Eco stages by cycle days. IVF procedure: stages by day. Differences in the main protocols

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

You can check the ovarian reserve by the level of the hormone FSH and inhibin B in the blood serum or by counting the number of antral follicles at the beginning of the menstrual cycle. Elevated FSH levels are associated with reduced ovarian reserve.

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

Pathologies of the uterine cavity, such as synechiae or polyps, must be removed before starting the IVF process. Hydrosalpinx - a fluid-filled blocked fallopian tube - reduces the effectiveness of IVF, because the fluid in the tube has an embryotoxic effect, and many doctors advise removing the damaged tube before IVF.

• Spermogram delivery

Before IVF, a semen analysis (sperm analysis) is performed. If deviations from the norm are found in the spermogram, a consultation with an andrologist is necessary to determine whether these violations can be corrected and whether they are associated with other medical problems. For example, genetic defects on the Y chromosome are associated with some cases of male infertility, and men with congenital absence of the vas deferens (channels that carry sperm out of the testicles) often carry the genetic defect responsible for cystic fibrosis. In such situations, genetic testing may be required. Often, various anomalies of male germ cells, including teratozoospermia, become the cause of infertility. Teratozoospermia is characterized by a violation of the structure of spermatozoa. The diagnosis of teratozoospermia is made to a man when half or more of his ejaculate is pathologically altered spermatozoa, and the teratozoospermia index exceeds 1.6. The experience of reproductive doctors shows that IVF is the best way to conceive a child with teratozoospermia

• Taking blood tests

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

Stimulation of superovulation

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

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

Ovarian stimulation drugs

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

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

Human Menopausal Gonadotropin (HMG) (menopur)
. Follicle stimulating hormone (FSH) (gonal-F, puregon)
. Human chorionic gonadotropin (hCG) (horagon, pregnil, ovidrel)
. Clomiphene citrate (Clomid, Clostilbegit)

Premature ovulation with IVF

Premature rupture of the follicle can nullify IVF. Therefore, so that the woman's own hormones do not interfere with the stimulation of superovulation and to control the process of superovulation, the production of her own hormones is blocked by agonists and antagonists. Also prescribed by a doctor individually.

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

ultrasound monitoring

When stimulating superovulation, it is necessary to regularly monitor the growth of follicles using transvaginal ultrasound. Follicle growth control is carried out every other day, starting from the fifth day of stimulation. It is also possible to adjust the dose of prescribed drugs. Some patients may be prescribed blood tests for estradiol. Normally, the level of estradiol in the blood increases as the follicles mature, and the level of progesterone remains low until the moment of ovulation.

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

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

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

With the maturation of a very large number of follicles (more than 25), or with a high level of estradiol in the blood, it is necessary to cancel the IVF cycle due to the threat of developing polycystic ovary syndrome (PCOS). In this case, ovarian puncture is performed and all resulting embryos are frozen. Interruption of the IVF cycle at this stage is due to the risk of severe ovarian hyperstimulation syndrome, since the impetus for the development of severe OHSS is usually the onset of pregnancy. Embryos can be later thawed and used in another IVF cycle without superovulation stimulation.

Follicle puncture

Follicle puncture is performed to obtain eggs. It is carried out with transvaginal ovarian puncture for IVF by pumping out the follicular fluid through a thin aspiration needle under ultrasound control.

Follicle puncture is performed under local or short-term (10-20 minutes) general anesthesia. A transvaginal ultrasound transducer is located in the vagina, with which mature follicles are visualized, and a thin needle is inserted into the follicles through the vaginal wall. The eggs are aspirated one by one from the follicles through a needle attached to an aspiration pump. Follicle puncture usually takes no more than 30 minutes. Follicle puncture is a minor surgical operation and does not require hospitalization. After the puncture, it is advisable to rest in the ward for 2-3 hours. After the puncture, driving is prohibited. Some women experience painful cramping after a puncture. A feeling of fullness or pressure in the abdominal cavity may persist for several days after the procedure.

Fertilization of eggs in vitro. Embryo culture

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

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

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

The incubator maintains a constant level of carbon dioxide, temperature and humidity. The conditions in the incubator and the composition of the nutrient medium mimic the conditions in the fallopian tubes, creating the best possible favorable conditions for the embryo in vitro. The nutrient medium has a high degree of purification from heavy metals and contains ingredients such as proteins, amino acids, salts, sugars, and a special acidity buffer that create optimal conditions for the growth and development of the embryo.

Intracytoplasmic sperm injection - ICSI

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

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

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

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

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

Embryo transfer at the blastocyte stage

It is now possible to culture embryos in the laboratory until they reach the blastocyst stage (usually 5 days after egg retrieval). The eco-blastocysts can then be transferred to the uterus. Some researchers note that the transfer of embryos at the blastocyst stage more often leads to pregnancy. There can be two explanations for this. First, the transfer of the blastocyst to the uterus is more natural, since in nature the embryo moves from the fallopian tube into the uterus at this stage. In addition, culturing to the blastocyst stage allows the embryologist to select the "best" embryos, as weak or genetically abnormal embryos stop developing before they develop into a blastocyst.

Blastocyst transfer also reduces the risk of potentially dangerous multiple pregnancies. The high rate of blastocyst implantation allows fewer embryos to be transferred into the uterus (typically one or two), reducing the risk of multiple pregnancies and associated complications.

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

Transfer of embryos into the uterus

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

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

Numerous foreign studies have shown that it is not necessary to be in a horizontal position after embryo transfer for more than 10 minutes, because this does not affect the onset of pregnancy. Once the embryo has entered the uterus, it can no longer “fall out” from there. Despite the apparent simplicity, the transfer of embryos into the uterine cavity is one of the most important stages of the IVF cycle. Data have been published in the literature indicating that up to 30% of embryos may be lost during transfer. The presence and consistency of cervical mucus has a great influence on success. Thus, for example, the embryo may adhere to the catheter internally or externally, or may be entrained following the outgoing catheter into the cervix. Much depends on the qualifications of the doctor, special equipment and the developed embryo transfer scheme, which allows preventing such situations.

Timing of ovulation after IVF during pregnancy

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

A negative result of an IVF procedure does not mean that this method is not suitable for you. With each IVF attempt, your chances of a successful conception increase and can reach 90% in a year of treatment. The people exist. Between attempts, you need to take a break of about 2 - 3 months.

IVF is a method of infertility treatment, a feature of which is the fact that fertilization takes place outside the body of the expectant mother, but in a test tube. The IVF protocol is a scheme for carrying out procedures, starting from the preparatory stage and ending with the transfer of the embryo. There are several types of protocols, each of which has its own characteristics. Which one to choose? This is determined by the doctor on an individual basis, taking into account the cause of infertility, age, the state of the reproductive and other body systems.

What is ECO?

In vitro fertilization is a reproductive technology that gives infertile couples a chance to become parents. After passing the necessary tests and the preliminary stage, the eggs are removed from the ovaries of the woman and artificially fertilized. Embryos are placed in an incubator where optimal conditions are created for them. After 2-5 days, the highest quality blastocysts are transferred to the uterus. IVF efficiency is 30-50%. The older the woman, the less chance of pregnancy.

Types of IVF protocols and their features

Types of IVF protocols:

1. in the natural cycle. Stimulation of ovulation does not occur, the egg matures naturally without the use of hormonal medications. The main difficulty is to calculate the right moment for the removal of the gamete. Often ovulation occurs spontaneously, so this protocol is the least effective.
2. modified protocol. Close to the protocol in the natural cycle, but involves taking medication to prevent spontaneous ovulation.
3. Long. Provides the maturation of a large number of high-quality eggs, the most productive. Requires long-term use of hormone-containing drugs.
4. Extra long. It is used when a woman is diagnosed with gynecological or endocrine diseases that require prior hormone therapy.
5. Short. Less effective than long, but easier to carry. Has a lower cost.
6. Cryoprotocol. After fertilization, some of the embryos are frozen. In the future, they can be replanted after any period of time.
7. Japanese. Medical burden is minimized. The main emphasis is on the quality of the embryos, and not on their quantity.

Short protocol

A short protocol reduces the risk of spontaneous ovulation, which often occurs with IVF in the natural cycle. It is relatively safe, the risk of adverse reactions is minimal, since the use of a large number of hormonal drugs is not required.

The likelihood of developing complications in the form of ovarian hyperstimulation syndrome with a short protocol is lower than with a long one. However, due to the fact that the number of eggs is small, and their quality sometimes leaves much to be desired, the effectiveness of the protocol is not too high compared to the long one.

Indications and contraindications

A short protocol is indicated for women with well-functioning ovaries who have reached the age of 30. It is used if the performance of a long protocol has been poor or there is a risk of developing ovarian hyperstimulation syndrome. Such an IVF program is not used if a woman does not ovulate or if her menstrual cycle is irregular.

Contraindications are also: pathology of the endometrium, a benign formation in the uterus (myoma) or polycystic ovaries. The protocol does not apply to chronic diseases of the liver, kidneys and other organs, incl. infectious (syphilis, hepatitis, tuberculosis) that are in the acute stage.

Stages of the short protocol

In the first days after the end of menstruation, gonadotropin-releasing hormone agonists are prescribed, which prevent a sharp increase in the level of luteinizing hormone that provokes ovulation. The next day, medications containing follicle-stimulating hormone are indicated to stimulate the growth and development of follicles, as well as to prepare the endometrium.

Once the follicles have reached the required size, a preparation containing human chorionic gonadotropin (hCG) is administered. This is necessary to stimulate the ovulatory peak of luteinizing hormone. At the same time, sperm is given. With the help of a puncture, which is performed under general anesthesia, mature eggs are retrieved and fertilized. For several days, the embryos are in incubators, after which the highest quality of them are transferred into the uterine cavity. At this time, progesterone preparations are administered, which are needed to maintain pregnancy.

What day of the cycle does it start and how long does it last?

Entry into the short IVF protocol begins immediately after menstruation. On days 2-3 of the cycle, injections of GnRH agonists are prescribed. Stimulation of follicle maturation lasts about 2-3 weeks, then hCG preparations are administered 36 hours before egg collection. After puncture, the gametes are fertilized. Embryos mature for 3-5 days, then they are placed in the uterus. Thus, the short protocol takes the same amount of time as the average cycle - about 28 days.

Long protocol

With a long protocol, there is more time to stimulate the follicles, so the likelihood of obtaining several high-quality eggs at once is higher, which increases the woman's chances of becoming pregnant. Due to the fact that the production of one's own hormones is blocked, the cycle is under the complete control of the doctor, and there can be no surprises in the form of accidental ovulation.

The disadvantages of a long protocol include high cost and a large drug load. There is a risk of developing complications in the form of ovarian hyperstimulation syndrome. According to statistics, every third woman who has entered into a long protocol faces this.

When is it prescribed, what are the contraindications?

Long IVF protocol is indicated for:

• endometriosis - inflammation of the lining of the uterus;
• increased production of androgens;
• hyperplastic processes of the endometrium, causing its abnormal thickening;
• obesity
• ovarian cysts;
• myoma - a benign formation in the uterus.

The protocol is contraindicated in oncological and infectious diseases, serious pathologies of the heart. It is used with caution in polycystic ovaries, high plasma estrogen levels, recent ovulation stimulation.

Stages of a long protocol

The stages of the long and short IVF protocols are the same, the difference lies only in their duration. Initially, gonadotropin-releasing hormone agonists are prescribed, which suppress their own hormonal levels. Further, preparations based on follicle-stimulating hormone are introduced to stimulate ovulation. When the follicles reach the desired size, medicines containing hCG are used, after which a puncture is performed. The eggs are fertilized, and after a few days the embryos are placed in the uterus.

What day of the cycle is carried out and how long does it last?

A long protocol is entered a week before the start of menstruation. GnRH agonists are used for 12-17 days. Medicines that stimulate the maturation of follicles begin to be administered from 3-5 days of a new cycle. On the 13-20th day, an injection of hCG is prescribed, 36 hours after it, the eggs are removed and fertilized. After 3-5 days, the transfer is made. Thus, the duration of the protocol is 40-50 days.

Extra long protocol

The extra-long protocol includes the same steps as the long protocol, but they are preceded by long-term hormone therapy. This is necessary if a woman has gynecological diseases or endocrine pathologies. One of the indications is endometriosis in severe form. The purpose of the preliminary stage is to reduce the severity of violations. On average, it lasts 3 months, but can be extended until the situation returns to normal.

Modified Protocol

The modified protocol is close to the natural cycle protocol. The maturation of the follicles occurs naturally, no stimulation is applied. However, the problem of sudden ovulation has been solved - the patient is prescribed GnRH agonists, which do not allow a jump in luteinizing hormone. Because of this, the modified protocol is preferred and used more frequently than the natural cycle protocol.

The in vitro fertilization procedure involves the use of one or another combination of medical actions that ensure the onset of a physiological pregnancy through auxiliary methods.

Entering the IVF protocol involves a number of special steps that prepare the female body for the implantation of a fertilized egg. Preparation is carried out with the help of hormonal effects on the patient's body and other secondary methods. The main stages of entry will be considered using the example of long and short in vitro fertilization protocols.

Depending on the woman's gynecological history and the presence of concomitant pathologies, medical reproductive specialists select an individual type of in vitro fertilization protocol for each patient. As indications for the implementation of a short protocol, there are:

• Previous attempts to implement one of the IVF protocols that were unsuccessful;
• The patient has no pathologies of the pelvic organs and problems with ovulation.

The long IVF protocol has the following list of indications for implementation:

• Previously failed fertilization episodes;
• Primary IVF in a patient who does not have functional and organic pathologies of the organs of the reproductive system;
• Uterine fibroids, endometriosis and other hyperplastic processes in the mucosa.

Short

Before you learn about entering the IVF protocol and what it is, each patient will need to prepare the body for this serious intervention. First of all, a lifestyle correction is recommended, and a complete rejection of bad habits at least 90 days before the start of the IVF protocol.

The next step is to examine the body, both the future mother and the future father. A married couple is recommended to perform a series of laboratory tests and an ultrasound examination of the organs of the reproductive system.

Many patients who are preparing to enter into one of the IVF protocols are prescribed Inofert. This pharmaceutical preparation contains folic acid, which reduces the likelihood of neural tube abnormalities in the unborn fetus. D

The duration of taking Inofert before entering the IVF protocol is at least 90 days. If a woman has problems with the structural and functional state of the endometrium, then reproductive specialists prescribe her a course of therapy with Norkulit.

Only if the female body is 100% ready for the process of hormonal stimulation and implantation of fertilized eggs, reproductologists begin the consistent implementation of one of the in vitro fertilization protocols.

A short IVF protocol has the following schematic form:

1. In the period from 2 to 12 days of the ovarian-menstrual cycle, the patient is prescribed hormonal stimulation of the body, the duration of which is about 14 days. To implement a short protocol, as a rule, a small amount of stimulant drugs is used. At the same time, reproductologists conduct laboratory monitoring of the hormonal background of a woman;
2. From the 15th to the 20th day of the ovarian-menstrual cycle, the seminal fluid of the potential father is donated for laboratory analysis for quantitative and qualitative indicators, as well as the follicle puncture of the expectant mother. The duration of the procedure for extracting female germ cells is no more than 40 minutes;
3. From the 18th to the 23rd day of the ovarian-menstrual cycle, fertilization of previously taken female germ cells is performed. The duration of this period is from 3 to 5 days;
4. From 22 to 28 days of the ovarian-menstrual cycle. The specified time period is used for the implantation of ready fertilized eggs into the uterine cavity of future mothers.

In order to control the effectiveness of the implemented in vitro fertilization protocol, on the 6th day from the moment of implantation of the zygote, the patient undergoes a control pregnancy test.

The average duration of the implementation of a short in vitro fertilization protocol from the moment of entry into it is 45 days. Since this variation of the IVF algorithm involves the use of minimal dosages of drugs, the patient is not at risk of such a side effect as ovarian hyperstimulation. After the successful implantation of the finished embryo, in order to support it in the conditions of the mucous membrane of the uterine cavity, progesterone-based drugs are used.

Long

In order to fully implement this kind of in vitro fertilization algorithms, more than one ovarian-menstrual cycle is required. After completing the preliminary preparation of the female body and successfully passing the laboratory and instrumental methods of research, on the 21st day of the cycle, the woman enters the long IVF protocol.

This procedure is characterized by the stage of inhibition of its own hormones in the female body, which allows you to control the process of egg maturation. In order to understand the specifics of this type of assisted reproductive techniques, it is necessary to familiarize yourself with its phased implementation:

1. The start of the IVF protocol occurs from the 21st to the 3rd day of the next ovarian-menstrual cycle. During this period, drug blockade of pituitary functions is carried out. The duration of this stage is from 12 to 15 days;
2. 3rd to 17th day of the cycle. During this period, the female body undergoes hormonal stimulation of the ovaries. The duration of the stage is from 2 to 3 weeks;
3. 36 hours before the follicle puncture, the patient is given an injection of hCG;
4. From the 17th to the 20th day of the ovarian-menstrual cycle, semen is taken from the future father for analysis, as well as the puncture of the finished follicles;
5. From the 20th to the 25th day of the cycle, medical specialists perform the fertilization of the taken eggs and monitor their condition;
6. From the 25th to the 27th day of the cycle, the implantation of the finished zygotes into the uterine cavity of the woman is performed.

The implantation phase is followed by a period of enhanced maintenance hormonal therapy, during which progesterone is used. The purpose of this stage is to provide favorable conditions for the attachment of the finished embryo to the uterine endometrium. The duration of maintenance therapy is 14 days.

The successful entry and implementation of a long in vitro fertilization protocol can only be judged on the condition that 12-14 days after the end of the procedure, the woman received a positive pregnancy test.

The reproductive specialist who is responsible for the implementation of this procedure will tell you in detail about the day of the cycle from which the IVF protocol begins.

When it is impossible to get pregnant, many women have to resort to assisted reproductive technologies. At the end of the preparatory stage, when the woman has passed all the necessary tests, the reproductive specialist will choose the optimal protocol for her - her personal infertility therapy regimen. Two types of schemes are widely used in Russia - long and short protocols. We will talk about the short one in this article. Let us consider in detail its pros and cons, advantages, description and detailed scheme by day.

What it is?

A short IVF protocol is considered more gentle than a long one, since with it the hormonal stimulation of the ovaries does not have the same scope and scale as with any subspecies of a long protocol. A woman cannot choose the type and regimen of treatment on her own, her fertility doctor must decide on a specific protocol, which, when choosing, will be based on the results of tests, on the characteristics of the endocrine system of a particular patient, on her age and reasons for childlessness.

The short protocol always starts on day 3 of the menstrual cycle and lasts no more than 28-36 days, while hormonal stimulation itself takes no more than 10-16 days. The ultrashort protocol lasts no more than 26-30 days, while the stage of hormonal stimulation takes no more than 7-10 days. Compare for yourself: a long protocol sometimes lasts up to one and a half months, in an extra long one - up to six months.

It turns out that the inevitable aggressive effect of hormones on the body of the fair sex in the protocol of the short type is reduced to the minimum values, which makes the protocol easier for the patient's well-being and minimizes possible complications and consequences.

Advantages and disadvantages

The main advantage of the short type scheme is the smaller number of hormonal drugs that a woman will have to take in the first phase of the menstrual cycle. This not only saves women's health, but also significantly reduces the cost of IVF, because almost half of the total cost of the protocol consists of the cost of expensive hormonal drugs.

Short protocols are considered to be the most preferred for women with normal or high ovarian reserve, with eggs of satisfactory or good quality. If the oocytes are weak and non-viable, if they cannot be fertilized even under laboratory conditions, a long protocol is more suitable.

Often, short protocols are recommended for women over the age of 35-37, but there is one important condition - all the functions of their sex glands (ovaries) must be preserved by this age in full. Quite often, changing the protocol from a long, but unsuccessful, to a short one leads to the desired result - pregnancy occurs.

The undoubted advantage of the short type protocol is the relatively low risk of developing such an unpleasant and even dangerous complication as ovarian hyperstimulation syndrome. This IVF scheme is more easily tolerated by patients.

Among the shortcomings that are mandatory for each treatment regimen, two aspects deserve special attention in short-type protocols:

• the probability of arbitrary ovulation, which will not make it possible to obtain oocytes and the protocol will have to be interrupted and repeated after 2-3 months;
• short hormonal stimulation does not allow obtaining a large number of oocytes, so there is no possibility of choosing the highest quality cells. Usually everything that is received is subject to fertilization. Because of this, the risk of replanting low-quality embryos increases. The success rate of IVF in a short protocol is always lower than in a long one.

Stages of the treatment cycle

The short protocol least of all resembles violent intervention in the work of the female body. It is fully consistent with its biological nature and proceeds in accordance with the natural cycle.

After the start of menstruation, the woman should go to the doctor and get an appointment to start the protocol. On the 3rd day of the cycle, hormonal preparations begin. When the follicles mature, ovulation is stimulated by other hormones. After that, after 36 hours, the woman is punctured with follicles and oocytes that are mature and ready for fertilization are taken.

At the next stage, the eggs are fertilized with the sperm of a spouse, partner or donor (depending on IVF conditions). After a few days of being in the nutrient solution and after assessing the quality of the embryos, the embryologist transfers the embryos to the uterus.

If the protocol is successful, the embryo (or several at once) is implanted in the endometrium of the uterus, pregnancy begins.

On the 3rd day of the menstrual cycle, a woman takes drugs that partially block the work of the pituitary gland with agonists (for example, Dexamethasone). At the same time, stimulation is carried out with follicle-stimulating drugs and menopausal gonadotropins (Meriofert). After the puncture of the follicles, the woman begins to take progesterone preparations in order to maintain the second phase of the cycle and, under favorable conditions, promote implantation and gestation.

Scheme step by step by day

There are three main varieties of short protocols, which differ slightly mainly in the selected hormonal drugs. This:

• protocol with agonist hormones;
• protocol with hormonal antagonist drugs;
• ultrashort protocol with antagonist drugs.

Under the protocol with agonists, stimulation with Dexamethosone or other hormones that belong to menopausal gonadotropins, or GnHRH agonists (Decapeptyl) begins on the 2nd day of the menstrual cycle and ends on the 5th day.

On the 14th day of the cycle, the follicles are punctured. A step-by-step description of the procedure will help a woman not be afraid of egg retrieval: everything takes place under anesthesia and lasts no more than 15 minutes. When the patient falls asleep after the introduction of intravenous anesthesia, doctors use a long needle under ultrasound control to make a puncture in the back wall of the vagina, get to the ovaries and “draw” the follicular fluid with the oocytes in it through the needle into special sterile containers. This completes the procedure.

When the woman wakes up, she is given progesterone to maintain the second phase and is allowed to go home until the day of the embryo transfer.

How a woman's well-being will change during a short protocol is an ambiguous question. Some do not show any significant changes. Others tolerate it more difficult, it all depends on individual sensitivity. From the 3rd day of the cycle, when there is stimulation with GrGNG agonists, as well as drugs that “stimulate” ovulation (“Puregon”, “Gonal”), there may be sensations of bloating in the abdomen, hot flashes, mild nausea and episodic headaches are possible.

Many women note an extremely unstable psychological and emotional state, in which tears are replaced by anxiety, and laughter is replaced by a depressive state. This is a side effect of agonists and antagonists. Gradually it will pass, you just need to be patient.

Here, I found information a long time ago on how to increase the chances of eco.
how to increase the chances of successful embryo implantation??? The first stage is replanting. 1. It is believed that on the day of replanting (a few hours in advance) it is necessary to have good sex with your husband (preferably with an orgasm). Why? Because this will in the best way increase blood circulation in the uterus, which means that it will be easier for the embryos to implant. But after replanting, up to the analysis of hCG (or until the first ultrasound - then consult a doctor) - you should not have sex, you must observe complete sexual rest. 2. Eat pineapples and protein foods, drink plenty of fluids. 3. 2 hours prior to embryo transfer, one tablet of PIROXICAM-Piroxicam should be taken, which increases the likelihood of successful implantation. The second stage - after replanting
1. The replanting was successful and you are already at home. The first three days you need to lie down, you can say “a corpse”, getting up only to the toilet and the kitchen for reinforcements. These first days are very important as the implantation of the embryos will take place. It is known that blastocysts are implanted on the first day (the day of transfer is not considered), and blastomeres in the first 2-4 days. I do not agree with this. IF I HAVE PROBLEMS WITH HEMOSTASIS AND, CONSEQUENTLY, WITH CIRCULATION IN THE UTERUS, THEN I SHOULD NOT BE A CORSE.
In the following days, it is advisable to start moving: do not strain, do not run, but just walk, walk, and it is better in the fresh air. An hour or two of walking per day is enough. 2. It is very important to insert Utrozhestan correctly, because many IVF pregnancies in the early stages are lost due to its improper use. Our body needs appropriate progesterone support, so it is important to follow the doctor's prescriptions for taking the necessary drugs on time and correctly. As for the introduction of Utrozhestan (many doctors do not focus on this - and this is important!) - for this we lie down on the bed, put a pillow under the ass, spread our legs wide and shove it far, far away (preferably right to the cervix or to the very ears)) into the vagina. It is advisable to lie down after this for about an hour and not get out of bed and from the pillow. Thus, Utrozhestan will not spill onto the pad and its maximum absorption into the body will occur. I don't quite agree with this either. Of course, it needs to be inserted correctly, but it dissolves in about an hour. It is enough to lie down for an hour, if then a part falls out, the body will take for itself what is needed for that time. You really need to push it in as deep as you can.
3. Aim for success and stay calm.
4. Discuss the situation with the doctor in advance, if you start to have pain, then how to eliminate them (you cannot tolerate it). The pain is the same as during menstruation, but can be worse. And they cannot be tolerated. The most harmless remedy is no-shpa. But, unfortunately, it does not help everyone. Everything else is more harmful. But in the period of 3-7 days (the first day - the day of the puncture), you can take almost everything (even analgin and other GINS). But you need to discuss this with your doctor. Candles with papaverine help well (absolutely harmless), but, again, not for everyone
5. Further, in the period of 3-7 days, maintain a semi-bed rest. No stress, no housework. Walk in the yard on a bench (I quietly went out into the yard with a book, sat on the bench for a couple of hours - and back to bed). There are no dog walks, shops, etc. Forget about all this
After the 7th day, you can already begin to move slowly. But everything is very, very moderate. I do not agree. It's better to take a little walk. Especially in summer. Nothing good comes from lying.
6. From the 4th day, you can lead a normal life, with the exception of the following:
- lift weights over 2 kg, jump, run;
- live sexually until the next menstruation;
- take hot baths and wash in the bath (you can take a shower);
- it is desirable to avoid hypothermia and overheating, to beware of colds;
- without special instructions (which can only be given by a doctor) to take medications;
- avoid all sorts of conflicts as much as possible;
- desirable to avoid