When you can not do without IVF?

According to the Health Ministry, faced with infertility for more than 15 percent of Russian couples. Every year in Russia are born thousands of babies conceived using the method of in vitro fertilization (IVF).

What techniques are used to treat infertility? To whom and when you can not do without IVF? Which species are used in IVF clinics in Russian? Are these methods of infertility treatment for families with average incomes? Are "test-tube babies" from the other kids?

These and other questions answered readers MedNovostey gynecologist, endocrinologist, a specialist in vitro fertilization medical center ASCON Larissa N. Singh.


Sergey: Hello! 1) Does the IVF procedure and preparation for it any damage to a woman's health? 2) Is there a choice of which of the fertilized egg implanting? If this choice is — is it possible to say that the IVF procedure can in some way to select the most "successful" of the child?

L S.:1) In the course of the IVF program is conducted by hormonal ovarian stimulation drugs. Some patients are at risk of ovarian hyperstimulation. Ovarian hyperstimulation syndrome (OHSS) — a serious complication of IVF procedure in which stimulation of the ovaries after the increase in size, there is a deterioration of the general condition of the body (an increase in the size of the stomach, nausea, shortness of breath, etc.) and changes in blood tests. To prevent this situation held individual selection of doses of drugs to stimulate, if necessary, be appointed special preparations for intravenous drip. If OHSS yet emerged, the physician may cancel the embryo transfer (in this case, the resulting embryos are frozen). After stabilization (typically in the next cycle) and is thawed embryos transferred.

2) embryologist assesses the quality of the resulting embryos, the best of which are transferred to the uterus. There is a special rating scale embryo with which to evaluate the speed of development and the shape of the embryos. The best the best embryos are born children.

i. Tell me, on what basis is chosen as their sperm … a million there … that is the doctor takes any responsibility for the fate of the child …

L S.: Sperm cells are measured under a special microscope, taking into consideration their morphological characteristics, t is, the form, the ratio of the size of the head and tail and TE selects the best sperm.

Inga: Hello, and there is already technology to be able to conceive a child of a particular sex? And then the husband ordered the boy, and what I do now, I'd really any technology agreed :) In Europe, at least in Austria, as a result of IVF are born more often than boys do, and usually twins, but it still does not guarantee a floor. There is an opinion that it's still possible, but is forbidden from an ethical position — is that true?

L S.: There is a special technique — pre-implantation genetic diagnosis (PGD), which really allows you to determine the sex of the child. This is a serious procedure, for which must be indicated (for example, the existence of a family of diseases that are inherited through the female or the male line). For ethical reasons, we do not do PGD for sex selection "to order".

Irina: Hello, Larisa. What is the percentage of twins or triplets as a result of IVF?

L S.: The frequency of occurrence of multiple pregnancies with IVF are much higher than in natural conception. This is due to the transfer of multiple embryos into the uterine cavity. About 50% of IVF pregnancies — twins, 2% — triplets. Currently, we carry no more than two embryos, you will need to understand that one of the embryos in the uterus may be divided (because there are identical twins), and there may come a triplet pregnancy.

Misha: Hello, Larisa! Tell me, how big is the risk of having an affected child after IVF? What are the most private developmental disorders in these children?

L S.: The risk of having sick children after IVF is exactly the same as after conception naturally. This is proven by numerous international statistical studies

Elmira: If I ask you, do you believe in the existence of the soul in man — is unscientific? I want to ask you if there is a soul of a person, who was conceived in a test tube?

L S.:Dear Elmira, IVF is a "tool" to help women become pregnant and give birth.

Xcc.: Larisa, hello! I heard that in vitro fertilization — the procedure unsafe for women. What are the most frequent contraindications? Is there a situation where such treatment is not possible?

L S.: IVF procedure is contraindicated in people with mental disorders and cancer in the acute stage. If a woman has a contraindication to nurturing pregnancy should IVF involving a surrogate mother.

Svetlana: Larisa, hello! What could be the complications of IVF?

L S.: Dear Svetlana, the most frequent complications of IVF treatment — is ovarian hyperstimulation syndrome, bleeding after puncture of the ovaries, multiple pregnancies.

Valera: Good day! The average number of procedures required to pass in order to get pregnant using IVF?

L S.: The average efficiency of one IVF attempt does not exceed 30-40%. However, in healthy young couples it reaches 60%. It is estimated that on average, to spend 3 IVF attempts to get pregnant. However, all this is very individual.

Anatoly: Good day! Do I like getting ready for the procedure of putting sperm before IVF? Are there any restrictions for smokers, any "preparatory" diet?

L S.: Before sperm must abstain from sexual intercourse during the 3-5 Days to avoid heat treatments (baths, saunas, hot tubs) and intensive sports. No special diets. Smoking is not fundamentally change the semen.

Ivanka: Hello Not once read that definitely need to quit smoking before IVF, and that some countries do not even IVF smoking. Really have to leave?

L S.: Indeed, there are studies showing that smoking reduces the incidence of female embryo implantation, and hence the rate of pregnancy.

Lara: Is it true that IVF can not be performed at excess weight? Under what terms this procedure is acceptable?

L S.: When overweight IVF possible. When planning a pregnancy desirable that BMI (body mass index) did not exceed 25.

Alain: Is it possible to conduct IVF with pituitary failure (panhypopituitarism)?

L S.: It is possible.

Margaret: Good day! Can I have my IVF patient with systemic disease (SLE) in remission against the maintenance of hormone therapy?

L S.:Probably.

Galina: after 45 to make IVF?

L S.: After 45 years of IVF performed, but efficiency of the procedure is reduced with age (the same as in the natural conception). To improve the efficiency doctor may advise you to use the egg donation program.

Andrey: It is very interesting to know how different medical institutions to provide services IVF? You are working in a private center, and I know there is a large public facility in the street Oparin, I can not make the right choice …

L S.: Dear Andrew, both in private and in public hospitals equipment, drugs and methods of IVF procedures are similar. In our clinic, you are guaranteed a friendly and personal approach. So the choice is yours.

Anna: Hello! I'm 40 let.bylo 3 pregnancies ended in miscarriage, still has not lost hope of becoming a mother, decided to IVF, but it's expensive! Did you hear about the action using IVF, there is this really the case and if it's possible Thanks

L S.: There is a national program of the IVF procedure under the quota, t is free. To clarify the conditions you need to apply to the antenatal clinic at the place of residence or to the Department of Health.

Jack: What is the difference between IVF and ICSI? how much is it both?

L S.:ICSI — a type of IVF in which in each egg using micromanipulation introduced specially selected sperm. ICSI is carried out in the presence of male factor infertility (reduced semen parameters), with a small number of eggs produced, or in the absence of fertilization in previous IVF attempts. In our center, IVF cost 65,000 rubles, the cost of ICSI depends on the number of eggs (15,000 to 25,000).

Said: Hello! I was diagnosed with polycystic ovaries, and the regular monthly. There was a two way laporaskopiya ovarian resection. Gonadotrophin stimulation was performed, but ovulation has not occurred. I'm trying to get pregnant for three years. Is there any hope of getting pregnant without IVF?

L S.: If the three-year pregnancy does not occur, you need to do IVF.
Anonymous: 1 Please tell me whether mandatory tracking hormone stimulation during and after replanting Specifically, I'm interested in the hormones estradiol and progesterone. 2 Can the start month for the support of only progesterone (Table 6 utrogestan a day), if the day of menstruation occurring after replanting Progesterone was 300 nmol / L? Because of what is happening due to lack of estradiol after replanting, due to his downfall? 3 Does the critical values of estradiol and progesterone, in which, because of their lack of after replanting there are failures of possible pregnancy? 4 I read on the Internet that stimulation should start at a value of Estradiol 30 pg / ml and 40 pg / ml, which is of increasing the chances of pregnancy Is it Explain, please. Thanks for the answers.

 L S.: 1. Monitoring of hormones during stimulation performed if indicated (for example, if there is a risk of ovarian hyperstimulation syndrome). After replanting monitoring of hormones is not mandatory. 2. They can. 3. Numerous studies have shown that there is no correlation between the level of hormones in the blood and the onset / non-occurrence of pregnancy. 4 At the present time to address the issue of early stimulation is carried ultrasound monitoring, the data is much more accurate than the performance of blood hormones.

Margot: Good day! The protocol was punctured 20YAK, fertilize all divided and began replanting the time (day 5 after a puncture), it remains a good quality 3 What reasons can be? The protocol is not a good thing to check in the first place and to eliminate before you next protocol? (Indications for IVF obstruction of the tubes, the Ministry of Finance reduced activity of sperm) Thank you.

L S.: The reasons can be many. When a large number of eggs received, usually suffers quality. Also on embryo quality is greatly influenced by the sperm. Before the next protocol to check the condition of the endometrium in the first place.

Olga: I repeated IVF-thaw. How effective is it? I was only 11 embryos. the first transplant (a miscarriage) left 9. When defrosting only take exactly two or even more?

L S.:The effectiveness of IVF with krioembrionov quite high and reaches 43-47%. Typically, thawed and transferred to 2 embryos.

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