In vitro fertilization (IVF)
Extracorporeal fertilization – IVF (Latin extra – outside, and corpus – the body, i.e. fertilization outside the body) is the fertilization of the egg outside the female's body in a “glass tube”. IVF procedure consists of several stages, each of them is important, each the success of your treatment depends on. So you need to arm oneself with patience and fulfill with responsibility all your attending doctor's appointments.
The IVF procedure:
Controlled ovarian stimulation involves injecting drugs that stimulate growth of several follicles in the ovaries, as well as ultrasonic and hormonal monitoring (on average 10–17 days from the beginning of menstruation).
If the natural cycle at ovulation in the ovary one egg matures, then for IVF it is required to obtain simultaneously a large number of oocytes. To do this, stimulation is conducted by the drugs containing follicle-stimulating hormone – FSH (puregon, menopur, gonal-f, elonva, metrodin, etc.). This is the hormone that is responsible for growth of the follicles.
Injections of the FSH drugs are started with the 2nd-3rd day of the menstrual cycle and continued on the average for 8–12 days. During this period, the follicles mature in the ovaries, which contain eggs inside. Simultaneously with the injection of drugs the physician, using ultrasonic monitoring, monitors the state of ovaries, follicular genesis and endometrium.
Stimulation can be conducted using different procedures ("protocols"), which differ mainly by the means of preventing premature ovulation and quantity of used drugs. In each particular case, the protocol is chosen by the physician individually.
To ensure the own female's hormones will not prevent the controlled ovarian stimulation (KOS) their production is blocked by analogues to gonadotropin-releasin hormone of the hypothalamus (dipheriline, cetrotide, orgalutran). When the “long protocol” is used, this drug is prescribed to take with the 20th–21st day of the menstrual cycle, preceding the stimulation, and when the “short protocol” is used — along with the FSH containing drug. Another group of drugs — antagonists of the gonadotropin-releasing hormone of the hypothalamus (cetrotide, orgalutran) — enable to block instantly the pituitary gland, and then quickly recover its operation. They are prescribed for taking with the 5th–6th day from the start of the ovarian stimulation by the FSH drugs.
When the follicles reach a certain size, that points to their maturity, the challenging dose of the drug is prescribed for taking, which launches the mechanism of the final maturation of the oocytes. For this purpose, human chorionic gonadotropin drugs (HCG, pregnil, choragon, ovitrel, etc.) can be used. In some cases, for this purpose agonists of the gonadotropin-releasing hormone (diphereline) can be used. On the day when prescribing the drug, the physician appoints the exact date and time of the puncture of follicles. The follicular puncture is performed under the ultrasonic control (ultrasonic sensor), typically 35 hours after injection of HCG. On the day when puncturing the follicle, the husband should be present. It is very important to strictly follow the doctor's instructions and meet the appropriate drugs timing.
Follicular puncture under ultrasonic control (ultrasonic sensor) is conducted by the transvaginal way using a hollow needle under short-term intravenous anesthesia. At this, the target puncture of each follicle is conducted and the follicular fluid is collected in the tubes.
Immediately after collection, the follicular liquid which contains the matured eggs is passed on to the embryologist, who finds the eggs under a microscope and determines their state. The obtained eggs are placed in a culture cup filled with culture medium. Cultivation of eggs and embryos is carried out in the CO2 incubator.
We strongly recommend you to refrain from driving after a puncture.
The next step is the fertilization of eggs with the husband’s or donor’s sperm. Despite the fact that only one sperm cell fertilizes the egg, for successful fertilization it is required that not less than 100,000 motile sperm cells were near the egg. Sperm cells surround the egg and try to get inside, dissolving a portion of the membrane with their enzymes. Only one sperm cell penetrates the egg, and its nucleus is fused with the egg’s nucleus. In case the mobility or number of sperm cells is reduced so that they are not sufficient for fertilization, forced feed injection of one sperm cell into each egg is performed – ICSI (IntraCytoplasmic Sperm Injection). This method has given the chance to have children to the males which, prior to ICSI technology, has not even hope for that. At present this technology is routine in our Clinic and throughout the world.
Fertilization has occurred - the development of a new life begins. In 12–18 hours in the egg two pronucleuses (male and female) are visible, and then the embryo begins to divide. In 48–72 hours the embryos consist of 4–8 cells. On the fourth day they usually are at the morula stage and on the fifth day at the blastocyst stage.
On the 3rd–5th day after the puncture 1–2 (in in exceptional cases 3) best embryos are transferred through the uterus cervix into the uterine cavity using a thin and flexible catheter. This procedure is absolutely painless.
If after the transfer there are unused good quality embryos, they are frozen (vitrified). Later they can be thawed and transferred into the uterine cavity in case of the negative result of this attempt, or after a few years if the couple wants to have children more.
The luteal phase support is required for all females after IVF. For this purpose, most often used various progesterone drugs are used. They are sometimes prescribed in combination with HCG drugs to enhance secretion of progesterone in the ovaries.
After the embryo transfer there is need for hospitalization, provided there are no complications. However, if desired, you can apply to our in-patient gynecology department. Try to spare yourself physically and mentally during the first weeks after the embryo transfer. If you have any concerns, please at once contact your attending doctor.
For the confident diagnosis of pregnancy, determination of the concentration of HCG in the blood is recommended not earlier than 12–14 days after embryo transfer. The result should be obviously informed to your attending doctor regardless of whether negative or positive. Do not make any modifications in the treatment and mode without consulting the doctor. If the result is positive, hormone support continues till 10–12 weeks of pregnancy.
Ultrasonic diagnosis of the pregnancy is performed 4 weeks after the embryo transfer. Ordinarily, on this term not only the number of eggs can be detected, but also fetal heartbeats can be visible.
If abdominal pain, bloody discharge and other troubling symptoms occur, immediately contact your attending physician.
If abdominal pain, bloody discharge and other troubling symptoms occur, immediately contact your attending physician or duty medical staff.
24-hour medical staff post is operating in the in-patient gynecology department of the Clinic.
Phones – (057) 7120101; (050) 3930101; (067) 8240101
Cost of services "In vitro fertilization (IVF)"
|Программа лечения бесплодия методом ЭКО «ОПТИМАЛЬНАЯ»||77500 UAH|
|Программа лечения бесплодия методом ЭКО «ИНТЕНСИВНАЯ»||81500 UAH|
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