Indications for IVF: a list of diseases, infertility, the right to an IVF for the policy, preparation, features of the conduct and contraindications

Modern technologies and the development of science make it possible, if not to cure infertility, then to have a child with such a diagnosis. The reasons for the inability to become pregnant in vivo are many. Increasingly, in vitro fertilization is used , which is quite expensive. Not every couple can afford such a procedure, and it is not carried out in all cities. To this end, the Ministry of Health has created a free IVF program for compulsory medical insurance. In this article we will consider indications for IVF. It will also talk about the process of its implementation and the features of the preparation.

The most common indications for IVF in women

The cause of infertility of the couple can be found both in the male body and in the female. Therefore, it would be logical to break down all the causes into de groups. First of all, we will consider indications for IVF in women. These include the following:

1. Endocrine infertility. This is a violation in the process of ovulation, which is the most urgent reason for the inability to become pregnant. Endocrine infertility is accompanied by anovulation, that is, a violation in the menstrual cycle, which leads to the inability to mature the egg and exit it from the follicle. Moreover, the duration of the cycle does not differ from healthy. As a result of deviations, the production of the hormone progesterone is disrupted, which leads to the inability to become pregnant or miscarriages. The cure for endocrine infertility is to take hormonal drugs that stimulate ovulation. If within 6 months the result is not achieved, then anovulation becomes an indication for IVF. After the procedure, most women with this diagnosis were able to become pregnant and have a baby. It's all about drugs that stimulate superovulation.
2. Tubal peritoneal infertility is the second most common indication for IVF. As a result of the development of such a disease, adhesions appear in the pelvic organs, which leads to the inability of the fallopian tubes to function properly. A fertilized egg cannot pass through them. The same category of indications includes weak tube contractions, due to which the cell does not reach the uterus. This pathology can occur as a result of infectious diseases in the abdomen, ectopic pregnancy, inflammation of the fallopian tubes and ovaries, postoperative complications or surgical interventions. With the help of IVF, this problem is solved.
3. Severe endometriosis is an equally common indication for IVF, during which the inner layer of the uterus grows very actively and begins to go beyond it. The danger of the disease lies in the fact that it is painless and may not even be felt by a woman. Treatment of the disease is carried out either using therapy (using hormones), or in an operable way. If the previous options have not yielded results, resort to IVF.

Other indications regarding women

In medicine, there are a number of factors that affect a woman's ability to become pregnant, but are rarely found in practice. We will consider them now.

1. Polycystic ovary syndrome is an indication for IVF. It is not so common. The disease leads to disruption of the ovaries. Often, the level of male hormones rises significantly. This leads to such visible signs as baldness, acne, lack of menstruation, and obesity. Treatment begins primarily with therapy that stimulates ovulation. If she did not bring results, IVF is performed.
2. Unclear genesis has recently become an official indication for the use of IVF. It is accompanied by the well-being of both spouses and the possibility of becoming pregnant, but despite this, all attempts are pumped out by failure. There are no more than 5% of such cases, since modern technology allows us to determine the cause of infertility.
3. Immunological infertility is very rare and is accompanied by the appearance and development of anti-sperm bodies. They can appear in both men and women. They strike the sperm, attaching to their tail and preventing the egg from entering. The reasons for this infertility are little known, therefore, first of all, a woman is again invited to undergo a course of therapy with hormones. The second stage is the conduct of IVF.
4. The age factor is an indication for IVF, which is increasingly common in recent years. The older the woman, the slower the processes in her body, and this does not only apply to ovulation. As a result of this, problems with conceiving a child may occur. Many women use the “delayed motherhood program”, which involves the removal of several mature cells into girls aged about 20 years. They are stored frozen for many years. At any time convenient for the patient, she can perform an IVF procedure with her own cells.

Sperm pathologies as indications for IVF

Problems with conceiving a child can occur in any pair, in which case both partners need to be examined. After all, there is a number of indications for IVF in men. Consider in detail the pathology of sperm, what they are:

1. Oligozoospermia, which implies a decrease in sperm count in semen.
2. Teratozoospermia, when the semen contains a large number of deformed cells with a short tail, disturbances in the head, and structure. Two-head sperm can be found, they are not able to fertilize a woman's cell.
3. Asthenozoospermia is very common and consists in a reduced sperm speed. Its severe stage is called akinospermia, when the cells completely lost their ability to move. Such pathologies are often formed as a result of excessive use of alcohol and tobacco.
4. Hypospermia is the secretion of a small amount of semen as a result of sexual intercourse. If the amount of material does not exceed 2 ml, this indicates a disease.
5. There is even necrospermia, in which sperm contains more dead sperm than living sperm.
6. Polyspermia involves a significant increase in the amount of secreted sperm and male cells in it. In this case, there are a lot of cells, but they cannot fertilize the egg - their penetrating ability is significantly reduced.
7. Pyospermia is a form of pathology in which there is pus in the semen. This is usually a consequence of various diseases.
8. Azoospermia is a disease in which there is no sperm in the sperm.
9. Aspermia is a condition in which there is no sperm at all.

All these pathological conditions are indications for IVF.

Other indications for men

There are two more reasons that lead to male infertility. Let's consider them in more detail:

1. Varicocele, which involves varicose veins of the testicle or spermatic canal. This reason is found in 40% of cases of male infertility. The expansion of veins leads to an increase in temperature and the creation of adverse conditions for sperm production. In most cases, this is treated by surgery. If she did not bring positive results, the disease becomes an indication for IVF.
2. Immunological infertility duplicates the eponymous species regarding female infertility. In the body of a man, sperm bodies are formed. They can arise as a result of trauma, expansion of veins, hereditary predisposition.

Indications for both spouses

Any genetic diseases and abnormalities are indications for IVF protocols. In addition, preimplantation diagnostics are performed, which allows to identify abnormalities and diseases. Indications are not only the classic causes of infertility described above, but also the following situations:

1. Disorders at the genetic level.
2. The spouses are over 35 years old.
3. Chronic diseases leading to infertility.
4. Frozen pregnancy in a woman’s clinical history.
5. Inability to bear a child.

Conducting preimplantation diagnostics allows you to generate results and data on the health of women and men, which will help increase the chances of a successful IVF.

Free IVF

On the territory of Russia, the Order of the Ministry of Health No. 107n is in force, which regulates the procedure and grounds for conducting free IVF. The law says that a woman and a man who are both single and unmarried can exercise the right to free in vitro fertilization. A woman who is single can also exercise this right.

What are the indications for IVF established by law?

1. Infertility, the treatment of which was unsuccessful. No matter what the reason and form of the inability to have a child.
2. Diseases in which pregnancy cannot occur on its own, IVF is necessary.

Patient Selection

The first step is to determine the cause of infertility and indications for IVF by compulsory medical insurance. As part of this stage, the endocrine state of patients is evaluated, as well as the ovulatory status of the woman. The patency of the tubes and the ability of the pelvic organs to function properly are assessed. The endometrium, its thickness, dimensions and borders are examined. The sperm of a man is examined to identify pathologies. Also, both spouses (cohabitants) are examined for infections. Thus, the reason why the couple cannot have children is calculated and a conclusion is made on the indications for IVF by compulsory medical insurance. The duration of this stage ranges from 3 to 6 months. After that, the following actions are carried out:

1. At the second stage, the doctor identifies the opportunity to cure the problem, various types of therapy are used, various kinds of help are provided. In this case, the duration of the stage may drag on to 12 months.
2. Directly before the procedure, a full examination of the man and woman is carried out. Blood is tested for antibodies to the human immunodeficiency virus, herpes, a molecular study for cytomegalovirus, chlamydia, mycoplasma, ureaplasma, treponema.
3. Women do additional tests - general blood count, biochemical analysis, general urinalysis, undergo fluorography, ECG, vaginal smears are examined. It also requires the determination of antibodies to rubella, cytology of the cervix, consultation with a therapist.
4. Women after 35 years of age are prescribed mammography, and up to 35 years of age, an ultrasound of the mammary glands is performed.
5. In men, semen is being tested.
6. If there are diseases of the pelvic organs, then they are treated.
7. In the presence of certain types of pathologies, consultations are prescribed with specialists in different areas.

Conducting a basic IVF program

The law regulates in detail not only indications for IVF on the policy, but also the procedure for conducting the procedure, which is no different from the paid procedure. Work Stages:

1. Stimulation of superovulation is the first stage of work, which involves a woman taking medications from the group of menotropins, gonadotropins. They can significantly increase the efficiency of the ovaries and, instead of a single egg, produce a lot. The quantity depends on the individual indications and the type of protocol. All this is discussed with the doctor at the preparation stage. The dosage and reaction of the woman’s body is monitored in tabular form, depending on which the procedure for the procedure is adjusted.
2. Puncture of eggs from the patient’s body. Using a transvaginal technique, all eggs that are mature are taken from the ovary. At this stage, anesthesia is used, therefore, the presence of an anesthetist is mandatory during the procedure.
3. Under artificial conditions, close to natural, the fusion of female and male cells is ensured, as a result of which in vitro fertilization occurs.
4. Cultivation of embryos implies the process of selection by the specialist embryologist of the strongest fertilized cells. They are grown under artificial conditions.
5. The last step is to plant the fertilized cells in the uterine cavity. For one procedure, it is not recommended to transplant more than 2 embryos. If the patient wants to implant 3 embryos, then she gives written consent.
6. After 12-14 days, the fact of pregnancy is checked.

Restrictions on the use of IVF

IVF for medical reasons, like any other procedure, has its limitations and contraindications. Restrictions on the use of IVF are:

1. Reduction of the ovarian reserve, which is detected at the stage of preparation for the procedure using ultrasound or blood results for anti-Muller hormones. Ovarian reserve is an indicator of the stock of eggs in the ovary laid even before a woman’s birth.
2. Conditions of patients in which the use of other programs would be more effective, for example, fertilization with the help of donor cells, canned cells, surrogate motherhood.
3. Gender-related diseases. In women, this is hemophilia, muscle dystrophy, and more. In this case, before IVF, patients are referred to a specialist geneticist.

Contraindications for IVF

The law establishes a range of indications and contraindications for IVF. If we examined the first in detail earlier, then we list the contraindications now:

1. Infectious or parasitic diseases. These include various forms of tuberculosis, viral hepatitis in all forms of manifestation. Also, a disease that is caused by human immunodeficiency, syphilis in a man or woman. Such a contraindication is relevant until cured.
2. Neoplasms. This includes malignant neoplasms anywhere. Benign formations that affect the uterus or ovaries are also a contraindication to IVF.
3. Diseases of the blood and blood-forming organs. This includes acute forms of leukemia, aplastic anemia, acute forms of hemolytic anemia, chronic myelogenous leukemia, high-risk lymphomas and much more. You can see the full list of diseases in Appendix No. 2 to the Order.
4. Diseases of the endocrine system and metabolic disorders. This includes diabetes mellitus with renal failure, or a condition after kidney transplantation, or progressive retinopathy. In addition to these forms of diabetes, hyperparathyroidism is a contraindication.
5. Mental disorders are serious contraindications. These are psychoses, dementia, hereditary degenerative disorders, affective disorders and diseases caused by the use of psychoactive substances.
6. Diseases of the nervous system associated with severe mental and motor disorders.
7. Circulatory system diseases, various types of heart defects, cardiomyopathy, Aerza disease, consequences of pulmonary hypertension, various kinds of vascular diseases, hypertension.
8. Respiratory diseases.
9. Digestive disorders.
10. Diseases of the genitourinary system.
11. Congenital developmental disorders.
12. Pathologies in bone, muscle and connective tissue.
13. Complications in previous pregnancy and childbirth.
14. Poisoning and injury from external causes.

All these contraindications are diagnosed by the doctor at the preparation stage, as a result of which other programs are used that are suitable for each specific case.