If all preparatory procedures have been successfully completed and there are no contraindications to in-vitro fertilization, the reproductologist conducts a detailed interview with the patient. IVF is performed in the following order:
- Stimulation of superovulation.
- Egg harvesting.
- In vitro fertilization.
- Embryo implantation.
- Pregnancy monitoring.
If the doctor deems it necessary, IVF may include additional steps such as:
- Selecting active sperm cells.
- Freezing the eggs.
- Selection of donor material.
- Introduction into artificial menopause with the help of hormonal drugs.
When different types of ovulation stimulation are recommended
Most women are recommended early hormonal preparation to help reduce the activity of the ovaries, as a result, the sex glands become under the control of doctors. However, there are a number of limitations.
Short – indicated for patients over the age of 40, with reduced AMH or depleted ovaries.
Long or varying – in the absence of contraindications with prolonged “switching off” of ovaries. Hormonal allows obtaining up to 20 oocytes at a time, fit for fertilization.
While during a natural cycle, only one or two cells are formed. That is, if a patient is recommended to undergo short stimulation, hormones are not taken, and the protocol is implemented in a natural cycle.
Oocyte retrieval
One of the main stages of IVF is follicle puncture. The procedure is done under anesthesia and takes no more than half an hour. The puncture is done through the posterior fornix of the vagina:
The needle is gradual, under ultrasound control, brought to the testis.
A puncture is made
Only medium or large follicles are aspirated with the help of a catheter.
If IVF is performed using a donor egg, the puncture procedure is ruled out, as is stimulation.
The extraction procedure is minimally invasive, so the patient can go home a short time after a successful procedure.
Fertilization of eggs
Sperm is collected strictly on the day of IVF. If this is not possible for some reason, the semen is donated earlier and frozen. Fertilization should be done no later than six hours after egg collection.
Cell fusion is performed under special laboratory conditions using high-powered microscopes. For the manipulation to be successful, natural conditions similar to the environment in the fallopian tubes must be created in terms of parameters:
- Temperature.
- Humidity.
- The presence of carbon dioxide.
Fertilization takes 3 to 5 days and is done by embryologists. However, unusual situations may arise when a couple is confirmed to have a poor spermogram. In this case, the method of ICSI (intracytoplasmic injection) should be used. It involves the collection of seminal fluid and its detailed analysis – experts will select the best sperm. After that, the injection of quality sperm into the cavity of the egg is performed, thus eliminating the possibility of a bad result.
If the spermatozoa are active enough, the cultivation process is traced quickly. On the second day, 2 to 4 cells are observed, on the third day – 10. Embryos of the highest quality, superior to the others, are selected for transfer.
Transfer of embryos into the uterus
The embryo is not implanted in the uterus until several days after fertilization. Most often it is five or three days, depending on the activity. The procedure takes place on a strictly scheduled day and time in a special office. Embryos are delivered through the cervix; they are in a nutrient medium.
The patient may feel discomfort in the lower abdomen, there is no pain, so no anesthesia is used.
After the procedure, it is necessary to stay in a lying position for a few hours, and then you can go home.
Experience shows that if several embryos are transferred into the uterus at the same time, it increases the probability of successful conception, but no more than three embryos are implanted. If embryos remain after IVF, they can be frozen at the couple’s request for the next fertilization attempts.
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Pregnancy monitoring
Fertilization results can be determined as early as 14-16 days after embryo insertion. The woman can do an express pregnancy test by buying it at the nearest pharmacy. You can also take a blood test for hCG levels at a nearby medical laboratory.
In case the result is positive, an ultrasound scan should be done a month after IVF. After the pregnancy is monitored in the standard model – in the antenatal clinic at the district gynecologist. Now it is important to follow doctor’s recommendations, take prescribed medications to preserve pregnancy, vitamins.
