In Vitro Fertilization in the Treatment of Infertility

(in vitro fertilization with embryo transfer)

Main stages of the treatment cycle:

• Examination of spouses
• Induction of superovulation
• Follicle puncture
• Collection of sperm
• Fertilization of oocytes with sperm
• Embryo culture
• Embryo transfer into the uterine cavity
• Support of the second phase of the cycle
• Pregnancy diagnosis

Stage 1. PATIENT EXAMINATION

The most correct approach, in our opinion, is to use a PREGNANCY PREPARATION KIT, which allows a comprehensive assessment of the condition and characteristics of the spouses' reproductive system, taking these factors into account when planning the IVF cycle. This maximizes the effectiveness of the treatment. It is no secret, that the quality of laboratory diagnostics depends both on consumables and reagents, as well as on the culture of performing techniques. An objective picture can only be achieved in a specialized center. **Stage 2. SUPER-OVULATION INDUCTION (SOI)** Conducting this stage requires patients to follow prescriptions accurately and precisely. The choice of the **super-ovulation induction** scheme depends on a variety of factors and is determined by the doctor individually. The cost of drugs for SOI (super-ovulation induction) constitutes a significant portion of the total cost of the IVF cycle. However, the use of cheaper, Previously used techniques without suppression of FSH and LH secretion increase the frequency of spontaneous ovulation to 30%, and this leads to the cancellation of the therapeutic cycle at this stage. Suppressing the secretion of one's own FSH and LH provides control over ovulation. To manage it, two groups of drugs are used: agonists and antagonists of gonadotropin-releasing hormone (GnRH). For the stimulation of the growth and development of follicles, natural LH and FSH or synthetic (RECOMBINANT FSH) are used. Control of follicle development is carried out by ultrasound monitoring. Not all of them contain egg cells. Not all obtained egg cells (oocytes) are of good quality, capable of fertilization and normal development. Therefore, a large number of obtained egg cells is a guarantee of success in the IVF cycle. When the follicles reach a certain diameter (usually 18-24 mm), and the endometrium reaches a sufficient stage of development, a decision is made to perform a puncture. The patient is administered HCG (from 5 to 10 thousand IU), which acts as LH in the natural menstrual cycle. Stage 3. FOLLICLE PUNCTURE Follicle puncture is performed under general intravenous anesthesia and transvaginally with ultrasound monitoring, lasting 5 - 7 minutes. The procedure is conducted quickly and comfortably for the patient. The doctor inserts a vaginal probe with a special needle attached. Then carefully collects the follicular fluid into tubes. The tubes are passed to a sterile box for the embryologist, who examines their contents under a microscope and quickly transfers the found eggs into a nutrient medium. Not all oocytes are equally viable and capable of fertilization and further development, so having a sufficient quantity is a key to success in the IVF cycle. At the same time, even obtaining a single oocyte under favorable conditions is a significant chance for success. After the puncture, the woman is monitored for 1.5-2 hours, and then leaves the clinic.

Stage 4. SPERM COLLECTION

This is no less important, though less complicated stage. Sperm (ejaculate) is collected in maximally sterile conditions after 3-4 days of abstinence ON THE DAY OF FOLLICLE PUNCTURE. Male genitalia must be clean. For obtaining the highest quality product, as good sexual stimulation as possible is necessary. 5 stage. FERTILIZATION OF EGGS For successful cultivation of human cells, it is necessary to create conditions similar to those inside the body. For this purpose, special CO2 INCUBATORS, LAMINAR BOXES, nutrient media, micro-tools, and much more. Cells, especially sensitive ones such as gametes, need to be protected from the aggressive microflora of the environment. Since there is a risk of CONTAMINATION by bacteria and fungi of nutrient media in which oocytes and embryos are situated, the requirements for the sterility of all premises, equipment, cultural dishes, tools, etc. are at the highest level. Processing of ejaculate, The preparation of sperm for fertilization is conducted by an embryologist over several hours. For this, only motile sperm that have undergone CAPACITATION are selected, approximately 50 - 100 thousand per each egg cell. And although normally only one of them should penetrate the egg cell for fertilization "in vitro", as with natural conception, a significant "critical biomass" of sperm is required. The results of fertilization are assessed the following day. Normal fertilization is considered to be 60-70% of oocytes. In another day, it is possible to see how many of them develop and turn into embryos. At this time, all technological operations are carried out to ensure the conditions for DIVISION - FRAGMENTATION of embryos, preparation for transfer to the maternal uterus. The cultivation stage can last 48-120 hours and depends on many factors.

Step 6. TRANSFER OF EMBRYOS TO THE UTERUS (TRANSFER)

Usually an absolutely painless manipulation, during which the best of the obtained embryos are introduced into the uterine cavity through the cervix using a catheter. By this time, the surface of the ENDOMETRIUM, that is, the inner mucous membrane of the uterus, is a folded tissue covered with unique micro-grasps called PINOPODS. Sinking into the folds, the embryos attach themselves with their help to the endometrium and, of course, cannot fall out of the uterus. For several hours, the woman is under observation, she calms down, and tunes into the necessary psychological wave. After all, her mood will largely determine whether the uterus will accept the new life. The number of embryos transferred is discussed with the patients and depends both on the characteristics of the woman and on the current results of the clinic's work. Stage 7. SUPPORT OF PHASE II OF THE CYCLE The next 2-2.5 weeks, the woman should spend in a state of physical, emotional, and sexual rest, following new doctor's prescriptions to maintain the endometrium, taking progesterone, estrogen, and HCG medications. Even with changes in well-being or the appearance of unusual symptoms, do not stop taking the medications without consulting YOUR DOCTOR. Based on our observations, minor slightly colored discharges close to the upcoming menstrual period are considered a normal variant.

Step 8. PREGNANCY DIAGNOSIS

At the time prescribed by the doctor, BIOCHEMICAL PREGNANCY tests can be conducted. The most informative is the quantitative determination of human chorionic gonadotropin levels in the blood (hCG), and after some time, the determination of the fetal egg via ultrasound (approximately 5 weeks after transfer). Premature use of not always stable urine tests can be both disappointing and confusing. EFFICIENCY Due to the relatively high cost of the IVF cycle, patients most often ask about the guarantees of pregnancy. The human reproductive system remains too complex to be compared to even the most sophisticated machinery repair. Therefore, only the probability of treatment success for a given couple can be seriously discussed. Based on health indicators, personal and global experience. Regardless of the level of medical service quality, pregnancy may not occur, may occur and be interrupted, and there is a risk of ectopic pregnancy. Patients should be fully informed about the characteristics of various treatment stages and its outcomes for making an informed decision. The risk of numerous complications is actually negligible, and the goal is worthy of applying serious resources and efforts. The likelihood of pregnancy occurring in a healthy married couple with regular sexual activity averages only 20%. Emphasis on - healthy. This means that only the fertilization of every fifth egg can initiate pregnancy. Human natural reproductive capability is rather low, however, the use of IVF provides an opportunity to almost double the probability. Each patient has her own individual chance, determined by dozens of different factors, including those not accessible for analysis. Among them are the age of the woman, the duration of the infertility period, and the moral-psychological climate in the family. A distinctive feature of our work is the absence of large patient flows. Thanks to this, the control of the main stages of reproductive function implementation is especially meticulous, and all stages of treatment for patients are conducted with enhanced comfort. The effectiveness of our work is stable and corresponds to the level of an average global reproductive center. BECOME A MOTHER WITH US - a pregnancy management program after IVF

Pregnancy onset after long-term infertility due to IVF becomes a reality even in the most hopeless cases. But this is just one of the stages of becoming a mother, as there is a risk of miscarriage and other complications. A characteristic of the psychology of many of our compatriots is the desire to hide from others, including local treating doctors, the origin of the long-awaited pregnancy. Local doctors, Those without experience in modern ART programs are often unable to propose the correct tactics for managing pregnancy. Any prescriptions must be coordinated with doctors who have achieved pregnancy.