IVF fertilization, pregnancy after IVF. In Vitro Fertilization: State Program
Infertility is one of the most pressing problems for 17% of married couples in Russia (according to WHO). If a woman cannot become pregnant for more than a year with regular sex life and without the use of contraceptives, then the couple should definitely consult a doctor.
Female and male infertility: what is the reason
There are various reasons for female infertility:
- Obstruction of the fallopian tubes (about 40-50%). It arises as a result of inflammatory processes, abortions, the use of the intrauterine device, transferred to the pelvic organs operations, due to endometriosis.
- Adhesions in the pelvis, ovulatory disorders (35-40%).
- Hormonal imbalance (5%).
- Disorders of the endometrium (this is the internal mucous membrane of the uterus), provoked by gynecological diseases (15-20%).
- Immunological, psychogenic causes (2%).
There is also infertility of unclear genesis (5-13%).
In men, the lack of fertility (fertility) is most often due to the low mobility of sperm or obstruction of the vas deferens due to an illness or a genetic disease.
What is IVF? Fertilization: how the process takes place
In vitro fertilization is a method of assisted reproductive technology in which the fertilization of an egg by a sperm cell occurs outside the body of a woman.
1. Stimulation of superovulation.
His goal is the maturation of a large number of eggs (up to 10 on average), whereas 1-2 usually matures. The procedure significantly increases the chances of successful fertilization. After all, the greater the number of eggs, the higher the chance of getting healthy embryos. Superovulation achieved through hormonal injections.
Stimulation is performed following the prescriptions of special IVF protocols. They regulate the sequence of drugs that will enter the body. The short protocol starts on the third day of the menstrual cycle, and lasts up to two weeks.The quality of the eggs is average, but its drugs are more easily tolerated, and the risk of ovarian hyperstimulation syndrome is much lower. The long protocol lasts up to a month, and its preparations contain much more hormones. Ovules are almost the same size and better quality, but the side effects are several times larger. The very process of fertilization (IVF) is the same in both cases.
2. Transvaginal puncture of the ovaries under ultrasound control.
The procedure is performed to obtain mature eggs from the follicles under intravenous anesthesia and lasts about 30 minutes. Using transvaginal ultrasound, the doctor inserts a needle into the ovary through the vagina and abdominal cavity. The tool must penetrate the follicle (it contains the egg itself) and transfer the matured germ cell to a special tube. The procedure is done on both ovaries.
3. Fertilization of eggs.
How do artificial insemination? This stage is carried out in a thermostat with observance of sterility, temperature and time (no later than 24 hours after taking). Before this, the eggs are cultivated, that is, they are checked for compliance with physiological norms: their shape and structure are analyzed. This is the key to the success of IVF. Fertilization can be carried out in two ways:
- many sperm are added to each egg cell;
- sperm is injected into the egg with a special syringe (ICSI procedure). This is done if there are very few active and healthy male germ cells.
Fertilization of the egg (IVF) can be assessed in a day. Good embryos are cultivated in a special environment for at least two days.
4. Embryo transfer to the uterine cavity.
It is produced maximum on the fifth day after fertilization. As a rule, two of the best in terms of embryo development are chosen, and with the help of a special catheter, they are transferred to the uterus for attachment. This procedure is painless. Unused embryos are frozen for the next IVF (in vitro fertilization) or with the consent of the couple transferred to another family.
5. Supportive therapy.
For at least two weeks, a woman needs to strengthen her body with hormonal drugs to increase the chances of a successful pregnancy.
Modern IVF Techniques
The method of fertilization is chosen depending on the state of health of the woman and man, the form of infertility.
Intrauterine insemination with sperm (ICSI)
This method is used in the case of sperm cell motility or if there are too few healthy male germ cells. Insemination is performed by the sperm of the husband or the donor.
In vitro fertilization
This term combines a whole range of procedures (ovarian stimulation, extraction of eggs for the IVF procedure, fertilization, embryo cultivation, transfer to the uterus, hormone therapy), the purpose of which is successful conception, pregnancy and successful delivery.
IVF in combination with ICSI
With male infertility, this particular IVF method is most effective. Fertilization - how does this process happen? The procedure consists in immersing the spermatozoon in the cytoplasm of the egg and transferring the embryo to the uterus.
ECO + ICSI + MESA
This method of reproductive technology involves the fertilization of the female germ cell by a sperm cell derived from the testicle or epididymis of the male testicle (in case of obstruction of the spermatic cord). The process of obtaining male germ cells from the appendage is abbreviated MESA.
In Vitro Fertilization Effectiveness
Unfortunately, the IVF procedure, which, although it is a modern method of assisted reproductive technology, cannot guarantee 100% effectiveness.World statistics says that only 50-55% of attempts fall on successful IVF fertilization. The consequences can be quite negative.
The outcome of IVF and ICSI depends largely on the age of the woman, the number of eggs produced, the quality and, again, the number of embryos, the state of the endometrium. If the blood circulation in it is impaired, this will impede the successful attachment of the embryo.
Even in a healthy couple, the pregnancy rate without the use of any hormonal stimulants reaches only 25%. In Russia, the success rate of artificial insemination reaches 34% (on average, out of three fertilizations, only one will be successful).
But in no case do you have to despair! With menopause, remote ovaries, problems with conception, artificial insemination is the only chance to have a baby.
If a woman’s body cannot produce its eggs or if there are genetic diseases, the couple can use donor material. It is formed from eggs that healthy women donated, and those that intend to undergo an IVF procedure and want to save.If the patient was a donor, then the cost of the procedure is usually reduced. But this nuance needs to be clarified in the selected clinic.
In addition, there is a program of surrogate motherhood. According to her, subject to mutual consent, the donor woman bears a genetically alien child to her. The embryo of the infertile couple is replaced by a surrogate mother, and after giving birth, she gives the child to the parents.
Complications after artificial insemination
1. Multiple pregnancy.
Pregnancy after IVF is often multiple. In case of successful fertilization of three or more eggs, the doctor performs the reduction (removal) of excess embryos in order to ensure the normal development of the fetus. It damages the endometrium, can provoke inflammation or miscarriage. Also, multiple pregnancies often cause diseases of the immune and endocrine systems, chronic infections of the urogenital tract.
2. Miscarriage after removing extra embryos from the uterus.
3. Spontaneous miscarriage.
4. Ovarian hyperstimulation syndrome.
Occurs due to hormone therapy before IVF. Fertilization in this case may be unsuccessful.As a rule, the syndrome provokes a long IVF protocol due to the heavy load on the pituitary gland. A woman suffers from abdominal pain, shortness of breath and violations of the ovulatory cycle in the future.
5. Ectopic pregnancy
This complication occurs in the case of embryo attachment not in the uterus, but in the fallopian tube. In such cases, it will not be able to develop normally and as it grows it will provoke its rupture.
6. Often children are born prematurely, which increases the risk of developing pathologies.
Pregnancy after IVF
The main danger is spontaneous abortion. As a rule, it can happen in the first trimester - either with an independent release of the rest of the ovum, or the egg remains in the uterus, but the pregnancy stops. In this case, the doctor is forced to do curettage, and this is bad for the condition of the endometrium and can provoke inflammation.
The most common causes of miscarriage are a genetic factor (embryo development), hormonal imbalances, maternal and fetal immune conflict, and multiple pregnancy. To reduce the risk of interruption and ovarian hyperstimulation, a woman is undergoing a course of hormonal maintenance therapy after IVF.Fertilization of the egg - this is only the beginning of the path, you need to save the pregnancy and create conditions for the normal development of the fetus. Doctors monitor the hormone levels of progesterone and estradiol in the blood (prescribed drugs "Duphaston", "Progesterone", "Estrofem", "Divigel", "Dexamethasone"). In the first month after fertilization, their level should not be less than 5000-10000 pmol / l for the last hormone and 100-150 nmol / l for progesterone.
A mandatory component of maintenance therapy is the intake of antihypoxic vitamin vitamins (increase the resistance of the embryo to oxygen deficiency): C, B-carotene, B, and folic acid (for normal development of the neural tube). The first ultrasound is advisable to do when you can see the fertilized egg (not earlier than three weeks) and objectively assess the condition of the ovaries and endometrium.
ECO State Program
For infertile couples who dream of children, but cannot independently pay for IVF fertilization, the state program is a real way out of the predicament. The state in vitro fertilization program is a special project funded by the Ministry of Health.With its help, infertile couples can do IVF fertilization for free. For the first time such an opportunity was provided in 2006, when artificial insemination was included in the list of high-tech medical care in the subordinate hospitals of the Russian Academy of Medical Sciences.
Since 2013, the IVF procedure can be completed free of charge within the framework of the “Program of state guarantees of free medical care to citizens” (even those who do not live in Russia). According to her points, the state will pay all the costs of drugs, clinical examination and fertilization. But it is worth remembering that this applies only to the first attempt (although the amount is not specified in the legislative base), and if it is unsuccessful, then all the next ones will most likely have to be paid for by patients. In 2014, the cost of one IVF protocol amounted to 113,109 rubles.
For those who are not able to accumulate the amount for IVF fertilization, the state program can pay for three methods of assisted reproductive technology:
- in vitro fertilization;
- embryo reduction (reduction in the number of developing embryos);
- the introduction of sperm into the egg (abbreviated ICSI).
In 2009, new rules were introduced into the Program, which are still in effect. They relate to the gender and medical aspects of IVF. Previously, women could undergo a free IVF procedure only with tubal infertility. Now it is available to everyone and for any diagnosis.
The artificial insemination program does not provide for any age restrictions. But it is worth taking note that each federal district still sets its own age limit. For example, in the Moscow region is the threshold of 38 years for women. Therefore, such moments must be specified.
List of documents for the commission for referral to the IVF procedure and issuing a coupon
1. Application of the patient or his representative to the executive authority in the field of health.
2. Extract from the medical record with the signature of the head physician of the medical institution where the patient is being monitored. The document must contain information about the state of health, treatment, examination results, as well as recommendations on the advisability of sending a person to provide high-tech medical care (abbreviation VMP).
3. A copy of the medical policy and passport.
4.If necessary, a copy of the mandatory pension insurance document.
The list of documents required for the commission of the clinic where artificial insemination is done (they are needed to substantiate the real need for a procedure for a particular person):
- coupon for the provision of VMP;
- test results (must be made no more than a month ago);
- extract from medical records and other medical documents;
- copy of the passport;
- medical report of the chief doctor on the rationality of the procedure.
The procedure for obtaining a quota for the free procedure of artificial insemination
First you need to get an extract from the medical records and the results of tests from your doctor. After the signature and the conclusion of the head doctor, this package of documents is considered by the commission under the health authority of the region where the applicant lives. Almost always the meeting is conducted without a patient. If the decision of the commission is positive, then the documents will be sent to the profile clinic that deals with IVF, and the applicant will be given a ticket with the date and name of the medical institution and the protocol of the meeting of the commission.
As a rule, the commission reviews the documents and makes a decision about 10 days. About two weeks they are analyzed by the specialists of the clinic, where they will do the procedure itself. On average, the final result on budget fertilization is reported after three weeks of waiting. But this is only part of the way, there is still testing at the clinic itself. It takes an average of 3 weeks to two months. She pays all tests that a couple makes before being officially included in the list at her own expense. Some of them can be made only on a paid basis, in case of refusal of the procedure their cost will not be reimbursed.
If, for medical reasons, a woman needs fertilization by IVF, then no one has a legal right to refuse his budget spending. The number of places for the procedure is regulated by quotas, which are approved every year. In the absence of quotas before the end of the year, the patient must provide a waiting list
An alternative version of the IVF procedure is to apply to paid reproductive health clinics.
Eco: where to do? Reviews
If the couple decides to do the procedure according to the state program, then they will need to focus on the specialized clinics that participate in it.Their list changes almost every month, so the information needs to be clarified on the website of the health department of your region. Remember that their number is not very large, so queues are possible. So far, specialized clinics that make free IVF under the policy of compulsory medical insurance are only in Moscow, St. Petersburg, Chelyabinsk, Tyumen, Ufa, Omsk, Samara, Perm.
Where to do artificial insemination? There are private clinics in almost every major city in Russia. There are no queues and a lot of paperwork, but absolutely all the procedures and techniques of the specialists are paid. In addition, you need to be careful not to engage yourself in deception. Some unscrupulous doctors are deliberately ineffective treatment tactics to advise the patient a little longer and get paid for it. On average, a private clinic will invoice in the amount of 180-220 thousand rubles. only for artificial insemination. Reviews (about 500) from various forums and comments on IVF articles allowed us to draw the following conclusions:
- there is a lot of bureaucratic red tape with papers and analyzes;
- Each region has its own peculiarities of including women in the queue for free IVF (for example, having a marriage certificate, family subsistence level, free IVF waiting time);
- Doctors in the residential complex often, contrary to the law, are refused to give out directions to that specialized center where a woman wants, offering institutions from her “special” list or dragging out time to issue referrals for IVF for personal reasons;
- tests that need to be passed before accepting a commission to include you in the list for a free fertilization procedure are very expensive;
- the process is expensive, and may have to be repeated several times;
- artificial insemination methods are effective by 40-50%;
- At the same time, IVF is the most effective way to give birth to a child with a diagnosis of "infertility" (if all other methods of treatment were ineffective).
The procedure of in vitro fertilization has its drawbacks: it is very expensive, it may not give the desired result on the first attempt, or not at all. But, on the other hand, if a woman cannot bear a child, and all IVF attempts fail, then there are programs for donation and surrogate motherhood.Despite all the disadvantages of this procedure, today, for many childless couples, ECO-fertilization is the last hope. Most of the reviews confirm that it is the most effective way to have a child with incurable infertility.