In vitro fertilization (IVF) is one of the methods of assisted reproductive technologies. The procedure involves fertilization of oocytes with sperm outside the woman's body and further transfer of embryos to the uterine cavity.
The main question that interests all patients is "What is my chance to become a mother?" To answer this question, many factors must be considered, such as:
- Woman’s age
- Cause of infertility
- Ovarian reserve
- Spouses lifestyle
- Genetic factor
IVF procedure consists of 6 stages
Stage 1: Stimulation of Superovulation
Controlled stimulation of superovulation is an important stage of the IVF program. It is carried out by prescribing hormonal preparations to obtain the optimal number of oocytes. The scheme is selected by the doctor individually, taking into account her health condition, the disease history, and the specific clinical situation. Treatment success depends on these conditions.
Stage 2: Ovarian Puncture
Puncture of follicles is carried out in order to obtain eggs (oocytes) for their further fertilization. Carried out under intravenous anesthesia. Oocytes are obtained by puncture of vaginal wall and aspiration of follicle contents.
How is the procedure going?
It is advisable to come to the clinic 15-20 minutes before the appointed time. The patient must comply with fasting regulations and stop eating 6-8 before the procedure. After paperwork is done, the patient goes to the ward to be examined by an anesthesiologist. Next, the nurse escorts the patent to the operating room, where manipulation will be carried out.
Puncture takes place under intravenous anesthesia. The procedure is performed under continuous ultrasound control. The doctor punctures the vaginal wall with a thin needle, and then injects it into the follicle. The liquid contained in the follicle is aspirated into a tube. Test tube transmitted to an embryologist who evaluates follicular fluid for the presence of an oocyte in it.
On average, the procedure takes about 20 minutes. After the procedure, the patient is escorted to the ward and further monitored by an anesthesiologist.
The partner comes to the puncture 15-20 minutes before the designated puncture time (if the partner's material is not cryopreserved and donor semen is not used). The term of abstinence of a partner from sexual life should not exceed 2 days.
After passing the biomaterial, the ejaculate undergoes a treatment in which mobile sperm are isolated for further fertilization.
Stage 3: Oocyte Fertilization and Embryo Cultivation
From the moment the embryologist receives a tube with follicular fluid, the embryological stage of the IVF procedure begins, which includes fertilization and cultivation of embryos.
The resulting follicle puncture eggs are placed in an incubator. It created optimal conditions similar to those in the mother's body.
After 4 hours, fertilization is carried out. The method of fertilization is chosen individually and depends on many factors
In our clinic, fertilization is carried out in the following ways:
- IVF - spermatozoa in a strictly defined amount are added to the medium where the oocytes are kept and fertilization occurs.
- ICSI - the procedure is carried out, as a rule, in case of male infertility factor. And it differs in that the sperm is introduced into the cytoplasm of the egg using a micromanipulator.
- PICSI is a method based on the ability of a sperm to bind to hyaluronic acid, which allows you to evaluate not only its morphology (correctness of structure), but also the integrity of the DNA chain, which makes it possible to bring sperm selection closer to physiological.
- The IVM program involves the production of immature oocytes from antral follicles. Immature eggs are ripened in a special medium and then a standard fertilization and cultivation procedure is carried out.
- placed in a special medium for ripening to metophase II, and mature ones are fertilized.
- Fertilization results are evaluated the following morning. The cultivation of embryos in our clinic takes place in multi-gas incubators of the last generation, which makes it possible to bring the cultivation conditions as close as possible to natural ones.
On day 5, the embryologist assesses the development of embryos and determines further tactics together with the attending doctor and patient.
Stage 4: Embryo Transfer
Embryos are transferred to the uterine cavity in a fresh cycle (in the stimulation cycle) or after defrosting of previously cryopreserved embryos.
Embryo transfer is carried out on day 3 (extremely rarely, there are certain indications) or day 5 of embryo cultivation. As a rule, one embryo with the best morphological characteristics is transferred. The remaining embryos are cryopreserved.
In cases of pre-implantation genetic testing, the risk of SGJ, endometrial pathology by ultrasound on the day of transfer, embryo transfer is not carried out, all embryos are cryopreserved (Freeze all).
The procedure is painless, carried out without anesthesia. Embryos are transferred by catheter into which embryo is pre-placed. The whole process takes place under the control of the ultrasound. Through the cervical (neck) canal, the catheter is introduced into the uterine cavity. The catheter is then removed and transmitted for examination to the embryologist. The specialist must make sure that the embryo does not remain in the catheter.
The duration of the procedure is 5-7 minutes. The patient is recommended to stay in the clinic for some time.
On what day the transfer of the embryo will be optimal for your couple, it is necessary to discuss together with the doctor, taking into account medical indicators and personal practical experience.
After the embryo transfer, the most exciting period begins - waiting. It will be possible to diagnose pregnancy 9-10 days after the transfer of the embryo.
Stage 5: Pregnancy Test
Definition of biochemical pregnancy: ingCGH in urine or blood. It is recommended to perform a blood test starting from 9-14 days after embryo transfer. Attending physician is going to help to read the test results.
6 stage. Ultrasound for 21 days
It is carried out with the aim of diagnosing clinical pregnancy. Determination of the presence of a fruiting egg in the uterine cavity, embryo in it, heartbeat. It is recommended to carry out no earlier than 21 days after the transfer of the embryo to the uterine cavity.
IVF in natural cycle
This program is suitable for patients who are contraindicated with hormone therapy (stimulation of superovulation), with cancer, thromboembolic diseases, with a sharply reduced ovarian reserve, with the risk of SGJ.
The difference is the lack of stimulation of ovulation, while 1-2 eggs can be obtained.
All further steps do not differ from the standard program.
IVF in the natural cycle can be combined with IVM.
IVF with reduced ovarian reserve.
With a reduced ovarian reserve, the chance of pregnancy is much lower.
First of all, together with the attending physician, it is necessary to determine the treatment tactics. To optimize the outcome, our Center uses different treatment approaches such as:
- Banking of own oocytes
- Double stimulation (Duostim)
- Protocol with minimal stimulation
- IVF in natural cycle
- IVF with donor oocytes