In Vitro Fertilization (IVF)

In the treatment of infertile marriage, in recent years, the method of extracorporeal fertilization (IVF) - the fertilization of oocytes outside the body, cultivating them with the subsequent insertion of crushing embryos into the uterine cavity, is becoming increasingly widespread.

At the present time, clear indications and contraindications to the use of this method of assisted reproduction have been developed.

[1], [2]

Indications for in vitro fertilization (IVF):

• Female infertility:
  • absolute tubal infertility (absence of fallopian tubes or their obstruction);
  • infertility caused by endometriosis (with unsuccessful drug therapy);
  • endocrine infertility (if hormone therapy is unsuccessful);
  • infertility of unclear etiology;
  • infertility caused by a cervical factor (with failure of treatment by intrauterine insemination);
  • absolute infertility and due to the lack or functional infertility of the ovaries (gonadal dysgenesis, premature menopause, resistant ovaries), in these cases IVF and PE will involve the use of donor oocytes.
• Male infertility:
  • oligoasthenozoospermia of the I-II degree.
• Mixed infertility (a combination of these forms of female and male infertility).

Stages of in vitro fertilization (IVF)

1. Stimulation of superovulation under the control of endocrinological and echographic monitoring.
2. Aspiration of preovulatory follicles under the control of echography.
3. Cultivation of eggs and embryos.
4. Embryo transfer to the uterine cavity.

Thanks to the use of methods of assisted reproduction, today's medicine is able to solve the most difficult problems of male infertility.

For example, the ICSI method can restore the fertility of the husband, even if only one sperm can be found in his ejaculate (instead of millions, as in healthy men). The egg has a dense outer shell, which is called shiny. With some diseases, the ability of spermatozoa to pass through this membrane can be disturbed - such spermatozoa can not fertilize the ovum. ICSI is this. Introduction with the help of special micromanipulators of one spermatozoon directly into the cytoplasm of the egg cell. This micromanipulation provides fertilization and makes it possible to have children in a whole series of completely hopeless cases of male infertility. Variants of the ICSI program conducted in the absence of spermatozoa in the ejaculate (azoospermia) are the methods of TESA and MESA. The sperm required for injection into the egg are removed when the testicle is punctured (TESA) or the epididymis (MEZA).

ECO pregnancy - hCG

A blood test for determining the level of hCG (human chorionic gonadotropin) at an early stage after IVF makes it possible to determine most precisely whether a pregnancy has occurred. A special pregnancy test with the determination of the level of hCG can be bought at the pharmacy. Also, the level of hCG is determined by taking blood from the vein, its accuracy is much higher, compared with the tests. The blood test for determining the level of chorionic gonadotropin is important not only for establishing the pregnancy, but also for the timely detection of pathological processes. The following are considered normal indicators of the level of CG at the onset of pregnancy:

• The first or second week is 25-156 mU / ml.
• The second-third week is md / ml.
• The third-fourth week is 1110-31500 mU / ml.
• The fourth-fifth week is 2560-82300 mU / ml.
• The fifth-sixth week is 23100-151000 IU / ml.
• Sixth-seventh week - 27300-233000 mU / ml.
• Seventh-eleventh week - 20900-291000 IU / ml.
• Eleventh to sixteenth week - 6140-103000 IU / ml.
• The sixteenth-twenty-first week is 4720-80100 mU / ml.
• The twenty first - thirty-ninth week - 2700-78100 mU / ml.

As practice shows, if in two weeks after placement of embryos in the uterus of the embryo the level of hCG is more than 100 mU / ml, then the fertilization was successful and the chances of bearing pregnancy are quite high. The indices in 300-400 mU / ml may indicate the development of two fruits. If the level of hCG is less than 25 mU / ml, this means that conception did not occur. If the level of chorionic gonadotropin ranges from 25 to 50-70 mU / ml, additional diagnosis is required to determine whether pregnancy is necessary. The chances of bearing with such indicators are extremely low.

[3], [4], [5], [6], [7], [8], [9]

Contraindications to in vitro fertilization (IVF):

1. Somatic and mental diseases, which are contraindications to gestation (according to the conclusion of specialized specialists).
2. Congenital anomalies: re-birth of children with the same type of malformations; the birth of a child with chromosomal abnormalities; dominantly inherited diseases of one of the parents.
3. Hereditary diseases.
4. Hyperplastic conditions of the uterus and ovaries.
5. Malformations of the uterus.
6. Synechia of the uterine cavity.

[10], [11], [12], [13], [14], [15]

Allocations for IVF of pregnancy

Isolation in IVF pregnancy may appear after the transfer of embryos into the uterine cavity, as a rule, they are not abundant, have a liquid consistency, may contain a small amount of blood. After implanting embryos, the dose of progesterone drugs is approximately doubled and continue to be taken up to a three-month period when the placenta begins to produce it on its own. After performing the procedure of in vitro fertilization, it is necessary to exclude physical activity, in the first day you can not take a bath and visit the pool. Also, a woman is recommended sexual rest.

[16], [17], [18], [19], [20], [21]

Signs of pregnancy after IVF

Signs of pregnancy after IVF, as a rule, begin to appear after fourteen days after its onset. In most cases, these signs are identical with those that occur with natural fertilization - the breast swells, increases in size and becomes supersensitive, the surface of the skin around the nipple acquires a dark shade, the woman becomes irritable, quickly becomes tired. If, in natural pregnancy, toxicosis is an optional symptom, then in pregnancy IVF such a disorder is felt in virtually all cases. It manifests itself in the form of nausea and vomiting, which in some cases can be repeated several times a day, excessive susceptibility to the surrounding odors. Of course, in each specific case, the signs may vary, for some women, for example, in the early stages after IVF fertilization, there is an increase in basal temperature. Signs of pregnancy after IVF can also include discomfort in the uterus and lower abdomen, low back pain, disruption of the digestive tract, flatulence. In connection with taking hormone-containing drugs, blood pressure, hot and cold flushes, and body temperature increase can also be noted. After the onset of in vitro fertilization, sleep disorders, sharp mood swings, and increased nervousness can also occur. Unpleasant symptoms usually occur in the second or third trimester of pregnancy.

Pregnancy after IVF

Pregnancy after IVF occurs as a result of placement in the uterine cavity of fertilized in vitro egg cells. Prior to the procedure, the patient is presumed to prescribe medications that enhance their growth and maturation. Three to five days after fertilization, the embryos are transferred to the uterus. During this period, the woman is prescribed the necessary drugs, so that they take root. Fourteen days after IVF, a blood test is taken to determine if further development of pregnancy occurs. After a month and a half, an ultrasound is performed. Absolute indications for in vitro fertilization is the obstruction or complete absence of uterine tubes in a woman or a lack, as well as the complete absence of sperm in a man. The risk of pregnancy after IVF is the development of several embryos (multiplicity), which in many cases is a threat of miscarriage, especially with the development of three or more fetuses. In such cases, to preserve pregnancy, the fetus is removed from the uterus, without touching the remaining one. Also, fetal reduction can occur on its own for about eight to nine weeks, with the remaining fruit, as a rule, does not stop its development.

Frozen pregnancy IVF

According to statistics, about twenty percent of pregnancies after IVF result in failure and pregnancy does not develop. One of the main factors provoking such a pathology are diseases of the genetic level, as well as infectious agents of viral or viral-bacterial etiology. Frozen pregnancy IVF can also be a consequence of violations of the hemostatic system, endocrine system diseases, elevated levels of male sex hormones. If the pregnancy does not develop, both partners are prescribed a test to determine hormonal status and compatibility according to the system of leukocyte antigens, detect infections, etc. And only after that plan repeated in vitro fertilization.

Pregnancy test after IVF

The first signs of pregnancy usually make themselves felt two weeks after the procedure of fertilization. During this period, the first pregnancy test after IVF is carried out. The most accurate diagnosis of early pregnancy allows a blood test to determine the level of chorionic gonadotropin, which increases when insemination occurs and is made by the placenta. Three weeks after in vitro fertilization, the doctor prescribes an ultrasound to confirm the pregnancy, make sure there is no ectopic pregnancy and determine the number of fetal eggs.

Conducting pregnancy IVF

At the onset of pregnancy, women need to take a lot of different tests and conduct various procedures for assessing the condition of the pregnant and fetus. Conducting pregnancy IVF, in addition to basic surveys, includes the following examinations:

• Beginning twenty-one days after the onset of fertilization, a hemostatic system is examined, the functions of which are to help stop the bleeding when the walls of the vessels are damaged and to keep the blood in a liquid state. Violations of the functioning of the hemostatic system carry the threat of miscarriage.
• On the twelfth or thirteenth week, a uterine examination is performed to determine ischemic-cervical insufficiency, in which the cervix can not retain the growing fetus in the uterine cavity until the required time.
• In the first trimester of pregnancy, the fetus is ultrasound.
• From the tenth to the fourteenth week, tests are performed to determine the level of alpha-fetoprotein and chorionic gonadotropin for the detection of malformations of the nervous system, chromosomal and genetic abnormalities.
• From the sixteenth to the twentieth week, a daily urine sample of 17-CS is used to determine the level of male sex hormones to prevent miscarriage or intrauterine fetal death.
• Conducting dopplerography allows to investigate the blood flow in the placenta, umbilical cord and uterus.
• In the second trimester of pregnancy, fetal ultrasound is again performed, a blood test for alpha-fetoprotein and chorionic gonadotropin, as well as the level of estriol to detect developmental delay.
• In the third trimester, the ultrasound can be used to determine the position of the fetus, whether the umbilical cord is crooked, deviations in the formation of bones, and assess the placenta condition. Determine the heart rate and motor activity of the fetus allows cardiotocography.

[22], [23], [24], [25], [26],