INFERTILITY IS A DIFFICULT DIAGNOSIS , which can have a variety of reasons. If a couple wants a child, but pregnancy does not occur, there are several options, the choice of which depends on the specific characteristics of the partner’s or partner’s organism, and on financial capabilities, and on personal preferences: apply for adoption, use the services of a surrogate mother, try to achieve pregnancy with the help of in vitro fertilization (IVF) procedures. Everyone has heard about the latter, but many are still not sure how it actually happens. We spoke with Tatyana Verkhovnikova, a fertility specialist at the Mother and Child clinic in St. Petersburg, and asked women who had gone through IVF about their IVF experience.
How to prepare for IVF
Preparation is, first of all, an examination, which is carried out according to a certain scheme (in Russia it is determined by Order of the Ministry of Health No. 107n). The purpose of the examination is to understand whether IVF is indicated and whether the pregnancy will be safe for the patient. The couple donates blood, tests for infections are performed, and a spermogram is performed for the man. The woman is also tested for hormones to identify diseases that can interfere with the onset and gestation of pregnancy – for example, problems with the thyroid gland. The level of the so-called anti-Müllerian hormone is determined, which helps to understand how many eggs are left in the ovaries, and to predict how many of them can be obtained.
Also, general blood and urine tests are done, an ECG and fluorography are performed, a therapist’s consultation is prescribed, a woman must undergo an examination of the mammary glands – stimulation with hormonal drugs can affect their condition. Sometimes you need the advice of other specialists to get their permission and recommendations. If the examination reveals any irregularities, then it may take several months to correct them. In addition, since the goal of IVF is pregnancy, the couple should follow the general recommendations for a healthy lifestyle: be active, get enough sleep, do not smoke and give up alcohol, adhere to a balanced diet; a woman should start taking folic acid three months before the procedure.
How eggs are taken and fertilized
IVF is a teamwork of a patient, a reproductologist and an embryologist. From the first day of the menstrual cycle, a woman begins hormonal drugs to help mature more than usual number of eggs. These medications are selected individually by the reproductive specialist; they are administered as injections, subcutaneously (in the abdomen) or intramuscularly – in the latter case, the injections bring quite noticeable discomfort. Eggs develop inside the ovary in follicles – structures like bubbles filled with fluid (in natural conditions, a follicle ruptures at a certain point, releasing an egg – this is called ovulation). Stimulation with hormones lasts ten to twelve days, during which ultrasound is done two to three times to assess the growth of follicles and adjust the dosage of the drug. In the middle of the menstrual cycle, when the follicles grow to a certain size, the last injection is given to ripen the eggs, and the day of the puncture is scheduled when they are finally removed.
Egg collection is usually done under general anesthesia; a thin needle pierces each follicle, and the collected fluid is transferred to the laboratory, where embryologists look for eggs in it under a microscope. On the same day, a man donates sperm, in which the same embryologists identify motile sperm. The patient goes home, and the embryologists begin to fertilize the obtained eggs. If there are a lot of motile spermatozoa, then the usual in vitro fertilization is carried out: sperm and eggs are left in the same cup with a nutrient medium in an incubator for sixteen to eighteen hours and there fertilization occurs in the same way as in the uterus. But if there are few motile sperm or they are of poor quality, then an ICSI (intracytoplasmic sperm injection, ICSI) procedure is performed. In this case, the embryologist with a microneedle under a microscope injects a sperm into each egg and leaves them in the incubator; sperm are selected based on the absence of abnormalities in their structure and normal motility.
How embryos are transplanted
On the next day after fertilization and on the following days, the embryologist evaluates the fertilized egg (from the fifth day it is called the blastocyst); this examines the inner cells that will become the fetus, the outer layer of cells that will become the placenta, and the cavity between them. There are criteria (what these cells should be and how many there should be) that help determine the “quality” of the embryo, that is, its viability and development prospects. It often happens that the processes do not go as we would like, and some of the embryos do not develop – that is why during stimulation it is important to receive not one egg, but several, so that there is a choice. For the next three to five days, embryos grow in a nutrient medium, and their condition is assessed by a specialist every day.
Then one or two embryos that meet medical criteria are selected and transferred into the uterine cavity. This procedure does not require pain relief; the patient sits down in an ordinary gynecological chair, and the embryos are transferred into the uterine cavity through the vagina using a tube (catheter). Finally, two weeks later, the patient does a pregnancy test (usually a blood test because it is more reliable than a urine test).
According to Verkhnikova, now, when reproductive science and embryology have reached a higher level, as a result of IVF, more embryos are obtained with the prospect of engraftment and growth – and the transfer of several embryos often leads to multiple pregnancies. By itself, pregnancy with more than one child is considered complicated: such pregnancies are more often interrupted or end in premature birth, which is dangerous for both the mother and the children. Since this is at odds with the very idea of IVF, designed to give birth to a healthy baby and preserve the health of a woman, recently only one embryo is transferred more and more often. The rest can be frozen and stored in a special jar of biomaterial; storage can cost about 35 thousand rubles for ten years. In the future, the couple may return to the clinic and use one of their own embryos for a second pregnancy – or sign a donation consent . Unfortunately, not all embryos are transferred to thawing either – about 15% lose their viability.