A few decades ago, test-tube babies seemed to be something of a fantasy. Today, more than 5 million people live on the planet, whose conception and the very fact of existence became possible thanks to IVF. What this technique is, how it works, how effective it is and how dangerous it is, we will tell you in this article.
What it is?
IVF stands for In Vitro Fertilization. This means that the process of fertilization itself does not take place inside the female body, as is the case with natural conception, but outside it in the external environment. The fertilized eggs are then transferred to the woman's uterine cavity, and she carries the baby and gives birth to it.
IVF (in vitro fertilization) is the last chance for couples with severe or total forms of infertility. If earlier they did not have much choice - all that remained was to come to terms with childlessness or raise adopted children, but now, even in critical cases, medicine is ready to offer a way out and help spouses become parents.
The study of methods for extracting eggs and their fertilization with sperm in laboratory conditions began in the middle of the last century. But significant success was achieved only in 1978, when the first girl was born in the UK, who was conceived in a test tube. Louise Brown is now 40 years old, she is a good specialist and an excellent mother - she has children whom she conceived naturally.
In the USSR, the first successful IVF protocol took place in 1985. In Moscow, and then in Leningrad, two children were born, conceived in a test tube and then planted by their mothers - a girl and a boy. In 2010, the IVF program was recognized at the state level and was included in the demography development program by the decree of the President of the Russian Federation. They began to give quotas for it, in vitro fertilization according to indications can now be done under the policy of compulsory health insurance.
Since then, thousands of IVF protocols have been carried out in Russia every year, many families have found the happiness of becoming parents and raising their own children, relatives by blood and genetics. IVF is done in all regions, many clinics, both private and public, provide such services on a quota and on a paid basis.
IVF implies the fertilization of a female egg with the sperm of a husband or donor in a special incubator with a nutrient medium. Both the cells and the resulting embryos undergo "quality" control, only then the best categories of embryos are implanted into the woman's uterus. Whether they will take root is a big question, the in vitro fertilization procedure does not give any guarantees that pregnancy will occur. The success of the procedure depends not only on the doctors, but also on the health and age of the expectant mother, as well as on banal luck.
IVF is not a panacea for infertility, but a real chance for a happy ending.
Kinds
There are several types of IVF reproductive techniques. They should not be confused with insemination, when sperm is injected into a woman's uterus, and conception takes place inside her body. All types of IVF imply fertilization in the external environment. Depending on the couple's reproductive health, there are several medical ways to help them become parents.
- IVF with the husband's own egg and sperm. This method implies the use of only biological materials of the spouses for fertilization.
- IVF with a donor egg. This method is used if a woman does not produce her own oocytes, or ovaries are absent or do not function.
- IVF with donor sperm. This method is recommended if the infertility is caused by the male factor and it cannot be eliminated by other therapeutic methods. If a man does not have a single living and suitable for fertilization sperm, the woman can be offered a donor biomaterial.
- IVF with surrogacy. Such IVF can be carried out with both own and donor sex cells, but the surrogate mother will carry the baby for the couple. This is important when a woman does not have the opportunity to endure pregnancy and give birth to a baby on her own - there is no uterus, labor and gestation are contraindicated by age, and so on.
- IVF with cryomaterial. In such protocols, the use of own or donated frozen oocytes, sperm or embryos is implied. The method is widely accepted and approved by the Ministry of Health because it has many advantages over stimulated attempts, during which a woman has to take huge doses of hormonal drugs.
- ICSI. Artificial insemination with simultaneous ICSI is indicated in severe forms of male infertility, when doctors have no choice but to self-inject one healthy sperm (if there is one in the ejaculate) with a needle into the egg.
In addition, IVF is also different in the process. Most often in our country, and in the world, the so-called stimulated protocol is used. In the course of it, doctors, using hormones, achieve superovulation - the maturation of several follicles, receive several eggs for fertilization. This method shows better results than others.
Fertilization is sometimes carried out in a natural cycle. In this case, the ovaries are not stimulated, hormones are not prescribed. Everything proceeds more naturally and naturally, but the effectiveness of the method is lower, because only one or two eggs can be obtained, which reduces the chances of successful fertilization and pregnancy.
Which method to choose, which way to go, is decided by the fertility doctor. It is he who, on the basis of analyzes and examinations, is able to assess all possible risks, prognosis and complications and offer the best protocol in each specific case. There are no universal successful protocols - everything is purely individual.
Indications and contraindications
The main indication for IVF is male and female infertility, and sometimes both, which cannot be eliminated by other methods of treatment. And also IVF is acceptable for couples or single women at their request with absolutely any form of infertility. This is regulated by the order of the Ministry of Health dated 08.30.2012.
It is important that the spouses do not have circumstances that are contraindicated for IVF appointment. Like any high-tech intervention, in vitro fertilization has its own nuances. The list of contraindications is also stipulated by the order of the Ministry of Health.
IVF will be refused if:
- the woman has mental illness that can interfere with childbirth and childbirth;
- with severe chronic diseases in which pregnancy and childbirth can be fatal for a woman;
- congenital malformations of the uterus, trauma, changes, absence of the uterus (only IVF with subsequent surrogacy is possible);
- tumors of the ovaries, uterus, requiring treatment;
- acute inflammatory processes in any organ or system;
- oncological diseases.
IVF is not contraindicated for a man in any case, because even with severe male infertility in medicine, there is an opportunity to obtain at least a few healthy sperm for fertilization under a microscope.
If contraindications are found for the couple, a temporary or permanent ban on IVF is issued. With uterine myoma, it is recommended to first undergo treatment, including surgery, with polycystic ovaries, the ban will also be temporary.
A final and irrevocable ban can be imposed only in the case of abnormalities in the anatomy of the uterus.
Stages - from start to finish
Planning a pregnancy with IVF is a rather lengthy process that requires a lot of attention to detail from the couple and the doctor. There are no trifles here. You should start preparing for IVF in advance, since the result of the procedure often depends on this. Below we will tell you about how each IVF stage goes in more detail.
Training
In order for a couple to be admitted to IVF, it is not enough not to have contraindications, you need to start collecting the necessary documents and certificates 3-4 months before the intended infertility treatment.
A woman must undergo a gynecological examination - she does an ultrasound of the pelvic organs, colposcopy and hysteroscopy. She tests smears from the genital tract for microflora and infections. On different days of the menstrual cycle (starting from the 5th day after the start of menstruation), a large list of tests for the hormonal profile should be passed - it is important for the doctor to know which hormones and how much are produced in the patient's body. The level of prolactin, testosterone, estrogens, estradiol, FSH and LH and other substances is investigated, without the normal ratio of which the onset of pregnancy and its course may become impossible.
A woman takes a large list of blood tests - for HIV and syphilis, for the group and Rh factor, for coagulation, general and biochemical analysis, analysis for the so-called TORCH infections (rubella, toxoplasmosis, cytomegalovirus infection, herpes of the first and second types. And also it is necessary to make an immunological blood test for antibodies to sexually transmitted infections.
For a man, if it is planned that his sperm will be used for fertilization, it is necessary to do a spermogram in advance, and then before entering the protocol again. This analysis allows you to establish the quantitative and qualitative parameters of the ejaculate, to assess the structure and viability of its germ cells. In addition, the man does chest fluorography, blood tests for HIV and syphilis, hepatitis B and C, and also takes a smear from the urethra for microflora and genital infections.
Together, the partners undergo all the necessary general analyzes, the list of which is standard and regulated by the order of the Ministry of Health. If the wife is over 35 years old, and the man is over 40 years old, you will definitely need a geneticist consultation, as well as tests for the karyotype and genetic compatibility of partners.
It should be remembered that all certificates have their own validity period. After the end of the examination, the woman receives the conclusion of the therapist on admission to the IVF procedure. This certificate will be valid for a year.
If during the examination, problems, diseases, infections are revealed, the couple will first have to be treated.
Approximately three months before the planned IVF, a man and a woman should begin a course of taking drugs that improve the quality of germ cells. The scheme includes vitamins and dietary supplements. And also the couple should lead a healthy lifestyle, exclude the harmful effects of nicotine and alcohol, do not go to the bathhouse, sauna, do not wear tight underwear that interferes with the normal blood supply to the genitals.
As soon as the preparatory stage is completed and the spouses receive admission to the IVF protocol, they will have to sign the contract and consent to the procedure. Please note - the standard contract always states that payment for each stage must be made in advance if IVF is done for a fee. The agreement to the procedure also stipulates that unprotected sex is prohibited throughout the protocol. Only condoms are allowed for contraception.
Start of the protocol
The protocol is entered 10-12 days before the start of the next menstruation. Within these terms, the couple needs to come to their doctor-reproductologist and provide all the documents and tests, as well as the contract and written consent to the procedure. The woman is given a control ultrasound scan and an individual prescription sheet is given to her hands. It is with him that she will have to come to every reception from that moment.
On the first day, the type of protocol and the first appointments are entered on the sheet. If the protocol is long, then hormonal stimulation may already be started a couple of weeks before your period. If the protocol is short, then the treatment, drugs, dosage will be scheduled for the period after the end of the next menstruation.
When entering the protocol, the couple is explained that the treatment can be interrupted for medical reasons at any stage, while the couple will be returned only those funds that were paid for the failed stage, the rest of the money for the procedures already performed will not be returned.
In case of IVF under the MHI policy, the couple is explained the list of those analyzes that they have to do for a fee, since not all of them are "covered" by the MHI funds.
Ovarian stimulation
With a long protocol, which is most often used in Russian medical practice, the ovaries are stimulated before the start of the next menstruation. During this period, hormonal agents inhibit ovarian function. This is how the gonads are prepared for the main stimulation. Then drugs are prescribed that should promote the growth of more follicles. The more eggs you get, the more likely you are to get pregnant.
Without stimulation, a woman develops one mature egg, rarely two. When stimulated with drugs, a woman can simultaneously mature 15-20 oocytes. To stimulate the ovaries, drugs such as Puregon, Orgalutran, Menopur, Meriofert, Decapeptil and others are most often prescribed. The use of these drugs is permissible at home. They are injected either intramuscularly or subcutaneously (an injection into the abdomen), many women follow the doctor's recommendations on their own.
During stimulation, a woman visits a doctor, takes blood tests for hormones, and also undergoes an ultrasound of the ovaries several times in order to assess the response of the gonads to stimulation. If it is excessive, the doses are reduced; if the response is insufficient, they are increased. As soon as the follicles with maturing eggs reach 16-20 mm, a single injection of hCG is given. This allows the eggs to mature. After this injection, eggs can be collected after 34-36 hours.
During stimulation, headaches, weight gain, nausea, pulling pains in the lower abdomen and in the lower back may occur.
At this stage, it is important to prevent SIA - ovarian depletion syndrome, which occurs as a result of hyperstimulation of the gonads.
Egg collection, puncture
The collection of mature oocytes is carried out by the puncture method. A long needle is inserted transvaginally into the follicles, from where the follicular fluid with the eggs present in it is pumped out. The accuracy of manipulation is controlled by an ultrasound probe. The procedure is performed under general anesthesia. The anesthetic is administered by the anesthesiologist intravenously.
The resulting contents of the follicles are immediately transferred into special containers and sent to the embryological laboratory. There, the eggs will be freed from the follicular fluid and placed in Petri dishes with a nutrient medium.
The puncture lasts no more than 15 minutes. After the end of the procedure, the woman remains in the clinic under medical supervision for another 2.5-3 hours. If there are no complications, they let her go home. It is forbidden to take food 12 hours before the puncture, it is not recommended to drink water and other liquids for 6-8 hours, sexual intercourse is not recommended on the eve of the manipulation.
You cannot come to the procedure, which takes place in a small operating room, with makeup, contact lenses, jewelry and bijouterie.
After the puncture on the same day, progesterone preparations are prescribed in a stimulated protocol. They are necessary to maintain the function of the corpus luteum, which forms at the site of the punctured follicles. If IVF is planned to be carried out with donor eggs or your own, but frozen in advance eggs, progesterone preparations are started from 14-15 days of the menstrual cycle.
This support helps to loosen the endometrium of the uterus, in which subsequent implantation will be easier. After puncture, short-term, non-abundant spotting is possible, as well as pulling pains in the lower back and lower abdomen on the right and left. Normally, they pass within a day.
Sperm collection
When the oocytes are obtained, the sperm is delivered to the embryology laboratory. The fresh portion of the man must be taken on the same day. Sperm is usually obtained by masturbation. In some forms of male infertility, independent ejaculation is impossible, or the ejaculate does not contain live spermatozoa. In this case, the collection of germ cells is also carried out under anesthesia. Depending on the individual indication, either a testicular biopsy or epididymis aspiration is performed.
If there is an indication for a surgical collection of sperm, the procedure takes place on the same day as the wife is punctured by the ovaries. The resulting sperm is delivered to the laboratory, freed from semen, and then the most healthy and mobile ones are selected from the total number of germ cells.
Fertilization and embryo culture
The fertilization process is carried out by embryologists. The selected best oocytes are first kept in a nutrient solution for 4-5 hours, after which fertilization can begin. This responsible process itself can be carried out in two main ways. In the first case, concentrated sperm, which has already undergone preliminary purification and primary selection, is added to the Petri dish with oocytes. In the second case, the method of intracytoplasmic sperm injection (ICSI) is used.
If there is a need to use frozen eggs or spermatozoa, they are first thawed and examined for integrity and viability. Cryoprotocols are in no way inferior in efficiency to fertilization with native (fresh) germ cells.
With IVF, there should be about 100 thousand sperm in a cup for each egg. With ICSI, a single sperm cell is injected “manually”. It is possible to understand whether fertilization has occurred within 2-4 hours. After 16 hours, changes become apparent at the cellular level and can already be recorded with powerful microscopes. The final conclusion about whether oocytes are fertilized is made in a day.
They are counted and given an initial assessment. If the egg is not fertilized in the dish, ICSI is recommended, although this significantly increases the cost of the protocol. A fertilized egg is called a zygote. On the first day it has only 1 cell, on the second - already four, on the third - 8, on the fourth - 16-20, and on the fifth - from 40 to 200 cells.
On the second day of cultivation, the first assessment of the viability of the embryos is carried out. Already at the zygote stage, doctors can detect hereditary diseases, defects. Only good quality embryos will be admitted to the transfer.
On the 5-6th day, the embryo becomes a blastocyst. It is believed that embryos take root better at this stage. But finally, the question of the transfer period is decided on an individual basis. Replanting can be carried out on any day from the 2nd day of cultivation to the 6th day.
At the stage of preimplantation diagnosis, embryologists, if there is a prescription from a geneticist, determine the sex of the embryos. This is done only if the spouses are carriers of diseases that are genetically linked to the sex chromosome, such as hemophilia. In this case, only embryos of a certain gender are planted, which will not suffer from a serious illness. The sex of the embryos is not determined or disclosed to the rest of the couples, it is prohibited by law.
Once the diagnosis is complete, the spouses are invited to transfer.
Embryo transfer, replanting
Embryos that have been cultured for five days have a higher chance of successfully implanting; there is no need for a large number of transferred embryos when replanting them. When replanting "two days" or "three days" there are higher risks that the embryos will not take root, therefore 2-3 embryos are injected into the woman's uterus.
The spouses are shown pictures of the resulting blastocysts with a detailed embryological description and are asked to make a choice - how many embryos will be planted. If more than three of them were obtained, doctors may suggest cryopreservation of the embryos remaining after the transfer.
Frozen embryos, which will be stored in the cryobank, can subsequently be used again by the couple, for example, if they want more children, or for a repeated protocol if the first one fails.
Legally, spouses have the opportunity not only to leave embryos for storage (for separate money), but also to donate them as donor for other couples who want to have children, as well as transfer them to the needs of science for study and experiments. The decision is not subject to appeal and is sealed with signatures.
When all the formalities are settled, the woman is escorted to the small operating room. On the gynecological chair, the doctor inserts the required number of embryos into the uterine cavity through a catheter. The procedure is painless and fast. After it, for an hour, the woman remains in a calm, fixed position without moving. Then they give her recommendations for the next stage and let her go home.
Implantation period
After the embryo transfer, the most difficult period for the woman and her husband comes - waiting. In the first days after replanting, a woman is on sick leave. She is advised to lie down more, rest, get enough sleep, eat well and worry less. It is strictly forbidden to take a hot bath, swim and lift weights while waiting for implantation.
A woman should follow all the doctor's recommendations, take hormonal drugs in the necessary dosages to support the pregnancy, if it takes place. Sex is contraindicated, you can also not masturbate and experience an orgasm in any other way, since the tension of the uterine muscles that accompanies a female orgasm can prevent the implantation of the ovum into the functional layer of the endometrium.
You should not wait for special symptoms and signs of pregnancy, since implantation after IVF often occurs much later than with natural conception. On average, it is considered quite normal if implantation occurs 3-8 days after the transfer of embryos into the uterine cavity.
Implantation bleeding, which manifests itself as a few drops of scanty bloody or bloody discharge at the time of attachment of the ovum, is far from everyone and not always, besides, against the background of the frequent "daub" after replanting, it is difficult to notice implantation bleeding.
The first symptoms can be indirectly attributed to an increase in body temperature a week or a little more after replanting. She rises in the evenings or in the afternoon, and at first a woman may think that she has a cold and is ill.
However, a reliable confirmation of a successful IVF protocol can only be a timely diagnosis of pregnancy.
Did you get pregnant?
Diagnostics of the "interesting situation" after IVF has its own characteristics. So, test strips, which are usually so fond of women, in this case are not suitable, because the patient received long-term hormonal treatment, she was given an injection of hCG, and therefore the test may show a false positive result.
The most reliable and trustworthy way to find out if an in vitro fertilization protocol is successful is with a blood test for hCG. It is recommended to start doing it from the 14th day after embryo transfer. If the implantation is successful, an increased concentration of this hormone will be found in the woman's blood. If not one baby was implanted, but two or three at once, then the level of the hormone increased in proportion to the number of fetuses.
If the hormone is found, but its level is too low, the woman is offered to come and donate blood again after a few days. This will help to understand whether the pregnancy is developing, or whether an ectopic, frozen pregnancy, a miscarriage has occurred at the earliest possible date.
On day 21 after embryo replanting, the first ultrasound is usually performed. It will help confirm laboratory test data. And after another 10 days, a second ultrasound is performed, which allows you to establish the viability of the fetus. The term of pregnancy after IVF is considered, as in a normal pregnancy, that is, at the time of the first ultrasound scan (21 days after the transfer), the woman is already five weeks pregnant.
The second ultrasound completely completes the successful IVF protocol. The woman is given an extract about the treatment and is sent to the antenatal clinic at the place of residence in order to register with the dispensary.
Repeated IVF
If it is necessary to do a second IVF, the couple will again have to collect all examinations and do tests. According to the quota, it is allowed to do IVF no more than once a year. For their own money, a couple can enter into repeated protocols more often. In preparation for repeated artificial insemination, if half a year has not passed, some of the analyzes collected earlier will still remain relevant.
Usually, repeated IVF after a cycle with hormone stimulation is recommended only 3 months after the first. This time is necessary to conduct a thorough examination and identify the reasons for the failed IVF in the previous protocol. If a woman was fertilized without prior and subsequent stimulation with hormones, a second attempt can be made as early as next month.
If a pregnancy has come, but ended in failure (miscarriage, missed pregnancy, ectopic pregnancy), after appropriate treatment and examination, a woman is advised to wait 5-6 months before starting to plan a new protocol.
Donor IVF
In vitro fertilization with donor biological materials has its own characteristics. If you plan to use a donor egg, it is rather difficult to choose a donor yourself. A woman must be completely healthy, she must have children conceived and born naturally, the donor and the recipient must match each other in terms of blood type and Rh factor, and also have a certain external similarity, because a child that one woman carries will be similar to another, his biological mother. The donor cannot be a blood relative of a man whose sperm is planned to be used for IVF.
The donor undergoes all the necessary tests and enters the donor program. He is an individual donor, his family pays for his services.
If a woman is offered a donor egg from a cryobank, then the donor is anonymous, the family will be able to receive only general information about him - age, occupation, eye color, hair, complexion, weight, height. All donor eggs in the cryobank are carefully examined and only the best of the best are selected.
Donor sperm also undergo strict control, six months after delivery it is in quarantine until tests are received confirming the donor's absence of genital infections, HIV and other diseases. Sperm donors are men of reproductive age with absolutely healthy and normal spermogram. Expectant parents will also receive only general information about their donor - height, weight, skin and eye color, race, age, occupation.
Protocols with donor biomaterials are much more expensive for the family.
Effectiveness and results
An expensive and rather complicated IVF technique, alas, is not highly effective. According to statistics, only about 35-45% of protocols in Russia are successful. Only 80% of women carry on pregnancy and give birth successfully, whose protocol has been successful. The fact that there are no guarantees of pregnancy is written in the contract for the provision of medical services, and patients are notified of this at the stage of preparation for IVF.
No more than a third of women, according to the Ministry of Health, became pregnant on the first try. However, with repeated protocols, the likelihood of a long-awaited pregnancy increases significantly. By about 10% - in the case of the second protocol and by the same amount - in the third attempt.
Starting with the 4th protocol, the effectiveness decreases, the predicted probability of pregnancy decreases, but this does not prevent some women from making 6, 7 or more attempts, one of which is necessarily successful.
In 60% of cases of replanting two or more embryos, multiple pregnancies occur. The number of boys and girls conceived with IVF is approximately the same, but after ICSI girls are more often born, however, the difference is small - 51% of girls versus 49% of boys.
Couples who managed to get pregnant on the first try quite often decide on a second IVF after a few years. But the success of the protocol the first time does not guarantee the same effectiveness on the second try.
Not so rarely, after the first unsuccessful IVF protocol, a woman becomes pregnant in a surprisingly all quite natural way. This happens in 25% of the failed protocols. Hormone therapy "starts" more intensive processes in the body, the woman's reproductive system is rebuilt and begins to work at full capacity, therefore, in some cases, pregnancy becomes quite possible without repeated in vitro fertilization.
The younger the woman, the more likely it is to become pregnant in the IVF protocol. The optimal age when the chances of pregnancy are estimated to be quite high is the age under 30. The chances are high for women under 35. After 35, the probability of getting pregnant in the first protocol decreases to 30%, and at 40 they are estimated at no higher than 20%. After 43 years, the chances are no more than 6-8%. However, history knows facts when women managed to get pregnant through IVF even at 50 years old.
The better the woman's health status, the higher the likelihood of success in the IVF protocol. Previous abortions, endometriosis, fibroids, and scars on the uterus as a result of previous surgeries reduce the chances of successful implantation.
Repeated protocols with cryomaterial - frozen eggs, embryos, or sperm - do not perform better than protocols with fresh eggs and sperm. Their effectiveness is on the same level.
On the other hand, natural cycle IVF protocols without hormonal support usually show lower and infrequent positive results than attempts with stimulation.
Pregnancy and childbirth after IVF
The approach to pregnancy, which has arisen thanks to IVF, should be completely different, not the same as in a natural pregnancy. And the point is not that carrying a baby (or babies) is something significantly different, just a woman who has been struggling with infertility for a long time, most likely, has a lot of associated problems, which initially became the cause of infertility.
Due to age and diseases, bearing a baby after IVF becomes more risky.
In the first trimester of pregnancy, women have a high probability of spontaneous abortion, miscarriage, and pregnancy fading. According to various estimates, it is about 30-60%.Women after IVF are often pregnant with twins or triplets, which is an additional risk factor. In addition, by the end of the first trimester, when the placenta begins to function in expectant mothers, in women after IVF, placental malformations, anomalies of its location (presentation, detachment, premature aging) are often revealed.
The risk of miscarriage is also created by the hormones that the woman took at the stage of ovarian stimulation, and then after embryo transfer. They not only change the balance of forces in the endocrine system of the expectant mother, but also often act as a factor provoking an exacerbation of old chronic diseases, which in the early stages does not in any way contribute to bearing a baby.
In the second half of the second trimester and in the third trimester, women who are carrying a child conceived in a test tube are more likely to develop preeclampsia, as well as all the complications associated with it. The incidence of preterm birth is around 25-36%.
That is why, from the moment of registration, a woman will come to her obstetrician-gynecologist much more often than other expectant mothers will. And also she will have to take more tests and more often to undergo certain examinations.
Carrying a baby after IVF requires responsibility from a woman and a great desire to give birth to this child. You will only have to eat correctly, as the doctor says, you will have to take pills and vitamins strictly on schedule, at any time you need to be ready to go unquestioningly in the direction of the doctor to the hospital to preserve the pregnancy.
Pregnancy without complications after IVF occurs in about a third of expectant mothers who have used methods of reproductive assistance. Women who underwent IVF due to male factor of infertility carry a child more safely and give birth to children.
Childbirth can be both natural and surgical.
The second option is the most preferable, and most women are prescribed a planned cesarean section so as not to risk the life of the mother and baby, because the birth process after IVF can also proceed with deviations and complications.
Reasons for failed IVF
Unfortunately, it is far from always possible to find out the true reasons for the fiasco, but it is necessary to try to do this. Sometimes the reasons are removable, and the doctor just needs to change the type of protocol, change the drug or dosage, so that the long-awaited pregnancy occurs. Most often, implantation is hindered by the following reasons:
- age;
- high values of the concentration of follicle-stimulating hormone;
- a small number of eggs obtained;
- a small number of embryos obtained during laboratory fertilization;
- poor quality of embryos.
Among the internal reasons that more often than others prevent the onset of pregnancy after embryo transfer, the following can be noted:
- endometriosis;
- other endometrial disorders;
- hydrosalpinx;
- genetic incompatibility of partners;
- overweight, obesity;
- poor sperm quality.
Bad habits (smoking, drinking alcohol) reduce the likelihood that embryos will take root. Even secondhand smoke is dangerous. Often the reason for the failure lies in the immune processes - the woman's body at the level of immunity rejects the ovum, even if it succeeds in implanting.
Anxiety, stress, excitement, emotional instability, conflicts at home and at work increase the likelihood of a violation of the production of sex hormones by stress hormones, as a result, implantation may not take place, or the ovum will be rejected as soon as possible.
IVF children - what are they?
Babies conceived in a test tube are no different at birth from their peers born after natural conception. However, popular rumor persistently prescribes differences for them, and a couple who are planning IVF may simply be frightened by those unlikely rumors that are floating around in society around IVF children. The most frightening of these concerns the reproductive abilities of the child himself.
For some reason, it is believed that an "eco-friendly" child will definitely be sterile when he grows up. Children who were conceived in this way 30-40 years ago have confirmed by personal example that this is not so. Infertility is inherited only when it is of genetic origin. In 99% of couples resorting to in vitro fertilization, it is acquired, therefore it cannot be inherited by children.
If infertility is genetic, the geneticist will definitely become aware of it at the stage of preparing a couple for IVF, the couple will be offered a protocol using donor sperm or an egg. Many pathologies of a genetic nature can be tracked by embryologists during preimplantation diagnosis. Moreover, true primary infertility is rare.
The second rumor concerns the health and life expectancy of babies conceived in a laboratory test tube. There really is a difference here, but clearly not for the worse. Due to the preliminary selection of only high-quality germ cells and diagnostics, only the strongest embryos are implanted before embryo transfer. Therefore, many pediatricians note that "eco-friendly" children are stronger and more resilient, they get sick less often, and recover faster.
Congenital defects in children conceived in the IVF protocol are 45% less common in medical practice than in ordinary children. Such babies sometimes develop ahead of the development calendar. They are welcome, beloved, parents gave a lot to have babies, so they are usually engaged in their development with special zeal.
It is still difficult to say about the life expectancy of IVF babies. The first girl born thanks to fertility specialists recently celebrated her 40th birthday. She does not complain about her health, she raises her children, so it would be most correct to return to the issue of life expectancy in another 50-60 years. Then the statistics will be complete and comprehensive.
Some are intimidated by the attitude of religion towards IVF. The most severe to this reproductive method are Catholics and Orthodox. The former do not take IVF in any form and form, under any conditions. The latter only recently made an important reservation - IVF has the right to exist only if the couple makes it out of despair, if other treatment has not shown an effect, if fertilization is performed only with the use of the spouses' own germ cells, and doctors do not destroy the remaining embryos.
The Orthodox Church does not approve of surrogate motherhood, donor sperm and eggs, as it considers that this violates the sacrament and inviolability of Orthodox marriage between a man and a woman.
In Islam, the requirements are almost the same - donor biomaterials are unacceptable, as is surrogacy. But the resection of extra embryos, as well as leaving the extra embryos unattended until their natural death, is not considered infanticide, since Muslims believe that a child's soul appears only at 4 months of mother's pregnancy, it is brought by angels.
Some restrictions on IVF are imposed by the Jews. In general, they are not against procreation, and even encourage it, but they prohibit surrogacy if a close relative becomes a surrogate mother.
Otherwise, in Israel, the state fully pays for IVF for infertile couples in the amount that is necessary until the spouses have two children.
The most loyal are Buddhists. They sincerely believe that all methods are good for achieving happiness if they naturally do not prevent others from being happy too. Therefore, in Buddhism, any type of IVF is considered acceptable if all participants are ultimately satisfied with the result and can become happy.
People who claim that an IVF child does not have a soul, that he is a “spawn”, are most often related to certain sects, which in themselves are destructive and rather aggressive.
But there are also isolated cases of personal rejection of IVF among representatives of official confessions. So, the problems that Orthodox parents sometimes face may relate to the refusal of a particular priest to baptize a child born through IVF.
This problem has a solution - you just need to find another, more adequate priest who is well aware of the latest recommendations of the Russian Orthodox Church regarding IVF.
Complications and risks after IVF
The main complication after IVF can be considered the consequences of hormonal stimulation. According to some reports, after several stimulated attempts, a woman's ovaries are depleted faster, and menopause occurs earlier. The link between IVF and cancer has not been proven. Rather, on the contrary, practicing oncologists and most of the world's scientists are sure that it is not IVF that provokes malignant tumors in the female body. According to statistics, cancer develops mainly in those for whom the initial examination did not reveal the beginning of the process, and hormonal therapy accelerated the growth of the tumor.
If a woman before IVF was completely healthy, and a blood test for tumor markers did not show abnormalities, then you should not be afraid of cancer. IVF also does not affect a woman's life expectancy, because the early menopause, even if it begins, does not shorten the allotted years of life.
Theoretically, complications can occur at any stage of IVF - during stimulation, hyperstimulation syndrome can occur, which can lead to ovarian depletion, there are many such stories on Babiplane. During a puncture of the ovaries, an infection may join, bleeding may occur, after replanting, a relapse of chronic diseases may develop, but the likelihood of such complications is very small.
Endocrine disorders, which in the female body are caused by aggressive hormonal stimulation of the ovaries, are easily eliminated, it is enough to visit an endocrinologist after childbirth and undergo corrective treatment.
Vascular problems, cardiomyopathy, which can also theoretically occur after IVF, are quite easy to correct by visiting a therapist and cardiologist.
The best opportunity to weigh all the possible risks before the IVF procedure is to talk to a doctor who will tell you about all the long-term and urgent consequences known to science that can occur after the protocol and a successful pregnancy.
The cost
Even IVF under the compulsory medical insurance policy does not guarantee that the couple will not have additional costs. During the examination, tests will be prescribed that are not included in the CHI program, for example, a spermogram. The pair will have to make them at their own expense. As a result, the amount will come out not so small, but not as large as if the couple did in vitro fertilization entirely at their own expense.
The cost of one IVF protocol includes basic tests and examinations, preparation, stimulation, puncture, embryological examinations and selection, transfer and support of pregnancy during the first month after transplantation. Cryopreservation of eggs or embryos remaining after the protocol is paid separately. Donor sex cells and embryos are also paid separately, if the need arises.
Some clinics for advertising purposes only indicate the price of certain stages, for example, only ovarian stimulation or only embryo transfer. You should check the full cost of the program if the price seems suspiciously low to you. In Russia in 2018, on average, IVF costs from 150 thousand rubles.
You should not assume that in foreign clinics you will get IVF cheaper, there this service is many times more expensiveFor example, in Spain this price is on average five times higher than in Russia, and in German clinics - three times.
The cost of IVF with a donor egg costs 250-300 thousand rubles. Donor sperm will cost half as much. Prices for the full program vary depending on the chosen drug support, depending on the need to conduct pre-implantation diagnostics (it increases the cost of the protocol by almost 40-80 thousand rubles).
The highest prices are observed in Moscow and the northern capital - on average, from 180 to 260 thousand rubles for an IVF program, taking into account medicines. In Volgograd and Voronezh, the average cost is from 150 to 200 thousand. In the Volga region, the cost starts from 120 thousand and reaches 180 thousand rubles.
Reviews
According to reviews, IVF gives a chance to become parents, and many women and men go through more than one, not two, or even three attempts to have their son or daughter born. Reviews of those who got pregnant the first time, only positive.
Women who, despite several punctures, have not yet managed to get pregnant, are looking for reasons in themselves and in the clinic, often inclining to decide to change the clinic and the attending physician. This, indeed, often works - the new specialist reassesses the patient's history and chooses a new, in fact, protocol that turns out to be more successful than all the previous ones.
Women who underwent IVF under the compulsory medical insurance policy often note a less attentive attitude towards themselves by medical personnel in many clinics, regardless of the form of ownership of the health care institution. The protocol is planned in a hurry, it is carried out in the same way, the patients are put on stream, and the doctor simply does not have time to delve into the personal circumstances of each of his patients in detail.
Among the shortcomings, women indicate the high cost of reproductive care, as well as a heavy psychological sediment that remains in case of an unsuccessful attempt, it is sometimes almost impossible to cope with depression without the professional help of a psychotherapist or psychologist. Some stages, for example, stimulation, are quite difficult for most women, and while waiting for the result they often experience fear and panic attacks.
For interesting information about IVF, see the next episode of the program "School of Doctor Komarovsky".
