IVF PROGRAMS

What is IVF?
IVF protocol is a method to treat infertility using in vitro fertilization, which is developed on the basis of specific characteristics and needs of each couple. With a properly developed and matched protocol, a chance to get pregnant increases significantly. The basis of the method lies in detailed scheduling of stages, clear definition of sequence and regimen of drug administrationMandatory Credit: Photo by Monkey Business Images/REX Shutterstock (3504111a) Laboratory Fertilization Of Eggs In IVF Treatment VARIOUS. The procedure itself represents fertilization of an oocyte outside the woman’s body, in vitro – in a test tube. Current IVF schemes combine use of two main hormones:

  • follicle-stimulating hormone (FSH);
  • chorionic gonadotropin (hCG) required for maturation of ova.

 

 

In addition to these hormones, drugs that blocks premature ovulation, as well as progesterone required for pregnancy development are also prescribed. According to statistics, addition of synthetic progesterone increases chances of successful embryo implantation and onset of pregnancy by several times.

 

The programs vary, primarily, in duration, types of hormonal drugs administered, use or non-use of cryopreservation and sequence of procedure stages.

The choice of the program will be individual for each couple, and the final decision is made by the attending doctor based on the cause of infertility, its duration, previous IVF attempts and woman’s characteristics. Indeed, it is a woman who will have to go through the whole procedure, while a man is involved only at its small stage.

 

In case if natural cycle IVF is chosen, the day before ovulation, an egg is retrieved from the ovary and placed in special medium, where it further matures. Once it is fully matured, male sperm cells that have been extracted from seminal fluid collected in advance are transferred into the tube containing the egg. Fertilization followed by development and division of a zygote takes place in the tube.

The zygote is transferred to the woman’s body once it reaches the state of a blastocyst or a gestational sac. Using a special catheter, the blastocyst is introduced into the uterine cavity, where it implants into the uterine wall – it is onset of pregnancy.

 

The difference between a cryopreservation protocol and other types of in vitro fertilization is that it includes use of previously frozen male germ cells, spermatozoa. In addition, cryopreserved embryos obtained within previous programs may also be used in the cryopreservation protocol.
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Short protocol. Characteristics and stages

 

A short program is considered to be more sparing for woman’s health, rather than the long one. Artificial stimulation exhausts ovaries and contributes to early hormonal depletion. That is why long programs are not recommended to be performed more than 3 times.

 

The duration of a short IVF protocol, including cryopreservation, usually equals to that of the female menstrual cycle. In contrast to a long program, it does not require any time for additional artificial ovarian stimulation, in other words, its regulating stage is eliminated, and the program itself starts immediately on day 3 of the menstrual cycle.

 

Short protocol stages:

  • cycle day 3: pituitary blockade;
  • cycle days 3-15: ovary stimulation with special drugs;
  • cycle days 15-20: oocyte puncture (exact date depends on the start of stimulation and its effectiveness);
  • days 3-5 after puncture: transfer of the fertilized egg at the stage of a zygote or a blastocyst;
  • days 1-14 after transfer: support to ensure implantation of the gestational sac into the uterine cavity and pregnancy onset;
  • since day 15 after transfer: confirmation of pregnancy.

 

Later, following the short IVF protocol, pregnancy is no different from normal pregnancy that has occurred naturally.

The gestation period is counted not from the moment of embryo transfer, but as usually, from the first day of the last menstrual period. A short cryopreservation program is performed in a similar way.

 

 

Undeniable advantages of a short IVF protocol:

  • reduction of the risk of ovarian hyperstimulation;
  • sparing influence on the woman’s body in general, and its reproductive system, in particular;
  • the number of attempts is almost unlimited;
  • minimal risk of cysts development in the ovaries.

 

However, as with any other procedure, there are certain disadvantages of a short IVF protocol:

  • risk of imbalance between growth of follicles and endometrium state;
  • the course of a short protocol is more difficult to control and adjust.

 

Nevertheless, a short IVF program has always been and remains one of the most popular programs of in vitro fertilization.
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Long protocol. Characteristics and stages

 

A long IVF program differs from a short one in that more ova maturate in woman’s ovaries within one cycle. This is achieved by additional medication-based stimulation of ovaries with special hormonal drugs. Use of several oocytes rather than one for fertilization increases procedure chances of success. In addition, approximately one week before new cycle initiation, hormonal stimulation within the current IVF protocol is supplemented with administration of antagonist drugs aimed to suppress production of endogenous hormones by ovaries and the pituitary gland. This is called complete hormonal blockade, leading to artificial superovulation with the help of additional administration of gonadotropin-containing drugs.

 

Long protocol stages:

  • day 21 of the current cycle: blockade of the pituitary gland and ovaries;
  • days 3-5 of the new cycle: superovulation stimulation with gonadotropins;
  • 36 hours prior to the start of oocytes puncture: single administration of a loading dose of hCG;
  • between days 15 and 22 of the new cycle: oocytes puncture;
  • after 3-5 days: transfer of embryos into the uterine cavity;
  • immediately after transfer: support with progesterone-containing drugs.

 

Confirmation of pregnancy onset after a long IVF protocol is performed just as after the short one – at least 15 days following transfer. A long cryopreservation program is carried out in a similar way.

 

An undeniable advantage of a long IVF protocol will be the fact that it allows complete control over growth of follicles and maturation of ova, as well as monitoring of the endometrium state.

 

Disadvantages of a long program:

  • high cost;
  • risk of occurrence of ovarian hyperstimulation symptoms;
  • menstrual cycle disturbance after a long program;
  • ovarian depletion.

 

A long IVF program is prescribed to women, whose cause of infertility is hyperandrogenism, cystic disease, endometriosis and overweight, as well as to those, in whom other methods have been unsuccessful due to poor-quality oocytes.

 

 

 

IVF programs allow not only to overcome infertility, but also to solve other problems

  1. Selection of sex of an unborn child.

Laws of Ukraine provide possibilities to select child’s sex through preimplantation genetic diagnosis (PGD).

Therefore, future parents are given an opportunity not only to select their baby’s sex, but also prevent the risk of having a child with genetic disorders.

 

  1. Selection of a healthy embryo. Genome-wide screening and determination of the complete set of chromosomes.

 

  1. Prevention of monogenic disorders in a fetus.

Identification of embryos-carriers of monogenic disorders and selection of healthy embryos for transfer.

 

Recommendations for parents prior to IVF

 

  1. Both future parents are recommended to exclude alcohol intake.

Alcohol affects the amount of seminal fluid and sperm motility. As for a woman, alcohol abuse at early stages after implantation and during pregnancy can result in fetal abnormality.

 

  1. You need to quit smoking.

Statistics shows that the time required for conception of a child by smoking parents (at least one parent) increases on average by one third. This is caused by chemical ingredients, negatively affecting man and woman’s reproductive capabilities. When the mother smokes it may reduce response to stimulation during an IVF procedure. This, in its turn, results in decrease of conception success probability by half.

 

  1. Weight.

Excess and deficit of weight decreases drugs effect during treatment, as a consequence, the body may not response to stimulation. In addition, from a practical point of view, carrying a child, while being overweight, makes the course of pregnancy much more complicated.

 

  1. It is very important to stick to healthy eating before and during IVF.

It must be highlighted that this is not about diets, but about healthy nutrition. It should contain plenty of vitamins, proteins, as well as moderate amount of carbohydrates and fats. It is recommended to give up on GM foods, preservatives and food products with “E” additives as well as reduce consumption of coffee.

 

  1. Taking of vitamin complexes intended for pregnant woman.

In order to reduce the risk of neuraxis malformations in a fetus, it is recommended to start taking folic acid 3 months before conception and continue for 3 months after it. Vitamin E should be taken one month prior to initiation of IVF stages.

 

  1. You need to avoid taking bathes with too hot water, visiting bath-houses and saunas.

 

  1. Active lifestyle.

But there is no need to push yourself too hard. You should not exercise intensely during the period of the IVF protocol. It will be enough to do light exercises for 20-30 minutes 3-4 times a day. These recommendations should be followed by both spouses.

 

  1. IVF procedure is not a contraindication for sexual life of spouses.

However, 3-4 days before the stage of follicles puncture, sexual intercourses need to be avoided in order to accumulate the required amount of seminal fluid. This term must not exceed 7 days, otherwise sperm would be considered “old” by this time. Following a program, it is not recommended to have sex prior to onset of pregnancy.

 

Anyway, each couple is individual and an attending doctor provides recommendations on the basis of a specific situation. Therefore, it is very important to find a competent and experienced doctor to achieve the long-awaited result.

 

Recommendations for a woman before IVF program

 

First of all, it is necessary to find out your ovarian reserve. This is inherent genetic supply of eggs in woman’s ovaries. Unfortunately, ovarian reserve decreases with age. In addition, its reduction is caused by: previous ovarian surgery, radiation exposure, anticancer chemotherapy and hormonal therapy.

Ovarian reserve is tested using ultrasound diagnostics (US) and according to the level of hormones AMH, inhibin B and FSH.

A swab should be tested for absence of infections. Depending on the results, a doctor may prescribe treatment and hormonal study. The best way is to carry out complete examination in order to take corrective measures in case of infections and hormonal imbalance prior to the start of in vitro fertilization stages.

Hormones that a woman needs to check:

  • at cycle days 3-5: FSH (follicle-stimulating hormone);
  • days 3-4: LH (luteinizing hormone);
  • cycle days 3-8: estradiol;
  • any day of the cycle: prolactin, thyroid hormones, AMH, androgens.

US examination should be performed two times during a menstrual cycle.

Recommendations for a man before IVF program

Spermogram needs to be carried out. Spermogram allows to determine male’s fertility and detect diseases of the genital sphere.

This analysis is performed before the first IVF stage. Sperm is collected by ejaculation at the clinic on the day of testing. For this purpose there is a specialized comfortable room in a clinic and a special container is given for free. If a man is experiencing discomfort and is not sure of positive outcome of ejaculation at the clinic it is allowed to perform the procedure at home. After sperm collection, seminal fluid needs to be transferred for analysis within two hours.

 

Examinations before IVF program recommended by the Ministry of Health of Ukraine
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For a woman:

  • HIV;
  • RW;
  • Hepatitis С;
  • HbsAg;
  • Complete blood count;
  • Urine analysis;
  • Blood sugar;
  • Blood group, Rh-affinity;
  • Coagulogram;
  • Cytology;
  • Analysis of discharge (swabbing);
  • Enzyme-linked immunoassay (Ig G, Ig M): toxoplasmosis, rubella, CMV, chlamydia;
  • Hormonal ELISA tests (FSH, LH, estradiol, prolactin, AMH, progesterone);
  • US examination of thyroid and mammary glands and the liver;
  • ECG + examination by a therapist;
  • Chest photofluorography.

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For a man:

  • HIV;
  • RW;
  • Hepatitis С;
  • HbsAg;
  • Spermogram;
  • Blood group, Rh-affinity;
  • Chest photofluorography.

What are the causes of IVF failure?

  • Procedural violations of the IVF technology when referring to an unspecialized clinic.
  • Poor quality of primary diagnostics performed.
  • Poor-quality genetic material (oocytes and sperm cells).
  • Chromosomal abnormalities of embryos.
  • Barriers for physiological implantation of embryos due to endometrial disorders.
  • Presence of chronic inflammatory processes in the area of appendages.

For example, hydrosalpinx hinders normal implantation of embryos.

  • Genetic factor.
  • Age-related aspects.
  • Presence of an autoimmune disease.
  • Endocrine disorders.
  • Blood-clotting disorders, trombophilias.
  • Early ovarian depletion syndrome.
  • Harmful habits.
  • Overweight.

 

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