What is IVF, how to prepare for it and what to expect after

2024 Author: Malcolm Clapton | [email protected]. Last modified: 2023-12-17 03:44

A life hacker, together with an obstetrician-gynecologist, understands the features of the procedure.

What is IVF?

In vitro fertilization, or IVF Patient education: In vitro fertilization (IVF) (Beyond the Basics), is a fertility treatment in which eggs are taken from a woman's ovaries and fertilized with sperm in a laboratory. Most often, hormone therapy is first prescribed to the patient so that the germ cells mature. The resulting embryos are grown in a test tube under the same conditions as in the fallopian tube. Only after that, one or more embryos, similar to balls of cells, are transferred to the uterus by a reproductive physician using a thin tube.

Olga Belokon Obstetrician-gynecologist, author of a blog and books on women's health.

IVF is the most effective method of infertility treatment. The probability of pregnancy on the first attempt in a young couple (if the woman is less than 35 years old) averages 25 to 35%.

The procedure requires special equipment and materials, so in vitro fertilization is quite expensive.

IVF is done to everyone who cannot conceive a child?

No, only those who cannot be helped by anything else.

Olga Belokon

Prescribing IVF to everyone is simply wrong at will from any point of view. And ethical, and medical, and financial. The fact is that in some countries, including Russia, IVF is done under compulsory medical insurance, that is, the procedure is paid by the state. And if IVF is carried out by everyone in a row, not a single health care system, even in very developed and rich countries, will survive. And it is somehow ugly and inhumane in relation to those couples who really need help. In addition, the procedure is quite complicated and involves certain risks.

Therefore, IVF is carried out strictly according to the indications Patient education: In vitro fertilization (IVF) (Beyond the Basics):

• The woman has no fallopian tubes or is completely blocked. This happens with chronic inflammation.
• The man has infertility. There are few germ cells in the sperm, they are not sufficiently mobile. Sometimes things are so bad that sperm can only be obtained by surgery directly from the testicles.
• The woman is over 35 years old, Order of the Ministry of Health of the Russian Federation of August 30, 2012 No. 107n "on the procedure for using assisted reproductive technologies, contraindications and restrictions on their use." In this case, she may not have time to conceive a child naturally.
• There is a hereditary genetic disorder. So that it is not passed on to offspring, embryos are carefully examined and those that do not have chromosomal abnormalities are selected.
• Other diseases have been diagnosed, due to which a woman cannot get pregnant, and the treatment does not help. These are pathologies such as endometriosis, ovulation disorders or infertility for unknown reasons.
• Premature ovarian failure developed. In this case, donor eggs are usually used.

Olga Belokon

If a woman suddenly does not want sex or, for example, is in a same-sex relationship, she can have intrauterine insemination of sperm (that is, inject sperm into the uterus with a special syringe), and not expensive IVF.

IVF can be dangerous?

As with any treatment method, IVF has complications. Here are In Vitro Fertilization (IVF):

• Ovarian Hyperstimulation Syndrome (OHSS) ovarian hyperstimulation. It develops with the use of hormonal drugs that stimulate the maturation of a large number of eggs. Manifested by abdominal pain, nausea, swelling and shortness of breath. In severe cases, blood clots form, which can lead to death.
• Bleeding. It can occur after the ovaries are removed from the ovaries if the doctor damages a blood vessel, but this does not happen often. Even less often, the bladder, intestines, or ovarian tissue are injured.
• Cancer. For example, some studies have shown the Association between fertility drugs and gynecologic cancers, breast cancer, and childhood cancers that, due to hormonal therapy, the risk of developing ovarian tumors is slightly increased.
• Multiple pregnancy. Often, women are implanted with multiple embryos to increase their chances of conception. Usually 1-2 of them take root, but sometimes more. The danger of carrying twins and triplets is that they are often born with low body weight or prematurely. In addition, some children take the wrong position in the uterus, which is why they cannot be born on their own and sometimes die. Therefore, they are now trying to implant fewer embryos.

In addition, with IVF, the risks of miscarriage, ectopic pregnancy, congenital fetal anomalies, premature birth and low birth weight remain.

What do you need to do IVF under compulsory medical insurance?

First, a man must be examined by a urologist, and a woman by a gynecologist. The latter will give a referral to a reproductive specialist if the diagnosis of infertility is confirmed. He will conduct a consultation, write out an opinion and explain how to correctly fill out an application for IVF under the compulsory medical insurance policy. Usually, for this you need to collect documents Conducting in vitro fertilization for residents of the Moscow region in 2020 (doctor's opinion, your passports, insurance policies, SNILS) and contact the local Ministry of Health. A special medical commission will decide if you will be referred for in vitro fertilization. The answer must be given within 10 days.

If you do not want to fiddle with documents, IVF can be done completely for your own money. But for this, there must also be a doctor's testimony.

Since IVF is done under the compulsory medical insurance policy, then you will not have to pay for anything?

Not really. The CHI includes only the basic Order of the Ministry of Health of the Russian Federation of August 30, 2012 No. 107n "On the procedure for using assisted reproductive technologies, contraindications and restrictions on their use", a program that does not include all procedures. For example, you will have to pay for the storage of a cryopreserved (frozen) embryo or donor sperm.

But the costs don't end there. The insurance covers only a certain amount, the amount of which depends on the region. So, in 2021 in St. Petersburg the LAW OF ST. PETERSBURG ON TERRITORIAL PROGRAM OF STATE GUARANTEES OF FREE PROVISION OF MEDICAL CARE TO CITIZENS IN ST. programs of state guarantees of free provision of medical care to citizens in the territory of the Komi Republic for 2020 and for the planning period of 2021 and 2022 - 214 thousand, in the Ulyanovsk region ON THE APPROVAL OF THE TERRITORIAL PROGRAM OF STATE GUARANTEES OF FREE PROVISION TO CITIZENS OF MEDICAL CARE FOR TERRITORIAL CARE 21 PLANNED PERIOD 2022 AND 2023 YEARS - 125 thousand. If the real cost of IVF is higher, the parents will pay the difference.

I heard that there is a queue for IVF. This is true?

In general, there should be no queue, but everything depends on the region and the quotas for IVF allocated by the government. This is the name of the number of procedures that the state pays for each year, and the numbers are different everywhere. For example, in the Moscow region in 2020, the number of quotas for IVF in 2020 was increased to 6 thousand quotas. If there are more people wishing to do IVF, they are put on the waiting list.

Can I choose a clinic?

Yes. According to the law, Order of the Ministry of Health of the Russian Federation of August 30, 2012 No. 107n "on the procedure for using assisted reproductive technologies, contraindications and restrictions on their use", parents can choose a private or public clinic from a certain list. If the places allocated for a particular medical center have run out, you will have to queue up or agree to the institution where they still exist.

How does it all happen?

In vitro fertilization is done in stages. Most often, the process takes about two weeks.

Ovarian stimulation

The woman is prescribed Patient education: In vitro fertilization (IVF) (Beyond the Basics) hormone injections to obtain at least two follicles (the so-called egg bubble) with a diameter of 15-18 mm. But sometimes more than 20 germ cells mature. Also, these drugs allow you to control the time when ovulation occurs.

Usually the patient comes to the doctor on the 3-5th day of her period. She undergoes an ultrasound of the pelvis, takes a blood test for hormones and determines the day from which stimulants need to be administered. As a rule, injections are given once a day under the skin.

Stimulation may or may not be performed. Then the procedure is called IVF in the natural cycle, but in this case, only one egg matures in a woman.

Getting germ cells

32–36 hours after the last Patient education: In vitro fertilization (IVF) (Beyond the Basics) hormone injections are punctured (punctured) of the follicles. To ensure that everything goes as accurately as possible, the process is monitored using ultrasound. Usually the woman is given light anesthesia to relieve pain.

Egg retrieval takes 15-30 minutes. After that, you need to lie down for several hours under the supervision of a medical staff.

On the same day, a man must donate sperm, unless cryopreserved germ cells are used for IVF.

Fertilization and embryo growth in the laboratory

The resulting eggs are combined with sperm in laboratory glassware. According to statistics Patient education: In vitro fertilization (IVF) (Beyond the Basics), about 65% of them are fertilized.

But if a man has a poor quality sperm analysis result, then fertilization can be performed using the IVF Procedures method of intracytoplasmic sperm injection (ICSI). In this case, the most mobile and structurally correct male reproductive cells are chosen, sometimes they are removed directly from the testicle. Then each sperm cell is injected into a single egg using a microneedle under a microscope. The probability of fertilization in this way is 50-70%. Patient education: In vitro fertilization (IVF) (Beyond the Basics).

After that, the embryo is placed in a special nutrient medium, which is changed daily. Specialists grow the embryo for 3-5 days, constantly observing the process of cell division.

Preimplantation diagnosis

If there is an increased risk of having a baby with Down syndrome or with hereditary diseases, such as cystic fibrosis, preimplantation IVF Procedures genetic diagnosis can be performed before embryos are transferred to the uterus. For this, one is taken from the embryo, which consists of eight cells, to study the chromosomes. True, because of this procedure, the embryo may die. Therefore, the study is performed strictly according to indications.

Embryo transfer

This is usually done on the 3rd day after fertilization. But some women are implanted with an embryo on the 5th day, so that there is time to observe cell division and choose the best embryo.

The transfer is performed without anesthesia or other anesthesia. The doctor inserts a thin catheter into the uterine cavity very carefully so that pain and spasms do not appear. Otherwise, the embryo will not take root.

Then the embryo is injected through a tube along with a minimum amount of liquid. Moreover, women under 35 are implanted with Patient education: In vitro fertilization (IVF) (Beyond the Basics) only one, and if IVF is not the first or the expectant mother is older, two or more embryos are transferred to increase the chances of pregnancy.

The remaining embryos are offered to be cryopreserved. They can be used later if the attempt to conceive is unsuccessful.

Olga Belokon

Today, in general, there is no difference whether IVF is performed with fresh or cryopreserved embryos. The efficiency is the same.

After transferring the embryo, it is recommended to lie down for a while. Although research shows Patient education: In vitro fertilization (IVF) (Beyond the Basics), it does not affect implantation success.

It is certainly difficult to prepare for IVF. This is true?

Yes. Most often, preparation takes about two months. To increase the chances of conceiving, doctors recommend Preparing for ART couples change their lifestyle, start eating healthy and take folic acid, quit smoking and alcohol, and reduce their caffeine intake. Exercise is also helpful as it helps control weight.

In addition, a woman needs to be cured of all chronic diseases, vaccinated against rubella, tetanus, whooping cough and flu, if she has not done so on time according to the vaccination schedule.

But the main preparations begin shortly before the IVF procedure. For this, In vitro fertilization (IVF) is carried out:

• Ovarian reserve testing. At the beginning of the menstrual cycle, a woman is tested for estradiol, follicle-stimulating and anti-Müllerian hormones. She is also prescribed a pelvic ultrasound. This will help to understand whether medications can be used to stimulate ovulation or whether only IVF in the natural cycle is suitable for the patient.
• Semen analysis. It is done if it was not performed during the examination for infertility.
• Screening for infections. Both partners are tested for syphilis, gonorrhea, HIV, hepatitis.
• False embryo transfer. It is usually done one month before the actual implantation of the embryo. This procedure allows you to better study the individual parameters of the uterine cavity, choose a more suitable catheter tube and find the optimal place for the embryo. In case of false transfer, there may be a blue dye in the tube to help control the fluid delivery process.
• Study of the uterine cavity. It is performed using hysteroscopy, when a tube with a video camera is inserted into the vagina. Sometimes sonohysterography is done (ultrasound of the uterine cavity with filling it with fluid).

In addition, a woman may be prescribed Patient education: In vitro fertilization (IVF) (Beyond the Basics) combined oral contraceptives one to two weeks before IVF. This is necessary so that the patient does not ovulate at an unplanned moment.

Some clinics suggest that women have fallopian tubes ligated before IVF to reduce the risk of ectopic pregnancy. During such an operation, the appendages are simply clamped in the middle with a surgical thread or staple. As Olga Belokon notes, in fact, this is not necessary for successful IVF. The dressing sometimes impairs blood flow to the ovaries, so stimulating them with hormones will not work well. And after the transfer, the embryo can still gain a foothold in the remaining "stump" of the fallopian tube.

It happens that before IVF, the fallopian tubes must be cut out completely.

Olga Belokon

If a woman accumulates fluid in the fallopian tubes (this is called a hydrosalpinx), they are offered to be removed before IVF. This is to increase your chances of success. If this is not done, fluid will enter the uterine cavity and wash away the embryo.

What will happen after the procedure?

Usually, a woman can immediately return to her daily life in vitro fertilization (IVF). But it must be remembered that due to stimulation, the ovaries are slightly enlarged and may hurt. To avoid discomfort, doctors recommend giving up physical activity.

To reduce the risk of losing pregnancy, from the first day after IVF, progesterone is introduced, a hormone that reduces uterine contractions and prepares the body for bearing a baby. Because of this, the state of health can change. Sometimes, within a few days, a clear fluid flows out of the vagina or spotting spotting appears, and this is normal. In addition, bloating, constipation and breast pain may occur.

12 days after receiving the eggs, you need to pass In Vitro Fertilization (IVF) tests for the hCG hormone. This will show if the woman is pregnant. If conception has occurred, the fertility specialist will refer you to an obstetrician-gynecologist, and after 3-4 weeks will recommend an ultrasound scan.

If hCG remains low, then nothing has worked out. In this case, it is necessary to stop taking progesterone and wait for menstruation. The specialist will then advise on when to try another IVF attempt.

What determines the success of IVF?

Olga Belokon

For some reason, there is a big misconception that there are methods that can guarantee pregnancy literally the first time. But IVF is not a guarantee of pregnancy. Sometimes you have to make more than one attempt, and not two, and not three, to get the desired result.

The following In Vitro Fertilization Factors (IVF) reduce the chances of conception:

• Mother's age. The older you are, the less likely you are to become pregnant. Therefore, women after 41 years of age are advised to use donor eggs.
• Features of the embryo. It is considered Blastocyst Transfer Ameliorates Live Birth Rate Compared with Cleavage-Stage Embryos Transfer in Fresh In Vitro Fertilization or Intracytoplasmic Sperm Injection Cycles: Reviews and Meta-Analysis that 5-day-old embryos take root better. But more often embryos are transferred on the third day, because under laboratory conditions, not all survive until the fifth day.
• Lack of pregnancy in the past. If a woman has never managed to conceive and give birth to a child before, then the chances of successful IVF are lower.
• The cause of infertility. Severe gynecological illnesses, such as endometriosis or ovulation disorder, reduce the likelihood of pregnancy more than unexplained infertility.
• Mother's lifestyle. Obesity, smoking, alcohol or caffeine abuse, and drug use reduce the chances of conception.