IVF is fertilization of the oocyte outside a woman’s body - “in vitro”. The medical procedure includes several stages:
- Superovulation induction
- Follicle puncture and oocyte retrieval
- Oocytes fertilization and embryo cultivation
- Embryo transfer into the uterus
What are the indications for IVF?
IVF was created for treatment of tubal infertility. At present IVF can be applied in treatment of all forms of infertility.Ifacouplehas notbeenabletogetpregnantfor 2 years (afterhaving unsuccessfully appliedthe othermethodsoftreatment - laparoscopy, insemination and the others),the European Society of Human Reproduction and Embryology recommends applying IVF.
What is superovulation induction necessary for?
Superovulation induction (hormonal ovarian stimulation) is carried out for obtaining several oocytes at once in the course of one menstrual period. It increases the probability of pregnancy in IVFprograms.
How is the superovulation induction carried out?
There are different schemes of superovulation induction. Up until recently the procedure has been conducted with the help of human menopausal gonadotropin medications (hMG) in combination with clomiphene citrate. The administration of substances started from the 2nd - 3rd day of menstrual period.
Over the last years the combination with hMG has been used more often.
As a rule, a-GnRH are administered on the 20th-21st day of the previous menstrual period, and administration of hMG starts from the 2nd day of the period. Such a scheme of stimulationis called “long protocol”. There exists a “short protocol” scheme as well, which implies the administration of a-GnRH from the 2nd day of menstrual period simultaneously with hMG.
It is customary to follow different variants of the schemes described above, to use combinations with other medications. The choice of superovulation induction scheme depends on many factors and is made by a doctor.
In our clinic we mainly apply the scheme of stimulation with GnRH antagonists. According to CSMU statistics this protocol increased cycle effectiveness by 8-10 %. Apart from that, to the advantages of this (“optimal”) stimulation protocol the following facts can be regarded: absence of necessity to prescribe LH (the medications do not block a woman’s own LH release in the cycle); application of average and low doses of FSH, which cuts down patients’ expenses on medications; minimization of average and severe ovarian hyperstimulation occurrence.
Follicles development is controlled by means of ultrasound. When the follicles reach a certain diameter, the chorionic gonadotropin (CG) is administered. It ensures the final maturation of oocytes.
How is the follicle puncture carried out?
At present the transvaginal methodis mostly applied. Ovarian puncture in this case is made through vagina with the help of a special needle with ultrasonic guidance. Due to minimal injury and painfulness,transvaginal method of ovarian puncture is convenient for patients and doctors. It is made out patiently. For a greater degree of comfort the puncture can be conducted under anesthesia.
How is oocyte fertilization made?
On the date offollicle puncture a couple come together. The husband provides sperm. An essential condition is abstaining from sex for three days before the puncture. The sperm is prepared in a special way, the healthiest male gametes are chosen.
Oocytes obtained in the course of follicle puncture are kept in special cups with nutrient medium, which are placed in an incubator, where the conditions, similar to those of the mother’s organism, are maintained (the same temperature, carbon content).
In 4-6 hours after the follicle puncture insemination is carried out: male gametes are added to oocytes. The male gametes attach to zona pellucida and secrete a special ferment, trying to penetrate inside with its help, but only one of several thousand of gametes will manage to do it and transmit its genetic material for a new life creation, that is for oocyte fertilization.
How and when is the embryo transfer carried out?
After fertilization the process of embryo development starts by way of cell division. In 48-72 hours after insemination embryos consist of 4-8 cells and can be transferred to the mother. In our clinic the embryo transfer is made on the 3rd or 5th day of embryo cultivation. If more than 2 embryos have been obtained, the embryo selection before transferring into uterus makes sense. This is possible only at the stage of blastocyst. That is why if 2 or less embryos have been obtained, we recommend to transfer them on the 3rd day, if more than 3 - on the 5th day.
The embryos are transferred into the uterus with the help of a special catheter. This procedure is painless and does not require a pain relief. To enhance the likelihood of pregnancy, 2-3 embryos are transferred. Since the day of transfer some medications which support implantation and embryo development (progesterone, CG) are prescribed, since pregnancies resulted from infertility treatment refer to the noncarrying of pregnancy risk group.
How is the pregnancy testing carried out?
After ART (assisted reproductive technologies) cycle the most valid way to determine pregnancy is ultrasound diagnosing of fetal heartbeats, which can be registered from the 6th week of pregnancy. Less valid method is the HCG blood test (it determines pregnancy only given the absence of HCG medication support of the second phase), which is conducted on the 10th-12th day after ET or urine test (determines pregnancy after 12-14 day after ET).
How effective is IVF?
The effectiveness of ART cannot be subjected to firm statistics. Many clinics overstate the percentage of successful cases to advertise themselves. However, it is possible to state that the number of successful programs is constantly increasing owing to appearance of new and more progressive nutrient media, medications, equipment and medical consumables (catheters, needles, plastic).
What does the outcome of IVF depend on?
Success of IVF depends on many different factors: parents’ age, reasons and duration of infertility, ovary reaction on stimulation, quantity and quality of oocytes that mature in follicles, sperm quality. Quite often the procedure outcome cannot be explained from the scientific point of view. The technology of the process, the character of hormone medications being applied, medium quality, provision of clinics with laboratory glassware and plastic ware are very significant for the increasing of IVF effectiveness.
What are possible complications of IVF?
Possible complications of IVFare:
- Ovarian hyperstimulation syndrome (OHSS)
- Bleeding in case if a blood vessel is injured by a needle
- Extrauterine pregnancy
- Multiple pregnancy
- Exacerbation of chronic female genital inflammatory diseases
What is an ovarian hyperstimulation syndrome?
Ovarian hyperstimulation syndrome (OHSS) is a complication. It occurs in approximately 25% to 44% of IVF patients. Usually the OHSS clinical course is benign. It declares itself by ovarian enlargement, flatulence, feeling of heaviness and pain in the lower abdomen. Sometimes these symptoms are accompanied by sickness and vomiting. If you have first signs of OHSS, you should consult a doctor, as early treatment prevents the development of grave conditions.
Is follicle puncture a dangerous surgery?
Surgical trauma at the time of transvaginal follicle puncture is minimal and is merely connected with tissue puncture by a needle. Some women notice a bloody issue from vagina on the first day after the ovarian puncture, but it is normal. To avoid a serious bleeding caused by possible larvated disorder of blood coagulation, thorough investigation before treatment is necessary.
How often does extrauterine pregnancy occur after IVF? What methods are applied to treat it?
Extrauterine pregnancy after IVF occurs in 3% to 5 % of patients. Up until recently surgery - Fallopian tube removal - had been the only method for its treatment. Today it has become possible to avoid traumatic operation. With ultrasonic guidance the puncture of gestational sac, located outside the uterus, is made. A medicine that stops further development of pregnancy is injected into its cavity. The gestational sac fully resolves after this procedure.
What are risks of multiple pregnancy occurrence after IVF?
After IVF multiple pregnancies occur more often than usually (1% in spontaneous pregnancies) and make up about 24%. Such a high rate in the quantity of multiple pregnancies after IVF is mainly connected with the transfer of several embryos into the uterus. Multiple pregnancy is often complicated by spontaneous miscarriage and preterm delivery (up to 50%). To reduce the noncarrying of pregnancy frequency, selective reduction is conducted.
What is selective reduction and why is it applied?
This procedure is carried out in case of multiple pregnancy after 7 weeks of pregnancy to prevent noncarrying, which in this case occurs 3-4 times more often than insinglet pregnancies. Selective reduction is termination of fetus development by way of gestation sac puncture through posterior vaginal vaultwith ultrasonic guidance.
Does IVF influence a future child’s health?
Parents are very often concerned about health of the child, conceived in vitro. The number of children around the world who were born owing to IVF application is already over 5 million. The occurrence of handicaps does not exceed that in children conceived ordinarily. Besides, apart from that with the help of IVFit is possible to reduce the number of children born with genetic diseasesto zero.