In vitro is a technology that allows you to reproduce the conditions for conception outside the human body. The main indications for IVF procedure are:
- female infertility: absence of fallopian tubes, obstruction of fallopian tubes, impaired follicular growth and ovulation, follicular luteinization syndrome, endometriosis, repeated failed IUI attempts, age-related factors (after 36 years) and premature ovarian failure; infertility, which cannot be treated by other methods.
- male infertility: infertility of unexplained genesis, diseases requiring PGD to eliminate hereditary pathology, different forms of pathoospermia, immunological factors and other factors of male infertility.
The IVF procedure can be divided into several stages:
The first stage: examination of a married couple.
Second stage: controlled ovarian stimulation (induction of superovulation).
Third stage: monitoring of folliculogenesis and endometrial development.
Fourth: puncture of the follicles to produce oocytes.
Fifth stage: semen preparation.
Sixth stage: in vitro fertilization using ICSI, PICSI, IMSI techniques and in vitro culturing of embryos.
Seventh stage: embryo transfer – transfer of embryos into the uterine cavity.
Eighth stage: maintenance of the luteal phase of the stimulated menstrual cycle.
Ninth stage: pregnancy diagnosis.
Examination of a married couple
The married couple to whom the IVF program will be conducted is examined according to the volumes stipulated by the order of the Ministry of Health of Ukraine. These examinations are mandatory for everyone and may require additional tests in certain cases.
Controlled ovarian stimulation (induction of superovulation)
After careful examination and choice of treatment, controlled stimulation of ovulation, which results in the maturation of several follicles. The choice of the scheme of stimulation, medicines and correction of their doses is made by a doctor.
Monitoring of folliculogenesis and endometrial development
In the process of controlled stimulation of superovulation the follicle growth and endometrial thickness are being monitored under ultrasound control. This is the only way to choose the right moment for follicular puncture.
Puncture of the follicles
For the production of oocytes transvaginal examination of ovarian follicles under ultrasound is performed. The procedure is performed in aseptic conditions of a small operating room under general anesthesia. Upon completion, the patient remains under the care of medical staff for at least two hours to monitor the overall health condition.
Oocyte fertilization is carried out after 2-6 hours after aspiration, and the fact of their fertilization is evaluated after 16-18 hours, when the male and female pronuclei are clearly visualized. The zygotes are transferred to a fresh culture medium, where the embryos develop initially.
Fertilized embryos are usually cultured for 5-6 days. This is required in order to assess their implantation potential. On day 5 there is an embryo transfer or cryopreservation of the embryos.
Embryo transfer – transfer of embryos into the uterine cavity (ET)
Embryo transfer into the uterine cavity is a painless procedure that is performed under ultrasound control on the 5th day after puncture. It is recommended that you carry one or two embryos (with the consent of the patient), since the transfer of more embryos significantly increases the risk of multiple pregnancy. The embryos remaining after ET are cryopreserved. For ET a special elastic catheter is used, which is introduced into the uterus through the cervical canal.
Support for the luteal phase of the stimulated menstrual cycle
To increase the chances of pregnancy, the luteal phase is maintained with progesterone drugs or analogues. The dose and frequency of drug administration are determined by the physician, taking into account the individual characteristics of the particular patient.
Diagnosis of pregnancy
To diagnose pregnancy 2 weeks after ET, the level of beta-chorionic gonadotropin in the blood is determined. A pregnancy ultrasound is performed three to four weeks after embryo transfer.