In-vitro fertilization is a modern procedure of reproductive medicine, which allows a woman to naturally bear and give birth to a child. The essence of this technology consists in introducing an egg fertilized in laboratory conditions into the uterus. Before conducting the IVF procedure, the doctor determines which cells will be used – donor or your own. In order for this type of procedure to be successful, all the stages of IVF must be followed on a daily basis, as stipulated by medical protocols.
Phase 1 – Preparation
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The IVF procedure lasts no longer than one menstrual cycle per day, but the preparatory stages of IVF itself can take much longer. The preparatory stage involves both the woman and the man who decided to undergo the standard IVF procedure.
Women.
Doctors perform a comprehensive examination of the woman and determine her ovarian reserve, the supply of unripe eggs. If the ovarian reserve is absent or reduced to a critical level, doctors offer an alternative – the use of donor eggs.
It is necessary to make sure the woman does not have any pathologies of the uterine, ovarian and fallopian tube tissues, such as synechiae, polyps or hydrosalpinx. These abnormalities must be removed prior to the IVF procedure itself.
The doctor will swab for bacterial flora to make sure there are no infections. If not, treatment will be necessary, as any infection reduces the likelihood of a favorable IVF outcome. Before entering the standard IVF procedure, a pelvic ultrasound is performed 7-10 days before your menstruation to assess the uterine cavity, its size, mucosal thickness, and ovarian function.
Men.
The man who will become an IVF donor will have to undergo a spermogram. This test determines the man’s fertility and identifies existing diseases of the reproductive system, if any. Before in vitro fertilization, male sex cells will be checked for genetic defects in the Y-chromosome, which often cause male infertility.
The man will also need to have a urethral swab and a TORCH infection test to make sure he does not have prostatitis, urethritis, or sexually transmitted diseases.
Step 2 – Hormone Therapy
The next stage of the IVF procedure begins on the second day of the menstrual cycle and lasts from 12 to 14 days. Its essence is to stimulate the ovaries with the help of hormonal therapy to obtain 8-10 oocytes capable of fertilization. This is the number of oocytes that will be sufficient for successful IVF.
During hormone therapy every four days, every four days, an ultrasound of the pelvic organs is mandatory, according to the results of which the doctor can adjust the dosage of drugs.
For the procedure of classical IVF can be used follicle-stimulating hormone of the pituitary FSH, ionic gonadotropin and analogs of gonadoliberin. The doctor prescribes a treatment regimen depending on the protocol to be chosen for IVF.
Various ovulation stimulation protocols have been approved by the international scientific community:
- Super long – it lasts 2-3 months;
- Ultra-short – lasts up to 10 days and involves high doses of hormones Typically, this protocol is prescribed for diagnoses such as insufficient follicular reserve and low levels of AMH hormone;
- Natural cycle IVF protocol – in this case there is no hormonal stimulation and one egg is taken for fertilization that has matured in the natural menstrual cycle;
- IVF protocol with minimal stimulation – small doses of hormones are used for stimulation.
The short protocol is most often used because women who need in vitro fertilization have serious ovarian problems. In any case, the doctor will choose the safest protocol for IVF. Very often, the IVF protocol is first used in a natural cycle to avoid hormonal load on the body, and only if this method does not bring results, hormonal stimulation is prescribed.
Step 3 – Follicle Puncture
The next stage of standard IVF lasts no longer than 1 day. When the woman’s eggs have matured under the influence of hormonal therapy, it is necessary to perform their puncture. This procedure is considered a minor surgical intervention and is performed under short-term general anesthesia. With the help of an ultrasound sensor, the doctor who performs the manipulation, chooses the shortest path with a minimum number of punctures of the ovarian capsules and vaginal walls, and then introduces a special needle and carries out the collection of eggs. The procedure itself lasts from 3 to 30 minutes.
After the follicle puncture in 2-3 hours, the woman can go home. Among the existing restrictions is the prohibition to drive on the day of the operation. For 2-3 days after the procedure, the patient may experience discomfort.
The male must donate sperm on the day of the follicle puncture, which will be used to fertilize the eggs in the laboratory.
Step 4 – Egg fertilization and embryo growth
The eggs are examined by embryologists to determine if they are at the level of maturation. They are washed of follicular fluid and placed in nutrient medium for transfer to an incubator, and then fertilized in a test tube.
If the outcome is favorable, 50% to 90% of the eggs are fertilized. Within 24 hours, the zygotes begin to divide. After 2 days they consist of 2-4 cells, after 3 days – of 6-10 cells. Normally, on the fifth day, the zygote divides into two types of cells – one of which will form the fetus in the future, and the other will form the placenta.
It is mandatory that fertilized eggs are examined daily by specialists to rule out developmental defects and any hereditary pathologies. When the zygotes reach the necessary level of development, the doctor will select the healthiest cells for the next stage of standard IVF.
Step 5 – Transferring the embryo into the uterine cavity
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The next step is a manipulation that takes only 1-2 minutes. Using a special catheter the doctor transfers the embryos with the nutrient medium into the uterine cavity. The entire process is monitored with an ultrasound scan. After the procedure, the patient should preferably spend a few hours in the hospital to avoid complications, and then she can go home. For most women, this procedure is completely painless.
Phase 6 – Maintenance of pregnancy
After in vitro fertilization, it is important to monitor how the embryo is developing. Hormonal treatment may be necessary and will be prescribed only after the ultrasound and the tests.
14 days after transferring the embryo into the uterine cavity should be tested for hCG hormone levels, the results of which can be concluded about the onset of pregnancy.
With a positive result in the first trimeter it is important to consult a doctor regularly and take all necessary tests to monitor the condition of the woman and the development of the pregnancy. Supportive hormonal therapy after IVF may last about 10-12 weeks.
In vitro fertilization indications
Each of the stages of standard IVF involves an interference in the natural processes of the body’s functioning. Accordingly, there are many risks to a woman’s health. This is why all stages require strict medical indications. It is also worth noting that IVF is prescribed only in those cases where it is impossible to conduct treatment and identify the causes of infertility.
The classic IVF procedure is performed for the following indications:
- Ovulatory disorders or lack of ovulation;
- Insufficient amount of ejaculate;
- Fallopian tube obstruction;
- Endometriosis;
- Serious inflammatory diseases of the urogenital system;
- Absence of the fallopian tube due to its removal because of an ectopic pregnancy;
- Prolonged treatment of gynecological diseases – it makes sense to perform IVF to bypass many obstacles to conception.
During the embryo rearing stage of IVF, all of the fertilized eggs are studied in the laboratory under mandatory conditions. This makes it possible to detect many genetic abnormalities. Thus, another indication for IVF is a high risk of genetic abnormalities and hereditary diseases. Modern diagnostic methods make it possible to select donor material that does not contain undesirable genes at the stage of embryo implantation in the uterine cavity, which increases several times the chances of giving birth to a healthy child.
Another indication for IVF is couple’s genetic incompatibility. This is one of the most difficult cases in the practice of fertility doctors. As a result of genetic incompatibility both spouses may be absolutely healthy, but they cannot conceive naturally and give birth to a healthy child. All couples diagnosed with genetic incompatibility must undergo a special test – karyotyping. At this stage, blood is examined for the number of chromosomes as well as their quality. As a result of such diagnostics, specialists make a prognosis concerning the success of IVF and the chances of delivering a completely healthy child. If the outcome is unfavorable, specialists will suggest alternative options, such as in vitro fertilization with donor egg or sperm.
In-vitro Fertilization at the “BFE”
Clinic.
BFE Clinic is a leading center specializing in the treatment of all kinds of infertility and in vitro fertilization. Our advantages include highly qualified doctors, use of advanced safe reproductive techniques approved by the international scientific community, modern technical base and affordable price for all types of research and treatment.
BFE Clinic offers the following services:
- Initial free consultation with doctors of various specializations – geneticists, embryologists, andrologists, obstetrician-gynecologists, therapists, endocrinologists;
- A comprehensive medical examination, which includes an examination by our leading specialists, a full range of necessary tests and instrumental diagnostics;
- Choosing the most appropriate IVF protocol;
- Determining the exact cause of infertility and making an accurate diagnosis;
- Follow-up with appropriate specialists not only when IVF stages are being carried out, but also throughout the pregnancy.
In-vitro fertilization can be performed in BFE clinic free of charge in accordance with the current state program of compulsory medical insurance.