase in follicle size by 1-2 mm is considered normal. The criterion for readiness for puncture is that most of them reach 15-20 mm. It is equally important to simultaneously evaluate the thickness of the inner layer of the uterus - the endometrium. When it reaches the 7 mm mark and acquires a three-layer structure, it is a good signal of readiness for implantation of the fertilized egg. As soon as all these conditions are met, the day of puncture is set, with the preliminary administration of the hCG hormone 36 hours before.

If we consider this procedure in a time period, then it occurs on days 12-22, 14-20 after the start of hormonal stimulation with a long and short protocol, respectively, and 10-14 days with an ultra-short one. Such periods almost completely coincide with the normal ovulatory cycle, simulating enhanced ovulation. After the follicles reach a preovulatory state and measures are taken to delay premature ovulation, a procedure for obtaining eggs is performed - puncture of several mature follicles. The more high-quality eggs obtained during this process, the more embryos can be grown in artificial conditions.

In such circumstances, it is possible to carry out IVF using a cryoprotocol, according to which viable embryos are frozen with liquid nitrogen and can be reused in case of unsuccessful previous attempts at in vitro fertilization. This type of protocol is more expensive if pregnancy is achieved on the first try. But if repeated IVF procedures are necessary, not only economic feasibility, but there is also less load on the woman’s body with hormonal drugs, since there is no need to re-stimulate superovulation.

The direct procedure for obtaining eggs is carried out using the puncture method. To do this, after putting the patient under anesthesia (gentle intravenous), under ultrasound control, a puncture is performed with a special needle, penetrating into the pelvic cavity. The puncture site is the posterior vaginal fornix, which is located in close anatomical proximity to the enlarged stimulated ovaries. The risk of damage to the pelvic structures is minimal, since the advancement of the needle is strictly controlled by an ultrasound monitor. Visualization of ovarian follicular formations is usually good.

In doubtful cases or in case of disruption of the normal anatomical relationships of the internal genital and abdominal organs puncture of the follicles under endoscopic control (laparoscopy) is prescribed. In any case, the procedure is painless and does not take more than half an hour. After completing it, bed rest for 2-3 hours is desirable. If general condition The woman’s condition is satisfactory and, apart from slight discomfort in the lower abdomen, nothing else bothers her; there is no need for further stay in the clinic until the next stage of IVF - implantation of the embryo into the uterus.

Egg fertilization and embryo culture

When follicles are punctured, impurities and fluids are aspirated along with the eggs. They must be separated from each other with a further detailed assessment of the usefulness of each egg and its readiness for fertilization. The second important component for this process is viable sperm. Obtaining them is very simple and in typical cases does not require any specialized measures. By masturbation or interrupted sexual intercourse, you can get a portion of fresh sperm, which is cleaned of all impurities, leaving only the highest quality sperm. Men with preserved signs of spermatogenesis in the testicles associated with ejaculatory dysfunction undergo testicular puncture. This biological material, like eggs, can be preserved by freezing, according to the cryoprotocol.

The connection of eggs and sperm with each other is carried out as soon as possible after they are received. This time should not exceed 6 hours. The process is carried out and controlled by an embryologist. During normal development, cells placed in special containers with nutrient media in an incubator that creates conditions close to natural are reunited with each other after a few hours. If this does not happen or the activity of sperm is doubtful in advance, a fertilization procedure using a special ICSI technique is indicated. Its essence emerges from the name - intracytoplasmic sperm injection. This means that the sperm is inserted into the egg using a microscopic needle under the control of electron optical microscopy.

The further fate of the fertilized eggs depends on how actively the process of cell division occurs. In any case, they are placed in a nutrient medium containing all the components and microclimatic indicators necessary to support life. The purpose of this stage: the creation of a blastocyst - a precursor to a viable embryo consisting of several cells. This requires from 2-3 to 5-6 days. All this time the patient can stay at home, following the rules of a gentle regime.

Important to remember! During one fertilization cycle it is necessary to obtain at least 2 blastocysts. The more of them, the better, since there is the possibility of cryopreservation of viable embryos, which can be used if repeated IVF sessions are necessary!

Transfer to the uterus

If fertilized eggs show signs of active cleavage after 18 hours, they are closely monitored. On average, on the 5th day after fertilization, embryos are ready for transfer into a prepared mother’s uterus. During this time period they are at the blastocyst stage. Scientists have found that it is in this state that maximum adaptation of the mother’s body to the embryo occurs, which best takes root by implantation into the endometrium.

The blastocyst transfer procedure is completed within 20 minutes to half an hour. For this, a special thin uterine catheter is used, connected to a syringe filled with a nutrient medium containing embryos. No anesthesia is required. The number of the latter may vary and depends on the signs of their probable viability. Usually two embryos are enough. Using more than that often causes multiple pregnancies.

Monitoring the entry of embryos into the uterine cavity is carried out using an ultrasound device. Despite the simplicity of the procedure, it is the errors in its implementation that cause failures. This is due to the characteristics of the mucus of the cervical canal and the correct insertion and removal of the catheter. Sometimes it becomes clogged with mucus, with which, when subsequently removed from the uterus, the embryos are also removed.

After implantation of the blastocysts, the woman is in a horizontal position on the gynecological chair for 10-15 minutes. There is no need to maintain bed rest for a longer period of time, since once the embryos have entered the uterus, they can no longer fall out of it. But adherence to a gentle regimen and minimal physical activity is mandatory, since intense exercise prevents the implantation and tight fixation of the embryo in the endometrium.

Monitoring the onset and course of pregnancy

The successful transfer of embryos into the uterus marks the end of the in vitro fertilization procedure. But the worries and stress of expectant parents and specialists do not decrease until pregnancy is confirmed. It is not possible to draw any conclusions in this regard within 2 weeks. All this time, the woman takes hormonal medications containing estrogen, progesterone and human chorionic gonadotropin. They are necessary to maintain pregnancy. Sexual contact, physical activity, and thermal procedures are excluded.

The first diagnostic step to confirm a successful IVF procedure should be a pregnancy test. This standard procedure is based on determining the presence of human chorionic gonadotropin in the urine, which is produced by fetal tissues. You can determine the amount of this hormone in the blood. Regardless of the test results (positive or negative), an ultrasound examination is required. Its maximum information content is no earlier than 3 weeks after implantation.

If the pregnancy test is negative, it must be repeated after a few days. A positive test, supported by repeated studies and ultrasound data, indicates the presence of one or two fertilized eggs in the uterine cavity, is a reason to consider the IVF cycle successfully completed. The woman is registered at the antenatal clinic and is systematically observed by an obstetrician-gynecologist with the necessary screening tests (blood tests and ultrasound).

The essence of a long protocol

The name of the long protocol contains its entire essence. It is quite clear that the duration of the protocol is long and covers the second (postovulatory) half of the previous menstrual cycle and the entire subsequent one (about 6 weeks). Its advantage is in the following moments:

• Maximum ability to control ovarian functions (hormone synthesis, follicle growth and ovulation);
• Allows you to obtain the largest possible number of mature follicles;
• Excellent for patients with concomitant endometrioid, cystic and fibromyomatous lesions of the genital organs;
• The highest efficiency when IVF is necessary in women of the young age group (up to 30 years).

It is not without its disadvantages, which may include:

• Complete blockade of the ovaries can cause a shift in the menstrual cycle in the form of a delay in menstruation;
• Signs of a dishormonal nature such as PMS and menopause;
• Psychological discomfort and tension from prolonged administration of hormonal drugs;
• High probability of apoplexy and ovarian hyperstimulation syndrome;
• Aftereffect syndrome – persistence of pituitary gland blockade for a long time;
• Potentially negative impact on the implantation abilities of the embryo and endometrium.

Important to remember! The choice of the type of IVF protocol is a strictly individual decision, which may change during its implementation. The main indicative criteria are presented by the real indicators of the female body and its reaction to medications used at different stages of the IVF cycle!

A short protocol as the gold standard for IVF procedures

The composition and activities of the short protocol are similar to the long one. The only difference is in the time and methodology of the superovulation stimulation stage. Its duration is significantly reduced. The rationale for such treatment tactics arises due to the high risk of side effects when using a long protocol.

Drug blockade of the pituitary gland and stimulation begin simultaneously within the same menstrual cycle, starting 2-3 days after the onset of menstruation. The duration of this period is reduced to 12-17 days, and the total IVF cycle when using a short protocol to 28-35 days. The drugs used for stimulation are the same as in the long protocol. In addition to agonists of releasing hormones, their antagonists are sometimes used, which even more actively block pituitary activity.

The real advantages of IVF using a short protocol are:

• Easy tolerability by patients;
• A small load on the body with hormonal drugs;
• Imitation of the natural ovulatory cycle;
• Reducing the risk of spontaneous ovulation, which reduces the need for additional hCG injections;

Among the disadvantages, there is only one - asynchronous maturation of follicles in the ovaries. This sharply reduces the likelihood of obtaining the required number of complete eggs at the time of puncture. Therefore, the short protocol is used in the presence of special indications, which include unsuccessful attempts or complications that arose during the long protocol or in women with practically healthy ovaries.

Ultra-short protocol: pros and cons

There are two other names for the ultrashort protocol: Japanese and Teramoto protocol. Its creation pursued the same goals as the development of a standard short protocol. The difference between them is that the woman’s body is even less loaded with hormonal drugs, which is why it is considered the most gentle.

Another difference is the types of drugs used. The ultra-short protocol uses exclusively GnRH antagonists, which makes it possible to achieve a rapid and persistent, but short-term blockade of the pituitary gland, which is necessary for obtaining eggs. It has been noticed that their quantity is significantly lower, but their quality characteristics have been improved. This is confirmed by the high percentage of pregnancy after the first IVF attempt using a short protocol.

The advantages of the Japanese protocol are the same as those of the short one. The most important advantage is the complete elimination of premature ovulation and hyperstimulated ovarian syndrome, and the extremely rapid restoration of pituitary activity. An additional dose of hCG is not required at all. It is extremely easily tolerated by women, since the treatment cycle is only 25-31 days, 8-12 of which can be spent on stimulation of superovulation.

Among the disadvantages of this treatment is the uneven development of follicles and slow preparation of the endometrium of the uterus, which causes it to be unready for implantation at the time of receiving a fertilized egg.

The choice of IVF treatment cycle determines the duration of this procedure. In this case, you need to be guided by a single rule: you should not justify your choice by the short duration of treatment and the easy tolerability of the procedure. Only careful weighing of the individual parameters of the female body will allow you to make the right decision and choose the right protocol. Otherwise, incorrectly selected minimum treatment periods will delay the onset of pregnancy due to the need for repeated IVF attempts.

Video: stages of the IVF procedure

One of the main factors influencing the duration of preparation for the IVF procedure is the health of both partners, especially their reproductive organs. For example, if a woman is diagnosed with endometriosis, fibroids or a cyst, treatment will take time. If antibodies to rubella are detected, you will have to vaccinate and postpone the IVF procedure for 2-3 months to eliminate the risk of infection of the embryo.

You will also have to delay the IVF procedure if your partner has poor sperm count.

It can take up to three months just to eliminate hypo- or vitamin deficiency in partners.

In addition, the duration of preparation for the procedure depends on the protocol prescribed by the doctor. Thus, the classic protocol takes 2-4 weeks, and the long and extra-long protocol takes from 1 to 3 months.

The procedure for preparing for the IVF procedure

First of all, both partners will have to give up alcohol, cigarettes and other bad habits. This is necessary in order to improve the condition of eggs and sperm. In addition, future parents are assigned vitamin complexes, which contain vitamin B 9.

Next, the spouses need to undergo consultations with an andrologist, gynecologist, endocrinologist, reproductive specialist and mammologist. The woman undergoes smears for infections, cytology (to exclude the possibility of cancer) and vaginal microflora. The partner, in turn, takes a spermogram.

To undergo the in vitro fertilization procedure, you must undergo the following tests:

1. Hemostasiogram.

2. Analysis that determines blood group and Rh factor.

3. Analysis to determine hormone levels.

4. Blood test for HIV, syphilis and hepatitis (B and C).

5. Biochemical analysis blood.

6. General analysis urine.

7. In addition, it is advisable to do a blood test for herpes, CMV and toxoplasmosis.

If the spouses are in the age group 35+, and also if there are hereditary diseases, it is also necessary to undergo genetic tests. After this, the most viable and healthy embryo will be selected for transfer to the uterus.

The woman is prescribed a biopsy, ultrasound, hysteroscopy and laparoscopy. Hysteroscopy is needed if there are problems with bearing the baby.

IVF protocol

After receiving the results of all tests, the doctor prescribes the optimal treatment. The IVF protocol is prescribed in accordance with the identified problems on an individual basis. However, there is a standard IVF protocol, which includes the following steps:

1. Ovarian stimulation.
2. Follicle puncture (oocyte retrieval).
3. Transfer of the embryo into the uterine cavity.
4. Hormonal support.
5. Testing for hCG.

Based on the test results, the doctor is able to more accurately determine the causes of infertility and, accordingly, prescribe the most effective treatment and develop a plan to prepare for the in vitro fertilization procedure.

How long does the preparatory stage last?

IVF is an extremely important step in the history of any childless family, because it is an opportunity to give birth to the desired baby, and perhaps even more than one.

And first of all, the question arises: what needs to be done to make the IVF procedure possible? How to prepare for IVF? And how long will this preparation last?

It is impossible to give an unambiguous answer to the questions posed, because individual treatment is selected for each couple, and the duration of the preparatory period before IVF depends on many factors, which include:

1. Duration of testing and waiting for test results.

2. The duration of a woman’s menstrual cycle and, accordingly, the time of egg maturation.

3. Time required for embryo implantation.

And if everything becomes clear with the last point within two weeks, then the first two provisions require clarification.

Time to prepare for the IVF procedure

No matter how it may look from the outside, throughout the entire IVF protocol, the feasible participation of not only the woman, but also the man is required. Partners need to take blood tests for coagulation, hormonal levels, etc., and do this as soon as possible. Typically this takes about a week. Then there will be a whole raid on doctors, and all examinations usually take 1-2 weeks, if you act quickly. A man must visit a urologist, and a woman must visit a gynecologist, mammologist, ultrasound specialist and cardiologist.

During a visit to the urologist, the history of diseases that the patient suffered at one time is studied, and then sperm is collected to determine its condition, quality and ability to fertilize. If the result does not satisfy the specialist, the man donates blood for analysis to identify the causes of such anomalies.

During a visit to a doctor, a woman takes a smear from the cervix and genital tract to determine whether there are any pathogenic bacteria there. After this, she must take hormonal drugs for two weeks that stimulate the maturation of eggs, and then the mature eggs are removed. After this, in laboratory conditions, sperm are injected into the extracted follicles. After a few days, the embryo is transferred into the uterine cavity, and after another 2 weeks you can take the first pregnancy test to find out the result. In other words, the average duration of preparation for IVF is from 1 to 2 months.

If the test shows a positive result, the woman becomes a regular visitor to the clinic for the next few months; During this time, her health, as well as the condition and development of the fetus, are carefully monitored. If the result is negative, do not despair: after a while you can make another attempt at IVF.

Where to start preparing for IVF

In vitro fertilization is becoming a salvation, the last hope for infertile couples who want to have their own child. IVF costs enough big money, however, the end result - the life of a child and a full-fledged family - is definitely worth it. Sometimes, due to the nature of the procedure, several children are born at once. The fact is that to increase the chances of a successful outcome, several embryos are transferred into the uterus at once, and sometimes several of them are successfully implanted at once. Multiple pregnancies are more difficult, and it is impossible to remove excess embryos, because it can provoke a miscarriage or disrupt the vital activity of the remaining embryo.

It is a combination of several required elements. To get started you need:

1. Quit smoking if you have had such a sin (you were planning to do it for a long time anyway, but now a wonderful and serious reason appeared).

2. Give up alcohol.

3. Balance your diet. Consult your doctor for extreme case– You can always read about the basic principles on the Internet.

The next step is moral preparation. Don't neglect them. Talk to relatives, consult with various doctors, and enlist the support of your partner. Or only after realizing that the decision has been made finally and irrevocably, go to the medical center. And do not forget to carefully check the information about the medical center itself before doing this. It is better not to contact clinics that do not have good recommendations.

What is the cIVF preparation program?

So, the documents are drawn up, the fee is paid, and the moment comes for the spouses when the doctor prescribes a special program that they will have to undergo.

The preparation program for the in vitro fertilization procedure comes down to one single task: the birth of a healthy child. The program includes a large number of different tests and studies, frequent visits to different doctors, ovarian stimulation, egg maturation and transfer of an already grown embryo into the woman’s uterine cavity.

The probability of pregnancy on the first attempt does not give clear indicators, however, on average, statistics show that approximately a third of attempts at in vitro fertilization end in pregnancy, which is generally consistent with the rates of natural conception. The likelihood of success depends on the lifestyle of the spouses, their health, age and other indicators.

If the first attempt is not successful, do not despair, because it is possible to make another attempt after some time.

Stages of preparation for the IVF procedure within the program

The preparation program for the procedure and IVF itself includes the following steps:

1. First of all, after the examination, the doctor determines a treatment regimen for partners and an action plan.

2. Then, all existing diseases in both partners are eliminated, as far as possible.

3. A woman is prescribed hormonal therapy.

4. At the appropriate moment, the eggs are punctured, and the man donates sperm at this time.

5. Direct fertilization occurs in the laboratory.

6. Specialists observe the development of embryos.

7. The most viable and healthy embryo is transferred to the uterus of the expectant mother.

8. A woman begins to take hormonal medications aimed at maintaining pregnancy.

9. A test is done to determine hCG hormones.

10. An ultrasound is performed to find out for sure whether pregnancy has occurred.

11. Doctors constantly monitor the condition of the expectant mother. The woman passes all the necessary tests.

12. Delivery.

How long does it take to prepare for the IVF procedure?

Preparation for the IVF procedure includes a number of tests and procedures, treatment of identified abnormalities and diseases, abstinence from alcohol and cigarettes, and much more. In connection with such a number of prescriptions and restrictions, many patients are very interested in the question: how long does it take to prepare for the in vitro fertilization procedure? However, there is no definite answer, because the time to prepare for IVF is individual for each individual case; it depends on how complex the situation is, but on average the preparation stage takes from a couple of weeks to several months.

Duration of preparation for IVF

The preparatory stage is a mandatory step for both partners, except in cases where donor sperm is used for in vitro fertilization.

The main determinant of the duration of preparation for the IVF procedure is the state of reproductive health of both partners. For example, if a woman suffers from a cyst, endometriosis or uterine fibroids, she will have to spend time to eliminate the foci of these diseases. The IVF procedure will also have to be delayed if the expectant mother has not been found to have antibodies to rubella: in this case, she needs to be vaccinated and IVF postponed for several menstrual cycles.

If the partner’s spermogram showed not the best best results, a course of treatment is also required. If both partners have vitamin deficiency, they will, among other things, have to undergo a course of treatment lasting approximately three months.

The preparation program for the IVF procedure itself is designed for approximately 1-2 months.

Preparing for IVF: the beginning

First of all, absolutely all patients, without exception, will need to completely stop smoking and drinking alcohol, because bad habits have a detrimental effect on the quality of the egg and sperm (accordingly, the same spermogram will leave much to be desired).

Then you need to consult a reproductive specialist, gynecologist and andrologist. The woman will be sent to take a smear in order to detect sexually transmitted infections, and the man will have to give sperm.

The third step in the list of necessary manipulations is passing all the necessary tests. Based on their results, the doctor will determine whether IVF can be performed.

The last stage will be various types of examinations: laparoscopy, biopsy and ultrasound.

Sometimes additional consultation with an endocrinologist and mammologist is required. In addition, the expectant mother will have to visit other specialists (including a dentist) in order to completely eliminate the possibility of any infections in the body.

Mandatory tests for both partners include:

1. Analysis of hormone levels.

2. Various blood tests (including to find out your blood type and Rh factor), urine test.

Preparatory stage before ICSI

Unlike IVF, with ICSI the embryo is introduced into the egg invasively. ICSI is usually recommended for male infertility. Preparing for ICSI takes about the same amount of time as preparing for IVF.

To prepare the body for embryo transfer, the woman is prescribed a course of hormonal therapy.

A man will have to donate a lot of sperm so that specialists can ultimately select the most viable sperm for implantation into the egg.

Transfer of the embryo into the uterine cavity

The fertilized egg is closely monitored if obvious signs of cleavage begin to appear after 18 hours. Usually on the 5th day the embryo is ready for transfer. During this period, the embryo is in the state of a blastocyst vesicle.

Embryo transfer occurs quite quickly, the transfer procedure takes only about 20 minutes, and the woman will experience only slight discomfort, so anesthesia is not required.

However, despite the apparent ease of the transfer procedure, it is minor errors in the process that can cause unsuccessful IVF. For example, it is important to insert the catheter correctly, because otherwise it may be clogged with mucus, along with which the embryos will come out of the uterine cavity.

So, the embryo transfer has been carried out, and now the woman needs to stay on the couch for the next 15-20 minutes. If the transfer is successful, bed rest is not necessary. However, it would be better to limit physical activity, avoid stressful situations and abstain from sexual intercourse.

Two weeks after the transfer, you can take the first pregnancy test and finally find out whether the in vitro fertilization procedure was successful. If the result is positive, the woman needs to register with the antenatal clinic. When pregnant through in vitro fertilization, women are constantly under medical supervision. They are more likely to undergo tests and undergo a variety of examinations than women who become pregnant naturally. The reason is that maintaining a pregnancy and carrying a child to term after IVF is a rather difficult task.

IVF is a serious step. Weigh the pros and cons, consult with relevant experts and, if possible, with those who have already walked this path. Talk about the duration of preparation, the risks and likelihood of complications specifically in your case, as well as the chances of success.

The main stages and rules of preparation for the IVF procedure

One of the important stages of the IVF procedure is preparation for its implementation. The success of the procedure largely depends on how carefully and correctly the preparatory stage is carried out. Moreover, for a positive result, you need not only to go through all the prescribed doctors and do all the injections, but also to prepare mentally (this applies to both partners).

Don’t forget, the in vitro fertilization procedure is an extremely serious step, and the life and health of not only the child, but also the mother depends on how everything goes. And even with total control over the situation, various force majeure circumstances can lead to failure. For example, a side factor such as nervous breakdown expectant mother, may cause mental disorder baby or miscarriage. Therefore, it is necessary to create as comfortable conditions as possible for the woman. The expectant mother should be in a warm family environment and not be left without the support of loved ones; she must feel that the child is desired by all family members, and be mentally prepared for a negative test result. A man should also mentally prepare for the long journey of in vitro fertilization and expect the birth of a baby.

In addition, you need to consult with your doctor and find out how the process of preparing for IVF goes and what is included. It would not be a bad idea to learn about the correct lifestyle and diet for each partner.

What should nutrition be like in preparation for IVF?

During preparation for the in vitro fertilization procedure, the diet for men and women should be as healthy, satisfying and varied as possible. This will not only be a step towards pregnancy, but will also help improve test results.

For men, everything is simple: they must give up alcohol and cigarettes and eat less fatty foods.

But for a woman there are a number of requirements:

1. It is necessary to give up losing weight and stop counting calories.

2. The diet should include as many protein foods as possible: eggs, cheese, fish, lean meat, chicken.

3. Food should be boiled, baked or steamed.

4. The less salt there is in food, the better. Ideally, it is better to abandon it altogether.

5. It is necessary to include more vegetables and greens in the diet, but this does not apply to cabbage, beans and corn, because these vegetables cause flatulence and inflammatory processes in the stomach.

6. You should avoid fatty meat and fish dishes, spices, white bread and sweets.

In addition, women should not visit baths, saunas, or take hot baths.

What tests need to be taken in preparation for IVF?

To determine the state of health of the spouses, you should undergo a number of tests.

The mandatory list of tests for men includes:

1. Spermogram.

2. Sperm culture.

Women will have to spend a longer time visiting doctors because they need:

1. Get an ultrasound.

2. Make a cardiogram.

3. And mammography.

4. Take a blood test for tumor markers, rubella, toxoplasma and, of course, hormones.

5. Get tested for the composition of microbes in the cervix.

Where to start preparing for the IVF procedure?

Usually people turn to IVF when all other chances of becoming parents have exhausted themselves and proven ineffective. And yet, the IVF procedure is very expensive in terms of finances, effort and time, and besides, it does not always end in pregnancy. The success of IVF depends on many factors, one of which is the correctly conducted preparatory stage.

Preparation for the IVF procedure within the protocol

Each IVF procedure is performed according to a protocol. The contents of the protocol depend directly on the causes of infertility and the health status of the spouses. Protocols are ultra-short, short and long. However, regardless of the size of the protocol, the preparation stage for the procedure is the longest, it can take approximately 25-40 days. At this stage, the task of specialists is to prepare the female body as effectively as possible for the upcoming fertilization. In other words, it is necessary to stimulate the production of oocytes (eggs). Everyone knows that usually in one menstrual cycle the female body produces one egg, but this is not enough for IVF, so the expectant mother is given special hormonal drugs that force the body to produce 5-6 eggs at the same time. This is done for this purpose. To increase the chances of fertilization the first time, because among several embryos you can choose the most viable one for transfer to the uterus.

However, preparation for EC begins much earlier than the protocol comes into force.

Where to start preparing for IVF?

Preparing for IVF in general is practically no different from thoughtful preparation for conceiving naturally. There are some rules that both partners should adhere to:

1. A couple of months before conception, give up bad habits.

2. Try to avoid stress.

3. Watch your diet: it should be healthy and varied. Sometimes doctors recommend supplementing it with multivitamins, which include vitamin E and folic acid.

4. Avoid excessive physical activity.

Preparing for IVF for men

Before the IVF procedure, a man will have to undergo a full medical examination, which will help find the cause of infertility, because failures of the reproductive system are possible not only in a woman’s body. For example, various types of genetic disorders can become an obstacle to natural conception. Before IVF, a man will have to pass:

1. Biochemical and general blood analysis.

3. Spermogram.

4. Analysis that reveals genetic pathologies.

5. Analysis for diseases that are sexually transmitted.

The treatment that will be prescribed to the man depends on the results obtained, because before the IVF procedure, both partners must be as healthy as possible.

Preparing for IVF for women

The health status of a woman before IVF is even more important, because she will have to subject her body to severe stress due to taking hormonal drugs and bear a child. The reproductive specialist prescribes a comprehensive medical examination to the patient, which, among other things (that is, this is not even a complete list), necessarily includes:

1. Ultrasound of the abdominal organs and pelvis.

3. Ultrasound of the mammary glands.

4. Test for STDs.

5. Analysis for TORCH infection.

6. Cervical smear nasitology.

7. Analysis that reveals genetic pathologies.

8. Blood test for hormones and clotting.

If the tests reveal any pathologies and abnormalities, the doctor begins to treat them.

Often, in the process of preparing for IVF, a woman undergoes surgery to remove the fallopian tubes, especially if obstruction has been detected, because damaged uterine appendages can become a serious obstacle to the normal course of pregnancy. In addition, a woman must take hormonal medications for some time in order to bring her hormonal levels to the required state.

Sexual life in preparation for the IVF procedure

This question often worries patients. Sometimes couples voluntarily abstain from intimacy for fear of causing harm and reducing the likelihood of successful conception, and sometimes this is due to the stress associated with waiting for the procedure. However, experts say that you shouldn’t give up sex at all. Moreover, sexual intercourse is even beneficial in the period before embryo transfer, because it is a natural way to improve blood circulation in the uterus, which increases the likelihood of successful implantation. Another thing is that it is necessary to abstain from sexual activity during the two-week period between embryo transfer and confirmation of pregnancy. In addition, it is necessary to abstain before sperm collection in order to be able to collect a sufficient amount.

Preparation program for the IVF procedure

Preparation for the in vitro fertilization procedure includes numerous examinations and tests, the purpose of which is to prevent and reduce all possible risks of any complications. In addition, the preparatory stage of IVF includes treatment of all detected diseases, cessation of smoking, alcohol and other bad habits, as well as the formation of a proper diet. In terms of duration, the standard preparatory stage takes approximately 2-3 weeks, but the duration is individual for each couple.

The main stages of preparation for the IVF procedure

Preparation for the IVF procedure includes several stages:

1. General health activities, which change the usual rhythm of life of both partners. This stage helps increase the likelihood of successful conception. This includes:

Complete cessation of alcoholic beverages, smoking, and drugs;

Maintaining a balanced, healthy diet that can provide the body with all the substances it needs during this period; among other things, the doctor may prescribe a special vitamin and mineral complex;

Regular walks in the fresh air, moderate physical activity;

Mandatory alternation of work and rest;

Abstinence from sexual intercourse at certain stages.

2. Full medical examination.

This is necessary to accurately assess the health status of patients. Based on the results of the examination, the doctor will determine the further development of events before starting the procedure. Spouses need:

Consult with various specialists: gynecologist, andrologist, reproductive specialist and endocrinologist;

Pass a series of urine and blood tests (biochemistry, general, analysis for the presence of infections and hormonal status);

Undergo hardware tests (those prescribed by the doctor): hysteroscopy, ultrasound, laparoscopy and biopsy.

Important to remember

If you decide to seek help from an IVF clinic, the contract should be signed only after there are no ambiguities and unknown details of a legal and ethical nature. After this, strictly follow the recommendations and instructions of your doctor, who will develop an individual plan of procedures for you; For this reason, it is quite possible that you will have to change and reconsider your work schedule. Following the recommendations of your doctor will help you avoid unnecessary stress and unnecessary expenses, and will also bring you closer to your cherished goal - the birth of the desired, long-awaited baby.

Analyzes at the stage of preparation for IVF

One of the fundamental stages of the IVF protocol is taking tests and preparing for the procedure. Based on the results of medical research, doctors determine how ready the expectant mother’s body is for pregnancy, whether there are any pathologies, diseases, infections, and what state the hormonal balance and immunity are in. Sometimes after this it takes time to eliminate health problems, and sometimes pregnancy is completely contraindicated.

It is also important for your partner to be examined. Men take a smear to rule out the presence of infections of the genitourinary system, take a spermogram, donate blood to check for antibodies to infections. A woman has a more difficult time: the list of tests in this case is more impressive. A woman needs:

1. Pass a general urine and blood test. Biochemistry will reveal health problems, and the doctor will find and eliminate the causes of the disease.

2. Take cytology and a smear for flora. These tests allow you to determine the condition of the cervix and vagina, because even the slightest inflammation must be eliminated.

3. Do a blood test to check for the presence of antibodies to infections or infections themselves. This study allows you to detect hepatitis type B and C, toxoplasmosis, herpes, syphilis, rubella, chlamydia. These infections can have a negative, destructive effect on the fetus. Rubella is especially dangerous, and if a woman has not had it before, a few months before artificial insemination it is necessary to undergo vaccination.

4. Get tested for hormones (reproductive and thyroid). Diseases endocrine system often cause infertility. The level of certain hormones will allow doctors to select the right medications for the period before the IVF procedure and in the first time after embryo implantation.

5. Do an ultrasound of the uterus, fallopian tubes and ovaries to exclude the possibility of a tumor or any developmental anomaly.

6. Determine blood type, Rh factor, blood clotting. If antiphospholipid syndrome is detected, characterized by increased blood clotting and, as a result, an increased risk of blood clots. In this case, the doctor prescribes special therapy.

What happens during preparation for the IVF procedure

Proper preparation for IVF significantly increases the chances of successful conception, so the question of what preparation for IVF includes is relevant for many couples. In general, the preparatory stage can be divided into the following components:

2. Complete medical examination.

3. Stimulation with hormonal drugs.

Before moving on to conception, both parents need to get their health in order as much as possible: they will have to give up bad habits, bring their weight back to normal and, of course, cure all the diseases that they never got around to.

In addition, it is necessary to normalize the diet. For example, to improve sperm quality, men should eat foods that rich in vitamins A (broccoli, carrots, dried apricots, oatmeal) and vitamin C (spinach, currants, green peas). In addition, the man is prescribed special medications.

The task of women is to do everything possible to stimulate superovulation. This requires, firstly, a set of exercises that helps optimize blood circulation in the pelvis. Secondly, nutrition is also very important. The diet for women should contain foods with a high protein content and a large amount of liquid, ideally 2-3 liters per day.

It is common practice to take contraceptive medications in preparation for IVF. The fact is that birth control pills reduce the risk of developing hyperstimulation syndrome and ovarian cysts, and sometimes even enhance the effectiveness of the procedures.

Analyzes and examinations

During preparation for IVF, the doctor prescribes huge amount analyses. A woman must submit:

1. Smears for oncocytology, flora, ureaplasmosis, mycoplasma and chlamydia.

2. General urine analysis.

3. Analysis for general hormonal levels.

4. Examination for HbsAg antigens.

5. General and biochemical blood analysis; It is also necessary to identify the blood type, Rh factor and estrogen levels in the blood.

6. Tests for genital herpes, rubella, hepatitis (B and C), HIV.

7. Blood clotting test.

8. Hormonal screening.

9. Fluorography.

10. Examination by a mammologist and gynecologist.

11. Ultrasound of the internal pelvic organs. This is necessary to identify cysts, if any, and determine the size of the ovaries.

The man will have to undergo the following medical procedures:

1. Spermogram.

2. Blood test for herpes infections, flora, chlamydia and mycoplasmosis.

3. Blood tests for HbsAg antigens.

4. Consultation with a urologist.

After studying the results of tests and examinations, the doctor prescribes a stimulation protocol for the expectant mother. This protocol specifies the duration and sequence of taking all hormonal drugs necessary in this particular case. A woman must strictly follow the instructions, because the success of subsequent steps directly depends on this.

Protocols are divided into:

1. Clean. Duration – 9-14 days. Only drugs containing FGS are prescribed.

2. Short. Duration - one menstrual cycle. Starts on the third day of the cycle.

3. Long. Duration – 10-15 days. Begins seven days before the next cycle. Drugs are prescribed that can improve the functionality of the ovaries.

Preparing a man for the IVF procedure

As you know, in vitro fertilization is used in cases where, due to health problems of the woman, man or both partners, the couple cannot conceive a child naturally.

During in vitro fertilization, a man performs the same role as during natural conception. The day for conception is determined by the woman’s menstrual cycle, therefore sperm collection is carried out on a strictly defined day. As a rule, to extract seminal fluid, a man simply masturbates, but, if necessary, various surgical methods can be used: testicular biopsy, aspiration of epididymal contents, etc. The only contraindication for IVF is the presence of hepatitis B, HIV and other hereditary diseases that can harm life and health baby.

No matter how frivolous it may seem, the correct psychological attitude is no less important than the state of health. If a man is calm and open-minded about the IVF procedure, then he will encounter only minimal problems in the process. It is important to understand: how serious are a man’s intentions to have a child? Will a man be able to support his wife throughout the entire period? Doesn't the in vitro fertilization procedure run counter to a man's worldview and religion? Will a man be able to afford the IVF procedure financially and emotionally? The process should be started only if the man can confidently answer positively to all questions.

Preparing for IVF for men

For men preparation for the IVF procedure not much different from preparing for natural conception. You just have to follow these recommendations, and it’s not difficult at all:

1. Forget about alcohol, cigarettes and other bad habits. Now you have strong motivation for this, because the life and health of your child is at stake. During the period before conception, it is unacceptable to use drugs, alcohol, or smoke.
2. Try not to overheat. Normal viable sperm develop at temperatures no higher than 34°C. Therefore, forget about saunas, steam baths and even hot baths. IVF is an extremely expensive proposition, so don’t neglect advice like this, which will increase your chances of becoming parents on the first try. In addition, you should spend less time driving.
3. Stick to moderate physical activity. 2-3 months before the procedure, avoid excessive physical stress, for example, about strength sports, exercise in the gym, as well as heavy physical work. But with all this, a completely sedentary lifestyle must be diluted with daily leisurely walks of several kilometers.
4. Make sure the underwear you wear is comfortable. For normal sperm maturation, underwear that is as spacious as possible is best. From a scientific point of view, this approach, however, has not yet been justified, but just in case, refuse uncomfortable and tight underwear.
5. Monitor the frequency of sexual intercourse. The best option will have sexual intercourse for 2-3 months before the procedure, once every three days, no more often. In this situation, the quality of sperm will not suffer, and the sperm themselves will

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

IVF: what is it?

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

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

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

Every married couple sooner or later comes to the conclusion that they want to have a child. If previously women became mothers at the age of 20-23, now this age is greatly increasing. Representatives of the fairer sex decide to have offspring after 30 years. However, at this moment everything does not always work out as we would like. This article will tell you how IVF is done (in detail). You will learn the main steps of this procedure. It is also worth mentioning the indications and limitations of this manipulation.

What is it?

Before you find out how IVF is done (step by step), it’s worth saying a few words about the manipulation itself. In vitro fertilization is a method of conceiving a child outside female body. Subsequently born babies are called “test tube babies.” The procedure was first performed several decades ago. It took a lot of effort and expense.

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

In what cases is IVF done?

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

Pipe factor

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

Male infertility

The indication will be low-quality sperm from the partner. The condition of the material is determined during a spermogram. In this case, the main factor will be that sperm reduces its quality in natural conditions (in the female genital organs).

Endometriosis

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

Age-related changes

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

Problems with ovulation

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

Contraindications you need to know about

Before IVF is done, the woman must be thoroughly examined. If any contraindications to manipulation are identified, then you should avoid it. These include the following situations:

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

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

How is IVF done?

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

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

Preparation and tests

Before IVF is done, the woman must be examined. Her partner must also undergo certain tests. Standard tests include tests for hepatitis, HIV, and syphilis. A man must take a spermogram. It is used to determine which method will be used for artificial insemination.

Also, a representative of the fairer sex should definitely visit some doctors. This is a neurologist, cardiologist, ophthalmologist, therapist. A conversation is held with a psychologist.

Prescribing drugs: choosing a protocol

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

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

Tracking follicle growth

So how is IVF done? In the process of taking hormonal drugs, a woman must visit the office ultrasound diagnostics. Typically, such a study is prescribed on the 5th, 9th and 12th day. However, if necessary, the doctor may recommend additional days. During an ultrasound, a specialist assesses the growth of follicles and the condition of the uterus and endometrium. The reproductive organ must be as ready as possible to receive the embryo.

During the last study, the date and time of the puncture are set. At this stage, stimulation is completed.

Egg selection

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

A disposable sharp needle pierces the back wall of the vagina and is brought under the sensor to the ovary. It must be said that the doctor must be extremely careful to avoid complications. After egg retrieval, the patient must remain under close medical supervision for at least two hours. During this period, the woman’s condition is monitored and intra-abdominal bleeding is excluded.

Fertilization

You already know that before IVF is done, the man’s sperm must be examined. The progress of the next stage will depend on the quality of the seminal fluid. With normal indicators, normal fertilization occurs. The required amount of sperm is simply combined with the selected eggs.

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

in vitro

After fertilization, each zygote is placed in a separate container. There conditions are created that are as close as possible to those found in a woman’s body. It is worth noting that at this stage (immediately after the follicles are removed), the woman continues to take hormonal medications. These are usually progesterone-based medications. They help maintain the functioning of the corpus luteum and prepare the uterus for pregnancy as much as possible.

The period for growing embryos may vary. Usually it ranges from 2 to 5 days. Many preparations die already on the third day. Only the strongest survive. Reproductionists try to bring embryos to the point where they have from 4 to 8 cells. After this they move on to the next stage.

Cell transfer

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

IN recent years specialists try not to transfer more than two embryos. However, for some indications this amount may be increased. Note that in this case a special agreement is concluded informing the patient of her rights and obligations. If viable embryos remain after the transfer, they can be frozen. You can use them at any time. This procedure does not affect the quality and genetic condition in any way.

Expectation

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

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

Result of manipulation

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

If the result is disappointing and pregnancy does not occur, the woman should stop taking all medications. In this case, the first question that interests patients is formulated as follows: how often is IVF done? Most couples want to try to become parents again as soon as possible. However, doctors do not advise rushing. In the process of preparing for artificial insemination, a woman’s body endures extreme stress. He needs time to recover. Typically, fertility specialists recommend refraining from trying to conceive for up to six months. The couple is also prescribed additional examinations that can find out the cause of the failure.

The final stage of the procedure

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

Hormonal support is provided for up to 15-20 weeks. After this, all drugs are gradually discontinued. At this time, the placenta, which supplies the fetus with everything it needs, is already formed and working at full capacity.

Delivery: what determines the choice of method

You already know how IVF is done. The procedure is quite complicated and requires the patient to comply with all the rules. The successful outcome of the manipulation can be discussed after the birth of the child. Often this issue is dealt with by specialists from the same clinic where artificial insemination was carried out.

If the pregnancy is normal and there are no contraindications, a woman can give birth on her own. Natural birth is encouraged in singleton pregnancies. If there are two or more babies, then doctors insist on a caesarean section. In this case, you will be sure that the babies will not receive birth trauma when passing through the birth canal, which often happens during multiple pregnancies. Doctors will help the children in a timely manner.

Results

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

The attitude of the couple plays an important role in this process. Think positive, eat right, spend more time outdoors. Follow all specialist instructions. Have a good result!