After puncture of the follicles, how long before replanting? A detailed description of preparation for follicle puncture during IVF and a description of the main nuances

If a woman long time cannot get pregnant, doctors recommend using the services of reproductive centers and undergoing the procedure of in vitro fertilization or, as it is also called, IVF. IN modern medicine There are many variations of artificial conception protocols, but in almost all of them follicle puncture is performed. However, few people clearly understand what this procedure is.

Egg puncture is classified as a low-traumatic gynecological operation. During its implementation, the doctor, using a special needle, pierces the fertilized egg and removes the mature germ cells. The duration of the procedure is no more than 15 minutes, however, the success of in vitro fertilization depends on the correctness of its implementation and the preparation of the woman’s body.

Women who were prescribed follicular puncture leave mixed reviews about the procedure. Some say that the intervention went without complications, while others encountered some difficulties.

It is very important to properly prepare for the collection of germ cells, so during the month you should follow a number of the following rules:

1. It is strictly forbidden to take any medications unless they have been prescribed by a gynecologist (reproduction specialist);
2. You should eat exclusively natural food, without food dyes or other chemical or biological active additives;
3. During intimate contacts, it is worth using contraception, which can protect against sexually transmitted infections;
4. It is better not to stay for a long time in places where there are large crowds of people, especially those who are carriers of the virus; you can wear a medical mask to enhance the body’s protection;
5. If necessary, you should take multivitamins and folic acid according to the regimen developed by your doctor;
6. The diet should be complete, with a predominance of dairy products, vegetable oils, nuts;
7. It is necessary to increase fluid intake (water, compotes, fruit drinks and unsweetened juices), but you should exclude confectionery, fruits and vegetables that cause bloating;
8. You should definitely quit smoking, you should not use alcoholic drinks different strengths, reduce the amount of coffee and tea consumed;
9. Many cosmetic procedures, visits to swimming pools, baths, saunas are prohibited; you cannot take hot baths or go to the solarium;
10. You should refrain from intense sports activities and reduce physical labor to a minimum;
11. About three days before the ovarian puncture is planned, all types of sexual intercourse are excluded;
12. In the evening, on the eve of the intervention, at about 6 p.m., you should have a light dinner; in the morning, you must defecate the intestines, do not drink or eat;
13. If it is necessary to cleanse the intestines, do an enema in the morning;
14. What to take with you for follicle puncture – a nightgown, a robe and slippers;
15. Insist on coming with makeup, painted nails and contact lenses;
16. It is better to leave home early, since it is very important to be on time for the procedure.

Preparing for follicle puncture we partially recall the principles healthy image life, therefore, if a woman adheres to it, then for her these rules will be easy to follow.

Peculiarities

Most modern fertility centers prescribe Progesterone to women before puncture. The norm for this indicator is up to 6 ng/l, and if it is higher than three on the day of puncture, then the protocol will most likely not be successful. In this case, it is very important that the doctor clearly calculates the period of the implantation window.

Before the puncture, patients are also given an injection of hCG, which promotes the maturation of eggs. It should be performed in accordance with medical recommendations, and not miss the time, since after it ovulation occurs in the period from 36 to 42 hours. Experts may also prescribe the drug Diferelin before puncture instead of hCG, which acts similarly.

After the woman’s body has suppressed its own gonadotropins, the above are prescribed hormonal drugs for the onset of superovulation. The main goal of such actions is to provoke the production of the maximum number of mature follicles, which contain eggs ready for fertilization.

The process of follicle growth in the ovaries is carefully monitored by specialists using ultrasound. Next, the final stimulation of the oocyte maturation process is performed. Only 34-37 hours after this, oocyte puncture is performed. If the manipulation is carried out earlier, the cells will not yet have time to mature, and a delay of more than 38 hours will lead to their release into the abdominal cavity.

Girls are also interested in what size follicles should be before puncture. Doctors highlight the most optimal size from 15 to 18 millimeters, while there must be at least three mature cells, otherwise the chance of fertilization will be critically low.

It is also worth answering the question of whether the follicles can burst before puncture. There are known cases of such situations when a woman came and prepared for manipulation, and during an ultrasound examination it was determined that the follicle had already burst before the puncture. In this case, another cycle of stimulation should be carried out after some recovery of the body.

Anesthesia

First of all, it is worth saying that follicle puncture is performed without anesthesia, however, if a woman expresses a desire, then, with the approval of a doctor, local or local anesthesia can be administered. general type. In particular, for pain relief, either a special facial or laryngeal mask is used, or Propofol or Rapifen is administered intravenously.

The intervention is performed laparoscopically, in which an endotracheal tube is necessarily inserted, and the normal functioning of all vital functions is monitored.

It is worth noting that, as such, local anesthesia is not performed during such a manipulation. If the patient refuses general anesthesia, then about an hour before the puncture, the doctor will give her a painkiller tablet. Performing manipulation without anesthesia may be justified in situations where the patient has a small number of mature follicles, but the ovaries are clearly visible.

Often, such a decision is made immediately before follicle puncture, when the doctor performs an ultrasound examination of the pelvic organs. Avoiding anesthesia significantly improves the quality of oocytes obtained and also increases the likelihood of successful completion of the protocol.

If the girl still cannot decide to undergo a puncture without pain relief, then the doctor will first conduct the necessary tests that will determine the presence or absence of allergies to medications. It is good if the woman herself tells the doctor what medications she has ever been allergic to, if any.

Technique

Let's take a closer look at how follicle puncture occurs. In most cases, patients undergo transvaginal puncture of the follicles, in which the vaginal vault serves as access for penetration of a medical needle. If the ovaries have an anatomically incorrect location, then the operation is performed laparoscopically.

The most acceptable position is that of a woman in a gynecological chair. When the position is accepted, the doctor administers anesthesia (if the intervention is done with anesthesia), after which the girl falls asleep. At the next stage, the specialist inserts a special instrument into the vagina, inside of which there is a puncture needle.

All through the same vaginal vault, and also based on the image available on the ultrasound machine monitor, the doctor advances the instrument to the desired ovary. When the goal is achieved, the fluid containing the follicles is aspirated. The resulting material is immediately sent to the laboratory, where the highest quality and most viable embryos are selected and placed on a nutrient medium.

When the needle is removed, the anesthesia gradually begins to wear off and the patient regains consciousness. Over the next two hours, doctors from the reproductive center monitor her condition in the ward. Be sure to take a one-time antibiotic wide range actions that will avoid the development of infectious lesions. If the procedure is successfully completed, the girl can go home the same day.

If puncture of the ovarian follicles is performed without the use of anesthesia, the woman will definitely feel discomfort and minor pain during the puncture of the ovary. How strong these sensations will be depends only on the skill of the doctor, as well as on the individual characteristics of the body. If the pain is severe, the patient will be given an analgesic.

Another question that girls ask relates to not knowing whether the follicle can still ovulate after a puncture. Yes, such a possibility exists, moreover, if it is impossible to collect all oocytes, for example, due to incorrect location ovaries, doctors leave them. Subsequently, the cells exit into the abdominal cavity.

For a clearer understanding of what will happen, you can watch a video - puncture of follicles (ovaries) - of which there are a lot on the Internet. Also, answering the question on what day of the cycle follicle puncture is done during IVF, doctors set the limit as 18-22 days. It is relatively clear what follicle puncture is and how the procedure is carried out; it is also necessary to understand the consequences of such an intervention.

After the puncture

Many girls are interested in how to behave after follicle puncture. Considering that this, albeit minimally invasive, is still an operation, a woman should rest as much as possible and restore expended strength. You will have to give up taking hot baths and other types of thermal procedures, intimate relationships, physical activity.

If your stomach hurts after egg puncture, this is considered normal, since the organ was injured. Depending on the type of surgery performed, discomfort may persist for a different amount of time, but on average from three to five days. Among the most likely consequences of puncture, doctors note the development of ovarian hyperstimulation syndrome, difficulties with defecation, and bloating.

If OHSS is pronounced and severe, then nausea and vomiting are added to these conditions, severe pain bursting in the abdomen and lower back, fever, diarrhea, painful urination, copious discharge from the genital tract. Such patients are placed in a hospital and treated by prescribing specific medicines.

Ovarian puncture, what it is and how it is performed, is best clarified at the selected reproductive center. Since private clinics may make some changes in the conduct of ovarian stimulation, as well as in the technique of collecting biological material. When the follicle puncture was done, the consequences, if proper operation doctor, life-threatening or health conditions of the patient do not develop.

Ovarian puncture during IVF is a mandatory procedure. Without performing this manipulation, it is not possible to use assisted reproductive technologies. The puncture is also performed for therapeutic and diagnostic purposes for ovarian cysts. The procedure requires preliminary preparation, the sequence of points of which depends on the final goal of the doctor and the patient.

What is ovarian puncture

Ovarian puncture is a medical procedure that involves taking the contents of the reproductive gland for further use. The procedure is performed exclusively within the walls of a hospital. The patient first undergoes a series of preparatory procedures, and the doctor chooses the method of pain relief. The puncture is a mandatory condition of the IVF protocol. After receiving the material, fertilization is carried out in vitro. The final stage of in vitro fertilization is the transfer of embryos into the uterus. The puncture also involves the treatment of tumors of the gonads. Using a well-known procedure, the contents of the cyst are collected for subsequent study. The histology performed gives a clear picture of the tumor process.

The procedure is a minimally invasive procedure. It is known that the smaller the area of ​​tissue damage, the faster the recovery and the lower the risk of complications. Based on this, we can call ovarian puncture a safe procedure. However, we should not forget that it is still a surgical intervention and also requires the use of anesthesia.

Today, ovarian puncture is recognized as a safe and accessible medical procedure. All women, without exception, who want to undergo IVF with their own eggs are subjected to it.

Indications and contraindications for the procedure

The main indication for puncture is the treatment of infertility using in vitro fertilization. The manipulation is performed at the second stage of the protocol. Statistics show that about 15% of couples suffer from infertility and need in vitro fertilization. No matter about the male or female factor we're talking about, ovarian puncture and egg retrieval are always carried out.

Another indication for puncture is ovarian tumors. Not all cysts undergo this procedure. At malignant neoplasm priority remains with surgical intervention (laparoscopy or laparotomy). It is advisable to perform a puncture when there is doubt about the origin of the cyst. It may be functional (not requiring treatment) or non-functional (requiring hormonal correction or surgical treatment). The study sets the vector for further medical action.

Purulent formations and abscesses on the gonads are a reason for puncture if there is a risk of their rupture. As alternative method Laparoscopy is considered for treatment, but the final decision is made only taking into account the individual characteristics of the patient.

Read also What is the purpose of electrocautery of the ovaries?

Other indications for performing a puncture and collecting material include:

• rupture of a corpus luteum or follicular cyst;
• polycystic ovaries;
• risk of peritonitis during suppuration;
• benign tumor processes of the gonads.

Despite the fact that IVF puncture is performed on all patients who have entered into the protocol, the procedure has contraindications. If a woman is found to have these, then manipulation is not possible:

• acute infectious pathologies;
• exacerbation of chronic diseases;
• suspicion of cancer;
• pregnancy;
• period breastfeeding(is a relative contraindication);
• bleeding disorders;
• tendency to bleed;
• somatic pathologies that exclude the possibility of performing anesthesia.

Each case requires a preliminary assessment of the woman’s condition and collection of an obstetric history. Based on the data obtained, the doctor makes a conclusion about the possibility of puncturing the ovary.

Preparatory activities before the procedure

Ovarian puncture is a manipulation that requires mandatory preliminary examination and careful preparation. Mandatory preoperative items are modified in accordance with the indications for the procedure. Each patient undergoes the following examinations:

• blood test (general and biochemical);
• urine test;
• cardiogram;
• fluorography;
• test to determine blood clotting;
• Ultrasound of the pelvic organs;
• examination by a gynecologist;
• flora smear;
• cytology.

If the puncture is carried out in the IVF protocol, then before the eggs leave the place of their formation, an hCG injection is given. The injection helps the oocytes mature to the desired state. The procedure for collecting material is prescribed 35 hours after the administration of the hormonal drug. It is important not to miss this time period, since it will no longer be possible to extract ovulated gametes. In addition to the generally established preparation rules, the patient in the IVF protocol must follow the following rules:

• exclude sexual intercourse several days before the procedure;
• eat protein foods, exclude gas-forming and salty foods;
• minimize fluid intake;
• on the eve of the operation, have a light dinner, and on the day of the procedure, refuse any food;
• stop all medications except those prescribed by a doctor;
• exclude physical activity;
• cleanse your bowels a few hours before surgery in a natural way or using laxatives (enemas, suppositories).

Methods of effective pain relief

The collection of genetic material in the in vitro fertilization protocol, as well as the puncture of neoplasms, is carried out with preliminary anesthesia. There are many organs in the female body that can undergo similar manipulation without pain relief, for example, breast biopsy. However, the ovaries are not included in the list of such. A woman's gonads are a fairly sensitive organ, and the manipulation itself is very delicate. Pain and stress can affect the course of the procedure, so fertility specialists prefer to use anesthesia. It can be local (with partial anesthesia of the pelvic organs and the patient remaining conscious) or general (with the woman completely immersed in sleep and physiological reflexes turned off).

Before performing anesthesia, the anesthesiologist interviews the patient. The woman’s height and weight must be recorded in order to select the required dose of medication.
The patient needs to tell the doctor about possible allergic reactions. They should be remembered on the eve of the procedure. For anesthesia, it is advisable to use Propofol, a short-acting intravenous agent. Numerous observations and studies in the field of assisted reproductive technologies have shown that this substance does not affect the quality of oocytes and does not have a toxic effect. If necessary, the woman is given tranquilizers and sedatives. You do not need to take any medications on your own, and if you do, you should inform your doctor about it.

Abroad, it is customary to perform the ovarian puncture procedure without anesthesia. It is believed that in this way the highest quality oocytes can be obtained.

How does ovarian puncture occur during IVF?

On the day of the procedure, the patient is not allowed to eat. You can drink no later than 6 hours before the puncture. To carry out the procedure, the woman is asked to sit on a gynecological chair. After this, the anesthetic is administered. If general anesthesia is not possible for medical reasons or the patient herself refuses it, then local anesthesia is performed.

When the analgesic effect occurs, an ultrasound sensor is inserted into the woman’s vagina along with a special hollow needle. The transvaginal meter receives impulses and transmits them to the monitor screen. In this way, the doctor can clearly control the direction of the needle. The egg retrieval machine is a vacuum device with a piston. The needle slowly moves towards the gonad, where it pierces the mature follicle. Graaf's vesicle contains one or more gametes, as well as fluid for their normal growth. The entire contents of the follicle are extracted with a needle, after which it is immediately placed in a comfortable environment.

At the same time, the sexual partner is also preparing for IVF. The resulting seminal fluid is subjected to quality control, as a result of which the best sperm are selected. Placed in the same container with the eggs, they begin fertilization.

The patient's condition after puncture

The ovaries may hurt after puncture, which is normal. Within a few days, the integrity of the covering of the reproductive gland and the vaginal mucosa through which the puncture was carried out will be restored. Immediately after puncture of the follicles, the lower abdomen may hurt, and to prevent pain, cold is placed on it. For several days, the patient is prescribed antispasmodics and antipyretics, which should be taken only if necessary. Discharge from the genital tract may be natural or bloody, but there should not be heavy bleeding.

The follicle puncture procedure is not simple or common. And although it does not imply any special difficulties or complications, it is worth approaching its implementation and the recovery period after it with due attention.

The procedure is aimed at taking mature ones from the ovaries for later artificial insemination and planting the resulting embryos into the body of the uterus of the expectant mother.

After discomfort often occurs and even painful sensations. In addition to them, the following may appear:

• light, spotting discharge with blood;
• pain in the lower abdomen and ovaries;
• increase in body temperature up to 38 degrees;
• bloating;
• feeling of tension and increased tone internal organs.

REFERENCE. If a woman’s condition after puncture does not allow her to work fully, the doctor may issue a sick leave for the period of the patient’s recovery.

Typically, these symptoms do not intensify and disappear within a few days. But sometimes the following complications may occur:

• copious discharge with blood;
• nausea and stomach upset;
• pain in the lower back and back;
• strong increase in body temperature.

All these are signs of hyperstimulation. In this case, it is advisable to immediately consult a doctor.

How you feel after the procedure

Despite the above list of symptoms, Not every woman necessarily exhibits symptoms.

During the puncture, the patient is under the influence of anesthesia so he doesn't feel anything. After waking up, you may experience weakness, drowsiness, and dizziness.

This condition may be accompanied by aching pain in the abdomen, a slight increase in temperature.

USEFUL TO KNOW. The procedure is carried out on an empty stomach, and on the day before the puncture it is advisable to adhere to light diet with a low-fat dinner. This is done to facilitate recovery from anesthesia.

After the procedure, it is advisable to provide the woman with peace. Typically, clinic specialists monitor the patient’s condition for several hours before discharging her.

If your temperature rises

This parameter is not a cause for great concern. This is a normal reaction of the body to the surgery. If the temperature is not high, does not exceed 38 degrees, there is no need to worry. If the temperature rises above 38 degrees, you should immediately go to the hospital.

Condition of the ovaries

Procedure performed doesn't go completely unnoticed for the ovaries. After puncture, they may swell slightly and increase to 10 cm in circumference.

Due to the heavy load on the internal genital organs Some women experience spotting and bloody discharge, the vascular network may grow. Due to these changes, the stomach begins to hurt and becomes bloated.

Stomach pain - is this normal?

Overall availability and strength painful sensations after puncturing depends on the number taken, and from individual characteristics female body.

When performing a puncture using the intravaginal method, the pain stops quite quickly. If laparoscopy was performed, painful sensations may last several days.

In severe cases, the pain can be severe and accompanied by diarrhea., bloating, back pain, bloody discharge and fever. In this case, the patient’s condition deviates from the norm and requires medical intervention.

How many days does recovery take?

In the absence of complications and following the doctor’s instructions, the lower abdomen stops hurting on the 2nd day of the post-puncture period. During this time, the ovaries have time to recover.

But in some cases, the duration of bed rest and the woman’s unfavorable state of health may be due to her individual characteristics and other reasons. Pain can also be prolonged due to the development of hyperstimulation.

If hematomas occur The recovery process may take up to a week. If they form, the pain lasts up to several months. In both cases, medical assistance is mandatory already initial stage occurrence of the disease.

How to relieve unpleasant symptoms?

If the recovery process goes without complications and is tolerated quite easily by the patient; no auxiliary medications are required. To make the post-puncture period a little easier, you can take analgesics.

If the pain is severe, the doctor often prescribes Ketonal, Diclofenac or Voltaren suppositories, rectally.

INFORMATION. It is important to remember that a number of drugs can cause intestinal disorders, which can cause confusion in the course of recovery period and cause suspicion of hyperstimulation. In this case, it is appropriate to consult your doctor for advice.

To relieve fever, antipyretic drugs such as Panadol are used.

Before taking any of the listed medications consultation with a specialist is required, since some drugs are contraindicated in the period after puncture. Do not self-medicate.

The appearance of discharge

This moment is usually associated with vascular damage when the body of the vagina and ovaries is punctured, which causes a small amount of blood to appear.

Spotting is considered a normal consequence of puncture. Their color may vary. If bright blood is added to the daub in copious quantities - this is an alarming sign that requires medical attention.

What happens to the follicles and corpus luteum?

During the puncture process using special therapy artificial and controlled growth is achieved follicle. When the desired size is reached, eggs are collected.

IMPORTANT. This procedure should not be perceived as a surgical intervention. Essentially, this is just the insertion of a needle into the follicle.

The withdrawal process does not last long; the entire procedure takes no more than half an hour.

The puncture needle is attached to the probe, as a result of which everything that happens is displayed on the monitor. A specialist uses a device to find mature follicles, removes them and places them in a special container. Next, the material is sent to an embryologist.

At the sites of punctured follicles, follicles are formed. The same situation occurs in the normal process, when a corpus luteum appears at the site of the ruptured follicle, promoting the production of progesterone, necessary for embryo attachment.

But During the puncture period, this process is disrupted, which causes an imbalance of hormones. For this reason, additional drug support is provided for the functions of the corpus luteum to normalize the proportional ratio of hormones.

What medications are prescribed?

Utrozhestan

This drug contains the hormone progesterone of natural origin. It is used either orally or vaginally. The second method is preferable because it has the most strong effect and speed of action, entering directly into the uterus, bypassing other organs.

The release form of the drug is capsules for oral and intravaginal administration.

It is prescribed to be taken immediately after the puncture and until 10-15 weeks of pregnancy.

Clexane

Before the puncture, the doctor plans 1 day, during which the patient’s body “rests” and prepares for the operation. On this day, the woman is prescribed hormonal drugs, supporting the general condition of her internal genital organs.

Clexane is one of these drugs. Dosage and rules of administration vary for each patient individually.

The drug is intended to thin the blood and stop the formation of blood clots.

Dostinex

Blocks the production of a hormone that promotes lactation. It is prescribed to bring into balance the hormonal system disturbed by puncture, to restore the menstrual cycle, to normalize the timely maturation of follicles and the onset of ovulation.

It is also used to prevent hyperstimulation.

Antibiotics

In order to prevent the occurrence infectious process During the puncture, a broad-spectrum antibiotic is administered.

It is important to remember that all of the drugs listed can only be used after the recommendation of a doctor and under his supervision.

What to do immediately after the procedure?

After the puncture need to adhere to bed rest. The clinic will give the patient the opportunity to rest after surgery for some time before being discharged.

This usually takes at least 4 hours. During this period, the doctor may prescribe IV drips and will also monitor general condition patients.

After discharge, you cannot drive a car.

What regime to follow and how to behave?

After the puncture It is highly advisable to observe bed rest. You can ask the doctor to issue a sick leave certificate for several days. During the recovery period, you should not be exposed to heavy physical activity or stress.

You should abstain for two weeks from going to the sauna, swimming pools, solariums, it is undesirable to take a hot bath.

After the event peace is important and proper nutrition . Due to discomfort in the abdominal area and the appearance of bloating, it is advisable to adhere to a certain diet without loading the stomach with heavy food. Usually during this period a protein diet is prescribed, but not every woman can stick to it without consequences.

If the intestines are not able to absorb large amounts of protein, you can help it by diversifying your diet with other foods. Eat oatmeal with prunes added, drink kefir, flavor your dishes with vegetable oils.

The following cold-pressed oils are beneficial:

• sesame;
• walnut oil;
• sea ​​buckthorn;
• pumpkin seed oil.

This product will help solve the problem of constipation. Don't go overboard with fiber-rich foods(raw vegetables, fruits, brown bread and legumes).

Drinks you can drink still water or unsweetened fruit drinks; the amount of liquid consumed per day should reach up to 3 liters. You cannot drink coffee, strong teas, or alcohol.

Is it possible to have sex?

The procedure puts a lot of stress on the female body, requiring considerable effort to recover. Sex can lead to breakup follicle and disrupt the functioning of the ovaries.

Orgasm and arousal are also able to tone the genitals, which may jeopardize the entire therapy process. For these reasons, intimacy is undesirable after the puncture.

Period

After the procedure, if it went without complications, menstrual cycle starts after 3-4 days. Subsequent cycles may be disrupted, which can be corrected by contacting your doctor.

REFERENCE. If implantation is prescribed after the puncture, and the procedure is successful, menstruation should not occur.

Polycystic disease or hyperstimulation can also manifest itself as disruptions in menstruation, so monitoring by a doctor during this period is important.

Consequences and complications

Usually the puncture proceeds normally, without being complicated by pathologies. In rare cases due to injury blood vessels possible hemorrhage into the abdominal cavity, trauma to the pelvic organs. An abscess of the ovaries or pelvis may occur.

If a cyst is present, it may be torsioned or ruptured., inflammation of appendicitis, violation of the integrity of the ureter. But in practice such situations rarely occur.

In most cases the procedure goes well, without complications. Mild discomfort is corrected medicines, the entire recovery process is carried out calmly. You should not worry or be afraid; the thought that all efforts will lead to the birth of the long-awaited baby should be a consolation.

Long before deciding on IVF, you need to be prepared in advance for the fact that going through all the stages of this procedure, which is called the “IVF protocol,” will require time and patience. So, before deciding on the possibility of fertilization using this method, using her own cells - egg and sperm, a woman will have to undergo a mandatory follicle puncture procedure.

What is this procedure? Under general anesthesia, the doctor, using a special hollow needle with an ultrasound sensor, inserts it into the ovarian area and then removes mature eggs from the follicle. These eggs are sent for analysis. And at the same time, the man donates his sperm. The condition and quality of the cells are immediately checked, and on this basis a conclusion is made about the possibility of fertilization.

Should you be afraid of follicle puncture?

Indeed, when they talk about possible consequences such a procedure, many women are plunged into a state of panic. For example, after puncture of follicles, ovarian hyperstimulation may occur in the body, as a result of which follicular cysts may develop; the ovaries increase in size up to 6 cm (normally after the procedure) and up to 12 cm, when the consequences of hyperstimulation are more severe. At the same time, nausea and vomiting are possible. In this case, the woman is even hospitalized. It is important to understand that ovarian hyperstimulation with all the ensuing consequences may not even occur immediately after the procedure, but even after a couple of days.
In principle, even after a successfully performed puncture, discomfort in the abdomen, back, and the appearance of discharge are inevitable. Therefore, as a rule, after the procedure it is recommended to undergo an ultrasound again. But for those who decide to resort to IVF, it will not be possible to avoid this necessary stage of examination.

How to properly prepare for the procedure

The duration of the procedure associated with the extraction of cells from the ovaries takes no more than half an hour. However, there are situations when it is necessary to undergo the procedure again. For example, if it was not possible to obtain eggs from the follicle.
To protect the patient as much as possible, before such a puncture and then for a week, it is recommended to adhere to a special diet, giving preference to meat and fish for several days, but avoiding, if possible, the consumption of fermented milk products and vegetables. It is believed that their use can cause ovarian hyperstimulation. The procedure itself is performed on an empty stomach, as it is performed under general or local anesthesia.

In addition to diet, it is recommended to avoid sexual intercourse for several days before and after the procedure.
Two days before the puncture, the woman is given an injection with hCG (the same one that is produced in the body during pregnancy), ideally 36 hours before. And then before ovulation occurs, the eggs are retrieved. Their size should reach 22 mm. It is very important to comply with all time requirements, otherwise after ovulation it will simply be impossible to do this.

Follicle puncture is performed transvaginally. The entire procedure is carried out under ultrasound guidance. The eggs from the follicles are sucked out along with the fluid they contain using a special hollow needle. If the puncture is successful, the eggs are placed in a container for storage and further fertilization. Similarly, men’s sperm are also stored in containers. Almost immediately, specialists fertilize the cells, and then, if the outcome is successful, together with the doctor, a date is set for placing the embryo into the body of the expectant mother.

But even at the same time, it is important to know that after the puncture of the follicles, the couple will have to exercise caution, avoid physical activity, stress for some time, and adhere to the previously agreed upon diet.

Of course for most couples similar procedure seems painful. But when other methods of treating a couple’s infertility have been tried and there is hope of conceiving a child using IVF, you can prepare for this.

Of course, performing such a puncture is a serious test for a woman’s body, which can affect her future health. Therefore, it is extremely important to find a doctor you trust implicitly.

Again, both man and woman should be prepared for the fact that the results of the first IVF may be ineffective, and the risk of pregnancy failure will also be high. However, hope remains. And today there are many examples of successful conception even in adulthood.

In vitro fertilization is a program of assisted reproductive technology that is carried out outside the woman’s body, but then pregnancy develops in her body under the strict control of reproductive specialists, which allows a married couple to acquire true family happiness. Just a few decades ago, no one could even imagine that fertilization was possible outside the female body. Nowadays, this is a fairly widely used procedure that allows many men and women to feel the meaning of true happiness.

The entire IVF procedure takes place in several stages: stimulation of superovulation, transvaginal superovulation, embryo transfer and maintenance of the luteal phase. A woman is often interested in how follicle puncture is performed, why is it dangerous and what are its consequences?

Collection of follicles during IVF

Let’s figure out a little about how follicles are collected during IVF, since a successful puncture affects a positive outcome and increases the chances of fertilization and pregnancy. To do this, a woman must contact an in vitro fertilization clinic at a certain time, since this procedure is carried out when the follicle matures to a certain size after preliminary preparatory materials. After emptying bladder and after preparing the intestines, the woman is taken to the operating room, where, under anesthesia, the follicles are punctured under ultrasound control transvaginally using a specific pump to obtain follicular fluid. You can also learn more about how ovarian hyperstimulation during IVF and pregnancy affects a woman’s body.

How many follicles are taken during IVF during puncture? According to standard IVF programs, it is necessary to take about 10-20 follicles, since embryos obtained during puncture may stop in their development. Therefore, to obtain such a number of follicles, the first step in fertilization is the doctor prescribes stimulation of superovulation.

Then, on a strictly individual basis, the reproductologist determines the day of the cycle to perform a puncture of the woman’s follicular apparatus with strict control over the cycle. To do this, he calculates the exact time from the first injection of human chorionic gonadotropin to the time of puncture, which should not exceed 1.5 days, which increases the likelihood of ovulation and then the eggs can be removed from abdominal cavity will be impossible. Therefore, there is no need to be late for the procedure and strictly arrive at the clinic at the appointed time with your husband to donate sperm.

In many cases, a woman is interested in how to prepare for a puncture? To do this, 5 days before the puncture, you must completely give up intimate relationships, give up alcohol, salty and spicy foods, as well as visit the bathhouse, sauna and take a hot bath. On the eve of the puncture, dinner should be light and you should not drink liquids 12 hours before the procedure. On the day of the procedure, do not drink, do not eat, do not brush your teeth, do not use makeup or nail polish, and also strictly take medications to stimulate ovulation and come to the clinic on time for the procedure.

After the puncture, rest is indicated on the first day, since the load reduces the chances of a favorable outcome of fertilization, a light diet, as well as strict intake of all medications according to the fertilization program, it is necessary to refrain from driving a car and equipment that requires strict attention, to avoid unnecessary emotional stress, sexual contacts, visits to baths and saunas.

The size of the follicles for puncture during IVF should be 18-22 mm, but there are cases when the follicle. Even if they have not grown 10 - 22 mm, they give positive results and there is an egg in them. Therefore, the size of the follicle does not always indicate the presence of an egg. Sometimes large follicles for IVF may not contain an egg, but small follicles do.

Empty follicles during IVF

Empty follicles during IVF or empty follicle syndrome is when a mature egg is missing from a follicle for no reason. It occurs quite often, up to 7% of cases. Very often this happens when the technique for obtaining follicular fluid is violated, the IVF protocol is not properly maintained, chromosomal abnormalities, PCOS, obesity, endometriosis, premature aging of the ovaries, adhesions and severe stress. Empty follicles can be false or true. With true empty follicles on the day of puncture, the level of B-hCG in the blood is sufficient, and with false follicles its level is low, which is associated with the administration of hCG or with its insufficient bioavailability and is diagnosed very rarely. Diagnosis of empty follicles is carried out 36 hours after the first administration of gonadotropin by determining the level of B-hCG in the blood and if its level is below 10 units per ml, this indicates empty follicles. But don’t get upset right away; you need to introduce gonadotropin from a different batch.

Empty follicles do not indicate that pregnancy is impossible. First of all, it is necessary to replace the dose and drugs in the protocol, increase the time between punctures to activate ovulation, and also wash the ovaries. Often, the eco program uses GnRH agonists for egg maturation. In almost half of women with empty follicles, SPF is associated with late administration of gonadotropin.

If only one follicle in the ovary matures during IVF, then this significantly reduces the chances of fertilization, which indicates a weak response to hyperstimulation of ovulation. But here the quality of the eggs matters, since sometimes pregnancy occurs with one egg. Therefore, before starting an IVF program, a woman needs to evaluate her ovarian reserve, when the number of 10mm follicles is assessed on the 2nd day and, depending on their number, it is judged. If there are five of them, this indicates a weak reaction to hyperstimulation; up to seven pieces indicate that it is necessary to change the dose of the drug; from 8 to 12 follicles indicate a satisfactory result; the presence of 13-20 follicles increases the risk of developing hyperstimulation syndrome.

Why do follicles grow poorly when stimulated?

All reproductive doctors know the norm for follicle enlargement during stimulation, and deviations from it indicate slow growth, which is determined by folliculometry. If a woman has a weak response to stimulation, this may be due to genetic abnormalities leading to ovarian failure, chronic anovulation, endometriosis or surgical interventions on the pelvic organs earlier.

Follicular cyst and eco. Why does it occur and how does it affect the environment? It is known that if ovulation does not occur and the follicle does not burst, then it begins to persist and develop into a cyst. In most cases, such cysts resolve on their own within several cycles, but in some cases the cyst does not resolve and continues to grow, which increases the risk of its rupture or torsion of its pedicle, which requires urgent surgical treatment. At follicular cyst the issue of IVF is decided individually, since in some cases the hormonal background contributes to the resorption of the cyst, and in some cases, stimulation of ovulation leads to its increase or the appearance of new cysts, its degeneration into malignant or rupture of the capsule, which increases the likelihood of complications. Therefore, the decision on whether to carry out an IVF protocol depends on the ovarian reserve, and if it is low, then stimulation is carried out under strict ultrasound control.

Multifollicular ovaries and eco

Multifollicular ovaries are not a diagnosis, this is a conclusion from ultrasound doctors, and among gynecologists it is called polycystic ovary syndrome, PCOS or Stein-Leventhal syndrome. The classic syndrome is characterized by: polycystic ovaries, hyperandrogenism and infertility, which is the main reason for which women consult a doctor.

Using an ultrasound, the doctor diagnoses MFN if the volume of the ovary exceeds 10 cm3 with the presence of follicles of more than 12 pieces with a volume of up to 10 mm, while there are no follicles larger than 10 mm, which indicates the absence of ovulation, and do not increase on other days of the cycle.

Pregnancy with MFI is impossible only in the absence of ovulation, which is associated with changes in the hormonal levels of the body and leads to the formation of a large number of defective follicles. If such ovaries are accompanied by anovulatory cycles, then pregnancy is completely excluded.

IVF for multifollicular ovaries is indicated for women who are planning to become pregnant, through ovarian stimulation and folliculometry to determine the exact time of ovulation.

Stimulation of ovulation during mfya is a rather complex and painstaking task, since this pathology is not always corrected by selecting a drug, so sometimes it is necessary to stimulate ovulation several times by selecting the dose and stimulation schedule. This all increases the risk of developing ovarian hyperstimulation syndrome or ovarian depletion. Therefore, stimulation of ovulation in polycystic disease is carried out only when the weight of an obese woman is normalized and all metabolic processes in the body are stabilized.

To carry out IVF with MFN, according to health recommendations, it is necessary to check the patency fallopian tubes by laparoscopy, which allows for interventions on the ovary by dissecting the dense tunica albuginea, drilling - destruction of androgen-producing stroma, as well as ovarian biopsy and exclude other genital pathologies. This procedure increases the chances of restoring ovulation and improves the prognosis of an adequate response to the use of ovulation inducers. If a woman refuses such a procedure or there are technical reasons for its implementation, then the patency of the tubes is checked by hysterosalpingography or ultrasound hysterosalpingoscopy. If the patency of the fallopian tubes is impaired, then the issue of laparoscopy or IVF is decided. According to the health order, in vitro fertilization is carried out if pregnancy does not occur within a year of regular sexual activity without the use of contraceptive methods after laparoscopic surgery or after ineffective methods of ovulation stimulation. But if a woman is over 35 years old, then this period is reduced to half a year.

All couples with a pathology such as infertility should not waste time on IVF. The IVF program under the compulsory medical insurance policy provides free assistance to all Russian citizens with established and confirmed infertility who have compulsory medical insurance policy up to 39 years of age and having no contraindications to undergoing the IVF procedure in any of the clinics participating in this program. Register, submit an application and your chances of having a child will increase significantly.