“How to get successful IVF?” is a question that worries every woman suffering from infertility. The process of artificial insemination is quite labor-intensive; it requires a lot of effort from future parents and often significant investments of money.

To increase the chances of successful IVF, you must strictly follow all the doctor’s recommendations and the rules of the procedure. If the doctor or future parents make a mistake, the likelihood of successful conception may be greatly reduced. Let's look at the effectiveness of IVF and how to increase it.

First of all, you need to understand how effective the in vitro fertilization method is. Currently, this ART method is the most effective, especially with additional procedures such as ICSI and PIXI.

But, unfortunately, IVF does not guarantee a 100% result, since the implantation of the fetus in the uterus is influenced by a large number of different factors. And even if the doctor creates the best quality embryos, they still may not implant in the uterus.

According to statistics, pregnancy occurs in approximately 50% of cases during IVF for women under 30 years of age. If a woman is 35 years old, then the probability of success does not exceed 30%, and after 40 years, the chance of having a child using her own egg is 10-20%.

The result is also influenced by the fact on what day IVF and embryo transfer is carried out, how healthy the woman is and how high-quality the man’s sperm are. The age of the spouses definitely has a great influence, since the reproductive cells change after 35-38 years and their quality deteriorates.

The process of fetal implantation has a great influence on the effectiveness of IVF. Superovulation, puncture and fertilization end favorably in 99% of cases, but after embryo transfer they can still die for the following reasons:

• due to hormonal imbalance;
• the cause may be too thin endometrium;
• inflammatory diseases;
• implantation does not occur in the presence of scars and polyps in the uterus.

To avoid difficulties during implantation, it is recommended to familiarize yourself with the rules for preparing and conducting IVF and follow them.

IVF rules

“How to increase the chances of implantation with IVF?” is a question that patients ask their doctors every time. It’s such a shame to waste a lot of money and time, and at the same time not get the long-awaited pregnancy. If a woman agrees to IVF, she must understand that there may not be a result. If a patient wants to be sure that the clinic will help her, she has the right to undergo IVF with a guarantee.

Let's consider what rules need to be followed in order to ultimately achieve successful IVF:

• Before entering into the protocol, a man and a woman must undergo examination and cure all diseases.
• To conduct IVF, you need to be responsible when choosing a clinic. The work of the embryologist plays an important role in the outcome of the procedure. If the doctor is inexperienced, then there is a high probability that poor-quality embryos will be used for transfer.
• During the IVF process, it is recommended to use the ICSI method, which increases the chance of obtaining high-quality embryos. And high-quality embryos are easier to implant into the uterus.
• It would also be a good idea to conduct preimplantation genetic diagnostics in order to select good blastocysts for transfer. If a doctor accidentally implants an embryo with a genetic abnormality, it will die.
• It is recommended to resort to maintenance therapy after replantation. As a rule, doctors prescribe progesterone, which improves the endometrium and relieves the tone of the uterus so that the embryo attaches normally.
• It is necessary to exclude increased blood clotting in the mother. This problem often causes disruption of blood flow between the uterus and the fetus, which leads to early miscarriage.

It is recommended to carry out IVF using five-day-old blastocysts. Only the strongest embryos survive to the blastocyst, and cells with abnormalities die, so the chance of pregnancy is higher. But it is worth noting that if the transfer of five-day embryos does not produce results, the doctor may prescribe the transfer of three-day embryos in the next protocol. Under natural conditions, the cell can develop better and still take root.

You need to understand that embryo cultivation is carried out under artificial conditions. Although the importance and temperature in the incubator is close to the environment inside the fallopian tubes, it has not yet been possible to create the same ideal conditions. Therefore, there is a chance that more embryos will survive to reach the blastocyst inside the uterus, and they will eventually implant successfully.

It is also very important to lead a correct lifestyle during the preparation for IVF and after the transfer. It is imperative to normalize your weight, eat right, and lead a healthy lifestyle. A woman should regularly engage in light sports. It is better for a man to follow the same recommendations to improve sperm quality.

Of course, nutrition and physical activity do not affect embryo implantation. But doctors still recommend leading a correct lifestyle after embryo transfer, so as not to harm the unborn baby.

How to increase your chances of successful IVF (Video)

For many women diagnosed with infertility, IVF becomes the only chance to give birth and raise a genetically natural child. But, despite the fact that in vitro fertilization procedures have been carried out in clinics around the world for decades, it is not possible to help a woman become a mother in all cases. Many factors can interfere with a successful protocol, so often, in order to finally get pregnant and give birth to a long-awaited baby, married couples have to go through several protocols. This takes away from the spouses not only significant financial resources, but also a lot of strength and emotional energy - it is difficult to continue to strive for the goal and maintain a positive attitude when all attempts are unsuccessful. However, there are ways that help increase the effectiveness of IVF and make it more likely to get a positive result, namely pregnancy.

1. ICSI– injection of sperm into the cytoplasm of the egg (ICSI – Intra Cytoplasmic Sperm Injection). This method is best suited for couples who have been diagnosed with problems with the man’s sperm parameters, that is, the ejaculate contains a low number of sperm, or the sperm themselves are of low quality. During the process, the most mobile, viable and morphologically correct sperm is isolated from a man’s ejaculate sample and, using a special needle, injects it directly into the cytoplasm of the egg. If several oocytes were obtained during puncture of a woman’s ovaries, sperm can be injected into each of them. ICSI increases the chances of successful fertilization by 70-80%.

2. Transfer of embryos in the blastocyst phase . Typically, the average duration of in vitro culture after fertilization is 3 days. That is, on the third day they are already transferred to the woman’s uterus. However, modern ones have come to the conclusion that it is much more effective to transfer more developed embryos into the uterus, namely, those that are cultivated in vitro for at least 5-6 days. Doctors explain this by the fact that in the blastocyst phase, embryos are already more hardy and are more likely to tolerate replanting well, adapt to a new environment and, therefore, be able to take root in. According to statistics, when transferring blastocysts, miscarriages, miscarriages and ectopic pregnancies occur much less frequently. Despite this, not all clinics specializing in ART methods practice the transfer of 5-6-day embryos, so in order to get what you need, discuss all the details of the IVF protocol with your reproductive specialist in advance

3. Assisted hatching - technology that helps the embryo break its own membrane and implant into the endometrium. Sometimes the procedure is necessary, since for some reason the embryo may be too dense, and the embryo simply will not be able to hatch from it on its own, and without this, implantation and subsequent pregnancy are impossible. There are several methods for performing auxiliary hatching (laser, mechanical, chemical, piezo technique), the choice in favor of one of which can only be made by a specialist.

4. Special diet . For women preparing for IVF, as well as women who are trying to get pregnant naturally, nutritionists recommend adhering to a special diet, namely the Mediterranean diet. Food should not only be balanced, but also varied. It should include various types of fish, meat, seasonal vegetables, fruits, and a variety of fermented milk products - cheeses, yoghurts, curdled milk. It is better to cook dishes in olive oil and season with it. Infrequent consumption of a glass of red wine with meals is not prohibited. The results of a study conducted at the Harvard School of Public Health confirmed that using a Mediterranean diet can increase the chances of successful IVF by 3.4 times.

5. Positive attitude and good mood . According to research by Israeli scientists, a woman’s psycho-emotional state significantly affects not only her reproductive function, but also her overall health. Therefore, during the period of preparation for the IVF protocol and after it, a woman needs to avoid stress, maintain a good mood, laugh more and believe that sooner or later everything will certainly work out and she will be able to hold her newborn baby in her arms.

Science does not stand still; the effectiveness of in vitro fertilization procedures is growing every year, as is the experience of reproductive specialists, who are also improving their skills. Do not despair if the first protocol was unsuccessful; a second attempt, as a rule, is much more effective. Also keep in mind the various methods listed above to increase the effectiveness of IVF, many of which are available to almost everyone.

There are more than 5 million infertile couples in Russia and half of them need assisted reproductive technologies. Deciding to take this step is not so easy. There are a lot of rumors around the IVF procedure, and understanding the essence of the laws on reproductive methods on your own is not so easy. We decided to look into this issue and talk in detail about the IVF procedure and all its stages.

Having decided on in vitro fertilization, you need to be mentally prepared for several attempts. According to statistics, 30–45% of women become pregnant after the first IVF attempt. In 18.9% - after the second. Another 24% of couples get the long-awaited result after 3-7 attempts. But, of course, it is impossible to guarantee pregnancy.

What is the essence of IVF

The basic principle of IVF is that sperm and eggs are not found in the female body, but “in vitro” by an embryologist. This allows you to control the entire process from the moment the gametes meet until the formation of a healthy embryo and its transfer to the uterine cavity, where the future baby will grow and develop.

There are several modifications of this method with which a couple can overcome problems that arise at any stage of IVF and increase their chances of having a healthy child.

ICSI

ICSI involves injecting sperm directly into the cytoplasm of the egg. The doctor evaluates the quality of male sperm and selects the most motile sperm without visible pathology for the procedure.

PIXIE

PIXI is a modification of the ICSI procedure. Here, the role of the leading factor in sperm selection is played not by the subjective opinion of the embryologist, but by selection based on the results of a biochemical reaction with hyaluronic acid. This increases the likelihood of selecting the most genetically complete cells. Spermatozoa are placed in a Petri dish with acid and the one that turns out to be the most mobile and the fastest to attach to the hyaluron is selected. The thing is that mature and healthy sperm must have receptors receptive to hyaluron, since hyaluronic acid is part of the cells surrounding the oocyte.

IVM

The IVM protocol is used when a woman's ovaries do not respond well to standard hormonal stimulation. In this case, high doses of drugs are used, immature oocytes are collected and left in a special incubator until they become full-fledged eggs ready for fertilization.

Assisted hatching

Hatching (from the English hatching, which means “hatching”) is an auxiliary procedure that helps the embryo “hatch” from the dense shiny shell. If this does not happen, the embryo will die without attaching to the uterine cavity. Hatching is performed in case of previous unsuccessful attempts at in vitro fertilization and some other indications.

Donor egg or sperm

Donors are selected from among healthy women and men who already have children. They undergo the same examinations as a married couple before IVF. This is the only option for those couples who do not have the opportunity to obtain their own genetic material.

How long does the IVF procedure take?

The gestation period for IVF pregnancy is no different from normal. The main task is to achieve this pregnancy.

The first diagnostic stage usually lasts about 2–3 months . During this time, the couple visits specialists and undergoes a series of examinations to identify the causes of infertility. If necessary, treatment of identified diseases and abnormalities is carried out. If it is not possible to achieve pregnancy even after correcting the identified abnormalities , IVF procedure is being carried out.

The duration of the IVF procedure from the start of treatment to confirmation of pregnancy depends on the protocol and can take from 25 to 45 days. During this period, all stages are carried out from ovarian stimulation to incubation of the embryo and monitoring the progress of implantation.

Diagnosis of the causes of infertility: stage 1

As we have already said, the diagnostic stage can take 2–3 months. The list of studies that a couple must undergo is regulated by law. This includes tests for infections, a spermogram, hormonal studies, and assessment of fallopian tube patency.

A marriage is recognized as infertile only after a year of regular attempts by the couple to conceive a child with a complete refusal of birth control.

Preparing for IVF: stage 2

If it was not possible to achieve pregnancy and a decision is made to undergo IVF, additional examination is necessary. Tests for infections and a repeat spermogram are carried out. For a woman, in addition to a gynecological examination, she will need fluorography, blood and urine tests, a physician’s report on the absence of contraindications to pregnancy, and a mammologist’s report.

Indications for IVF are infertility, which cannot be treated with other methods. Contraindications - active tuberculosis, acute form of infectious hepatitis, malignant neoplasms, severe somatic pathology in the acute stage.

This stage can last about a month. Depending on how quickly the couple can collect all the necessary documents.

Stimulation of superovulation: stage 3

To obtain mature oocytes, a woman is given hormonal drugs of different mechanisms of action from a certain day of the menstrual cycle. Some of them suppress the work of the pituitary gland (Decapeptyl, Diferelin, Buserilin), some stimulate the ovaries and the active maturation of eggs. This is called superovulation stimulation.

Depending on the protocol, this phase can take from 8 to 22 days. Taking medications is associated with possible complications, so the entire process takes place under the strict supervision of doctors.

It is important
Ovarian hyperstimulation syndrome, which sometimes occurs as a result of such protocols, was first described in the 1930s. The incidence of this complication can range from 0.5 to 23% depending on the drugs used, protocols and physician experience.

Signs of complications are discomfort in the abdomen, bloating, heaviness, nagging pain in the lower abdomen. If any discomfort occurs, you should immediately inform your supervising physician.

Puncture of ovarian follicles: stage 4

At the previous stage, under the influence of drugs that stimulate the ovaries, several follicles begin to develop at once. On days 10–22 from the start of drug administration, follicle puncture is performed under ultrasound control. During the ultrasound scanning process, the doctor uses a special needle to remove the follicular fluid with the eggs contained in it and transfer the material to the embryologist. The embryologist then selects oocytes from the follicular fluid for further fertilization. The more eggs you can get this way, the better. Selected mature eggs that will not be used in this IVF protocol can be frozen at the request of the couple and used in the next attempt, even after several years. This is especially true for women with low ovarian reserve.

Insemination of oocytes with specially prepared sperm: stage 5

Sperm for use in the IVF process is cleaned in a special way. Then the eggs and sperm are placed in an incubator, in a nutrient solution, where the fateful meeting should take place. This is, in essence, the IVF procedure itself: fertilization of eggs occurs outside the mother’s body, in an incubator at a temperature of 37°C, with a carbon dioxide concentration of 5% and high humidity.

When ICSI is indicated, the role of selection factor is played by the embryologist, who himself selects the most complete sperm for introduction into the egg. With PIXI, only those sperm that have the most mature genetic material are allowed into the oocyte. In this case, the selection is carried out, as we have already said, not “by eye”, but with the help of hyaluronic acid.

Cryo-freezing of fertilized oocytes: stage 6

If, during fertilization of eggs, it was possible to obtain several healthy embryos, they can also be kept “in reserve,” that is, subjected to cryopreservation. In this case, the next time you try IVF, you will not need to perform ovarian stimulation, puncture and fertilization procedure again. It will be enough to introduce the embryos into the uterine cavity.

For information
Embryos are stored in liquid nitrogen at minus 196°C.

PGD: stage 7

The abbreviation PGD covers such an important stage as preimplantation genetic diagnosis. In short, before the embryo is placed in the uterus, it is additionally tested for common genetic abnormalities.

Serious indications for PGD are the age of the couple, poor sperm quality, and the presence of genetic abnormalities in relatives.

It should be remembered
The IVF procedure itself does not eliminate the risk of having a child with chromosomal abnormalities. There are cases when children with Down syndrome are born after in vitro fertilization. Therefore, if at least one genetic risk factor is identified, this is a reason to conduct PGD.

Embryo cultivation: stage 8

For about 3–5 days, fertilized eggs grow and develop in a special nutrient medium. An embryologist has the opportunity to monitor their division and remove cells that are not suitable for some reason for transfer into the uterine cavity, and select the most “promising” embryos.

Intrauterine insertion (transfer) of embryos: stage 9

Among all the embryos formed, several are selected for transfer into the uterine cavity. Usually 1–2 embryos are used for this. When one embryo is transferred, the chance of its implantation decreases. The final number of embryos to be transferred is determined by the couple together with the attending physician. In the case of an additional written application from a married couple, the transfer of 3 embryos is allowed, but this increases the possibility of multiple pregnancies. And this is fraught with complications during pregnancy and childbirth for both mother and children.

Luteal Phase Support: Stage 10

In some cases, at the site of the follicle from which the egg was taken, a full-fledged corpus luteum is not formed - a temporary endocrine gland that produces progesterone, necessary for the onset and development of pregnancy.

In this case, it is necessary to prescribe additional hormonal drugs.

Diagnosis of pregnancy: stage 11

Starting from approximately 9–12 days after placing the embryo in the uterine cavity, they begin to monitor the level of the hCG hormone in the blood. If pregnancy occurs, its level should rise sharply.

And after 21 days from the day the embryos are transferred to the uterus, an ultrasound scan of the uterus and ovaries can be performed, during which the presence of a fertilized egg in the uterine cavity is assessed. After another week, it is possible to detect the presence of a heartbeat in the embryo and examine the placenta attachment site.

Removal of excess oocytes: stage 12

As we have already said, several embryos can be transferred into the uterine cavity at once. In some cases, if three or more fruits begin to develop, one or more of them must be removed.

This may be necessary if the mother’s health does not allow her to carry a multiple pregnancy, if there is a danger of losing all the embryos at once, or if signs of genetic diseases or developmental defects were detected in one of the fetuses.

Embryo reduction is a rather complex operation, so it is performed only if there are serious indications. In this case, the mother's written consent is required.

The IVF procedure itself does not take much time. On average, 1–1.5 months after its start, a woman will know for sure whether she succeeded in achieving the long-awaited pregnancy. It takes much more time to diagnose and prepare both spouses for this procedure. If the first attempt was unsuccessful, do not despair. And in order to increase your chances, you can use additional modern technologies.

How to choose a reproductive medicine clinic?

We asked fertility specialist, candidate of medical sciences Kim Nodarovich Kechiyan about what to look for when choosing a clinic for IVF:

“The success of in vitro fertilization depends on the main components: the age and health of the couple, the availability of modern technologies in the clinic and the experience of doctors.

A healthy child will be born only if complete reproductive cells are obtained from both parents. To obtain the most viable embryos, a method of long-term - up to 120 hours - cultivation of embryos to the blastocyst stage is used; assisted hatching can be used. And before implantation, preimplantation genetic diagnosis can be performed. If necessary, oocytes or embryos can be cryopreserved. But for all this, the clinic must have two other components - technology and experience.

Our medical center provides medical services that may include assisted reproductive technologies. They help increase the chance of conceiving and bearing a healthy child. There is cryogenic storage for sperm and embryos. It is possible to use donor germ cells. The more opportunities the clinic has, the more opportunities the couple has.

We were one of the first to provide this service. In 1986, the first test tube baby was born in the Soviet Union. And in 1987, our medical center began to use this technology.

Of course, when choosing, you should also not forget about the statistics of a particular clinic and pricing policy. And remember that the choice of medical center largely determines whether you will become happy parents.”

P.S. Kechiyan Kim Nodarovich - chief physician of ZAO Medical Center for the Treatment of Infertility, Candidate of Medical Sciences, laureate of the Russian Government Prize.

License to carry out medical activities LO-77-01-007343 dated January 9, 2014 issued by the Moscow Department of Health

Editorial opinion

A complete list of all conditions for the IVF procedure, indications and contraindications can be found in the order on the procedure for assisted reproductive technologies. For 2017, the version of Order No. 107n, approved on August 30, 2012, remains relevant. You can find it in the public domain.

Assisted reproductive technologies – a method of providing medical care in which some or all stages of conception and (or) early development of an embryo (embryos) before transferring it (them) to the uterus are carried out in a laboratory setting.

The center can provide a photograph of the embryo on the day of the transfer!

The effectiveness of the IVF procedure

Time and age are insurmountable factors that significantly reduce the effectiveness of IVF.

The most desired outcome is, of course, pregnancy and the birth of a healthy child. However, there may be obstacles on the way to this goal. Each stage is of great importance for the effectiveness of the procedure.

IVF stages:

1. Complete clinical examination of the married couple.

2. Stimulation of superovulation in order to obtain a large number of eggs. (The stimulation scheme is selected individually by the doctor, taking into account the preliminary examination).

3. Ultrasound and hormonal monitoring of follicle growth and development.

4. Follicle puncture and oocyte retrieval. (The puncture is performed under intravenous anesthesia, under ultrasound control).

5. Fertilization with the sperm of the husband or donor. (On the day of the puncture, the patient’s husband donates sperm, which undergoes special treatment before fertilization of the eggs).

6. Transfer of the resulting embryos into the uterine cavity. (Usually 2-3 embryos are transferred; the remaining embryos are cryopreserved and, if unsuccessful, are used for subsequent transfer).

7. Support of the luteal phase, determination of pregnancy and development of further pregnancy management tactics.

8. Prevention of hyperstimulation syndrome and miscarriage.

If there is a history of genetic diseases, preimplantation diagnostics (FISH method) is performed - a cytogenetic study of embryos at the stage before they are transferred into the uterine cavity.

The effectiveness of the procedure and the presence of complications are negatively affected by:

Age;

Late treatment, duration of previous treatments;

Surgical interventions on the appendages and uterus;

Inadequacy of examination and correction of identified violations;

Poor nutrition;

Unhealthy lifestyle, smoking, alcohol, bathhouse, solarium, long-term use of medications;

Electromagnetic vibrations (computers, mobile phones);

Sexual infections;

Failure to comply with all doctor's instructions;

Negative emotions;

Occupational hazards;

Excess weight, physical inactivity.

Remember: Infertility examination should be no more than 2 months, conservative treatment - no more than a year, surgical treatment to restore tubal patency - no more than 1 time.

^ It is important to remember that each patient has her own individual response to the medications received during treatment, and that each subsequent treatment cycle is different from the previous one. This means that in reality your response will be different from the response of other patients to the same drugs, but your body may also respond differently to each subsequent cycle of IVF treatment, i.e., not the same as in the previous cycle ECO. In this regard, your examination, treatment and, accordingly, its results may differ from those of other patients. The results of your examination and treatment, as well as planned future treatment, cannot be compared with the results of examination and treatment obtained in other patients. Although there are many similarities, it must be remembered that IVF and ICSI treatment is a personal matter and that most patients feel uncomfortable and embarrassed when discussing their personal problems in public.

^ If you are planning IVF treatment, it is recommended that you consult a doctor approximately 1-2 months before the start of the cycle you have chosen for IVF to resolve all your questions. At the appointment, the results of the preliminary examination are re-evaluated, including: examination on a chair, ultrasound, hormonal studies, identification of pathogens of sexually transmitted infections, i.e. standard examination for patients before IVF treatment. According to indications, additional examination methods are carried out. For review and subsequent registration, the patient is given an agreement for IVF treatment (including ICSI methods, assisted hatching, fragmentation removal). All forms of agreement between the parties for each procedure must be signed before the start of the treatment cycle. One of the main requirements for starting IVF treatment is protection from pregnancy in the cycle in which treatment begins using barrier methods of contraception (condom) rather than hormonal ones.

^ Activities that help increase the chances of success in a given treatment cycle

^ For women:

Avoid, if possible, taking any medications other than regular aspirin. If you are prescribed any medications by another doctor, you must inform your doctor before starting treatment. - Avoid smoking and drinking alcohol. - Limit your intake of coffee and caffeine-containing drinks as much as possible (no more than 2 cups per day). - Avoid changes in diet and weight loss diets during an IVF cycle. - Refrain from sexual intercourse for 3-4 days before follicle puncture, and subsequently after embryo transfer until the day of the pregnancy test (detailed recommendations will be given to you in the statement on the day of embryo transfer). Ordinary physical activity, as well as physical exercise, are not contraindicated until the enlarged ovaries as a result of treatment do not create some discomfort. - Avoid hot baths, baths and saunas. - Try to avoid communicating with patients with acute respiratory viral infections (ARVI), avoid hypothermia. If your body temperature rises or cold symptoms appear, tell your doctor.

^ For men:

An increase in body temperature above 38° C 1-2 months before the IVF / ICSI procedure can negatively affect sperm quality; If you are sick, please measure your body temperature and report any increase (any illness or illness accompanied by an increase in body temperature). Visiting baths and saunas is not recommended, as elevated temperatures can adversely affect sperm quality; please refrain from visiting them for at least 3 months before you are due to start treatment. Taking medications, drinking alcohol and smoking cigarettes should be avoided before starting IVF/ICSI treatment. Do not start any new sports or strenuous activities for 3 months prior to starting IVF/ICSI. If you run, please try to switch to walking without overload. Refrain from wearing tight underwear. Avoid sexual intercourse for at least 3 days, but no more than 7 days before sperm collection (on the day of follicular puncture).

^ For both spouses:

If you have a genital herpes infection, you must report the appearance of symptoms preceding the disease (general malaise, general weakness, unmotivated fatigue), acute manifestations of the disease or healing rashes. Regardless of whether a man or a woman suffers from genital herpes, any of the indicated stages of herpes infection will require immediate cessation of IVF/ICSI treatment.

^ Beginning of the IVF program (entry into the program)

^ On the eve of the start of the IVF program, 7-10 days before menstruation, you need to make an appointment with your attending physician to conduct an ultrasound of the pelvic organs and assess the condition of the ovaries and the thickness of the endometrium (uterine mucosa). After the doctor verifies the normal condition of the ovaries (absence of ovarian cysts) and endometrium, in the presence of the necessary official documents (a contract for the provision of medical services, an agreement for this method of treatment, signed by both partners) and the results of the necessary examinations, the doctor enters the patient into the program (IVF treatment cycle). The patient is given an individual prescription sheet, the rules for administering medications and the “lifestyle” during the IVF treatment cycle are explained in detail. The patient should come to each subsequent appointment with an appointment sheet. The prescription sheet indicates the patient’s name, her age, outpatient card number and describes in detail the entire treatment regimen: the name of the drugs, daily doses, frequency, route and sequence of their administration and the date of each subsequent appearance at the doctor’s appointment. During the treatment cycle, both spouses must strictly follow all prescriptions and recommendations of the attending physician and appear for examination at the appointed time. The patient is given directions (vouchers) to pay for each stage of IVF treatment. Before each stage of treatment begins, it must be paid in advance. Treatment may be stopped at any stage if, in the opinion of the doctor, the chances of successful completion and obtaining good results are extremely low. In this case, the patient will receive a refund for the stages of treatment not completed. The first stage is stimulation of superovulation Its goal is to increase the chances of pregnancy. To do this, a woman is prescribed hormonal drugs that cause the simultaneous maturation of several follicles in her ovaries. In each of the follicles, one egg matures, which is collected during puncture. After their fertilization, several embryos are obtained. The more embryos were obtained, the greater the chances of successful development of pregnancy after their transfer to the patient’s uterus.

^ Drugs to stimulate superovulation:

^ GnRH agonists (a-GnRH) – “ Diferelin" or " Decapeptyl"; GnRH antagonists (anti-GnRH) – “ Orgalutran », « Cetrotide"; Preparations of human menopausal gonadotropins (HMG) - « Menopur"; FSH preparations – “ Puregon », « Gonal-F"; Human chorionic gonadotropin (HCG) preparations – “ Decayed " All these drugs are prescribed according to developed treatment regimens or “protocols for stimulating superovulation.” Currently, several such “stimulation protocols” have been developed and successfully used all over the world, providing for the joint or sequential use of drugs from these groups to achieve the main goal of ovarian stimulation in IVF cycles - the growth of several follicles. Before the start of stimulation, the doctor discusses with you the stimulation protocol that is most suitable for you. As a rule, a GnRH agonist - Diferelin or Decapeptyl - is first prescribed for 10-14 days from the middle of the second phase of the previous cycle (21 days of the menstrual cycle) to suppress spontaneous ovarian activity. This is not the stimulation itself, but only the preparation of the ovaries for its implementation with HMG or FSH drugs. It is very important because... increases the effectiveness of subsequent stimulation and allows you to reduce the dose of prescribed HMG (FSH) drugs and, accordingly, the cost of treatment. This is an important argument, since all stimulation protocols used in IVF are carried out exclusively with expensive hormonal drugs. The start of the administration of a - GHRH usually occurs on the 21st day in a 28-day cycle or the 23rd in a 30-day cycle and lasts, on average, 10 -14 days, but possibly longer if necessary. This scheme for stimulating superovulation is the most traditional, most widespread and effective of all those proposed today. It is called the “long” stimulation protocol. There are other stimulation schemes (“short” and “ultra-short” protocols), but they are used much less frequently and, mainly, when standard “long” modes are ineffective. For 10 - 14 days of ovarian preparation the patient needs to come to see the doctor only twice: before the start of the administration of a-GRG (1st appointment, that is, direct entry into the IVF program) and after this period (2nd appointment). Of course, if there are no unforeseen reasons for an additional visit to the doctor. After the necessary degree of ovarian suppression is achieved under the influence of a-GnH (as judged by the doctor at the 2nd appointment by the decrease in the concentration of estradiol in the blood and the characteristic ultrasound picture ), the doctor makes additional prescriptions for the patient. The dose of a-GnRH is halved and a new drug is prescribed directly to stimulate the “suppressed” ovaries - drugs of gonadotropic hormones - "Menopur" or "Puregon" ("Gonal-F") in addition to a-GrH for 12 - 14 days. The scheme described above - the α-GRG + HMG (FSH) complex - can significantly increase the number of follicles in the ovaries. This, in turn, improves the quantity and quality of the resulting embryos and allows you to plan the treatment cycle taking into account the wishes and needs of the patient: “bring closer” or, conversely, “pushing back” the puncture of the follicles for several days to obtain the eggs that have matured in them without fear that this will worsen the results of treatment. This stimulation continues until a single appointment in the middle of the cycle of the drug hCG, which causes the maturation of eggs in the follicles, which allows them to be prepared for puncture at the second stage of treatment (the stage of puncture of the resulting follicles). To stimulate ovulation, gonadotropins are usually used three types: HMG - "Menopur" and FSH - "Puregon" or "Gonal-F". The first day of administration of gonadotropins is considered the first day of the cycle, and further counting is carried out from this day. This makes IVF treatment cycles different from other stimulated cycles used in assisted reproduction (intrauterine insemination or insemination with donor sperm), in which stimulation begins on the 3rd - 5th day of the menstrual cycle and without prior administration of a-GnRH. The drugs act on the ovaries and stimulate maturation of follicles. The dose of the administered drug to stimulate follicular growth is selected individually, taking into account the woman’s age, her weight and the initial state of the ovaries (their functional reserve) and depends on the response of the ovaries to the IVF treatment. This reaction is assessed periodically by the level of sex hormones in the blood serum (estradiol) and the ultrasound picture (the number and size of follicles in each of the ovaries, as well as the thickness of the endometrium). Carrying out an ultrasound and determining the concentration of estradiol during treatment with hormonal drugs is called “Ultrasonic and hormonal monitoring."

^ Ultrasound and hormonal monitoring

^ Organizational issues

^ Ultrasound monitoring is carried out by the attending physician at the appointment, and a blood test for estradiol is given upon the doctor’s direction in a diagnostic laboratory. Monitoring is not paid separately, since its cost is included in the cost of this stage of treatment. The frequency of monitoring is set by the doctor depending on the results obtained (ultrasonic picture and estradiol concentration). The date and time of each subsequent visit to the doctor for monitoring is entered on the appointment sheet held by the patient. As a rule, the number of visits does not exceed 4 or 5. The time must be chosen taking into account the wishes of the patient, because most of them continue to work. Typically, ultrasound is performed with a vaginal sensor (abdominal ultrasound), which is significantly more informative than conventional ultrasound through the abdominal wall. Before performing a abdominal ultrasound, you need to empty your bladder to improve the quality of the resulting image. The nurse invites you to the monitoring room. You will be asked to undress as if for a gynecological examination, after which you lie down on a prepared gynecological chair and your attending physician is invited. The sensor is inserted by the doctor into the patient’s vagina; a sterile condom is first put on it, which is discarded after use. The ultrasound procedure is completely painless and safe. Some patients may experience a feeling of discomfort or tightness, and there may be slight vaginal discharge after the end of the ultrasound procedure, mainly associated with the use of a special gel to improve the quality of the resulting image. What is assessed during monitoring? The first ultrasound monitoring is usually carried out on the 5th or 6th day of stimulation with gonadotropins to assess the response of the ovaries (dynamics of follicle growth) and endometrial thickness in order to select the most optimal dose of the drug and determine the date of the next visit. Before the active growth of follicles begins (until they reach sizes of 10 mm and above), an ultrasound scan is performed once every 4-5 days, then the ovaries are examined more often - once every 2-3 days. Blood tests for estradiol are taken either with the same frequency or somewhat less frequently (depending on the specific situation). Depending on the dynamics of follicle growth and hormonal levels, the attending physician determines the frequency of attendance for monitoring individually for each patient and selects the exact dose of drugs. At each monitoring the doctor determines the number of follicles in each ovary, measures the diameter of each follicle, and evaluates the thickness of the uterine mucosa. Finally, when your doctor decides that you are ready for follicle puncture (more precisely, the follicles are mature enough for puncture to collect oocytes), you will be given an injection of hCG. As a rule, this drug is prescribed 35 - 36 hours before the puncture itself for the final maturation of the eggs. If the puncture is not performed, ovulation occurs 42 - 48 hours after the time of injection. The main and mandatory conditions for prescribing hCG are a certain degree of follicular development according to ultrasound (at least 3 mature follicles). A potentially mature follicle against the background of stimulation is a follicle measuring 18-20 millimeters.

^ Second stage - puncture of follicles

^ The purpose of this stage is to obtain eggs from the follicles of stimulated ovaries by puncturing them with a hollow needle (puncture). This intervention is carried out under ultrasound control, in sterile conditions (operating room) and under intravenous anesthesia. The time for the puncture is scheduled by the doctor in advance and according to the standard schedule: 35-36 hours after the administration of hCG. The date and time of the proposed puncture are recorded in the patient’s appointment sheet. The contents of the follicle (follicular fluid with eggs) are transported to the embryology laboratory in special sterile disposable plastic containers made of non-toxic polymer. The entire follicle puncture procedure lasts, on average, 15-20 minutes.

^ Memo for patients before follicular puncture

^ In order to avoid vomiting during and after anesthesia, it is necessary: ​​In the evening, on the eve of the puncture, refrain from eating after 18-00 and from taking any liquids after 24-00. On the day of the procedure, refrain from eating or drinking any liquids until the procedure begins. We strongly ask that you come to the puncture without makeup, contact lenses, manicure or jewelry. You don't have to take off your wedding ring. By the time the puncture is completed, the spouse or donor must donate sperm for subsequent analysis, special processing and fertilization of the resulting eggs. Then the patient is invited to a special room for changing clothes: her body temperature and blood pressure are measured, her general well-being is determined, and she is asked to completely empty her bladder. She is escorted to the operating room, where she is prepared for the puncture: they are helped to lie down in a gynecological chair, the external genitalia are treated. An anesthesiologist and an attending physician are invited to the operating room. After the administration of drugs for anesthesia (that is, when you fall asleep), the procedure itself is carried out. After the puncture, you are under the supervision of hospital medical personnel for 1.5-2 hours. Once the anesthesiologist is satisfied that your condition is satisfactory and you are feeling well, you will be allowed to stand up. The IVF laboratory nurse will accompany you and your husband to the attending physician.

^ Memo for patients after follicular puncture

^ The doctor informs you about the results of the puncture, makes new appointments, and sets the date and time for embryo transfer. After the puncture, you can eat and drink as you see fit, depending on how you feel. In order to prevent the occurrence of an infectious process after a puncture, you will be recommended to take antibiotics (a single loading dose of a broad-spectrum antibiotic - for example, 1 capsule of doxycycline).

After the procedure, you may experience some soreness in the pelvic area, a feeling of fatigue, or even drowsiness (the latter is associated with the use of anesthesia). Slight bleeding from the genital tract after puncture is also possible, associated with a puncture of the vaginal wall during puncture. As a rule, they are scanty and vary in color from red to dark brown.

^ Please tell your doctor if you experience the following symptoms after the puncture:

High temperature (over 37 degrees C).

Severe bleeding from the vagina.

Unusual or severe pain in the pelvic area.

Difficulty urinating or bowel movements.

Nausea, vomiting, or diarrhea.

Sharp or shooting pain.

Pain or sting when urinating.

Unusual back pain.

Increase in abdominal circumference.

^Support corpus luteum function

^ In place of the punctured follicles, yellow bodies are formed. Normally, at the site of a mature follicle that “bursts” during ovulation in a woman of reproductive age, a corpus luteum is also formed, the main function of which is the production of the hormone progesterone, which “prepares” the uterine mucosa for the attachment of the embryo. However, in IVF cycles, α-GnRH drugs are used to stimulate ovulation, which reduce the function of the corpus luteum. Moreover, levels of the hormone estradiol in stimulated cycles are disproportionately increased compared to progesterone. Therefore, drug support for the function of the corpus luteum and normalization of the ratio of estrogen and progesterone are necessary, starting from the day of follicle puncture. This improves the condition of the uterine mucosa - the endometrium and thereby increases the chances of successful implantation (attachment) of embryos. In most cases, a natural hormone is prescribed progesterone in the form of a pharmaceutical preparation Utrozhestan"or synthetic progesterone" Duphaston"Utrozhestan is available in the form of capsules for oral administration (oral) or vaginal administration. The vaginal method of administering the drug is preferable, since in this case it immediately goes to the uterus, bypassing the systemic (general) blood flow. “Duphaston” is available in tablet form and is taken only orally. In some cases, after follicular puncture, until the day of the pregnancy test, medications such as, for example, “ Proginova" or " Estrofem" Both drugs contain another female hormone, estradiol, which also takes part in preparing the uterine lining for implantation. The drugs are available in tablet form, but Proginova is taken orally, and Estrofem is inserted into the vagina. The type and dosage of the drug is selected individually. All prescriptions are recorded by your attending physician on the prescription sheet immediately after the puncture, and then after the embryo transfer the dosage of the drugs is adjusted.

^ The third stage is fertilization of eggs and cultivation of embryos

^ After the follicular fluid arrives at the laboratory, the embryologist conducts a “search” for eggs, which are then placed in an incubator. Fertilization is carried out with concentrated sperm 4-6 hours after receiving the eggs. For normal fertilization, approximately 50 thousand sperm are used for each egg. If sperm parameters do not meet the requirements of standard IVF or previous IVF attempts have been unsuccessful, further treatment tactics are discussed (possibly ICSI or IVF using donor sperm). The ICSI technique is used to fertilize mature eggs in the case of sperm abnormalities in the spouse (“ICSI”). If it is difficult to obtain sperm on the day of puncture or there are no sperm in the ejaculate, a special procedure is provided - testicular biopsy. The day of puncture is considered the zero day of embryo culture; The first day of cultivation is the day following the puncture. It is on this day that most eggs show the first signs of fertilization. They are already noticeable 16 - 18 hours after the union of eggs with sperm (insemination). Fertilization is re-evaluated 24-26 hours after insemination. Fertilization control is carried out by an embryologist when viewing dishes with cultured cells under a microscope. One of the reasons for failures in IVF is the lack of fertilization of eggs. Often the reason for this is not possible to establish, despite the extensive knowledge of scientists in this area. No one is immune from this, and such an outcome is often difficult to predict, but it must be remembered. If your couple did not have eggs fertilized using the standard IVF method, you and your husband need to visit a doctor to decide on further management tactics for your couple. Possible options: repeat donation of sperm and performing the ICSI procedure or performing ICSI with sperm already obtained on the day of puncture (if it is of good quality). It is advisable from the very beginning, even before the puncture, to discuss the possibility of switching to ICSI if the standard IVF procedure fails.

^ Stages of embryo development

^ A fertilized egg is called a zygote - it is a one-cell embryo that already contains a double set of chromosomes, that is, from the paternal and maternal organism. However, the presence of zygotes is not yet sufficient to resolve the issue of the possibility of embryo transfer into the uterine cavity. First you need to make sure that the embryos are splitting and developing normally. This can only be judged based on the quantity and quality of the dividing cells of the embryo and not earlier than one day after fertilization, when the first signs of fragmentation appear. They appear most clearly only on the second day of cultivation. Every day, an embryologist evaluates the embryos, recording all parameters: the number and quality of embryonic cells (blastomeres), the rate of fragmentation, the presence of abnormalities, etc. Only good quality embryos can be transferred. Embryo transfer is carried out on the 2nd - 5th day of cultivation - depending on the pace of their development and the quality of the embryos. Until recently, embryos were cultured for three days and then transferred to the uterus and/or frozen. Nowadays, so-called extended culturing of embryos for five or six days until they reach the blastocyst stage is common. Blastocysts have a higher implantation success rate, allowing fewer embryos to be transferred and reducing the risk of multiple pregnancies while increasing pregnancy rates.

^ Stage four - embryo transfer

^ As mentioned above, embryo transfer is carried out on the 2nd - 5th day of cultivation, depending on the stage of their development. On the day of embryo transfer, you must arrive 30 minutes before the appointed time. The presence of the husband is possible, but not required. On the day of the transfer, we allow patients a light breakfast, but liquid intake should be limited. This will reduce the discomfort associated with a full bladder. Immediately before the embryo transfer, the doctor, embryologist and couple decide on the number of embryos to transfer. The embryologist demonstrates in the photograph the embryos selected for transfer and answers questions of interest to the couple. After receiving information about the doctor’s readiness to carry out the embryo transfer procedure, the embryologist collects the embryos into a transfer catheter, which is a thin plastic tube with an attached syringe, and hands it over to the doctor, carrying out the transfer. The embryo transfer procedure is technically simple. The patient lies down on the gynecological chair. The doctor exposes the cervix in the speculum, and then inserts a catheter through the cervical canal into the uterine cavity. The catheter contains embryos that enter the uterine cavity. Then the doctor passes the catheter to the embryologist, who examines its contents under a microscope for any embryos remaining in the catheter. Transferring embryos usually does not take much time (5-10 minutes). The procedure is painless, although sometimes the patient may experience slight discomfort. If, after embryo transfer, a couple has “extra” embryos of good quality, the couple is asked to freeze them for further storage and subsequent transfer after thawing if there is no pregnancy after this IVF attempts (“Cryopreservation of embryos”). After embryo transfer, you are in a horizontal position for 40 - 45 minutes, after which you get dressed and are invited to see your doctor to discuss further features of treatment and lifestyle.

^ How to behave after embryo transfer?

^ Your attending physician will provide a detailed statement in 2 copies (to you and your attending physician at your place of residence) about the IVF treatment performed. The extract indicates: lifestyle recommendations, timing of pregnancy tests and ultrasound examinations, dosages and duration of medication use. In addition, if necessary (working patients), a certificate of incapacity for work (sick leave) is issued. Nonresident patients are given an open sick leave certificate, which they can extend at their place of residence. After embryo transfer, the dose of progesterone drugs (Utrozhestan or Duphaston) is usually doubled, and their use can last up to 12-14 weeks pregnancy, when the placenta (baby place) is formed and releases “its” progesterone in sufficient concentration. After the transfer, some patients note slight spotting or the release of air bubbles from the genital tract. Please don't worry about this. This does not mean that at this time your embryos are expelled from the uterine cavity. Immediately after the embryo transfer, it is very useful to come home, lie down and try to relax. From the moment of the transfer until the pregnancy test, you can safely return to most of your daily activities and responsibilities with the exception of excessive physical activity. It is considered absolutely normal that if the results of the pregnancy test are negative, you will blame yourself for something you did or , on the contrary, did not do during this period of time - the waiting time. In this regard, try not to do anything for which you will reproach yourself if pregnancy does not occur, and adhere to the recommendations below: - Do not take a bath or swim in the first day after the transfer. - Do not shower or douse yourself with water. - Don't use tampons. - Do not be sexually active until you receive your first pregnancy test. - Do not engage in jogging, aerobics, tennis, skiing, mountaineering or other similar sports. - Do not start playing other sports or physical education. - Don't lift heavy objects. You can return to "work" after 24 hours in bed and one or two days of moderate physical activity. Trying to keep yourself busy and distracted from waiting for your pregnancy test results will help you get through those 12 to 14 days. You may experience some spotting or spotting from your vagina before taking a pregnancy test. Approximately 50% of our pregnant patients after IVF had similar discharge before the test and even after receiving a positive result! Don't lose optimism! You should definitely get your blood tested, even if you think that this discharge is menstruation and pregnancy has not occurred. A quantitative pregnancy test must be done - determination of hCG in the blood. Diagnosis of pregnancy Quantitative hCG - a pregnancy test must be done 14 days after the embryo transfer. If this time falls on a “Sunday” day off, the test can be done on Monday. Non-resident patients are recommended to do an hCG test at their place of residence and inform us by phone about its results. A blood test for hCG determines the hormone (chorionic gonadotropin) secreted by the embryo if it is attached to the uterine cavity. As a rule, the concentration of this hormone is comparable to the result of IVF treatment: the presence of pregnancy, the number of embryos in the uterine cavity, etc. Most pregnancy tests give either positive or negative results. However, sometimes there are “weakly positive” results - a low concentration of hCG in the blood. If you were given exactly this result, it may indicate the following: - Late but normal implantation of the embryo. - Interrupted pregnancy. - Ectopic pregnancy. - Laboratory error. Further monitoring of hCG is extremely important in each of the above situations. 2-3 days after the weakly positive result, you need to repeat this study. Repeated blood testing for hCG will allow us to determine whether your pregnancy is progressing and developing normally. The first ultrasound is recommended to be performed one week after the day of the pregnancy test (or 3 weeks after the embryo transfer). This ultrasound at such an early stage is extremely important in terms of the possibility of termination of pregnancy (miscarriage), ectopic pregnancy and multiple pregnancies. Ectopic tubal pregnancy can occur in 2-3% of pregnancies after IVF. Timely, early diagnosis of ectopic pregnancy and laparoscopic surgery avoids serious complications that threaten the woman’s life. A second ultrasound examination is performed 10 days from the first to confirm the normal development of pregnancy - definitions fetal heartbeat. As soon as the doctor detects a fetal heartbeat, he recommends that you contact your obstetrician-gynecologist for early pregnancy registration. The approximate pregnancy period at the moment will be 6-7 weeks. If the pregnancy test is negative, you stop taking progesterone medications. It will take 3 or 5 days before your period arrives, if it has not arrived earlier. Your menstrual flow may be different from your usual periods (heavier, lighter, shorter or longer). If menstruation does not come within the next week, inform your doctor and repeat the blood test for hCG. Gonadotropin preparations The active principle of such medications are the two main gonadotropic hormones of the pituitary gland, which are necessary for the normal functioning of a woman’s ovaries. FSH - follicle-stimulating hormone is responsible for the growth and development of the follicle in the ovary, and LH - luteinizing hormone ensures the final maturation of the egg and ovulation in the middle of the cycle (rupture of the leading follicle and release of the mature egg into the abdominal cavity). There are two types of gonadotropic hormone drugs: HMG drugs – contain both hormones – FSH and LH; FSH preparations contain only the FSH hormone. In our clinic, the most commonly used HMG drugs are Menopur (Ferring, Germany), and the FSH drugs are Puregon (Organon, Holland) and Gonal-F (Serono, Italy). . These medications differ not only in composition, but also in their production technology. “Menopur” is obtained from the urine of menopausal women using a special highly purified technology. The drugs “Puregon” and “Gonal-F” are created by genetic engineering - the drugs contain only a certain part of the FSH molecule, which directly ensures the growth of the follicle. The use of all drugs is safe from the point of view of the risk of developing an immune reaction against “foreign” hormones. Side effects These medications occur infrequently and include abdominal discomfort, flatulence (bloating), mood swings, fatigue or restlessness, which in most cases improves or disappears completely after follicular puncture. One of the possible complications of therapy with gonadotropic hormone drugs is multiple growth of follicles and the development of ovarian hyperstimulation (“Ovarian hyperstimulation syndrome”). The drugs are available in the form of a dry substance (powder) and an accompanying solvent (in ampoules) and are administered intramuscularly once a day. In this case, 2-4 ampoules of dry substance are diluted with the contents of one ampoule of solvent. Usually patients give themselves injections, sometimes they involve their relatives or friends who know how to do intramuscular injections. It will be better if the first injection is given by a nurse in order to teach the patient or whoever will be injecting her how to administer the drug. It is important to administer the drugs in the dose prescribed by the doctor, at the same time of day, preferably in the 2nd half of the day. Instructions for IVF patients on administering the drugs “Menopur”, “Puregon” and “Gonal-F” Wash thoroughly and dry your hands. Prepare in advance: one sterile syringe with a needle for intramuscular injection, 2 cotton balls moistened with 70% alcohol, one ampoule of solvent and 3 or 4 ampoules of the drug (in accordance with the prescription sheet). Treat the index and thumb of your right hand with an alcohol ball and quickly (in one motion) uncork the ampoules. Remove the cap from the needle and draw 1 or 2 ml of water (the proposed sterile solvent) into a syringe and dissolve this amount of solvent alternately in each of 2 to 4 ampoules with a dry substance, sequentially transferring the contents of the previous ampoule (already dissolved) into the next ampoule (with the dry substance not yet dissolved). The substance dissolves almost instantly; the needle should be inserted into the ampoule as deeply as possible. Draw the dissolved contents of all ampoules into the syringe; Hold the syringe vertically and lightly press the plunger to remove all air bubbles from the syringe. Take the syringe and the new alcohol ball in your right hand. Select the injection site; preferably, it does not coincide with the site of the previous (yesterday) injection. Gently grab the skin in this area with your left hand. Take a comfortable position and, leaning on the leg opposite to the one where the injection is to be made, try to relax the muscles of the latter as much as possible. Apply an alcohol ball to the injection site and hold the ball under your left thumb. Holding the drawn syringe like a “throwing spear,” pierce the skin with the needle (the depth of penetration should be at least 1/2 the length of the needle) and quickly insert the needle into the muscle. Smoothly press the plunger to squeeze out the contents of the syringe, then quickly remove the needle. Treat the injection site with an alcohol ball. All used material (cotton balls, used syringes, etc.) is thrown away (in ordinary waste containers - no special equipment is required). GnRH agonists To prevent a woman’s own pituitary hormones from interfering with the stimulation of superovulation, their production is blocked by analogues (agonists) hormone gonadoliberin (a - GnRH). The active principle of the drugs is the compound triptorelin, a synthetic analogue of GnRH. The latter causes the release of gonadotropic hormones in the female body, which, in turn, have a direct effect on the production of female sex hormones, the growth of follicles and the maturation of eggs in the ovaries. GnRH agonists prepare the ovaries and thereby “unify” the conditions for subsequent maturation of follicles during stimulation. In addition, these drugs prevent premature ovulation, that is, rupture of follicles before puncture. Of the agonists, the most commonly used are Decapeptyl-Daily (Ferring, Germany) and Diferelin-Daily (Ipsen, France). The drugs are available in the form of daily injections (daly - from the English word “daily” - daily) and deposited forms (the drug is administered once every 4 weeks). In the IVF program, drugs with daily administration are most often used. Most drugs are produced for subcutaneous injection, some drugs are administered intramuscularly. "Decapeptyl-Daily" The drug is available in the form of ready-made syringes of 2 types: "Decapeptyl - Daily 0.5 mg" - and "Decapeptyl - Daily 0.1 mg". Each such syringe looks very much like an insulin syringe, which is used by patients with diabetes - a very thin needle (no thicker than a hair for painless subcutaneous administration of medication). We usually prescribe Decapeptyl Daily 0.1 mg as a daily subcutaneous injection. One package contains 7 or 28 syringes with the drug. The drug is stored in the refrigerator. One syringe is enough for one injection (if prescribed in the first 10-14 days of treatment); when the doctor reduces the daily dosage (the next 12-14 days of administration of a-GRG - already together with gonadotropin preparations), it is enough to administer not the entire syringe, but only half of its contents per day, and it is recommended to store the remaining medicine in the syringe (0.5 ml) in refrigerator until the next dose (after putting the cap on the needle). Immediately before administering the drug, there is no need to warm it up further. Instructions for administering “Decapeptyl-Daily 0.1 mg” Open the package and take the syringe from the package. Remove the plastic cap from the syringe needle. Take the syringe in your left hand and a cotton ball soaked in 95% alcohol in your right hand. Select a subcutaneous injection site (on the shoulder or on the anterior abdominal wall); It is advisable to change injection sites daily. Gently clean the injection site with a cotton ball moistened with alcohol. Holding the syringe in your right hand like a “throwing spear” at an angle relative to the surface of the skin, quickly insert the syringe needle under the skin. Smoothly, without jerking, squeeze out the entire contents of the syringe, then remove the needle, treat the injection site with a new cotton ball with alcohol and throw away the used syringe. When you start administering Menogon or Puregon, the dose of Decapeptyl-Daily is reduced by exactly half; the syringe is not thrown away, and the second half of the contents of the syringe remaining after injection is stored until the next injection in the refrigerator, for which the cap is put on the needle again. ampoules) and are administered subcutaneously once a day. In this case, the contents of an ampoule of dry substance are diluted with the contents of one ampoule of solvent. Instructions for administering Diferelin-Daily 0.1 mg Wash and dry your hands thoroughly. Prepare in advance: one sterile syringe with a needle for intramuscular injection, 2 cotton balls moistened with 70% alcohol, one ampoule of solvent and a bottle of dry substance. Treat the index and thumb of your right hand with an alcohol ball and quickly (in one motion) open the ampoule with the solvent. Spray the cap of the bottle with an alcohol ball and open it. Remove the cap from the needle and draw 1 or 2 ml of water (the proposed sterile solvent) into the syringe and dissolve this amount of solvent in the vial with the dry substance; The substance dissolves almost instantly; the needle should be inserted into the ampoule as deeply as possible. Draw the dissolved contents of the bottle into the syringe; Hold the syringe vertically and lightly press the plunger to remove all air bubbles from the syringe. Take the syringe and the new alcohol ball in your right hand. Select a subcutaneous injection site (on the shoulder or on the anterior abdominal wall); It is advisable to change injection sites daily. Gently clean the injection site with a cotton ball moistened with alcohol. Holding the syringe in your right hand like a “throwing spear” at an angle relative to the surface of the skin, quickly insert the syringe needle under the skin. Smoothly, without jerking, squeeze out the entire contents of the syringe, then remove the needle, treat the injection site with a new cotton ball with alcohol and throw away the used syringe. When you start administering Menogon or Puregon, the dose of Diferelin-Daily is reduced by exactly half; the syringe is not thrown away, and the second half of the contents of the syringe remaining after injection is stored in the refrigerator until the next injection, for which the cap is put on the needle again. GnRH agonists must be administered at the same time, preferably in the evening. If the time of administration of the drug changes (the difference is more than an hour), it is necessary to inform the attending physician about this and discuss with him the time of the next injection. Each drug is accompanied by detailed instructions from the manufacturer about the features of use and storage of this drug, its side effects, what significantly facilitates their administration by the patients themselves. Side effects of agonists do not occur often and are associated mainly with a decrease in the level of sex hormones in the blood: a decrease in sexual desire, rapid changes in mood, hot flashes, and rarely depression are possible. But all of these manifestations are transient in nature and indicate the effectiveness of the drug, paradoxically, because they are associated with a temporary decrease in the level of sex hormones (estradiol) in the body. All of these symptoms associated with a decrease in estrogen saturation disappear after the start of gonadotropin administration due to increased production of estrogen in the woman’s stimulated ovaries. The drugs do not accumulate in the body, and all side symptoms disappear without a trace. Sometimes there is slight soreness, redness or, less commonly, itching at the injection site (injection site). This is a local allergic reaction, which usually does not require the prescription of additional medications and discontinuation of the drug, but it, like other possible side effects of the drug, should be reported to your doctor in a timely manner. GnRH antagonists GnRH antagonists (ant-GnH), like agonists, block the functioning of the pituitary gland, and thereby provide conditions for stimulating follicular growth. Antagonists are prescribed at the final stage of stimulating follicular growth to prevent premature ovulation (usually from the 6-7th day of stimulation, that is, the use of Menopur or Puregon). During the stimulation process, as a rule, no more than 4-5 injections are required. Drugs in this group include Organutran (Organon, Holland) and Cetrotide (Serono, Italy). Our company uses the drug “Orgalutran”. The drug is available in the form of ready-made syringes “Ogralutran 0.25 mg”. Each such syringe looks very much like an insulin syringe, which is used by patients with diabetes - a very thin needle (no thicker than a hair for painless subcutaneous administration of medication). The drugs are prescribed in the form of subcutaneous injections at the same time of day, which is indicated by your attending physician. Instructions for administration of the drug "Orgalutran 0.25 mg" Open the package and take the syringe from the package. Remove the plastic cap from the syringe needle. Take the syringe in your left hand and a cotton ball soaked in 95% alcohol in your right hand. Select a site for subcutaneous injection (on the shoulder or on the anterior abdominal wall); It is advisable to change injection sites daily. Gently clean the injection site with a cotton ball moistened with alcohol. Holding the syringe in your right hand like a “throwing spear” at an angle relative to the surface of the skin, quickly insert the syringe needle under the skin. Smoothly press the plunger to squeeze out the contents of the syringe, then quickly remove the needle. Treat the injection site with an alcohol ball. All used material (cotton balls, used syringes, etc.) is thrown away (in regular waste containers - no special equipment required). Human Chorionic Gonadotropin (HCG) Human Chorionic Gonadotropin is a hormone similar to luteinizing hormone (LH), which causes ovulation of the leading follicle in the middle of the menstrual cycle. HCG injection is intended to prepare the follicles for puncture and the final maturation of the eggs. Ovulation occurs 42-48 hours after hCG administration. Therefore, follicular puncture must be performed before ovulation, otherwise the follicles will be empty. HCG is prescribed 35 - 36 hours before the puncture. The time for prescribing the drug is recorded in the prescription sheet and is once again clarified by your doctor immediately before the puncture. Many patients experience discomfort in the lower abdomen after an injection of hCG due to an increase in the size of the ovaries and are sure that they are ovulating. In fact, careful monitoring of patients during treatment and the drugs used (a-GnRH or antagonists) almost completely eliminate the risk of premature ovulation, i.e., ovulation before follicle puncture. HCG is produced by different companies under different commercial names. The most commonly used drug is Pregnil (Organon, Holland). The drug looks like a white powder. Each ampoule of dry substance is accompanied by 1 ampoule of solvent. The drug is administered intramuscularly. The hCG injection is carried out only once during the entire treatment cycle, the injection is painless and, as a rule, the patient gives it to herself. Before the appointed time of puncture (written down in the appointment sheet), the patient does not need to visit the doctor or take blood tests for hormones. Instructions for administering the drug “Pregnil” The time of administration of hCG is a decisive moment in treatment, so the drug must be administered exactly at the calculated time! Wash and dry your hands thoroughly. Prepare in advance: a disposable syringe with a needle, 2 cotton balls moistened with 70% alcohol, and medicine (ampule with dry substance). Take the ampoule with the dry substance from the package; remove all plastic protective coverings. Treat each ampoule with an alcohol ball. Remove the cap from the needle, insert the needle straight and firmly into the center of the rubber cap of the solvent ampoule. Turn the ampoule upside down. Lower the plunger of the syringe to withdraw sterile solvent (in an amount of 3 ml), and then disconnect the empty ampoule. Remove air bubbles from the syringe by lightly flicking it or shaking it with your fingers, then squeezing out the air with the syringe plunger. Select the site for the intramuscular injection. Stretch the skin in the selected area with your left hand. Take the ready-to-use syringe and a cotton ball soaked in alcohol in your right hand. Treat your skin with alcohol and hide the used ball under your left hand. Holding the syringe like a “throwing spear”, insert the needle into the muscle at an angle, then with sharp pressure on the piston, squeeze out the entire contents of the syringe, remove the needle, and treat the injection site with a new cotton ball with alcohol. Place used instruments and medications in a waste collection container.0Topic closedPage: 1" GOAL - PREGNANCY! » Articles (recommended reading) » Very detailed article about IVF (step by step)Forum rating | Create a forum for free © 2007–2016 “QuadroSystems” LLC