It happens that too frequent attempts to get pregnant deplete male and female reserves. In such cases, it is advised to have sexual intercourse once a month, then it will lead to. In more complex cases, technological methods are used.

If all types of infertility treatment do not bring results, then they turn to life-saving fertilization outside the body - (In Vitro Fertilization). In vitro fertilization can be used in all cases of infertility. In in vitro fertilization, a pre-extracted egg is artificially fertilized “in vitro.” The embryo develops for about 5 days in the clinic incubator. Next, for further growth, the embryo is transferred to the uterus.

Artificial insemination

The effectiveness of artificial insemination

The average IVF protocol success statistics are as follows:

1. Under the age of 35, the birth of a child occurs in 40%
2. In women aged 35-37 years, a child is born in 30%.
3. In patients aged 38 to 40 - in 20% of cases.
4. At 40 years of age, the IVF birth rate is about 10%, and the percentage decreases with age.

Do not confuse IVF with intrauterine insemination (IUI or otherwise artificial insemination). This medical procedure is also classified as assisted reproductive technology. IUI involves the introduction of a man's sperm, obtained in advance, rather than an embryo, into the woman's uterus.

Video: Artificial insemination

• Start:

When contacting the clinic, the couple must prepare the necessary test results. The doctor must be completely sure that the woman has no contraindications to IVF. According to the law, there are no contraindications for a man’s health for IVF. The decision on the advisability of artificial insemination is made by the doctor and the couple.

• Egg:

After additional examinations and consultations, the patient is prescribed a course of treatment. To achieve superovulation, injections of hormonal drugs are used. Ovarian hyperstimulation will allow you to obtain more than one egg during one menstrual cycle. The effectiveness of the artificial insemination method depends on the number of eggs. In most cases, the use of hormone therapy does not adversely affect a woman's health. But sometimes complications arise, consult your doctor about measures to be prepared on your part to promptly identify dangerous symptoms. Be aware of how to react when they occur. Also at this stage, the endometrium is prepared for embryo transfer a few days later.

• Sperm:

The man himself obtains sperm through masturbation according to medical instructions. In cases where this is not possible, surgical methods are used: aspiration or biopsy. The best time to obtain sperm is on the day of fertilization. But it is also possible to freeze and store previously obtained sperm. In the laboratory, on the day of transfer, sperm are separated from the seminal fluid. The highest quality livestock will be used in fertilization.

Cryopreserved sperm

• Fertilization:

Embryologists carry out the procedure using the in vitro method or the ICSI method (intracytoplasmic sperm injection). During insemination, one out of 100 thousand sperm penetrates the egg completely independently. This fertilization takes about 2-3 hours. With regard to the quality of sperm, microsurgical instruments come to help in fertilization. Then the ICSI method is used, which involves mechanically introducing sperm into the egg.

From the moment of fertilization, the embryo is stored in an incubator for up to 6 days. Embryos are kept in plastic Petri dishes or Nunk dishes. There they are kept in a nutrient medium based on blood serum. The number of cells that make up the embryo increases many times from 1 cell on the first day, 4 cells on the second, to 200 cells on the fifth.

Fertilized embryos

By the way, viable embryos can be used for repeated transfer into the uterus. In this case, additional embryos are frozen, which is called cryopreservation. The embryos will be stored until they are used. This allows you to try again if the first transfer did not continue with pregnancy.

• Embryo transfer:

Already 2 days after fertilization, the embryo can be transferred to the uterus. This procedure is carried out a few days later. In any case, no anesthesia is required. The transfer procedure lasts only a few minutes. To increase the chances of pregnancy, 2 embryos are usually transferred. Using a thin elastic catheter, they are transferred directly into the uterus. How artificial insemination occurs is shown in the video below.

Video: The process of artificial insemination

How does artificial insemination work?

The artificial insemination procedure, regardless of the chosen protocol or methodology, requires careful preparation, patience, precise and well-coordinated work by laboratory staff, related specialists and a married couple.

• Preparing for in vitro fertilization
• Ovarian puncture during artificial insemination
• How artificial insemination occurs in an embryology laboratory
• Embryo cultivation
• Embryo transfer

How to prepare for artificial insemination

Artificial insemination in the embryology laboratory

Embryologists, being in sterile conditions, search for eggs in the follicular fluid under a microscope, move them into a test tube or Perti dish filled with a nutrient medium, and send them to an incubator for 4–6 hours.

At the same time, the sperm is prepared: washed and cleaned. The sperm becomes concentrated.

After the specified period, “improved” sperm is added to the eggs and sent back to the incubator. To fertilize one egg, 100-200 thousand live sperm are needed. One penetrates inside, all the others serve to melt the shell of the egg at the site of entry of the “main” sperm.

Observation is carried out for 48 hours. Then they look at which eggs are fertilized. And the development of the embryos is observed for another two days. Only the best will be placed in the uterus: those that develop in a timely manner and do not have anomalies.

• number of cells;
• fragmentation percentage;
• fission rate;
• presence of deviations in the division process;
• the presence or absence of inclusions in the cytoplasm;
• absence of multinucleated blastomeres;
• regularity of form;
• equal size, etc.

In case of a repeated process, after and for a number of other reasons, a more subtle procedure of artificial insemination can be used - (, or) intracytoplasmic injection of sperm into the egg. The membrane is pierced with a thin needle under an electron microscope and the selected male germ cell is introduced into the cytoplasm. This development of events is discussed in advance with the doctor. One of the undoubted advantages of the ICSI technique is the possibility and prevention of possible deformities.

Cultivation

Depending on the quality and rate of development, within 2–4 days. There is an option for long-term cultivation for 5–6 days, in which the percentage increases. allows you to reduce the likelihood, since there is no need to transfer a large number of embryos. At the same time, the likelihood of pregnancy increases. In case the embryos good quality a lot, then after the completion of the artificial insemination process, the “extra” are offered to be sent to.

Embryo transfer day

The main recommendation on the eve and on the day of the transfer is not to worry. Be patient and have a positive attitude. often prescribed in the morning. Therefore, breakfast should be light, with limited liquid intake.

Before the procedure, the couple has a conversation with an embryologist. The doctor shows photographs of embryos taken under multiple magnification. Characterizes the development and degree of their maturity, gives recommendations on choice and answers questions. Together with the doctor, the couple decides which ones.

Embryo transfer technique

Then they begin the procedure on a gynecological chair. It only takes 10–15 minutes. An embryologist collects embryos into a long sterile plastic tube - a catheter attached to a syringe. The attending physician, having previously exposed the cervix in the speculum, inserts a catheter into the uterine cavity through the cervical canal and performs the transfer. To make sure that all the embryos from the tube have entered the uterus, the catheter is examined under a microscope.

The sensations during the manipulation will most likely be slightly unpleasant, but the discomfort quickly passes. The woman remains in a horizontal position for 20 to 45 minutes, after which she is invited to the doctor’s office, where the doctor will schedule further treatment - hormonal support, antispasmodics, vitamins, give recommendations, schedule the next consultation and the date of delivery.

The effectiveness of artificial insemination

The effectiveness of IVF ranges from 25 to 33%. Continuous scientific work is underway to increase positive results. Since its inception, the procedure and technology of artificial insemination have not stood still, but continue to improve.

Instructions

Artificial insemination or insemination is used for certain diseases (impotence, lack of ejaculation, hypospadias, etc.) with anatomical changes in the cervix, vaginismus, as well as when antisperm antibodies are detected in the cervical mucus in women. With this method of artificial insemination, sperm is injected into the uterine cavity or into the lumen of the fallopian tubes. One of the sperm produces a mature egg, after which it is implanted into the wall of the uterus.

Insemination is carried out two to three times during one menstrual cycle, the procedure must be repeated at least three cycles. If pathological changes were detected in the husband during examination, donor sperm is used. The reason for using donor sperm is also a Rh-conflict that cannot be treated, as well as genetic diseases in the husband’s closest relatives. The positive result of the procedure will largely depend on the diseases that the couple has. As a rule, after insemination, pregnancy occurs in eighty percent of cases.

In vitro fertilization is performed outside the body. This procedure is resorted to if a woman has had her fallopian tubes removed, in case of low patency or obstruction of the fallopian tubes, in the absence of effect from long-term treatment (longer than five years), in case of unexplained infertility. Before IVF, the condition of the genital organs is examined. A woman’s uterus and ovaries must retain their functions, in reproductive organs there should be no neoplasms, inflammation or anatomical changes.

The in vitro fertilization procedure includes: obtaining eggs from a woman, fertilizing eggs with the sperm of a husband or donor, observing embryos in the laboratory, transferring embryos into the uterine cavity. Miscarriage during IVF occurs in 40% of cases, and fetal death during childbirth is often observed. Doctors associate these circumstances with the age of women in labor, as well as with pathologies in their reproductive system.

Artificial insemination using the ICSI method (intracytoplasmic injection) is performed for severe male infertility. During the procedure, a sperm is injected into an egg that is removed from the body of the woman's ovary. The difference between this method and IVF is that with ICSI, one, the most viable sperm is selected, which is placed inside the egg with a needle, and with in vitro fertilization, the sperm are present with the eggs in a special solution and penetrate inside on their own.

Artificial insemination

a set of methods for treating infertility, including artificial insemination (introduction of the husband's or donor's sperm into the woman's genital tract) and in vitro fertilization followed by transplantation of crushed embryos into. IN recent years are developing a method for transplanting female and male germ cells into the lumen of the fallopian tube.

Artificial insemination (insemination). Depending on the method of introducing sperm, there are vaginal, intracervical and intrauterine methods of artificial insemination. Vaginal method (injection of sperm into back vaginal vault) are rarely used; it is the simplest, but the least effective, since vaginal contents can adversely affect. The intracervical method (injection of sperm into) is also not effective enough due to the possibility of the formation of antisperm antibodies in the cervical mucus. The most effective intrauterine method is the introduction of sperm into the uterine cavity. However, when the titer of antisperm antibodies in the cervical mucus is more than 1:32, they are also found in the uterine cavity; V similar cases Before introducing sperm, a nonspecific desensitizing agent is required.

Artificial insemination with the husband's sperm is carried out according to the following indications: on the husband's side - the urethra, absence of ejaculation, with normal sperm structure and motility; on the part of the woman - anatomical changes in the cervix that cannot be treated, the presence of antisperm antibodies in the cervical mucus. in women: acute and chronic inflammatory diseases of the genital organs, true erosions and pseudo-erosions of the cervix.

Before insemination, it is necessary to examine the husband’s sperm, to exclude tubo-peritoneal and uterine causes of infertility (Infertility). In order to establish the time of ovulation and the presence of the corpus luteum, functional diagnostic tests are performed (see Gynecological examination), and the content of luteinizing hormone and progesterone in the blood is determined. Using ultrasound, the diameter of the dominant follicle is determined (see Ovaries).

Insemination is carried out on an outpatient basis during 3-5 menstrual cycles, 2-3 times during the cycle (on days 12-14 with a 28-day cycle). Necessary conditions are at least +++, cervical mucus tension at least 8 cm, the diameter of the dominant follicle is at least 18 mm.

The procedure is carried out in compliance with the rules of asepsis with the woman in the gynecological chair. The husband's sperm, obtained during masturbation after abstaining from sexual intercourse for at least 3 days, is collected in a plastic container of 1 ml. A polyethylene catheter is attached to the syringe (a subclavian catheter can be used), which, without fixing the cervix, is inserted into the cervical canal or into the uterine cavity by the internal catheter. Sperm in the amount of 0.4 ml inserted into the cervical canal or into the uterine cavity. To retain sperm, a cap is placed on the cervix, usually used for the purpose of contraception (Contraception); the woman remains in a lying position for 30 min.

In case of an incomplete luteal phase of the menstrual cycle (Menstrual cycle), after artificial insemination, it is recommended to administer drugs that stimulate the development of the corpus luteum (chorionic 750 IU intramuscularly on the 11th, 13th, 15th, 17th, 19th and 21st days of the cycle). With an extended follicular phase of the menstrual cycle, follicle maturation and ovulation are stimulated (preferably under ultrasound control of the diameter of the dominant follicle). For this purpose, clomiphene citrate (clostilbegit) is prescribed 50-100 mg orally from the 5th to the 9th day of the menstrual cycle and inject 3000-4500 IU of human chorionic gonadotropin intramuscularly on the 12th day of the menstrual cycle. A mandatory condition for observation after artificial insemination is the measurement of basal (rectal) temperature or determination of the β-subunit of human chorionic gonadotropin in the blood for the purpose of early diagnosis of pregnancy.

Artificial insemination with donor sperm is carried out in case of azoospermia in the husband (absolute indication), as well as in case of oligo- and asthenospermia in the husband in combination with morphological changes in sperm, an immunological conflict due to the Rh factor that cannot be treated, hereditary genetically determined diseases in the husband’s family (relative ). The contraindications are the same as for insemination with the husband's sperm.

Artificial insemination with donor sperm is carried out after obtaining the consent of both spouses. must be under 36 years of age, physically and mentally healthy, have no hereditary diseases or developmental disorders, and first-degree relatives must not have had more than one case of fetal death or spontaneous abortion. It is mandatory to conduct the Wasserman test and test for HIV infection. When selecting a donor, the Rh and blood group are taken into account, incl. , height, hair and. The donor undertakes never to search for his biological descendants for the purpose of making any demands on them.

Before insemination, it is necessary to conduct a test to identify local antisperm antibodies to the donor's sperm and a test to determine the ability of sperm to penetrate into the cervical cavity. In approximately 1/3 of women who have previously been inseminated with donor sperm, local antisperm are formed; their detection is an indication for intrauterine injection of sperm.

For insemination with donor sperm, native or canned sperm can be used. The most common method of sperm preservation is cryopreservation in liquid nitrogen, which allows you to create a sperm bank and store it for a long time. According to the method recommended by V.I. Grishchenko et al (1986), sperm is frozen in a subclavian catheter containing a multicomponent preservative. This reduces the temperature and creates favorable conditions for the preservation and survival of sperm. Insemination is carried out using the same catheter, which greatly simplifies the procedure. The technique of introducing sperm into a woman’s genital tract, the method of stimulating ovulation and the corpus luteum are the same as for insemination with the husband’s sperm. Sperm from the same donor should be used for three consecutive menstrual cycles.

The frequency of pregnancy after insemination with the sperm of a husband or donor is approximately the same and, according to various authors, reaches 30-70%. Women who become pregnant after artificial insemination should be under the supervision of an obstetrician-gynecologist at the antenatal clinic, as well as pregnant women with a complicated obstetric history. The course of pregnancy and childbirth does not differ from those during normal conception; fetal development anomalies occur no more often than in the population.

In vitro fertilization followed by embryo transfer and uterine cavity- one of the modern methods of treating female infertility. There are over 5 thousand children in the world who were born after a woman was fertilized using this method.

Some success has been achieved in its application, but due to the need to use expensive apparatus and equipment, the use medicines Mainly imported production in the USSR, it is established only in large research and clinical institutions.

Indications: absolute tubal (condition after bilateral tubectomy); obstruction or difficulty in the patency of both fallopian tubes in the absence of effect from a previously performed surgical or long-term (more than 5 years) conservative treatment, infertility, which after a full clinical examination (including hormonal, endoscopic, immunological) remains unclear; subfertility of the husband's sperm (in case of ineffective homologous insemination).

Conditions: fully preserved functional ability of the uterus for embryo implantation and pregnancy; absence of contraindications for pregnancy and childbirth (due to somatic, mental, genetic diseases of the woman); preserved ability of the ovaries to adequately respond to exogenous or endogenous stimulation of ovulation, absence of neoplasms, inflammatory and anatomical changes in the pelvic organs.

The success of the method largely depends on the number of eggs obtained by puncture of preovulatory follicles and on the number of embryos transferred to the uterus. In this regard, it is necessary to stimulate superovulation through the combined administration of antiestrogens (clomiphene citrate) and gonadotropins (pergonal, human chorionic gonadotropin). B.V. Leonov and his colleagues developed the following schemes for stimulating superovulation: the first scheme is clomiphene citrate orally, 50-150 mg per day from the 2nd or 3rd day of the menstrual cycle for 5 days and pergonal 75-150 intramuscularly on the 3rd, 5th, 7th days of the cycle and then daily until the dominant follicle reaches a diameter of 16-18 mm; the second scheme - pergonal 75-150 units intramuscularly from the 2nd day of the menstrual cycle daily until the dominant follicle reaches a diameter of 16-18 mm. In 24-48 h after the follicle reaches the specified size, 5000 - 10000 units of human chorionic gonadotropin are administered intramuscularly. According to the authors, the use of these superovulation stimulation schemes leads to the formation of up to 20 follicles, from which up to 60 eggs can be obtained.

During stimulation of superovulation, the woman is under constant dynamic monitoring: daily ultrasound examination of the ovaries with measurement of the diameter of the follicles, determination of estradiol and luteinizing hormone in the blood.

Puncture of preovulatory follicles is carried out after 34-36 h after administration of human chorionic gonadotropin. Previously, it was carried out transabdominally, and in recent years it has been performed under the control of vaginal ultrasound sensors, which, compared to the first method, significantly facilitates the visualization of follicles and reduces the incidence of complications (pelvic organs and large vessels). In addition, transvaginal puncture of the follicles makes it possible to aspirate eggs even with severe adhesions in the abdominal cavity. The introduction of this method made it possible to perform in vitro fertilization on an outpatient basis.

The eggs are placed in a special container, into which the sperm obtained after washing the husband’s sperm and separating it by centrifuging the seminal plasma are also transferred. 200-300 thousand sperm are added per egg. The process of culturing crushed eggs is carried out in a special environment at a temperature of 37°, absolute humidity, 5% carbon dioxide, providing an optimal pH level. At the stage of 4 or more blastomeres, crushed embryos are placed in a special plastic catheter and introduced through the cervical canal into the uterine cavity (to the area of ​​its fundus) in a minimum volume (0.05 ml) nutrient medium.

After embryo transplantation, a dynamic determination of the β-subunit of human chorionic gonadotropin in the blood is carried out, which helps to establish the onset of pregnancy from the 7-9th day after transplantation. When pregnancy occurs, women are constantly monitored by an obstetrician-gynecologist at the antenatal clinic, just like pregnant women with a burdened obstetric history.

The effectiveness of the method increases with the improvement of equipment and medications to stimulate ovulation. Failures of the method can be due to many reasons, among which the main ones are the unsuccessful transfer of the embryo into the uterus, dysfunction of the corpus luteum formed at the site of the hyperstimulated follicle, changes in the endometrium as a result of the use of antiestrogens, lack of synchrony between the degree of maturity of the embryo and the endometrium.

The frequency of ectopic pregnancy with this method is, according to various authors, 2-10%, the frequency of miscarriage reaches 40%. Relatively more often than in the population, fetal death during childbirth is observed. These complications are not a consequence of this method, but are undoubtedly associated with the age of women and the presence of pathological changes in their reproductive system. Born children develop normally. The existing observations about the faster intellectual and physical development of these children are obviously associated with the special conditions of their life and upbringing.

Transplantation of female and male germ cells into the lumen of the fallopian tube carried out using a Teflon catheter and a plastic probe as a conductor, which are inserted through the uterine cavity into the lumen of the fallopian tube ampulla under ultrasound control using a vaginal sensor. Eggs (at least three) and 200-600 thousand sperm are injected through a catheter with a syringe in 50 ml nutrient medium. In this case, fertilization occurs in the fallopian tube, which is much more physiological than in a test tube. The method is considered quite promising for the treatment of infertility of unknown origin, infertility in some forms of endometriosis, as well as infertility caused by impaired spermatogenesis in men. A prerequisite for its use is the patency of the fallopian tubes.

Bibliography: Infertile marriage, ed. R.J. Pepperella et al. from English, p. 247, M., 1983; Davydov S.N., Kustarov V.N. and Koltsov M.I. Heterological artificial insemination in patients with impaired ovulation processes, Obstetrics. and ginek., No. 9, p. 20, 1987; and treatment of infertile marriage, ed. T.Ya. Pshenichnikova, s. 190, M., 1988; Nikitin A.I. Current state problems of in vitro fertilization and embryo transplantation, Akush. and ginek., No. 8, p. 10, 1989.

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First medical care. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

Differences between IVF and artificial insemination

Currently, with the help of new reproductive technologies, the process of artificial conception gives many childless couples diagnosed with infertility the hope of becoming parents.

How does conception occur?

AI is a technology that is used to give birth to children in women suffering from various types infertility. Today they are widely used 2 most popular methods of fertilization, each of which has its own specifics:

• Artificial insemination
• In Vitro Fertilization

IVF involves creating conditions for conception outside the woman’s body, while artificial insemination occurs directly inside it.

Intrauterine insemination method

The essence of the method is to introduce male semen into female body, bypassing many different obstacles. The main condition is the patency of the fallopian tubes. The fact is that, despite the guaranteed “landing” in the uterine cavity, the sperm must themselves reach the egg. But they can only do this through the fallopian tubes. If there are problems with patency, this method is not recommended.

Before sperm is injected, it is subjected to special processing, during which only healthy sperm are left. Thus, not only the quality of sperm increases, but also the risk of having a child with pathological changes is reduced.

IVF – laboratory way of origin of life

Among the scientific achievements of the twentieth century, the method of in vitro fertilization is perhaps one of the most outstanding. Using this method, the problem of infertility was almost completely solved.

IVF is a technology that allows you to reproduce the necessary conditions for conception outside the human body. As a rule, this procedure is resorted to by people who have been trying to conceive a child for several years and have failed and treatment has been ineffective.

Today there are about five million IVF children on earth, many of whom have already become parents themselves. Currently, we can safely say that children conceived in a laboratory are no different from babies conceived naturally.

IVF technology involves going through several stages, during which patients are under constant medical supervision.

1. The first phase involves taking hormonal drugs that stimulate ovulation. This procedure is necessary for the maturation of a large number of eggs.
2. The second stage involves transvaginal puncture of the follicles, during which mature eggs are extracted.
3. Next comes the third phase. The so-called embryo cultivation: the resulting egg and sperm are subjected to special processing, after which their fusion (fertilization) occurs. The embryos must then reach a certain stage of development.
4. At the final stage, the embryos are transferred into the uterine cavity for their further development.

As a rule, several embryos are placed into the uterus at once to increase the likelihood of a favorable outcome.

Cost of the procedure and statistics

It should be noted that no one can guarantee a 100% result that will follow after artificial conception. Some women manage to get pregnant this way after the first attempt, while others get a negative result after several procedures.

In the case of artificial insemination, the probability of a positive result is about 30%. The cost of the procedure ranges from 15 to 30 thousand rubles.

When using in vitro fertilization, the chance of getting pregnant is about 40%. The price for IVF varies from 115 to 200 thousand rubles.

If you are unable to conceive a child naturally, this does not mean that you cannot become the genetic parents of your child. Modern medicine really does work miracles. The main thing is not to lose hope and only move forward.