In-Vitro Fertilization (IVF) is the leading trend in assisted reproduction technologies, which represent infertility therapy methods, where separate or all stages of fertilization of oocytes and early development of an embryo are carried out outside the body.
IVF is used in world’s practice by treating infertility since 1978. In Belarus In-Vitro Fertilization and Embryo Transfer is carried out by our specialists since 1995.
IVF procedure consists of following steps:
- Controlled Ovarian Hyperstimulation, including monitoring of folliculogenesis and endometrial development
- ultrasound guided transvaginal puncture of ovaries
- in-vitro fertilisation of eggs and early embryo development
- transfer embryos to uterus
- support of lutein phase
- diagnostics of pregnancy on early stages.
IVF is also possible in natural menstrual cycle, without ovulation induction.
Indications for IVF:
- infertility, not treatable by therapy, or infertility which can be more successfully treated with IVF than using other methods. If there are no contraindications IVF can be carried out by the request of a couple (or woman who is not married) by any form of infertility.
- Somatic and mental diseases, which are contraindications for carrying of a pregnancy and childbirth
- inborn malformations or acquired deformations of uterus cavity, which make embryo implantation or carrying of a pregnancy impossible
- ovary tumors
- benign uterus tumors, which require operational treatment
- acute inflammatory diseases of any localization
- malignant new formations of any localization, also in anamnesis
Plan of infertility pretreatment using IVF method in the medical center for assisted reproduction “EMBRYO”:
I stage (it can be carried out ahead of time so that pathologies can be detected and corrected):
1. Hormonal blood test
Prolactin, thyroid-stimulating hormone, Òç, Ò4, testosterone, cortisol (in any day), follicle-stimulating hormone, luteinizing hormone – on 2-5 day of menstrual cycle. Blood is taken on an empty stomach, in a state of emotional stability, on the day before – sexual rest. A week before the test all antibiotics, anticoagulants, sulfonamides and hormonal medicine should not be taken (only in case if doctor did not prescribe them). Results of a test are valid during 2 years.
2. Complex checkup for urogenital infections (smear for chlamydia, smear for mycoplasma, smear from genital tracts). In the absence of pathology the results are valid during 6 months.
3. Ultrasound examination of pelvis organs.
4. Spermogram (after 3-4 days of sexual abstinence). This test we recommend to run at our Center.
5. Smear for cytology from cervix (Pap-test) plus colposcopy. In the absence of changes the results are valid during 1 year.
II stage (is carried out directly before starting IVF and other programs of treatment):
1. Ultrasound examination of pelvis organs and consultation of a doctor in the Center “EMBRYO” on 5-7th day of menstrual cycle. It is required to have data from the fists stage of examination and extracts from previous examinations and treatments.
2. Blood test of both spouses for WR, HIV, hepatitis B and C (valid during 1 month), blood group, Rh-factor.
3. For a woman: Blood test for sugar, general blood count, common urine analysis, biochemical blood analysis, coagulogram, smear from genital tracts. (Results are valid during 10 days).
4. Diagnosis of a physician on state of health and absence of contraindications for pregnancy.
TREATMENT IN IVF PROGRAM USUALLY STARTS ON 21ST DAY FROM THE MENSTRUATION START. ATTENTION:
In the absence of possibility to conduct medical examination at the place of residence, all tests can be conducted in the Center of auxiliary reproduction “EMBRYO”.
TREATMENT BY IVF METHOD
Controlled ovarian hyperstimulation is carried out in order to get as many mature ovules as possible. This stimulation is carried out using medicine of leading companies (“Organon” The Netherlands, “Serono” Switzerland, “Ipsen” France etc.). There are several different stimulation protocols. Classic “long protocol” starts on 21st day of menstrual cycle and lasts for a month. For superovulation induction in our Center patients are supplied by medications registered in the Republic of Belarus. Choice of stimulation scheme, medications, dosage corrections and changes in protocol are carried out individually.
Folliculogenesis and endometrial development monitoring.
Control over follicular and endometrial development during ovarian stimulation is carried out using ultrasound examination. In the process of ultrasound monitoring the quantity of follicles is registered, their average diameter is measured and endometrium thickness is registered as well.
Hormonal monitoring represents dynamic detection of estradiol and progesterone (E_2) concentration in the blood. It provides support for the data of ultrasound examination by valuating functional maturation of follicles.
Follicles puncture and eggs retrieval.
Follicles puncture and oocytes aspiration is carried out by transvaginal access under ultrasound control using special puncture needles. This method allows getting 5-10 (sometimes up to 30) eggs. In rare cases this procedure is impossible, because oocytes are not present in follicles. This procedure implies using either intravenous or local anesthesia. Patients can leave the Center in one hour after the procedure.
Receipt and registration of sperm for IVF.
Previously prepared sperm of a spouse or a donor is used for IVF. Sexual abstinence for 3-5 days is recommended before the procedure. Sperm is generated in the process of masturbation. Sperm can be freezed for future use.
Oocytes fertilization and cultivation of embryos in vitro.
Ovules and spermatozoa are placed in special nourishing environment and are stored in an incubator, where all necessary conditions are created for eggs fertilization and early embryo development.
Embryo transfer to the uterus cavity.
Embryo transfer to the uterus cavity can be carried out on different stages, beginning from the zygote stage to the stage of blastocyst, which is forming on 5-6th day after fertilization. In order to achieve optimal results it is generally recommended to transplant 2-3 embryos to the uterus cavity. However, transfer of larger number of embryos is possible when the chance of successful implantation is relatively low. Special catheters inserted in uterus cavity through cervical canal are used for embryo transfer. This stage of treatment does not require anesthesia.
Support of luteine stage of stimulated cycle.
Support of luteine stage of stimulated cycle is usually carried out by progesterone medications or similar drugs. By absence ovarian hyperstimulation syndrome risk support of luteine stage of the cycle can also include chorionic gonadotropin medication.
Diagnostics of early pregnancy stages.
Pregnancy diagnostics by using data on concentration of beta chorionic gonadotropin in the blood or in the urine is carried out after 12-14 days from the moment when embryos have been transplanted. Ultrasound pregnancy diagnostics can be conducted strating from 21st day since embryos transplantation.
Possible outcomes of treatment and complications by IVF:
Most wanted outcome is of course pregnancy and birth of a healthy child. However, there might be several obstacles on the way to this purpose:
- Follicles on the oocytes can not grow during the stimulation, In this situation attempts are seized and oocytes are not taken.
- Adhesions in the cavity of small pelvis and (or) technical problems can hinder egg receipt.
- Premature ovulation can also lead to impossibility of getting eggs.
- Ovarian follicles can not contain eggs.
- Sperm can not be received.
- In the spem can be insufficient number of spermatozoas for fertilization.
- Fertilization can not occur.
- Embryo transfer can be technically complicated or impossible.
- Embryos transfered to the uterus can not live, or their development stopr or they develope incorrectly.
Possible side effects:
- Multiple pregnancy (in 25-30% of cases),
- Extra-uterine pregnancy (in 1-3% of cases),
- Ovarian hyperstimulation syndrome (in 2-5% of cases),
- Infectious complications (rare cases, less than 2%),
- bleeding in the process of eggs retrieval (as a rule – not serious).
Thorough examination on the stage of preparation for IVF and correct fulfillment of prescriptions and recommendations of doctors increase efficiency of the method and decrease complications risk.