All about the eco procedure. Federal free eco program to help infertile couples

The birth of a baby is the most long-awaited joy for the mother and the whole family. Unfortunately, not everyone is able to conceive a child for various reasons. Until recently, a considerable amount of money was required, but now the situation has changed. Let's consider important questions: what is needed for IVF, how to get in and sign up, up to what age can IVF be done for free?

Let us briefly consider the essence of the artificial insemination operation. Fertilization does not occur naturally, but in vitro. Test tube baby - realities modern world, and in many countries women were able to become mothers thanks to IVF. The embryo grown under artificial conditions is transplanted into the uterus for further development. In some cases, a child can be carried by and.

Who gets IVF for free? It is carried out:

• in case of female infertility;
• in case of male infertility;
• after ineffective infertility treatment.

The procedure is carried out in the presence of an insurance policy and relevant documents. Since 2013, the possibility of artificial conception has become possible “on a competitive basis,” that is, with sponsorship payment. How to find a sponsorship program? You can find out about this from your gynecologist.

Note! Since 2013, artificial insemination under the compulsory medical insurance policy has been available to everyone.

Until recently, an infertile woman was given the only free chance to become a mother. After an unsuccessful attempt at in vitro conception, the couple was forced to take out a loan to pay for a repeat procedure. How many times can you do IVF for free? Since 2013, the state has not limited the number of attempts to conceive, with the goal of improving the demographic situation in the country. A strong family is the basis of a strong state.

New IVF law

According to the new legislation, any woman can undergo artificial insemination, namely:

• outside of marriage registration;
• with HIV infection;
• in case of infertility of the husband.

What services does the state pay for? The list of services provided free of charge includes:

• ovarian stimulation;
• fertilization procedure;
• growing an embryo in vitro;
• implantation of the embryo into the uterus;
• examination of the patient;

Ovarian stimulation aims to obtain as many mature eggs as possible. For this, the patient is administered hormonal drugs. The stage of cell maturation is monitored through ultrasound.

Next, germ cells ready for fertilization are removed from the woman’s body and insemination is carried out with the sperm of her husband or donor under artificial conditions. Fertilized cells are kept in special conditions for about six days, observing the development process.

The embryos are then transferred into the uterine cavity. Usually 2 or 3 embryos are transferred, so women after IVF can give birth to twins or triplets. On at this stage It is possible to perform resection (removal) of excess embryos at the request of the patient. However, often this procedure ends in termination of pregnancy.

After the embryos are implanted into the uterus, the progress of the pregnancy is monitored using ultrasound. This procedure is performed 21 days after embryo transfer. To maintain the successful development of the embryo, patients are administered progesterone preparations.

Unfortunately, donor materials and additional treatment not included in the list of services are paid for by the patient herself. That is, the state can only pay a fixed amount of 106,000 rubles: everything above this amount is paid by the patient.

Note! Before attempting artificial insemination again, you must again collect and provide the Commission with the entire package of necessary documents.

Is it possible to do IVF twice in a row if the first attempt was unsuccessful? According to the resolution of the state program, the fertilization procedure can be carried out twice during the year.

It is worth noting that in modern society the problem of infertility for various reasons has reached large proportions. Sometimes you have to wait for your turn for about a year, however, waiting does not become an obstacle to achieving results. Many women get a chance to get pregnant thanks to sponsorship programs.

How to get IVF for free

This procedure is included in the compulsory health insurance program, so any citizen of the Russian Federation has a chance for artificial conception. How to sign up for free IVF? To do this you need to do the following:

• contact a gynecologist;
• take an extract from the medical record;
• take a referral for IVF.

Note! The gynecologist is obliged to first conduct a course of therapy for the treatment of infertility, and only then gives a referral for artificial insemination.

The choice of a clinic where IVF is performed free of charge is at the discretion of the patient. How to find a suitable clinic? It is on the list of the medical insurance policy. If the specified clinics are not suitable for the patient, you can choose a paid medical institution.

How many days to wait for a decision on approval for IVF? This usually does not take more than ten days. The relevant information is displayed on the official website of the Commission.

When contacting the clinic, you must have copies of the following documents:

• compulsory medical insurance policy;
• passport of both spouses;
• extract from the medical card;
• SNILS.

The extract from the medical card must indicate the exact diagnosis of the disease and the ICD 10 code. The extract also records a conclusion about the health status of the woman, and sometimes the spouse.

Up to what age can IVF be done for free? According to the federal program, artificial insemination can be performed on women from 20 to forty years old. However, there are certain rules that provide for the procedure.

IVF is carried out if:

• Both spouses have Russian citizenship;
• no children of their own;
• confirmed ;
• there have been unsuccessful attempts to treat infertility in other ways;
• missing .

What restrictions may there be for the procedure? These include:

• the presence of a malignant tumor;
• severe pathologies of the genital organs;
• drug/alcohol addiction;
• open foci of acute inflammatory processes;
• mental disorders.

Is it possible to do IVF for free if there are benign tumors? If a woman has a benign tumor, surgery to eliminate it is indicated. After this, you can queue up for artificial insemination.

Efficiency of IVF

Thanks to the current federal program, more than five million babies have been born. However, the effectiveness of artificial insemination largely depends on several factors:

• age and health of parents;
• quality of medicines used;
• qualifications of doctors;
• embryo viability.

In practice, the first attempt at fertilization does not always bring the desired result. According to statistics, conception in most cases occurs on the second or even third attempt. Some women successfully become pregnant on the first try, while others need to repeat the procedure many times.

Do I need new embryos for every IVF attempt? IN modern conditions It is possible to freeze grown embryos, so repeated egg retrieval is not done. The problem with artificial insemination is not the removal of eggs and the cultivation of embryos, but multiple pregnancies. Reduction (removal of excess embryos) can lead to spontaneous rejection of implanted embryos in the uterus.

However, artificial insemination has one undeniable advantage over natural conception - the ability to identify and prevent genetic diseases, such as Down's disease. The expectant mother can be completely calm about her child and not be afraid of severe developmental defects and other troubles. It is also possible to determine in advance the gender of the fetus - boy or girl.

Children conceived in a test tube show the best results in everything - in academic performance, health and development. These are long-awaited babies who receive special attention. Childbirth after IVF takes place as usual; complications can be caused not by the method of fertilization, but by the patient’s health condition. It should be taken into account that women with various health conditions are enrolled in artificial insemination.

Bottom line

The dream of being a mother has become a reality in our country. Any woman, single or married, has a chance to become pregnant and bear a healthy baby. The federal program of the Russian Federation took care of this, which legislated the right to artificial conception. If previously the chance for free IVF was given once, then after 2013 attempts at fertilization are unlimited. To do this, you must have a medical insurance policy and an extract from your medical card about unsuccessful conservative treatment of infertility.

There are also restrictions for artificial insemination - age after forty years, severe health pathologies, immoral lifestyle (drug addiction and alcoholism). HIV-infected patients have the opportunity to carry and give birth to a healthy baby, thanks to new technologies for hardware-based sperm purification from viruses. New program IVF is confidence in the absolute health of the fetus, since the embryo is checked for genetic and other abnormalities before being transplanted into the uterus. The joy of motherhood has become available to every woman.

Infertility problem in last years more relevant than ever. If until 2014, childless couples did IVF at their own expense, now the budget allocates money for this procedure. Of course, this amount is not enough for everyone. However, if you get in line and wait your time, you may have a chance at in vitro fertilization.

However, there are a number of restrictions, as well as a huge number of conditions for receiving this public service. Before submitting all the necessary documents, you need to find out everything related to free artificial insemination.

How to do IVF for free

The in vitro fertilization procedure is performed as part of a compulsory health insurance policy. Every citizen of Russia receives compulsory medical insurance without paying a single ruble. A free policy allows you to be examined and treated at a local clinic. Previously, infertile couples could not afford IVF. Its high cost and lack of guarantees of successful fertilization frightened many women dreaming of a child. Every couple who does not have additional funds for this now knows how to do IVF for free.

In 2014, the state began to allocate quotas for childless couples who are unable to conceive a child naturally. Since 2016, the IVF procedure has been included in the list of services covered by compulsory health insurance. Since then, every couple who has no medical contraindications for it can undergo in vitro fertilization, and has also received a verdict - infertility.

Now this procedure can be done absolutely free. You just need to go to the hospital for a consultation to make sure there are no contraindications, collect the necessary set of documents and stand in line from the same couples who want to have a child.

Queue for free in vitro fertilization

After all the necessary documents have been reviewed and accepted, both partners are put in line for free IVF. For each woman, a unique code consisting of numbers is created. With it you can easily and simply track the movement of the queue. This can be done on the official website of the state executive body of the constituent entity of the Russian Federation. The electronic queue will allow you to constantly monitor the situation and see how close the dream of pregnancy is becoming.

In which clinic can IVF be done?

A couple can choose a medical institution specializing in IVF on their own. The commission provides an impressive list of organizations from which you can choose the most suitable clinic. Before undergoing IVF for free, many couples choose a medical center in advance, based on numerous recommendations from acquaintances or friends.

After the clinic has been selected, the commission issues a referral for IVF there. After a successful result, the woman is under the supervision of doctors throughout the pregnancy from the same medical institution that performed in vitro fertilization.

Features of the free IVF procedure

Based on medical reports, the cost of in vitro fertilization is no more than 141 thousand rubles. This amount includes the following services:

• Consultation by medical specialists during the entire IVF process.
• Stimulating ovulation with medications.
• Fertilization and embryo transfer.
• Confirmation or denial of pregnancy.

If the procedure turns out to be more expensive than the amount provided for it, cash in excess of the established norm are paid by patients of the clinic. The price quite often increases due to biological material from donors.

Conditions for participation in the program

Not every couple can receive free IVF services. To sign up for the queue, you must meet all the conditions. To begin with, the couple is sent for examination to ensure through tests that they are unable to conceive a child naturally. Not every city has the appropriate equipment with which IVF can be performed. Therefore, some couples have to go to large cities to get the necessary medical service.

After passing the commission and issuing a health report, the institution sends a request to the local hospital to which the woman is assigned. From there they are sent a medical history, as well as information about all the procedures performed, including gynecological ones. The doctor prepares this information antenatal clinic. Then the extract is reviewed by a commission that issues permission to participate in the free IVF program.

Indications for in vitro fertilization

IVF can be done under the compulsory medical insurance policy only after a strong recommendation from a doctor. Only if there are certain indications, the commission gives the couple a chance to undergo free in vitro fertilization. Such indications include the following processes:

• Endocrine diseases.
• Surgeries on the pelvic organs (uterus, ovaries).
• Obstruction of the fallopian tubes.
• Spikes.
• Diagnosis of infertility.
• Lack of pregnancy after long treatment, proven by hospital discharge.

Free IVF and age are inextricably linked. Only women under 38 years of age can be admitted to the procedure. It is also necessary to remember that infertility can occur not only in women, but also in men. Therefore, both partners should be examined. Not only those couples who are legally married can participate in the free IVF program under compulsory medical insurance. Absolutely everyone has the right to become happy parents. The stamp in the passport does not play a decisive role.

Infertility and in vitro fertilization

Free IVF in Moscow is a great success among women of all ages. Every year in the country the percentage of couples who are diagnosed with infertility is increasing. Unfortunately, this pathology does not bypass young girls and boys. Previously, the statistics were not so depressing, and most often only women on the verge of menopause suffered from infertility.

Worsening conditions environment, harmful products, containing dangerous preservatives, as well as life in constant stress - all these reasons contribute to the deterioration of the demographic situation in the country. Therefore, the inability to get pregnant is familiar to women of different ages. In such cases, for many couples, the free IVF program is considered the only way to try to have children. For most couples, in vitro fertilization has a favorable outcome, and the fetus successfully takes root in the womb of the expectant mother. However, we must not forget the statistics, in which a woman’s age plays an important role.

At what age is it better to do IVF?

Pregnancy, both natural and accompanying the IVF procedure, can only occur in the presence of ovulation. Therefore, the sooner a girl decides to have a baby, the easier it will be for her to do so. Many are concerned about the question up to what age free IVF can be done with maximum chances of success. So, it is necessary to remember that over the years the eggs in female body is getting smaller. In this case, new ones do not appear, and old ones do not have the ability to be restored.

In addition to their quality deteriorating over the years, they are killed by alcohol and chronic stress, as well as various diseases. Therefore, every year the chances of natural conception decrease. Even the IVF procedure cannot give a 100% guarantee that fertilization will occur successfully and the embryo will strengthen. Therefore, age plays a significant role in the natural and artificial method of pregnancy formation.

Age restrictions for IVF

Many patients interested in this type of fertilization are concerned with the question of up to what age free IVF can be done without various health complications. Doctors are unanimous that it is better to decide on this method before the age of 35. The possibility of a favorable outcome at this age is 40%. For the in vitro fertilization method, these statistics are very positive.

Women between the ages of 35 and 40 fall within the success rate of 30%. After passing the 40-year mark, the chances of becoming a mother are reduced to a minimum. At this stage, women have only 10% chance of becoming pregnant. In addition to successful fertilization, they face a difficult journey of bearing a child. The older future mom, the more difficult it will be for her to endure pregnancy. Free IVF under the compulsory medical insurance policy can only be done up to 38 years of age.

Tests required for the free procedure

The woman and her partner are required to undergo a medical examination in order to be placed on the waiting list for in vitro fertilization. The list provided by the compulsory medical insurance policy includes the following tests:

• Blood composition studies.
• Analyzes for infectious diseases.
• Examination of hormone levels.
• Examination and ultrasound of the mammary glands.
• Checking the fallopian tubes.
• Consultation with an endocrinologist.
• Fluorography.
• Spermogram.

IVF can be done free of charge under the policy only after passing all the above tests. It is impossible to get results from all of them in one day. Therefore, it is necessary to prepare to wait for the doctors’ verdict. If deviations from the norm are detected, treatment is carried out. Only after this the woman is given permission to undergo IVF.

Documents for the free IVF procedure

When signing up for in vitro fertilization, you should know what documents are needed for this. Especially when it comes to carrying out a free procedure under the compulsory medical insurance policy. Doctors will not provide special consultations to explain in detail all the documents that are needed to be placed on the waiting list. Fortunately, their list is freely available. For IVF you will need the following list of documents:

• Medical certificates confirming all tests.
• Discharge from the hospital where the client and her partner were initially examined. It must contain a recommendation from the head physician for in vitro fertilization.
• Original and copy of civil passport, as well as compulsory medical insurance policy.
• SNILS insurance certificate (original and copy).
• Consent of both partners to undergo the IVF procedure.

Before submitting all of the above documents, you should make sure that you have copies of certificates from hospitals, as well as important opinions and recommendations of doctors. These copies can help if any document gets lost.

What you need to know about the IVF procedure

Free IVF under compulsory medical insurance is done in exactly the same way as paid IVF. The procedure is no different using other devices and medical technologies. First, doctors perform artificial stimulation on both partners to collect the necessary biological material for in vitro fertilization. Eggs and sperm are carefully examined before they are given birth to a new life.

How is artificial insemination done?

A woman undergoes superovulation using hormone injections. With artificial stimulation, the ovaries produce several eggs instead of one. After this, a day is set for their removal. The operation is performed under general anesthesia. A certain amount of sperm is taken from the man. Unlike women, they have it much easier, since the collection of biomaterial occurs naturally and without the intervention of doctors.

The collected material is sent to the laboratory. The sperm along with the egg are placed in a special environment that will trigger fertilization. Under the constant supervision of an embryologist, an embryo emerges within the environment. If sperm are not motile enough, the process is accelerated using the ICSI procedure. In this case, the sperm fuses with the egg thanks to the action of a very thin microneedle.

After about 3 days, the created embryo is placed in the woman's uterus. Guided by the law of the Russian Federation, during free IVF under the compulsory medical insurance policy, doctors have the right to transfer only 2 embryos. Most often, only one takes root. But it is after IVF that the opportunity to carry and give birth to twins increases. In the USA, it is allowed to place 3 embryos in a woman’s uterus, but in Sweden only one. All remaining eggs and sperm are frozen. This is done in order not to subject the woman to another major operation in case a repeat IVF procedure is needed.

Women

WOMEN

First of all, you need to identify your ovarian reserve. This is a genetically stored supply of eggs in a woman’s ovaries in the absence of pathophysiological changes in her reproductive system. Unfortunately, ovarian reserve decreases with age. Also leading to its reduction are: ovarian surgeries, radiation exposure, antitumor chemotherapy. It is checked by the level of hormones AMH, inhibin B, FSH. Either in the first days menstrual cycle you can count the number of antral follicles.

It is important to prepare the uterine cavity. The operation is performed according to personal indications; if a woman has pathologies of the uterine cavity, such as synechiae or polyps, they must be removed before IVF. Also, hydrosalpinx, a fluid that accumulates in the fallopian tubes, negatively affects the effectiveness of the program, since this fluid has an embryotoxic effect. Treatment of this pathology must be carried out before the start of the IVF procedure.

You need to check the smear for infections. Give a smear for bacterial flora. Based on the results, the doctor may prescribe treatment and hormonal testing. At best, do a full examination so that if there are infections or problems hormonal levels correct this before the in vitro fertilization stages begin.

HORMONES THAT A WOMAN SHOULD CHECK:

ULTRASOUND STUDIES MUST BE DONE TWO TIMES PER CYCLE TO DETECT PATHOLOGIES.

As soon as you have completed all the examinations and are fully prepared, you begin to enter the IVF procedure. 7-10 days before the start of your menstrual cycle, make an appointment with your doctor. You should perform an ultrasound of the pelvis, assess the condition of the ovaries, and the thickness of the uterine mucosa. Upon completion of all examinations, your treating doctor should have a complete picture of your health status, as well as the health status of your spouse. A personal card is created for each patient, which indicates the patient’s health status, the entire treatment regimen, medication dosages, and the dates of each subsequent visit.

On days 3-5 of the cycle:

FSH. This is a very important indicator. The set of drugs for further stimulation of a woman depends on its level;

On day 3-4:

On any day of the cycle:

Prolactin

Days 3-8 of the cycle:

Estradiol

Androgens

On any day of the cycle:

thyroid hormones

For men

DESCRIPTION OF PREPARATION FOR IVF STAGES TO THE MAN

The man needs to pass spermogram is an analysis of seminal fluid that determines a man’s reproductive ability. It is also possible to take this test in our clinic. This analysis is done before the first stage of IVF, as the process of taking a spermogram is quite simple. Sperm is donated by ejaculation in the clinic on the day of the test. For this purpose, the clinic has a special comfortable room, and a special container is provided free of charge. If a man experiences discomfort and is not sure of the positive outcome of ejaculation in the clinic, it is allowed to do it at home. To do this, you need to buy a container specially designed for this at the pharmacy. After collecting the sperm, the seminal fluid must be submitted for analysis within two hours.

A spermogram allows you to establish a man’s fertility and identify existing diseases of the reproductive system. If the results of the analysis reveal deviations from the norm in the spermogram, then a consultation with an andrologist is necessary in order to understand whether the abnormalities can be corrected and what they are associated with. There may be other medical problems, such as genetic defects on the Y chromosome.

Such defects are sometimes the cause of male infertility. Men with a congenital absence of the channels through which sperm exit the testicles - the vas deferens - are often carriers of the disease cystic fibrosis. If this problem is detected, genetic testing should be performed.

The man must also undergo a urethral smear. This analysis identifies diseases such as prostatitis, urethritis, and sexually transmitted diseases. Full list You can find out about the tests in the article “Preparing for IVF: tests that need to be taken.” You should be tested for infections and latent infections (TORCH infections).

I WOULD LIKE TO REMIND THAT TO OBTAIN A CORRECT RESULT, YOU SHOULD FOLLOW THE FOLLOWING RULES:

Avoid sexual intercourse. Optimally - 4 days.

Avoid alcoholic drinks, sleeping pills and sedatives during this period.

Avoid visiting saunas, baths, hot baths.

BELOW IS A DECODING OF THE CONCLUSIONS SPERMOGRAMS

		Normospermia (normozoospemia).	Sperm counts are normal.
		Polyspermy.	Increased amount of ejaculate produced.

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

Ovarian reserve can be checked 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. Increased FSH levels are associated with decreased 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 the IVF process begins. A hydrosalpinx, a fluid-filled, blocked fallopian tube, reduces the success rate of IVF because the fluid in the tube is embryotoxic, and many doctors advise removing the damaged tube before IVF.

• Taking a spermogram

Before IVF, a spermogram (sperm analysis) is performed. If abnormalities are detected in the spermogram, a consultation with an andrologist is necessary to determine whether these abnormalities can be corrected and whether they are associated with other medical problems. For example, genetic defects in the Y chromosome are associated with some cases of male infertility, and men with a congenital absence of the vas deferens (the tubes that carry sperm from the testicles) often carry the genetic defect responsible for the disease cystic fibrosis. In such situations, genetic testing may be required. Infertility is often caused by various abnormalities of male reproductive cells, which include teratozoospermia. Teratozoospermia is characterized by a violation of the structure of sperm. The diagnosis of teratozoospermia is made to a man when half or more of his ejaculate consists of pathologically altered sperm, and the teratozoospermia index exceeds 1.6. The experience of reproductive doctors shows that with teratozoospermia, IVF the best way conceiving a child

• Taking blood tests

Undergoing IVF requires taking blood tests for HIV, syphilis, hepatitis B and C, and for the presence of antibodies to rubella. It is also necessary to make a smear of mucus from the vagina and cervical canal for bacterial flora to ensure the absence of infections. According to 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, a TSH test is one of the first to be done before planning a pregnancy under the IVF protocol. 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 as progesterone if it is normal. 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 an IVF cycle - from 10 to 20 (the exact number of eggs during IVF depends on the patient’s body) suitable for fertilization. This 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 an IVF cycle, hormonal drugs are used and a scheme for their use, called a “stimulation protocol,” is determined. The process of stimulating ovulation is of great importance for the IVF procedure.

Ovarian stimulation drugs

To stimulate superovulation, drugs 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 drugs are somewhat cheaper than recombinant drugs, and contain, in addition to the FSH hormone, also the LH hormone. Recombinant FSH preparations are synthesized using biotechnological methods; they provide maximum precision of injection thanks to the injector pen and can be used by the patient independently. Drugs to stimulate superovulation are selected strictly individually.

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

Human menopausal gonadotropin (HMG) (menopur)
. Follicle-stimulating hormone (FSH) (gonal-F, puregon)
. Human chorionic gonadotropin (hCG) (choragon, rotten, ovidrel)
. Clomiphene citrate (Clomid, Clostilbegit)

Premature ovulation with IVF

Premature rupture of the follicle can negate IVF. Therefore, to prevent a woman’s own hormones from interfering with the stimulation of superovulation and to control the superovulation process, 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. Control of follicle growth is carried out every other day, starting from the fifth day of stimulation. It is also possible to adjust the dose of prescribed medications. Some patients may have blood tests to measure estradiol levels. Normally, the level of estradiol in the blood increases as the follicles mature, and the level of progesterone remains low until ovulation.

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

When the follicles have reached the desired size (usually on days 10-14 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 abort nearly 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 by the pituitary gland, thereby reducing the risk of premature ovulation. However, even today about 10% of cycles are interrupted, even before the injection of hCG. Most common reason cycle cancellation - 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 likelihood of pregnancy is extremely low, 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 operated ovaries, i.e. in those patients who have a reduced ovarian reserve (the supply of follicles in the ovaries). As a result of a decrease in the number of follicles, the level of FSH in the blood increases. It is possible to adjust the dose of the drug to stimulate the ovaries, or prescribe stronger stimulating drugs, such as recombinant ones.

When a very large number of follicles (more than 25) mature, or when the level of estradiol in the blood is high, the IVF cycle has to be canceled due to the threat of developing polycystic ovary syndrome (PCOS). In this case, the ovaries are punctured and all embryos obtained are frozen. Interruption of an IVF cycle at this stage occurs 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 later be thawed and used in another IVF cycle without inducing superovulation.

Follicle puncture

Follicular puncture is performed to obtain eggs. It is carried out during transvaginal puncture of the ovaries for IVF by pumping out follicular fluid through a thin aspiration needle under ultrasound control.

Follicle puncture is performed under local or short-term (10-20 minutes) general anesthesia. The vagina contains a transvaginal ultrasonic sensor, with which mature follicles are visualized and a thin needle is inserted into the follicles through the vaginal wall. The eggs are sucked out from the follicles one by one through a needle attached to a suction 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 room for 2-3 hours. After the puncture, driving is prohibited. Some women experience painful cramps after the puncture. A feeling of fullness or pressure in the abdomen may persist for several days after the procedure.

Fertilization of eggs in vitro. Embryo cultivation

After puncture of the follicles, the follicular fluid (corpus luteum) containing the eggs is immediately transferred to the embryology laboratory, where it is examined by an embryologist under a microscope, selecting the eggs. The eggs are washed in a special medium and their maturity is then 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 puncture of a woman's follicles, her husband donates sperm into a special non-toxic sterile container. Some men have great difficulty collecting sperm to order. They must 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 sperm are washed from the seminal fluid using a special technology, which makes it possible to select the most motile and morphologically normal sperm. A specified number of motile sperm (usually 100,000 sperm/ml) are mixed with the eggs (called in vitro fertilization or in vitro insemination) and placed in an incubator. Penetration of a sperm into an egg usually occurs within a few hours. Fertilization is usually carried out 2-6 hours after puncture of the follicles; 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 imitate the conditions in the fallopian tubes, creating the maximum possible favorable conditions 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, which create optimal conditions for the growth and development of the embryo.

Intracytoplasmic sperm injection - ICSI

When, for various reasons, a low fertilization percentage is expected during the IVF procedure (for example, with a small number of motile sperm in the semen or a low fertilization percentage 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. Pregnancy rates and birth rates after ICSI are comparable to results after traditional IVF. If a man has hereditary pathologies that cause infertility, which can be transmitted from father to son, medical genetic counseling is recommended before ICSI.

After adding sperm to eggs or performing ICSI, the embryologist checks how many eggs are fertilized normally. A normally fertilized egg (zygote) at this moment is one cell with two pronuclei. Pronuclei are like small transparent vesicles inside the cell, one of them carries the genetic material of the father, and the second - the mother. When they merge, a new life with a unique genetic makeup is formed. Eggs 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 fertilized normally after in vitro insemination or ICSI. A lower percentage of fertilization is observed 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 sperm or with pathology of the eggs.

Normally fertilized eggs (zygotes) continue to be cultured; they begin to fragment, and their quality is assessed after another 24 hours. Embryos are assessed based on their appearance and crushing speed. Good quality embryos divide fairly quickly: two days after fertilization, normal embryos have 2-4 cells of approximately equal size with clear 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 fluid has formed 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 into 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 into 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 day 5 after egg retrieval). The eco blastocysts can then be transferred to the uterus. Some researchers note that transfer of embryos at the blastocyst stage more often leads to pregnancy. There can be two explanations for this. Firstly, transfer of the blastocyst to the uterus is more natural, since in nature the embryo passes from the fallopian tube into the uterus at this stage. In addition, culture to the blastocyst stage allows the embryologist to select the “best” embryos, since weak embryos or embryos with genetic abnormalities are arrested before they develop into a blastocyst.

Blastocyst transfer also reduces the likelihood of potentially dangerous multiple pregnancies. The high implantation rate of blastocysts allows for the transfer of fewer embryos into the uterus (usually one or two), reducing the risk of multiple pregnancies and associated complications.

While blastocyst transfer is very promising for patients who have many eggs maturing, its benefit for patients with poor ovarian response to stimulation and a small number of eggs retrieved is still questionable. If few eggs are retrieved from a patient, 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 cultivation conditions, despite all latest developments in this area, still far from natural, many embryologists believe that transferring embryos into the uterus is more early is more favorable for them than being in artificial conditions. Embryos that would not reach the blastocyst stage in vitro can safely continue embryo development after IVF transfer in the uterus and implant successfully.

Transfer of embryos into the uterine cavity

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

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

Numerous foreign studies have shown that there is no need to remain in a horizontal position after embryo transfer for more than 10 minutes, because this does not affect pregnancy. Once the embryo has entered the uterus, it can no longer “fall out” from there. Despite its apparent simplicity, embryo transfer into the uterine cavity is one of the most critical 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. For example, the embryo may adhere to the catheter internally or externally, or may be carried along with the catheter into the cervix. Much depends on the qualifications of the doctor, special equipment and the developed embryo transfer scheme to prevent such situations.

Timing of ovulation after IVF when pregnancy occurs

Do not try to independently determine pregnancy using tests earlier than the 14th day after 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 embryo transfer, contact 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 moment on, the amount of hCG will grow rapidly. Starting from the 3rd week after embryo transfer, pregnancy must be confirmed by ultrasound, which allows you to see the fertilized egg. You should be under constant supervision of an obstetrician-gynecologist, since you are yet to carry the pregnancy to term. If you experience abdominal pain or bleeding, consult a doctor immediately. A negative test result for hCG, the absence of a fertilized egg according to ultrasound, and the onset of menstruation indicate that pregnancy has not occurred. In this case, you should 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 from an IVF procedure does not mean that this method is not suitable for you. With each IVF attempt, your chances of successful conception increase and can reach 90% per year of treatment. Among the people there are signs for eco. Between attempts you need to take a break of about 2 - 3 months.