In vitro fertilization (IVF)

In recent years, the method of in vitro fertilization (IVF) has become increasingly widespread in the treatment of infertile marriages – fertilization of oocytes outside the body, their cultivation, followed by the implantation of dividing embryos into the uterine cavity.

Currently, clear indications and contraindications for the use of this method of assisted reproduction have been developed.

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Indications for in vitro fertilization (IVF):

• Female infertility:
  • absolute tubal infertility (absence of fallopian tubes or their obstruction);
  • infertility caused by endometriosis (if drug therapy is unsuccessful);
  • endocrine infertility (if hormone therapy is unsuccessful);
  • infertility of unknown etiology;
  • infertility caused by cervical factors (if treatment by intrauterine insemination is unsuccessful);
  • absolute infertility and that caused by the absence or functional inadequacy of the ovaries (gonadal dysgenesis, premature menopause, resistant ovaries), in these cases IVF and PE will include the use of donor oocytes.
• Male infertility:
  • oligoasthenozoospermia grades I–II.
• Mixed infertility (a combination of the above 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 ultrasound control.
3. Cultivation of eggs and embryos.
4. Transfer of embryos into the uterine cavity.

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

For example, the ICSI method can restore a husband's fertility even if only one single spermatozoon can be detected in his ejaculate (instead of millions, as in healthy men). The egg has a dense outer shell, which is called shiny. In some diseases, the ability of spermatozoa to pass through this shell can be impaired - such spermatozoa cannot fertilize the egg. ICSI is the introduction of one spermatozoon directly into the cytoplasm of the egg using special micromanipulators. This micromanipulation ensures fertilization and makes it possible to have children in a number of completely hopeless cases of male infertility. Variants of the ICSI program, carried out in the absence of spermatozoa in the ejaculate (azoospermia), are the TESA and MESA methods. The spermatozoa required for injection into the egg are extracted by puncture of the testicle (TESA) or epididymis (MESA).

IVF pregnancy – hCG

A blood test to determine the level of hCG (human chorionic gonadotropin) in the early stages after IVF allows you to determine most accurately whether pregnancy has occurred. A special pregnancy test to determine the level of hCG can be purchased at a pharmacy. The level of hCG is also determined by taking blood from a vein, its accuracy is much higher compared to tests. A blood test to determine the level of chorionic gonadotropin is important not only for establishing the onset of pregnancy, but also for the timely detection of pathological processes. The following are considered normal levels of hCG at the onset of pregnancy:

• First-second week - 25-156 mIU/ml.
• Second-third week - mIU/ml.
• Third-fourth week - 1110-31500 mIU/ml.
• Fourth-fifth week - 2560-82300 mIU/ml.
• Fifth-sixth week - 23100-151000 mIU/ml.
• Sixth-seventh week - 27300-233000 mIU/ml.
• Seventh to eleventh week - 20900-291000 mIU/ml.
• Eleventh to sixteenth week - 6140-103000 mIU/ml.
• Sixteenth to twenty-first week - 4720-80100 mIU/ml.
• Twenty-first to thirty-ninth week - 2700-78100 mIU/ml.

As practice shows, if two weeks after the embryos were placed in the uterine cavity, the hCG level is more than 100 mIU/ml, then fertilization was successful and the chances of carrying a pregnancy are quite high. Indicators of 300-400 mIU/ml may indicate the development of two fetuses. If the hCG level is less than 25 mIU/ml, this means that conception has not occurred. If the level of chorionic gonadotropin fluctuates from 25 to 50-70 mIU/ml, additional diagnostics are required to determine whether it is necessary to support the pregnancy. The chances of carrying a pregnancy with such indicators are extremely low.

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Contraindications to in vitro fertilization (IVF):

1. Somatic and mental illnesses that are contraindications to pregnancy (according to the conclusion of specialized specialists).
2. Congenital anomalies: repeated birth of children with the same type of developmental defects; previous 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. Adhesions of the uterine cavity.

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Discharge during IVF pregnancy

Discharge during IVF pregnancy may appear after the embryos are transferred into the uterine cavity, as a rule, they are not abundant, have a liquid consistency, and may contain a small amount of blood. After the embryos are implanted, the dose of progesterone drugs is approximately doubled and they continue to be taken until the three-month period, when the placenta begins to produce it on its own. After the in vitro fertilization procedure, it is necessary to exclude physical activity; in the first day, you cannot take a bath or visit a swimming pool. The woman is also recommended to have sexual rest.

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Signs of pregnancy after IVF

Signs of pregnancy after IVF usually begin to appear after fourteen days from its onset. In most cases, these signs are identical to those that occur during natural fertilization - the breasts swell, increase in size and become hypersensitive, the skin around the nipple acquires a dark shade, the woman becomes irritable, gets tired quickly. If toxicosis is an optional symptom during natural pregnancy, then during IVF pregnancy such a disorder makes itself known in almost all cases. It manifests itself in the form of nausea and vomiting, which in some cases can be repeated several times a day, excessive sensitivity to surrounding odors. Of course, in each specific case, the signs may differ from each other, for example, in some women, in the early stages after IVF fertilization, an increase in basal temperature is noted. Signs of pregnancy after IVF can also include discomfort in the uterus and lower abdomen, lower back pain, disruption of the digestive tract, flatulence. In connection with taking hormonal drugs, a decrease in blood pressure, hot and cold flashes, and an increase in body temperature may also be observed. After in vitro fertilization, sleep disorders, sudden mood swings, and increased nervousness may also occur. Unpleasant symptoms usually disappear in the second or third trimester of pregnancy.

Pregnancy after IVF

Pregnancy after IVF occurs as a result of the placement of fertilized eggs in the uterine cavity. Before the procedure, the patient is prescribed medications to 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 medications so that they take root. Fourteen days after IVF, a blood test is taken to determine whether the pregnancy is continuing to develop. An ultrasound scan is performed after a month or a month and a half. An absolute indication for in vitro fertilization is obstruction or complete absence of the fallopian tubes in a woman or a shortage, as well as a complete absence of sperm in a man. The risk of pregnancy after IVF is the development of several embryos at once (multiple fetuses), which in many cases is a threat of miscarriage, especially when three or more fetuses develop. In such cases, to preserve the pregnancy, the fetus is removed from the uterus without affecting the remaining one. Also, fetal reduction can occur on its own at approximately eight to nine weeks, while the remaining fetus, as a rule, does not stop developing.

Frozen pregnancy IVF

According to statistics, approximately twenty percent of pregnancies after IVF fail and the pregnancy does not develop. One of the main factors provoking such pathology are genetic diseases, as well as infectious agents of viral or viral-bacterial etiology. A frozen pregnancy after IVF can also be a consequence of disorders in the functioning of the hemostasis system, diseases of the endocrine system, and an increased level of male sex hormones. If the pregnancy does not develop, both partners are prescribed an examination to determine the hormonal status and compatibility according to the leukocyte antigen system, identify infections, etc., and only after that is repeated in vitro fertilization planned.

Pregnancy test after IVF

The first signs of pregnancy usually become apparent two weeks after the fertilization procedure. During this period, the first pregnancy test after IVF is performed. The most accurate way to diagnose pregnancy at an early stage is to take a blood test to determine the level of human chorionic gonadotropin, which increases when fertilization occurs and is produced by the placenta. Three weeks after in vitro fertilization, the doctor prescribes an ultrasound scan to confirm the pregnancy, ensure that there is no ectopic pregnancy, and determine the number of fertilized eggs.

IVF pregnancy management

When pregnancy occurs, women need to take a lot of different tests and undergo various procedures to assess the condition of the pregnant woman and the fetus. In addition to the main examinations, IVF pregnancy management includes the following examinations:

• Starting from the twenty-first day after fertilization, the hemostasis system is examined, the functions of which are to help stop bleeding when the walls of blood vessels are damaged and to keep the blood in a liquid state. Disruptions in the functioning of the hemostasis system carry a risk of miscarriage.
• At the twelfth to thirteenth week, the uterus is examined to detect isthmic-cervical insufficiency, in which the cervix cannot hold the growing fetus in the uterine cavity until the required time.
• In the first trimester of pregnancy, an ultrasound examination of the fetus is performed.
• From the tenth to the fourteenth week, tests are prescribed to determine the level of alpha-fetoprotein and human chorionic gonadotropin to identify developmental defects of the nervous system, chromosomal and genetic abnormalities.
• Starting from the sixteenth to the twentieth week, a 17-KS daily urine analysis is performed to determine the level of male sex hormones to prevent miscarriage or intrauterine fetal death.
• Dopplerography allows us to examine blood flow in the placenta, umbilical cord and uterus.
• In the second trimester of pregnancy, an ultrasound examination of the fetus is again performed, as well as a blood test for alpha-fetoprotein and human chorionic gonadotropin, as well as estriol levels to detect developmental delays.
• In the third trimester, an ultrasound examination allows you to determine the position of the fetus, whether there is cord entanglement, abnormalities in bone formation, and to assess the condition of the placenta. Cardiotocography allows you to determine the heart rate and motor activity of the fetus.

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