How is the IVF procedure carried out in stages

How is the IVF procedure

Many couples who decide to use artificial insemination to conceive a child do not know how the IVF procedure works.

This is not one single manipulation, but a whole range of activities that usually lasts several weeks, and, if successful, ends with the woman's pregnancy.

Let's talk about how IVF goes step by step.

This procedure can be divided into stages:

1. Preparation for IVF.

Preparation for IVF includes a comprehensive examination of the couple.

Diagnostic procedures are required for:

There are mandatory and optional tests. Compulsory examinations are assigned to all married couples without exception. Without them, you will not be able to enter the IVF protocol. Additional studies may be ordered according to indications.

Mandatory tests and diagnostic procedures for both spouses:

1. Blood for HIV, viral hepatitis B and C, syphilis, genital herpes.
2. Determination of blood group and Rh factor.
3. Microscopy of a smear from the genital tract.
4. PCR smear from the genital tract for infections: chlamydia, ureaplasmosis, mycoplasmosis, cytomegalovirus, herpes.

Mandatory tests and consultations for men:

Mandatory tests, consultations and diagnostic procedures for women:

1. Blood test for sex hormones.
2. Blood test for TORCH infections (rubella, toxoplasmosis, cytomegalovirus).
3. Coagulogram (hemostasiogram).
4. Clinical analysis of blood and urine.
5. Blood chemistry.
6. Microscopy of a smear from the urethra, cervical canal, vagina.
7. Cytological examination of a smear from the cervix and cervical canal.
8. PCR smear for herpes type II, HPV 16 and 18 types.
9. Ultrasound of the pelvic organs.
10. Ultrasound of the thyroid gland.
11. Electrocardiography.
12. Echocardiography.
13. Fluorography.
14. Ultrasound of the mammary glands, and after 35 years - mammography.
15. Mammologist consultation.
16. Therapist's consultation.

Sometimes women are prescribed additional examinations, such as hysteroscopy or laparoscopy.

2. Stimulation of superovulation.

A woman is prescribed hormonal drugs to stimulate the maturation of several eggs at once. With a good ovarian reserve, about 10 follicles mature in one cycle. From most of them it will be possible to obtain high-quality eggs in the future.

The stimulation scheme is selected for each woman individually. There are many types of IVF protocols. To stimulate ovulation, special hormonal preparations are used. The main criteria for choosing a stimulation regimen and dosage are the woman's age, her ovarian reserve and previous stimulation experience.

Sometimes this step is missing. IVF in women with low ovarian reserve is often performed in a natural cycle. That is, hormonal preparations for the maturation of a large number of eggs are not prescribed.

3. Puncture of follicles.

With the help of ultrasound, the process of growth of follicles in the ovaries of a woman is regularly monitored. These are fluid-filled vesicles, most of which contain an egg. To obtain germ cells, a puncture of the follicles is performed.

This procedure takes place under general intravenous anesthesia and lasts only a few minutes. After the oocytes are collected, they are immediately placed in a nutrient medium and sent to the embryological laboratory.

4. Fertilization of eggs.

On the same day, the eggs are fertilized. For this, the sperm of the spouse (if necessary, a donor) can be used. Therefore, the husband must also come to the clinic on the day of the follicle puncture in order to donate sperm.

Sometimes frozen (cryopreserved) sperm is used. This is usually required if:

• the husband has little sperm, and it needs to be accumulated before the fertilization procedure;
• the husband does not have time to come on the day of the follicle puncture, and he donates sperm in advance.

Also, frozen sperm is usually used if there is a need for egg fertilization using donor biomaterial. Donor sperm may be required for single women or with absolute infertility of the husband.

5. Cultivation of embryos.

Embryos are made from fertilized eggs. They are in a special nutrient medium. Then they develop in an incubator within 3-5 days. For embryos, conditions are created that are as close to natural as possible.

At this stage of IVF, PGD is possible. This is a method for diagnosing genetic and chromosomal abnormalities. It allows you to choose a healthy embryo for transfer into the uterus, which is highly likely to develop normally.

6. Embryo transfer.

1 or 2 embryos are transferred into the uterus, depending on how the chances of pregnancy are assessed. When transferring 2 embryos, the success rate is higher. However, the risk of multiple pregnancy also increases.

The transfer procedure itself is simple and painless. It only lasts a couple of minutes. With a special device resembling a syringe with a flexible tube at the end, the embryo is placed in the uterine cavity. With the successful implantation of the embryo in the endometrium (the mucous layer of the uterus), pregnancy occurs.

7. Control and support of pregnancy.

After the embryo transfer, the woman is prescribed hormonal preparations for the normal development of pregnancy. Its confirmation is carried out after 2 weeks using a blood test for hCG. After another 1 week, the woman undergoes an ultrasound scan. Pregnancy is diagnosed when a fetal egg is detected in the uterus using ultrasound.

Now you know how IVF goes step by step. Do not be afraid of this procedure. It is a safe and highly effective method of overcoming infertility. Thanks to IVF, hundreds of thousands of couples around the world have already become happy parents.

In vitro fertilization is a modern reproductive medicine procedure that allows a woman to naturally bear and give birth to a child. The essence of this technology is the introduction of a fertilized egg in the laboratory into the uterus. Before carrying out the IVF procedure, the doctor determines which cells will be used for this - donor or own. For this type of procedure to be successful, you need to follow all the IVF stages by day, as provided for by medical protocols.

Stage 1 - Preparation

The IVF procedure by day lasts no longer than one menstrual cycle, but the IVF preparatory stages themselves can take much longer. Both the woman and the man who decide to carry out the standard IVF procedure take part in the preparatory stage.

Women

Doctors conduct a comprehensive examination of a woman and determine her ovarian reserve - the stock of immature eggs. In the event that the ovarian reserve is absent or reduced to a critical level, doctors offer an alternative - the use of a donor egg.

It is necessary to make sure that the woman does not have any pathologies of the tissues of the uterus, ovaries and fallopian tubes, such as synechia, polyps or hydrosalpinx. These pathologies must be removed before the IVF procedure itself.

The doctor will take a swab for the bacterial flora to make sure there are no infections. Otherwise, it will be necessary to carry out treatment, since any infection reduces the likelihood of a favorable IVF outcome. Before entering the standard IVF procedure, 7–10 days before menstruation, an ultrasound of the pelvic organs is performed, which allows you to assess the condition of the uterine cavity, its size, the thickness of the mucous membrane, and the functioning of the ovaries.

Men

A man who becomes a donor during IVF will have to pass a spermogram. This analysis allows you to determine the reproductive ability of a man and identify existing diseases of the reproductive system, if any. Before performing the in vitro fertilization procedure, male germ cells are checked for the presence of genetic defects in the Y chromosome, which often cause male infertility.

The man will also need to have a urethral swab and a TORCH test to make sure he is free of prostatitis, urethritis, and sexually transmitted diseases.

Stage 2 - Hormone Therapy

The next stage of the IVF procedure begins on the second day of the menstrual cycle and lasts from 12 to 14 days. Its essence is to stimulate the work of the ovaries with the help of hormone therapy in order to obtain 8-10 oocytes capable of fertilization. It is this amount that will be enough for successful IVF.

During hormone therapy, an ultrasound scan of the pelvic organs is mandatory every four days, according to the results of which the doctor can adjust the dosage of the drugs.

For the classical IVF procedure, the pituitary follicle-stimulating hormone FSH, ionic gonadotropin and gonadoliberin analogues can be used. The doctor prescribes a treatment regimen depending on the protocol that will be chosen for IVF.

The international scientific community has approved various protocols for ovulation stimulation:

• Super long - it lasts 2–3 months;
• Ultrashort - lasts up to 10 days and involves high doses of hormones. Typically, this protocol is prescribed for diagnoses such as insufficient follicular reserve and low levels of the hormone AMH;
• IVF protocol in a natural cycle - in this case, hormonal stimulation is not performed, and one egg is taken for fertilization, which has matured in the natural menstrual cycle;
• IVF protocol with minimal stimulation - small doses of hormonal drugs are used for stimulation.

Most often, a short protocol is used, since a woman who needs in vitro fertilization has serious problems with her ovaries. In any case, the doctor will choose the safest protocol for IVF. Very often, the IVF protocol in the natural cycle is used first in order to avoid hormonal stress on the body, and only if this method does not bring results, hormonal stimulation is prescribed.

Stage 3 - Follicle Puncture

The next stage of standard IVF lasts no longer than 1 day. When, under the influence of hormone therapy, the woman's eggs mature, it is necessary to perform their puncture. This procedure is considered minor surgery and is performed under short-term general anesthesia. Using an ultrasonic sensor, the doctor performing the manipulation chooses the shortest path with a minimum number of punctures of the ovarian capsules and vaginal walls, and then inserts a special needle and collects the eggs. The procedure itself lasts from 3 to 30 minutes.

After the puncture of the follicle, after 2-3 hours, the woman can go home. Among the existing restrictions is a ban on driving on the day of the operation. Within 2-3 days after the procedure, the patient may experience discomfort.

On the day of the follicle puncture, a man must donate sperm, which will be used to fertilize eggs in the laboratory.

Stage 4 - Fertilization of the egg and cultivation of the embryo

The eggs are examined by embryologists to determine their level of maturation. They are washed from the follicular fluid and placed in a nutrient medium for transfer to an incubator, and then fertilized in a test tube.

With a favorable outcome, from 50% to 90% of the eggs are fertilized. Within 24 hours, the zygotes begin to divide. After 2 days they consist of 2-4 cells, after 3 days - from 6-10 cells. Normally, on the fifth day, the zygote is divided into two types of cells - from some of them the fetus will form in the future, and from others - the placenta.

Without fail, fertilized eggs are examined daily by specialists in order to exclude developmental defects and any hereditary pathologies. When the zygotes reach the required level of development, the doctor will select the most healthy cells for the next stage of standard IVF.

Stage 5 - Transfer of the embryo into the uterine cavity

The next step is manipulation, which takes only 1-2 minutes. Using a special catheter, the doctor transfers the embryos with a nutrient medium into the uterine cavity. The whole process is controlled by ultrasound. After the procedure, it is advisable for the patient to spend several hours in the hospital to avoid complications, and then she can go home. For most women, this procedure is completely painless.

Stage 6 - Maintenance of pregnancy

After in vitro fertilization, it is important to monitor how the embryo develops. You may need hormone therapy, which will be prescribed only according to the results of ultrasound and tests.

14 days after the transfer of the embryo into the uterine cavity, it is necessary to pass an analysis for the level of the hCG hormone, based on the results of which it can be concluded that pregnancy has occurred.

With a positive result in the first trimet, it is important to regularly consult a doctor and take all the necessary tests to monitor the woman's condition and the development of pregnancy. Supportive hormone therapy after IVF can last about 10-12 weeks.

Indications for IVF

Any of the stages of standard IVF is associated with interference with the natural processes of the functioning of the body. Accordingly, there are many risks for women's health. That is why all stages require strict medical indications. It is also worth noting that IVF is prescribed only in cases where it is impossible to carry out treatment and establish the causes of infertility.

The classic IVF procedure is carried out with the following indications:

• ovulation disorders or lack of ovulation;
• insufficient amount of ejaculate;
• obstruction of the fallopian tubes;
• endometriosis;
• serious inflammatory diseases of the genitourinary system;
• absence of the fallopian tube due to its removal due to ectopic pregnancy;
• long-term treatment of gynecological diseases - it makes sense to perform IVF in order to bypass many obstacles to conception.

At the stage of growing embryos during IVF, all fertilized eggs are studied in the laboratory without fail. This allows you to identify many genetic abnormalities. Thus, another indication for IVF is a high risk of genetic abnormalities and hereditary diseases. Modern diagnostic methods make it possible to select donor material that does not contain unwanted genes even at the stage of implanting the embryo into the uterine cavity, which increases the chances of having a healthy child several times.

Another indication for IVF is the genetic incompatibility of the couple. These are some of the most difficult cases in the practice of fertility specialists. As a result of genetic incompatibility, both spouses can be absolutely healthy, while they cannot conceive naturally and give birth to a healthy child. All couples who are diagnosed with "genetic incompatibility" must undergo a special analysis - karyotyping. At this stage, blood is examined for the number of chromosomes, as well as their quality. As a result of such a diagnosis, specialists make a prediction regarding the success of IVF and the chances of having an absolutely healthy child. In case of an unfavorable outcome, specialists will offer alternative options, for example, in vitro fertilization with a donor egg or sperm.

Conducting in vitro fertilization in the clinic "For the birth"

The clinic "For birth" is a leading center that specializes in the treatment of all types of infertility and in vitro fertilization. Among our advantages are highly qualified doctors, the use of advanced safe techniques in the field of reproductive medicine, approved by the international scientific community, a modern technical base, an affordable price for all types of research and treatment.

Artificial insemination is one of the most common procedures for conceiving childless couples. Families dreaming of the birth of their child have the right to use similar services of specialized centers. First you need to find out all the questions and understand how important such an offer is, how we will step by step consider how the eco procedure goes.

The essence of the method

Before using the services offered, it is advisable to find out what the eco procedure is. It is assumed that the technique is also called "in vitro conception." The basis is the isolation of the egg with its further connection with sperm in special test tubes. Then, the development of embryos is monitored, the transplantation of which is carried out only on a certain day.

Preparatory procedures before IVF allow you to provide powerful support to the female body at the hormonal level, resulting in pregnancy.

Doctors always remember that there are stages of IVF by the day and embryos are allowed to be planted only when the woman is ready to conceive.

To increase the chances of pregnancy and its successful course, not only step-by-step preparation is required, but also further careful monitoring. During the first trimester, the girl takes special hormonal drugs that guarantee an increase in the chances of having a healthy baby.

Recently, the eco procedure has become increasingly popular, but at the same time, it began to be developed since the 1970s. The birth of the first baby "from a test tube" took place in 1986. Doctors note that cases when an IV procedure is performed instead of natural conception guarantee the birth of healthy children with good immunity. Any influence on the child is excluded.

Improved artificial insemination and high chances of conception bring hope to many childless couples. In order to successfully carry out the procedure and know what awaits in the very near future, you need to find out in detail all the information about how fertilization is done.

Stages

Below we will consider how the eco procedure goes through in stages.

Preparation. The first stage is moral preparation and analysis. It is advisable to set aside a couple of months for it. Often, experts advise compliance with recommendations related to the right lifestyle. Only in the absence of contraindications, the help of specialists becomes possible.

Stimulation. Before the IVF fertilization procedure takes place, the female body is stimulated with the help of hormonal preparations. The type and duration of the protocol is determined to increase the chances of pregnancy. Stimulation is possible at home, but only with strict adherence to all recommendations.

The next stage of stimulation is to control the growth of follicles. Women regularly visit the ultrasound diagnostic room in order to eliminate the risk of missing a favorable date for embryo transfer. The specialist evaluates the development of follicles, the condition of the uterus, endometrium. The female genital organ should be prepared to receive the embryo.

Puncture. At the onset of the optimal date, a puncture is performed with the selection of eggs. After sampling, the patient remains under medical supervision for about two hours, and in some cases for a day.

Insemination. Specialists combine the egg and sperm for the further development of the embryo in a test tube, where suitable conditions are created. Usually the duration of the stage is 2 - 5 days.

Cell transfer is the next stage, which should take place in stationary conditions. Surviving embryos are introduced into the female uterus for their further development. The result becomes known only after 2 weeks.

In 35 - 50%, the IVF procedure ends with pregnancy, during which constant monitoring of the female body and support for the development of the unborn baby is required.

Methods of carrying out

In the 21st century, in vitro fertilization is carried out using different methods. Every couple dreaming of a child undergoes diagnostics to determine the appropriate way to conceive a baby with the help of specialists.

IVF is routine (conventional) and ICSI (intocytoplasmic sperm injection). In the first case, the egg and spermatozoa are placed in a special container for their further independent cultivation, and in the second case, the most active spermatozoon is selected for the introduction of the egg using the device.

Taking into account the fact that pregnancy does not always occur after IVF, the frozen embryo transfer procedure becomes possible. If a woman is lucky and there are many surviving embryos left after the puncture, experts suggest freezing several for subsequent procedures if necessary.

The obligatory stage is the transfer of embryos into the uterus of the girl. Such a painful procedure is carried out only after anesthesia. It is mandatory to use a sterile and sealed embryo transfer catheter, maintaining optimal conditions for preserving their vital functions during a critical procedure.

A suitable fertilization technique is determined on an individual basis after passing diagnostic measures, passing established tests, and making an accurate diagnosis for each of the partners.

Event dates

How long does the IV procedure take? Artificial insemination is carried out on the basis of a regulated protocol, divided into days. The duration is determined by the method of the procedure.

1. ultrashort Japanese - 25 - 31 days;
2. short protocol - 28 - 35 days;
3. long protocol - 40 - 45 days.

As a result, IVF lasts from 25 to 45 days. At the same time, it is recommended to prepare and switch to the correct lifestyle within 2 to 3 months.

In each case, the procedure for taking an egg is carried out with monitoring of the ovarian response to taking hormonal drugs. The main task is the full preparation of the female body for conception. If necessary, after each ultrasound, the doctor adjusts the dosage and schedule for taking hormonal drugs with a focus on the optimal timing of artificial insemination.

If the IVF process is successful, doctors receive the eggs by puncture. With a long protocol, the procedure is prescribed for 12-22 days from the moment the first dose is administered, for a short one - for 14-20, for an ultrashort one - for 10-14.

Patients have the right to learn a detailed description of the IVF procedure in consultation with a specialist, since the approach is determined by the reproductive problems of the couple, the type of protocol used.

Issue price

In Russia, the service is provided by more than 70 metropolitan hospitals. Many institutions specialize in reproductive technologies.

The cost of the IVF procedure depends on many factors:

• the doctor's consultation;
• examination of spouses (diagnosis of eggs, sperm with an assessment of the possibility of conception);
• treatment of pathological processes;
• the selected protocol for stimulating the female body;
• follicle puncture;
• egg fertilization and cultivation;
• transfer of embryos into the female body;
• support during the second phase of the menstrual cycle and pregnancy;
• diagnostics after conception (consultation, analysis for hCG, ultrasound).

Sometimes it is possible to pay for the event in stages.

Every couple should know how much the eco procedure costs. The minimum price reaches 16,500 rubles, the maximum - 215,000.

Average pricing data:

• classic IVF - 90 - 110 thousand rubles;
• natural cycle - 70 - 80 thousand rubles;
• transfer of a donor egg - 200,000;
• use of donor sperm - 100,000;
• embryo freezing service - 10,000, followed by a monthly payment of 1,000 rubles.

Artificial insemination is the hope for motherhood and fatherhood for many childless people. The correct procedure increases the chances of a favorable outcome.

After the onset of pregnancy and the birth of a beautiful baby, it becomes clear that family happiness is worth any money.

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

What it is?

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

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

When is IVF done?

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

Pipe factor

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

male infertility

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

endometriosis

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

Age changes

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

Problems with ovulation

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

Contraindications to be aware of

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

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

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

How is IVF done?

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

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

Preparation and analyzes

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

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

Prescribing drugs: choosing a protocol

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

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

Follicle Growth Tracking

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

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

Egg selection

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

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

Fertilization

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

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

in vitro

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

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

Cell transfer

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

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

Expectation

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

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

Result of manipulation

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

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

The final stage of the procedure

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

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

Delivery: what determines the choice of method

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

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

Results

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

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

On the way to finding the highest and unique gift of nature - childbirth, 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 specialists in reproductive medicine and in public circles.

But couples who have struggled for a long time to have a baby tend to stay away from any IVF controversy. After all, often only 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 the opportunities and risks, plan upcoming actions and choose a medical institution where the in vitro fertilization procedure will be performed. The key informational 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 pattern. This is due to a clear standardization and unification of clinical treatment regimens, concluded in the form of clearly regulated IVF protocols. This means that all reproductive centers perform certain medical manipulations at a certain stage of the procedure for certain types of infertility.

But this 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, according to which infertility treatment can take place. Protocols can be:

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

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

General scheme and characteristics of IVF stages

Whatever the reason for the persistent infertility of a married couple, the occurrence 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 there are indications. The stages of in vitro fertilization are more relevant for a woman than 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 spermatozoa;
4. The procedure of in vitro fertilization of eggs (in vitro conception) and the cultivation of embryos;
5. Transfer of embryos into the uterine cavity;
6. Monitoring the onset and course of pregnancy.

Characteristics of IVF protocols by day and preparation

A general visual description of the basic IVF protocols for the days of the menstrual cycle and the time of each of the stages is given in the form of a table.

Preparatory activities. In medicine, there is not a single medical procedure that would not require appropriate training. When it comes to such a complex procedure as IVF, the value of the preparatory stage increases hundreds of times. Any unrepaired breakdown in the body will necessarily affect the subsequent stages of the procedure and may cause its failure.

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

Preparatory measures should consist of general, aimed at eliminating somatic pathology (acute and chronic diseases of internal organs, infections) and special, designed to correct the pathology of the female genital organs (drug treatment, laparoscopy). Particular attention is focused on the need to bring lifestyle, physical activity and nutrition in line with the proper.

The body of future parents should be as limited as possible from any harmful influences. This will allow you to get the most complete and viable germ cells (spermatozoa and eggs). The total duration of training can take from one to three months. The couple spend most of this time at home. A stay in the clinic may be required only during the collection of tests or when performing medical procedures.

Important to remember! It is not worth starting preparatory measures for IVF before consulting a specialist in the reproductive medicine center where the procedure is planned. Some studies and measures may not be necessary due to their previous implementation during the examination and other infertility treatments!

How is superovulation stimulated?

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

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

Phase one - blockade of the natural activity of the pituitary gland. The physiological rationale for this event is 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 both gonadotropin releasing hormone agonists - GnRH (diphereline, decapeptyl, buserelin, suprefact, zoladex), as well as its antagonists (blockers): cetrotide, orgalutran. 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 - accelerate the maturation of follicles. During the second phase of the first stage of in vitro fertilization, simultaneous active growth and the achievement of maturity of all follicles that have responded to stimulation with hormonal drugs are achieved. Instead, high doses of drugs containing a large dose of pituitary hormones (luteinizing and follicle-stimulating) are administered:

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

In a natural ovarian-menstrual cycle, this is not possible. 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 - Premature Ovulation Delay. In order to ensure that the most mature ovarian follicles do not ovulate prematurely at the end of the superovulation stimulation stage, 36 hours before their puncture, human chorionic gonadotropin preparations (hCG hormone) are administered: pregnin, horagon, 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 introduction of an embryo into it.

The drugs used for stimulation can be short-acting and prolonged (depot drugs). During their administration, the patient is not necessarily in the clinic, since injections can be performed independently using a special syringe pen containing a solution with a hormonal substance. But control over stimulation is necessarily carried out systematically according to an individual program. The mode 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 stimulation of the superovulatory activity of the ovaries occurs, 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 with its ultrashort and short types to 40-45 days with a long one. Half of that time is spent on the first step!

How and when eggs are obtained

Artificially stimulated ovaries increase their size and volume due to the simultaneous maturation of many follicles. Control over this process is carried out with the help of ultrasound monitoring and determination of the hormonal spectrum of blood (estrogen, FSH). A daily increase in the size of follicles by 1-2 mm is considered normal. The criterion for readiness for puncture is the achievement by most of them of 15-20 mm. It is equally important to simultaneously evaluate the thickness of the inner layer of the uterus - the endometrium. Reaching the 7 mm mark and acquiring a three-layer structure is a good signal of readiness for implantation of the fetal egg. As soon as all these conditions are met, the day of the puncture is scheduled, with a preliminary introduction of the hCG hormone 36 hours in advance.

If we consider this procedure in the time interval, then it falls 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 ultrashort one. Such terms almost completely coincide with the normal ovulatory cycle, simulating increased ovulation. After the follicles reach the pre-ovulatory state and take measures to delay premature ovulation, the procedure for obtaining eggs is performed - the puncture of several mature follicles. The more high-quality eggs are obtained during its implementation, the more embryos can be grown in artificial conditions.

Under such circumstances, it is possible to carry out IVF according to the 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 the pregnancy is obtained on the first try. But if repeated IVF procedures are necessary, there is not only economic feasibility, but 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 by a puncture method. To do this, after the introduction of the patient into anesthesia (sparing intravenous), under the control of ultrasound, a puncture is performed with a special needle with penetration into the pelvic cavity. The puncture site is the posterior fornix of the vagina, which is 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 on the ultrasound monitor. Visualization of ovarian follicular formations is usually good.

In doubtful cases or in violation of the normal anatomical relationships of the internal genital and abdominal organs, a 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 its implementation, bed rest is desirable for 2-3 hours. If the general condition of the woman is satisfactory and, apart from slight discomfort in the lower abdomen, nothing else worries, there is no need for further stay in the clinic until the next stage of IVF - implantation of the embryo into the uterus.

Ovum fertilization and embryo cultivation

When the follicles are punctured, impurities and liquids 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 are viable spermatozoa. Their obtaining is very simple and in typical cases does not require any specialized measures. Through masturbation or coitus interruptus, 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 spermatozoa with each other is carried out as soon as possible after their receipt. This time should not exceed 6 hours. The process is carried out and controlled by the embryologist. Under normal conditions, 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 spermatozoa is doubtful in advance, a fertilization procedure is indicated using a special ICSI technique. Its essence emerges from the name - intracytoplasmic sperm injection. This means that the spermatozoon is injected into the egg using a microscopic needle under the control of electron-optical microscopy.

The further fate of fertilized eggs depends on how actively the process of cell division takes place. In any case, they are placed in a nutrient medium containing all the components and microclimatic indicators necessary to sustain life. The purpose of this stage is to create a blastocyst, the precursor of 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 sparing regimen.

Important to remember! A minimum of 2 blastocysts must be obtained in one fertilization cycle. The more of them, the better, since there is a possibility of cryopreservation of viable embryos, which can be used in case of need for repeated IVF sessions!

Transfer to the uterus

If fertilized eggs show signs of active cleavage after 18 hours, they are carefully monitored. On average, on the 5th day after fertilization, the embryos are ready for transfer to the prepared maternal uterus. During this time period, they are at the blastocyst stage. Scientists have found that it is in this state that the maximum adaptation of the maternal organism to the embryo takes place, which is best acclimatized by implantation in the endometrium.

The blastocyst transfer procedure is performed 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 with embryos. Anesthesia is not required. The number of the latter can be different and depends on the signs of their probable viability. Usually two embryos are sufficient. Using more often causes multiple pregnancies.

Monitoring of the entry of embryos into the uterine cavity is carried out using an ultrasound machine. 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 is clogged with mucus, with which, during the subsequent extraction from the uterus, the embryos are also removed.

After implantation of 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 time, because once the embryos have entered the uterus, they can no longer fall out of it. But compliance with a sparing regimen and minimal physical activity is mandatory, since intense loads prevent the implantation and tight fixation of the embryo in the endometrium.

Monitoring the onset and course of pregnancy

Successful transfer of embryos to the uterus marks the end of the in vitro fertilization procedure. But the worries and stress of future parents and specialists do not decrease until the onset of pregnancy is ascertained. It is not possible to draw any conclusions in this regard for 2 weeks. All this time, a woman takes hormonal preparations containing estrogen, progesterone and human chorionic gonadotropin. They are necessary to maintain pregnancy. Sexual contacts, physical activity, 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 the determination of the presence of chorionic gonadotropin in the urine, which is produced by embryonic tissues. You can determine the amount of this hormone in the blood. Regardless of the test results (positive or negative), an ultrasound examination is mandatory. Its maximum informativeness is not earlier than 3 weeks after implantation.

In the case of a negative pregnancy test result, 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 fetal eggs in the uterine cavity, and is a reason to consider the IVF cycle successfully completed. A woman is registered in a antenatal clinic and is systematically observed by an obstetrician-gynecologist with the necessary screening studies (blood tests and ultrasound).

The essence of a long protocol

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

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

It is not devoid of shortcomings, which can be as follows:

• 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 by the type of PMS and menopause;
• Psychological discomfort and tension from prolonged administration of hormonal drugs;
• High probability of apoplexy and ovarian hyperstimulation syndrome;
• Aftereffect syndrome - preservation of the blockade of the pituitary gland for a long time;
• Potentially negative impact on the implantation ability 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 response to medications used at different stages of the IVF cycle!

A short protocol as the golden standard of the IVF procedure

The composition and activities of the short protocol are similar to those of the long protocol. The difference is only in the time and method of carrying out the stage of stimulation of superovulation. Its duration is significantly reduced. The sense in 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 from 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 is up to 28-35 days. The drugs used for stimulation are the same as in the long protocol. In addition to releasing hormone agonists, their antagonists are sometimes used, which block pituitary activity even more actively.

The real benefits of short protocol IVF are:

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

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

Ultrashort 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 an even lower load on the woman's body 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 only GnHRH antagonists, which makes it possible to achieve a rapid and persistent, but short-term blockade of the pituitary gland, which is necessary for egg retrieval. It is noticed that their number is much lower, but the quality characteristics are improved. This is confirmed by a high percentage of pregnancy after the first short protocol IVF attempt.

The advantages of the Japanese protocol are the same as in the short one. The most important advantage is the complete exclusion of premature ovulation and hyperstimulated ovary syndrome, an exceptionally rapid recovery of pituitary activity. An additional dose of hCG is not required at all. It is exceptionally easily tolerated by women, since the treatment cycle is only 25-31 days, 8-12 of which can be occupied by superovulation stimulation.

Among the disadvantages of such treatment is the uneven development of follicles and the slow preparation of the endometrium of the uterus, which causes it to be unprepared 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, one should be guided by the only rule: you should not justify the choice with short treatment periods and easy tolerability of the procedure. Only a 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: IVF procedure steps