One of the gentle methods of artificial insemination is IVF in the natural cycle. Patient reviews confirm that no risks and complications can be expected, but the effectiveness of the procedure is quite low. In addition, IVF in the EC is not suitable for all patients, but it is a way to reduce the hormonal load on the body, if there are contraindications to standard protocols.
Classic IVF procedure
How is IVF (in vitro fertilization)? The standard procedure involves the fertilization of eggs (own or donor) in the laboratory and their subsequent insertion into the uterine cavity. Multiple oocyte growth is achieved by stimulation, which can take place in short or long patterns.
A short IVF protocol lasts about four weeks. Fertilization according to a long pattern involves the creation of a completely artificial hormonal background. So, for some time, the patient is actually introduced into an artificial menopause, which stops the progression of hormone-dependent gynecological diseases.
As part of the preparation of a woman for IVF, hormonal drugs are prescribed, under the influence of which the eggs mature actively. Depending on how sensitive the body is to therapy, one to twenty viable eggs can mature in one cycle.
Not all germ cells reach maturity sufficient for successful fertilization and further development, so that part is rejected. Oocytes are extracted from a woman’s ovaries by puncture. This is a minimally invasive surgical procedure, during which a follicular fluid is taken with a special needle with an ultrasound probe. Together with the liquid, the eggs get into the test tube.
Classical IVF implies independent fertilization in an environment as close as possible to natural conditions. With a favorable combination of circumstances, the resulting several high-quality (most viable) embryos are planted back into the female body. The procedure is called embryo transfer. When pregnancy occurs, then everything happens naturally.
Why is stimulation carried out?
Reviews of IVF in the natural cycle often indicate that this is a less traumatic method of artificial insemination for women's health, because strong hormone therapy can be ruled out. Indeed, the preparation of a woman by prescribing a course of hormonal drugs is an obligatory stage of the artificial insemination protocol.
Why is a woman undergoing medical preparation for participation in the protocol? The list of indications for IVF includes gynecological diseases and other pathological conditions of the body that prevent the onset of ovulation, which means that pregnancy is also impossible. But stimulation is carried out even if the eggs develop.
It is necessary that the reproductologist has a choice of eggs, and later embryos. From the "quality" (viability) of biological material depends on whether pregnancy will occur after the procedure. A fertilized egg may not take root or become damaged, so development will stop. So hormonal stimulation in preparing a woman for IVF is necessary to increase the effectiveness of the procedure.
IVF in the natural cycle
IVF is carried out in a natural cycle without stimulation or with stimulation in a significantly reduced volume. In the absence of medical intervention in the functioning of the female body, the growth of one of the follicles in each menstrual cycle is provided by the hormones LH and FSH, which are produced in the pituitary gland and are released into the blood. The most complete follicle reacts to this “hormonal release”. Subsequently, the egg grows and matures in it.
When the oocyte reaches the required size, the brain sends a large dose of LH to the ovaries. As a result, the egg finally ripens, disconnects from the follicle wall, the membrane ruptures - ovulation. Before that, the reproductologist must get an egg and stop ovulation. In this case, it is very important to correctly determine the moment, because an immature egg will not be suitable for fertilization. Modern medicine uses special media that allow an immature oocyte to mature properly and become fit for fertilization.
Key indications for IVF in the EC
The procedure is performed only for those women who have preserved their natural ability to ovulate. The greatest effectiveness of the method is observed for women aged 18-35 years. Mandatory conditions are the regularity of the menstrual cycle, ovulation, confirmed by ultrasound and hormonal examination. Moreover, the absence of ovulation in several cycles during the year and the maturation of two eggs (instead of one) is considered the norm.
IVF in the natural cycle can be shown to women who cannot become pregnant due to the male factor, have previously suffered from thromboembolism or cancer, are at risk for ovarian hyperstimulation syndrome, want to avoid excessive hormonal load, have a weak body response to hormonal stimulation, suffer diseases of the pancreas and liver.
Possible difficulties and disadvantages
What does “IVF in the natural cycle” mean? This is the same procedure of artificial insemination, only without the need for strong hormonal therapy, stimulating the growth of a large number of eggs.
Despite the fact that the method is considered more natural and safer for health, reproductologists can not control the maturation of the egg, the peak production of the hormone LH, the final maturation and the very moment of ovulation. As a result, a number of difficulties may arise.
In the reviews of IVF in the natural cycle, one can find various examples of complex situations that lead to inefficiency of the procedure. During the puncture, doctors can get only follicular fluid without an egg, if the oocyte is not fully matured and has not had time to move away from the wall.
The egg obtained as a result of a puncture may simply be unsuitable for the procedure due to insufficient maturity or degeneration. The natural process is not controlled at all stages, so this is entirely possible. In addition, at the time of puncture, the follicle may be empty. This means that ovulation has already occurred.
With an ideal combination of circumstances, doctors receive only one oocyte, which is subjected to fertilization. With additional stimulation with hormones, it is possible in the laboratory or in the body of a woman to artificially provoke the ripening of the follicle or to suspend ovulation until the eggs are punctured.
Stages of the procedure
How is IVF going? At the preparation stage, ultrasound monitoring of the development of the follicle is carried out. The procedure is repeated in dynamics from the seventh to eighth day of the menstrual cycle. Later, the peak of LH production is determined using special test strips, ultrasound and hormonal studies.
Based on the obtained data, the reproductologist plans a puncture, and somewhere two days before it recommends an injection of hCG so that the pregnancy is not rejected by the body immediately after embryo replanting. After the puncture, sperm of the partner is taken or donor is used. The doctor cultivates the resulting embryo, and on the second or third day of development, it plants it in the uterine cavity. In this case, medical support for pregnancy is not required.
Individual IVF program in the EC
To prevent the inefficiency of the procedure, reproductologists develop an individual protocol scheme for each patient. Preparing a woman for IVF begins with taking medications that prevent premature egg aging. They begin to be injected with the follicle reaching a size of 14 mm.
For final ripening, hCG preparations are used. The time for an egg puncture is calculated from the administration of the drug. At the same time, attempts at drug exposure of the reproductive system do not always lead to a positive result. Full control is only possible using standard in vitro fertilization schemes.
Preparing a man for sperm collection
An individual scheme for a man is usually not developed. Recommendations are given mainly to women. However, a certain preparation of a man for IVF is also necessary (even if the spouse is healthy). To increase the chances of success, you need to abandon the use of alcohol, drugs, smoking, water procedures that are associated with thermal effects on the genitals. You need to have a regular sex life and not wear tight underwear.
Preparing a man for IVF involves taking certain vitamins that will improve the quality of seminal fluid. To ensure normal spermatogenesis, group B drugs are prescribed. Folic acid is taken in the form of tablets, which takes part in the synthesis of DNA and RNA.
The importance of IVF in natural cycles
Judging by the reviews, IVF in natural cycles is still of great importance, despite possible difficulties. There is a certain group of women for whom this method is considered the most preferable. So, with a combination of young age and a high risk of complications or infertility, consisting in tubal or male factors, the procedure can be effective and will help avoid hormonal stress on the body.
When the ovarian stock is depleted, the procedure in the natural cycle allows the body to independently choose the most healthy and strong follicle, which contains a genetically complete oocyte. In addition, there is no risk of hyperstimulation. IVF in the EC is also successfully carried out in the presence of contraindications to the standard protocol (oncology, benign neoplasms in the mammary glands), which provides for a serious drug load.
Artificial insemination in the EC after 40 years
After 40 years, the ovarian reserve is only 3%, which is accompanied by a decrease in the likelihood of a natural pregnancy. Official statistics confirm that the number of pregnancies that began naturally at the age of 41 to 45 years is only 5%. The risk of failure increases because the eggs that remain in the ovaries age faster than the body as a whole.
For a reproductologist, IVF in the natural cycle at an older reproductive age becomes a daunting task. This scheme involves the rejection of hormonal drugs or their minimal use. The disadvantage of this method is that as a result of the puncture only one or two eggs are obtained, which at this age women may already be unviable.
Improving the chances of patients after 40 years
The chances of success of the procedure increase with an early visit to the clinic and a thorough diagnosis. If the ovarian reserve is normal, then it is possible to use the IVF protocol in the natural cycle. It is important that there are no concomitant diseases and a good partner spermogram.
If necessary, you can turn to additional technologies, namely preimplantation diagnostics (the chromosome set of the embryo is examined) and embryo hatching (helps the cells to implant). After embryo transfer to the uterus, medical support for pregnancy is necessary.
The effectiveness of the IVF procedure
Unsuccessful IVF in the natural cycle is not uncommon. The effectiveness of the method is 2-10%. Artificial methods do not always allow you to get pregnant the first time, but the percentage of any complications is low. For this reason, IVF in the EC is a choice that is made based on the health status and characteristics of the patients. So, with IVF in the natural cycle after 40 years, there is little hope for success, but if this is the only opportunity to become parents, then it is definitely worth a try.
Cost of participation in the IVF protocol
IVF protocols in the natural cycle are offered by many clinics. The interest of specialists in this method is increasing, because the procedure can reduce risks and make fertilization cycles as safe as possible. How much does IVF cost in 2018? The cost of artificial insemination with stimulation is 100-150 thousand rubles.
How much does IVF cost in 2018 in Moscow? If there is no need to carry out hormonal stimulation, then the procedure will cost 70-100 thousand rubles. When using donor cells, you will have to pay up to 200 thousand rubles for the opportunity to become parents, excluding the cost of donor material. Total expenses can reach 400 thousand rubles.