Scheme of the IVF protocol in the natural cycle. What is IVF in a modified cycle

IVF in the natural cycle is associated with a number of difficulties associated with the quality of oocytes obtained during puncture. The situation is aggravated by the presence of only one (in isolated cases two) follicles, characteristic of natural menstrual cycles. To increase the effectiveness and in the absence of contraindications, it is used scheme of the IVF protocol in the natural cycle with the use of hormone-containing drugs. Medicines allow you to slightly influence the process of maturation of the egg and prevent spontaneous.

• IVF in the natural cycle: protocol schemes
• Common to all schemes

Why is there a need for hormonal "intervention"?

Performed to aspirate the follicular fluid along with the egg in the natural cycle, may be accompanied by:

• The absence of an egg in the follicular fluid. A mature egg must separate from the wall of the Graaffian vesicle and be in a free state (float in a liquid). If the separation of the oocyte did not occur, then the puncture is not effective - the egg was not received.

• Receipt. In both cases, it is impractical to fertilize the egg. There is a technique used in the IVF scheme in a natural cycle, which allows cultivating an immature egg to a mature state.

• The absence of an oocyte due to spontaneous ovulation - the puncture was carried out late. It is difficult to predict the release of an egg.

• A mature egg is obtained, which is “taken into work” and subjected to fertilization. In ideal cases, a fertilized egg, which allows.

In order to increase the likelihood of obtaining a full-fledged oocyte, schemes have been developed using hormonal drugs.

Protocol schemes

There are the following types of protocols in the natural cycle, the scheme of which differs in the degree of drug exposure:

• Pure natural cycle - without artificial influence on the processes of maturation of the oocyte.

• Modified natural cycle. Improves the quality of the resulting eggs.

• Modified IVF protocol in the natural cycle.

Scheme of the IVF protocol in a "clean" natural cycle:

• From 7–8 days, folliculometry is performed - the growth of the follicle is monitored;
• When the follicle reaches a diameter of 15–16 mm, laboratory monitoring of the LH level is carried out. To do this, donate blood for analysis (several times a day) or do ovulation tests.
• Not later than 24 hours after a positive result on LH, a puncture is performed.

Scheme of the IVF protocol in a modified natural cycle:

• When the follicle reaches an average diameter of 17-18 mm, hCG is injected into the body, which mimics the conditions that occur during the LH peak. This contributes to the maturation of the egg.
• Aspiration of follicular fluid 28-34 hours after hCG injection.

The chances of obtaining a mature oocyte are increased with this regimen, but spontaneous ovulation is possible. To prevent premature release of the egg, the following scheme has been developed.

Scheme of the modified IVF protocol in the natural cycle:

• Folliculometry is performed from 7–8 days.
• From the day the follicle reaches 15 mm, a GnRH antagonist is prescribed (the drug blocks the synthesis of LH - spontaneous ovulation is prevented) and an FSH drug (it is administered for 2-3 days, under its action the follicle matures).
• When the dominant follicle reaches an average diameter of 18 mm, the hCG preparation is injected
• After 30-34 hours - aspiration of the contents of the follicle.

This sequence of actions allows you to intervene in the maturation process and gives the maximum probability of obtaining a mature oocyte.

Common to all schemes

For any scheme is acceptable without anesthesia. Since there is only one follicle, anesthesia is not required. The sensations during the puncture are similar to those that occur during an injection.

Minasyan Margarita

Holding in vitro fertilization goes through several programs. Her choice will depend on the state of the menstrual cycle, the age of the patient and the examination data. The implementation of IVF in the natural cycle is the safest, but not always effective. It is necessary to understand in what cases such a transfer of the embryo into the uterus is used, and what is the probability of a successful pregnancy under such conditions.

Indications and contraindications for IVF in the natural cycle

IVF at the EC without ovarian stimulation or with minimal hormonal exposure is suitable for:

• if the problem of conception is caused by male infertility, subject to a young age (18-35 years);
• when regular periods are observed;
• if even after SA there is a poor reaction (from one to three eggs);
• if there is information in the anamnesis about weak or operated ovaries,
• therefore, it is pointless to use stimulant drugs;
• when the cause of infertility is obstruction of the fallopian tubes;
• when it is possible to get good embryos, but pregnancy did not occur due to unsuccessful implantation;
• if a woman, for health reasons, is not contraindicated in artificial insemination of an egg, but it is forbidden to use stimulants and other hormonal therapy.

Among the main contraindications it is worth highlighting:

1. Age from 36 years old. Due to the state of the reproductive system, the chances of getting pregnant the first time will be minimal, and more attempts will be required for which there is no time.
2. The male factor. If the partner has weak sperm, then they can provoke the receipt of an unsuitable embryo in advance. But with a long protocol or stimulation, it is possible to fertilize several eggs.
3. Additional reasons. This includes couples who have bad habits(cigarettes, alcohol). And also if there is an unstable menstrual cycle or there is no natural ovulation.

What is the procedure

There are many myths around the IVF program in natural cycles, and few women really know what it is.

By such a process, doctors mean a method of treating infertility, during which only one egg (maximum two) is punctured and fertilized for further transfer to the uterine cavity.

The main difference from the standard program is the complete absence of hormonal drugs to stimulate ovulation and control the cycle. In rare situations, medications are still used, but in very small doses.

Features of the IVF procedure against the background of the natural cycle:

1. The development of the endometrium is not supported.
2. Little material is being extracted for work.
3. The puncture does not use anesthesia.
4. There are practically no complications and side effects.
5. The result is difficult to predict.

Pros and cons of fertilization

When conducting IVF in a woman's own cycle, the following advantages can be distinguished:

1. Prevention of ovarian hyperstimulation.
2. Exclusion of hormonal load on the body.
3. The possibility of re-protocol in the next cycle immediately after unsuccessful IVF.
4. No risk of oncological neoplasms.
5. The cost of the service is somewhat lower due to the use of inexpensive medicines.
6. Increased chances of implantation due to the quality of the endometrial layer.
7. Minimize stress on the body.
8. Impossibility of multiple pregnancy.
9. No need to freeze the remaining embryos.

In any good clinic where a woman decides to go, they will definitely talk about the disadvantages of fertilization in a cycle without control and stimulation:

1. To a greater extent, success will depend on the experience of the specialist who performed the puncture and chose the time for the transfer.
2. The follicle may not mature this month, which is why the procedure is interrupted.
3. Due to the sudden release of luteinizing hormone, the follicular sac may rupture before the egg is retrieved.
4. During the puncture, sometimes it is not possible to extract the oocyte.
5. Often, specialists fail to fertilize one female material.
6. There is a high risk of damage to the egg during conception.
7. Rarely do women get pregnant the first time.

That is why all such issues are discussed exclusively with a reproductologist. The doctor will decide whether it is possible to carry out fertilization in a natural cycle or whether it is better to use hormonal support.

Protocol schemes

There are several protocol schemes for IVF in the natural female cycle. The difference lies in the degree of drug load on the body:

• clean protocol;
• modified cycle;
• modified scheme in the EC.

When patients go to a medical institution, they often have a desire to protect their body from the consequences. But this does not mean that you need to insist on an absolutely pure fertilization scheme. The doctor, based on the state of the reproductive system and the results of past procedures, will select the optimal program.

Standard steps for EC:

• preliminary examination of the patient;
• primary ultrasound;
• monitoring the growth of the follicle and the structure of the uterine mucosa;
• tracking hormone levels;
• control of approaching ovulation;
• puncture;
• fertilization of the oocyte;
• the cultivation of the embryo;
• transfer to the uterine cavity;
• observation of the patient.

Pure IVF Protocol:

1. Examination of the body begins after menstruation.
2. From about 7-8 days, the doctor observes the growth of the follicular sac.
3. LH level control is carried out when the follicle acquires a diameter of 15-16 mm (find out).
4. You can donate blood for tests or conduct ovulation tests.
5. The puncture will be done no later than one day after positive test for luteinizing hormone.

Modified IVF Cycle:

1. Conducting folliculometry on the 7th or 8th day.
2. As soon as the follicle grows to 17-18 mm in diameter, an injection of hCG is necessary.
3. The hormone creates conditions similar to the situation at the peak of LH.
4. As soon as the eggs are mature, the follicular fluid is aspirated. Most often, this procedure is carried out 30-34 hours after the introduction of the hormone into the body.

Modified IVF scheme in EC:

1. Follicle growth tracking begins in the same way as in the first two schemes.
2. When the follicular sac reaches 15 mm in diameter, the doctor prescribes a GnRH antagonist.
3. After blocking spontaneous ovulation, FSH is injected a few days later so that the follicle successfully matures.
4. The introduction of human chorionic gonadotropin is prescribed for follicle sizes from 18 mm.
5. Then, after 28-34 hours, a puncture is performed.

Sometimes, without stimulation, Eco in the natural menstrual cycle does not give the proper result. Therefore, doctors decide to introduce a small amount of hormones into the fertilization program in order to increase the chance of successful aspiration, fertilization and embryo transfer.

Possible situations during IVF

Low AMH

After passing tests and receiving disappointing results, patients think about stimulation. But even if women drink Clostilbegit, the quality of the eggs will not improve from this. Therefore, with EC, it is worth thinking about donor oocytes.

Elevated FSH

Fertilization will be possible only after stimulation or elimination of the factors that caused the increased content of the hormone in the body.

endometriosis

When EC is preserved big chance success, but only if the woman has a normal ovarian reserve. Also, a specialist can prescribe cauterization or removal of foci of the disease.

Where to go for the procedure

It is not advisable to select a clinic for IVF according to reviews in the natural cycle. Patients may be upset by an unsuccessful result, or unforeseen situations arose during the protocol (premature ovulation, a bad egg), which specialists warn about in advance.

It is difficult to evaluate the work of a medical institution and the experience of specialists, but it is better to do this during a consultation. And the following factors will help in this:

• the doctor must conduct a comprehensive diagnosis;
• a woman is not given a 100% guarantee;
• several options for fertilization are offered at once;
• the specialist must talk about the possible consequences.

Previously, it was believed that the best clinics are located only in major cities. But this area has recently improved significantly in the country, so almost any woman can find a suitable place.

Probability of Success

Most of all, women are interested in who managed to get pregnant after IVF carried out in a natural cycle. A positive result without drug influence occurs less frequently than with a long protocol. Most often this happens due to the following factors:

1. Premature rupture of the follicular sac.
2. The absence of an egg in the follicle.
3. Availability low interest successful fertilization of the resulting material.
4. Transfer of a non-viable embryo.
5. Performing a premature puncture.

According to statistics, with EC, the procedure has the following indicators:

1. The onset of pregnancy in 7% of cases from the first manipulation.
2. Successful fertilization and embryo transfer increase the chance of implantation up to 16%.

In most cases, several attempts are needed. With EC, this does not take much time, since the body does not need a break. If the first attempt was unsuccessful, the doctor reviews the protocol and may add:

• drugs to ensure the maturation of eggs;
• medicines to prevent premature ovulation;
• stimulants to produce multiple oocytes.

Any information from forums and other sites should not affect the choice of a woman regarding the implementation of IVF with the EC. It is impossible to predict or give guarantees for successful fertilization and implantation. You need to be patient and trust a specialist to increase the chances of a long-awaited pregnancy.

• Prescribing a treatment regimen in the natural cycle.
• Reproductologist consultation (up to 3 times)
• Ultrasonic folliculometry (up to 3 times)
• Hormonal monitoring of ovarian stimulation (LH, estradiol, progesterone - express study up to 3 times)
• Use of one of the drugs:
  - diphereline (0.1),
  - chorionic gonadotropin (up to 10,000 units)
• Ovarian puncture in natural cycle
• Stay in the ward of a day hospital with condition monitoring up to 3 hours
• Embryological stage:
  - identification and assessment of the degree of maturity of the oocytes
  - preparation of sperm for fertilization from 2 ejaculate samples
  - fertilization: ICSI
  - cultivation of embryos

Not included in the program

• Medications not listed in the program description
• Organization of inpatient care in case of complications
• Embryo transfer
• Assisted hatching
• Embryo biopsy.
• Any type of preimplantation genetic testing.
• Embryo storage
• Additional consultations of related specialists
• Use of donor material and its defrosting

What is eco in the natural cycle?

In patients with preserved ovulation under ultrasound control, the growth of the dominant follicle in the ovary is monitored. With a follicle size of 18 mm, or under the control of an ovulation test, or after an intramuscular injection of an ovulation trigger, the follicle is punctured in order to obtain an egg. The rest of the process of the IVF program remains the same.

To increase the effectiveness of IVF, the program includes the study of the spindle of egg division. This procedure is carried out on a special Poloscope device, which allows you to examine the spindle, identify defects that can subsequently lead to the development of chromosomal abnormalities in the fetus. The use of this technique allows you to increase the chances of implantation and pregnancy and minimize the risk of miscarriage and the birth of a sick child. The rest of the process of the IVF program remains the same.

In the ovaries, as a rule, one egg matures, which is then removed by puncture, after which it is the turn of its fertilization. In order to simultaneously obtain several mature eggs during IVF, hormonal stimulation is often used. This process, as a rule, is positively perceived by the female body. However, it is worth considering that hormonal stimulation is still a rather serious test for a woman, exposing her body to increased stress. This main reason, for which women are interested in how much IVF costs in the natural cycle. They want to minimize risk side effects medicines.

For some patients, the introduction of significant doses of hormonal drugs is unacceptable due to intolerance to their body. Some patients wish to avoid hormonal effects on the body or have contraindications for superovulation induction. So alternative method IVF in the natural menstrual cycle can serve to obtain an egg for these women.

IVF in the natural cycle: pros and cons

The reason for the low demand for the IVF procedure in the natural menstrual cycle is that it is characterized by a rather low efficiency. In most cases, reproductologists prescribe ovulation stimulation, and not IVF in the natural cycle. Statistics do not speak in favor this method fertilization. The pregnancy rate is lower than with insemination in the natural cycle, it is about 7% in terms of each started cycle.

This is due to the fact that not every mature follicle is an egg carrier. In addition, as a result of the puncture, only one egg is removed, which may not be capable of fertilization. Also, when using this method, there is a risk of canceling the oocyte sampling procedure due to premature ovulation. But reviews of IVF in the natural cycle testify to its significant advantages. The advantage of this method is to minimize the risk of complications such as ovarian hyperstimulation syndrome.

The undoubted advantages of the IVF method in the natural cycle include the possibility of carrying out the procedure for several menstrual cycles in a row. However, do not forget. that a single puncture of stimulated ovaries will cause less harm to health than multiple.

IVF in natural cycle - cost

Compared to other reproductive technology programs, the cost of IVF in the natural cycle is lower than in programs where superovulation was induced with hormonal drugs. But it can vary depending on the age of the patient, the condition of the ovaries, as well as lifestyle. However, the treatment process is purely individual, so it is better to get information about the cost from your doctor.

IVM procedure

IVM stands for in vitro egg maturation (in vitro) followed by IVF. The specialists of the AltraVita clinic have sufficient capabilities and knowledge to carry out this process with high efficiency, as evidenced by the reviews of IVF in the natural cycle.

IVM involves the extraction of eggs from the ovaries in an immature state, after which they are placed in special environments, which are ideal option for the final maturation of the egg. This is achieved by creating an optimal hormonal balance in them. The advantage of the IVM method is that female body practically does not undergo hormonal stress, and sometimes it is completely absent. After the maturation of the eggs in a test tube, fertilization is carried out using the IMSI method, the embryos are cultivated, their quality is assessed and transferred to the uterus.

Combination of IVM and IVF methods in the natural hormonal cycle

The combination of IVM and IVF methods allows you to simultaneously obtain a mature egg from a dominant follicle and a number of immature eggs from small (antral) follicles. The maturation of eggs takes place "in vitro", and a mature egg undergoes fertilization in the standard way. High-quality embryos obtained by both methods are transferred to the uterus.

Indications for IVF in the natural cycle together with IVM

• polycystic ovary syndrome
• Significant risk of ovarian hyperstimulation syndrome
• A history of benign hormone-dependent tumors
• Contraindications for superovulation induction

Factors influencing the choice of IVM method

• Possibility to avoid the risk of developing OHSS
• Lack of hormonal stimulation
• Affordable cost of the procedure, which is due to the small amount of hormonal drugs used

Usually, IVF is accompanied by the use of hormonal drugs to stimulate the ovaries. Sometimes the doctor may decide to perform the artificial insemination procedure in a natural cycle. For those who are preparing for artificial insemination by IVF in such a cycle, it is imperative to know what it is and how it is done.

This approach is considered the most gentle for the woman's body. The method almost completely repeats the natural one. The only differences are ovarian puncture and embryo transfer. However, not everything is as beautiful as it looks at first glance.

According to statistics, in vitro fertilization performed in this way has a much lower chance of success compared to the classical procedure.

How is it different from regular IVF?

The most important difference is the lack of taking hormonal drugs, as with conventional IVF. In the classic version, hormonal stimulation of the body is carried out before fertilization, thus increasing the likelihood of a favorable result. Thanks to artificial stimulation, a woman's ovaries produce much more high-quality eggs, which has a beneficial effect on the final result.

At in large numbers high-quality oocytes can be grown more embryos suitable for fertilization, which will then go through the selection procedure and the best of the best will be selected for subsequent replanting in the uterus. Among other things, it is easier for doctors to control ovulation and calculate the moment for puncture.

Stages of IVF with stimulation:

1. After the doctor assesses the state of health of the woman, a plan for preparing for the procedure will be drawn up. The most appropriate type of protocol will be selected and suitable drugs for stimulation will be selected. Protocols are long, short (with or without pituitary block), and natural.
2. After the doctor calculates the course of conventional IVF, ovarian stimulation with antagonists begins. You need to start taking medications from the 4th day of the onset of menstruation. The duration of the course is prescribed by the doctor, usually it lasts only a few days.
3. Sometimes it may be necessary to induce ovulation with injections of human chorionic gonadotropin. This is the stimulation of the artificial growth of eggs.
4. At the last stage of stimulation of superovulation, a puncture is made, and mature eggs are removed from the ovaries for subsequent fertilization.

These are the main stages of IVF with a long or short protocol with stimulation with hormonal drugs.

Many women do not quite understand what IVF is in the natural cycle and how it differs from the usual procedure. The most important difference is the lack of hormonal preparation of the body and stimulation of the ovaries.. In addition, ovulation is not controlled, it passes on its own, as does the growth of the egg.

A puncture during a natural cycle is done just before the onset of ovulation, at which point the oocyte has already developed and is preparing to exit the ovarian follicle. A significant difference is the number of eggs obtained for fertilization. With EC, in general, only one suitable oocyte is obtained, sometimes there are 2. Judging by the feedback from women, doctors say that the probability of fertilization with EC will be less than 15%.

As a result of IVF puncture in the natural cycle, very few suitable eggs are obtained, at best, there will be from one to two pieces.

With conventional in vitro fertilization with egg stimulation, there can be from 7-11 pcs. That is, the chances of getting pregnant are much higher.

The advantage of the natural cycle in in vitro fertilization is the reduction of unpleasant side effects to zero. The woman will not have ovarian hyperstimulation syndrome, the patient will not puzzle over the fate of the remaining embryos, there will be no multiple pregnancy. All this allows us to say that this method is very sparing. However, it doesn't suit everyone. Everything will depend on individual characteristics and capabilities of the organism.

A common question when planning such a procedure is: “How many eggs will mature in one follicle with and without stimulation?”. First you need to understand that the follicle is a cavity on the body of the ovary in which the egg matures and develops. At normal development events in one follicle, one egg should appear. This should happen both with and without stimulation. It happens that the follicle is empty - this is an indication for the use of hormonal stimulation. With stimulation, more follicles mature, and therefore more eggs.

Who suits

A characteristic feature when a doctor chooses such a scheme is age. If a woman is between 30 and 35 years old and has a regular menstrual cycle without deviations lasting from 28 to 35 days, then she is suitable for such an IVF program. In addition to these conditions, there are Additional requirements to the procedure.

IVF in the natural cycle is done if:

• the diagnosis of infertility was made in connection with the tubal factor (there is an obstruction of the fallopian tubes);
• the indicator of female sex hormones is normal (the level of estradiol should be at least 100 pmol / ml, the concentration of follicle-stimulating hormone is at least 8.5 -8.7 IU / l);
• there are contraindications for artificial insemination with hormonal stimulation;
• women say in reviews that the natural cycle is used if oncological pathologies (for example, thromboembolism, kidney or liver disease) were previously detected;
• had an operation on the myocardium with the implantation of an artificial heart valve;
• the embryo develops and takes root better without hormonal stimulation;
• a woman is prone to developing ovarian hyperstimulation syndrome;
• the patient has a weak response to hormonal ovarian stimulation. In such a situation, even despite the completed course of hormone therapy, very few suitable eggs mature (from 1 to 3 pcs.).

IVF in the EC is not suitable for everyone, there are many restrictions, please read them carefully.

Who is not suitable

There are a number of contraindications. In their presence, in vitro fertilization is not carried out in a natural cycle.

Contraindications:

• patient older than 35 years;
• in a married couple, a man is infertile (sperm is of very poor quality, read more about the spermogram in our separate article);
• lack of ovulation;
• disruptions in the menstrual cycle.

After 40 years

The choice of a suitable IVF protocol is made for each woman individually. A lot of course will depend on the age of both partners, on the result and the number of previous attempts (if any). The doctor will check if there are any contraindications for the procedure. hormone therapy. It is important to consider the presence and number of frozen embryos. In practice, there are exceptions that allow IVF to be carried out in the natural cycle and after 40 years.

Stages of artificial insemination in the EC

Many expectant mothers are interested in exactly how IVF works in the natural cycle. There are 8 steps in this procedure in total. Depending on the clinic, the number and features of these stages may vary slightly.

Artificial insemination takes place in several stages.

IVF program at the EC in stages:

1. The program begins with the preparation and complete medical examination of the couple.
2. Further, from the end of the first week of the cycle, the development of the follicle and endometrium is monitored using urine tests and ultrasound diagnostics. The growth of the follicle can also be judged by measuring the basal temperature.
3. The next step is the exact choice of the right moment for the puncture. By monitoring the levels of estardiol and luteinizing hormone, a fertility specialist with sufficient experience can determine exactly when the egg should be retrieved. With a natural IVF cycle, it is quite difficult to determine this moment.
4. Puncture. Very often, before a puncture in a natural cycle, 35 hours before ovulation, at the time of development of the follicle to a size of 17-21 mm, hCG injections are given. If before the onset of ovulation the size of the follicle does not reach the right sizes, a GnRH and FSH antagonist will be administered.
5. Sperm collection and egg fertilization.
6. Cultivation of embryos occurs within two to three days.
7. Replanting (transfer) of embryos into the uterine cavity.
8. The final stage of all IVF in the EC is the confirmation of pregnancy 14 days after the transfer.

Chances

The effectiveness of IVF in the natural cycle is much lower. Getting good oocytes in the right amount is extremely difficult. Even if they are obtained, the chances of their successful fertilization and further growth are very small. So 8-9 attempts out of 10 fail with this approach to artificial insemination. One plus is the minimum load on the body and a quick recovery for the next attempt.

Japanese protocol

There is another way to increase the effectiveness of in vitro fertilization in a natural cycle. The so-called Japanese protocol allows you to increase your chances by several times. With this type of protocol, the focus is not on the quantity, but on the quality of the embryos. This is achieved by the method of cryopreservation of eggs and their subsequent replanting after several cycles (from 1 to 4).

The Japanese method of IVF is carried out in a natural cycle. The collection of oocytes lasts 3-4 months. The collected eggs are frozen until replanting.

In the Japanese protocol, the woman undergoes gentle hormonal stimulation to collect more viable oocytes. Each cycle is performed puncture of the eggs. After they are fertilized and frozen using vitrification technology to protect against crystallization and preserve the molecular structure. After 4 cycles, reproductologists will have 4-5 embryos in the cryobank, which are planted in the uterine cavity in the next cycle. With standard IVF, embryos are obtained twice as many in just one cycle.

It needs to be known

Most often, with a natural cycle, the ICSI method is used (read more about it). Replanting is done on the third day, five-day-old embryos are very rarely tolerated. With this protocol, the puncture is often done without the use of anesthesia. At the request of the patient, anesthesia can be used.

Repeated procedures will not bring serious complications. The number of protocols is unlimited. Many future mothers say that it is this method of artificial insemination that is much easier to endure psychologically and physically, because the hormonal load is minimized. After the procedure, there is no severe pulling pain in the lower abdomen.

At the dawn of its introduction, IVF was done exclusively in a natural cycle. Later, when the technology of hormonal ovarian stimulation became available, doctors began to induce superovulation in order to increase efficiency by collecting more oocytes in one cycle. Nowadays, there is a tendency to move towards the original methods, in which the conditions for artificial insemination should be more natural.

Duration

A very popular question among expectant mothers is related to the duration of the course. The duration will depend on the type of protocol selected. There are three duration options.

How long will IVF last:

• the duration of the short protocol reaches 30 days. Stimulation from 10 to 14 days;
• the duration of the long protocol is 45-53 days. Starts before menstruation. Hormonal stimulation of the ovaries lasts up to two weeks;
• the natural protocol does not provide for hormonal preparation of the ovaries. Therefore, IVF lasts an average of 2 weeks. This is the time from puncture to confirmation of pregnancy. Sometimes, if you need a little stimulation before the puncture, it may take another 6 days.

This is what the IVF instruction calendar looks like in a natural cycle.

Price

More important point this is the price. How much does IVF cost in a natural cycle if there is no hormonal stimulation? It is clear that it is cheaper than the usual protocol. The average for Moscow and St. Petersburg varies from 66900 to 91000 rubles. Many clinics give three attempts included in the price.

You need to understand that with a natural cycle, only 1-2 women out of 10 will get pregnant. Therefore, additional funds should be included in the budget. The desire of a woman to minimize the risks during the procedure is understandable, but if there is an opportunity, it is better to do a full-fledged IVF.

Self-preparation

In order to properly prepare for fertilization in the EC, you must definitely know how to do it correctly. Simple Rules will significantly increase the chances of successful pregnancy. Both partners should be trained - this is very important. Let us consider in more detail what is the help for the body in the process of preparing for the protocol.

Nutrition

A woman should improve her body as much as possible. The result can be achieved in several ways. Among these methods is a special diet. The diet should include more vegetables and fruits. It is convenient to prepare for artificial insemination in the summer season, when they start selling seasonal fruits and vegetables. There are very few calories in cherries, which is useful for those who want to keep their figure (64.3 Kcal per 100 grams). These wonderful fruits contain a lot of vitamin C, A, PP (niacin), E, ​​a group of vitamins B of both types.

Another super useful berry for preparing for conception by natural cycle IVF is watermelon. Its pulp is also very low in calories, but very much indispensable folic acid. Such acid is the main active element in many medical preparations for the treatment of female and male infertility.

Bad habits

Avoidance of alcohol and tobacco is required. The body suffers greatly from these poisons. Very strong Negative influence appears on the reproductive organs of both men and women. According to statistics, if a woman or a man smokes or abuses alcohol during the preparatory period, the chance of pregnancy will decrease from 10 to 3%. Pay special attention to this!

Physical exercise

An active lifestyle normalizes blood circulation in the pelvic organs. It is very useful for men (spermatogenesis improves). Be sure to keep in mind that playing sports should not be exhausting. If you ignore this rule, you can get the opposite effect. Dancing, walking in the park or yoga are great for those preparing for IVF at the EC. Physical exercise should not be everyday. Enough to give them a few days a week for an hour.

By following these tips, you can quickly put your body in order, which will help you get pregnant more likely.

Currently, in the "arsenal" of reproductive medicine there is a sparing way to overcome infertility - IVF in the natural cycle (IVF in the EC). Of course, such a protocol is not suitable for all women who want to get pregnant. But with a competent approach, it has a fairly high performance, although it usually takes more time to achieve the desired goal. This protocol is most often used in patients with reduced ovarian reserve of older reproductive age.

How is IVF in the natural cycle different from the standard protocol?

The key feature of IVF in the EC is the absence of any medical interventions at the stage of egg maturation in a woman, the rejection of hormonal stimulation of the ovaries. In fact, the reproductologist waits for the independent (spontaneous) growth of the dominant follicle in a woman to the required pre-ovulatory size. And only after that he begins to take action.

All subsequent stages of IVF in the natural cycle do not differ fundamentally from the standard protocol. It is important to understand that in this case, a woman can be prescribed hormonal drugs - not only to provoke ovulation, but also to maintain the second phase of the cycle. But this will not lead to subsequent violations of the natural cycle. And you should not expect serious side effects from such drugs.

What does IVF include in the natural cycle?

As with standard IVF protocols, spouses must first undergo a comprehensive comprehensive examination. It does not have any fundamental features and is carried out according to the basic program. This allows not only to identify the most likely causes of marital infertility and to determine the general health of a woman.

Thanks to this examination, an experienced doctor gets the opportunity to predictively assess the prospects and feasibility of using a standard protocol with hyperovulation stimulation. After all, sometimes already at this stage, contraindications to the use of hormonal drugs are revealed. If at the same time the woman has regular independent ovulatory cycles, with her consent, a decision can be made to refuse stimulation.

The main stages of IVF in the EC:

• Observation of the process of natural growth of the dominant follicle. In this case, ultrasound monitoring and the determination of the level of her own luteinizing hormone in the woman's blood are used. This is necessary so as not to miss the optimal time period for provoking ovulation of a mature egg. Optimal size preovulatory follicle is considered 18-20 mm.
• The introduction of an ovulatory dose of human chorionic gonadotropin (CG). This is analogous to the natural pre-ovulatory peak of luteinizing hormone and triggers the release of a mature egg. The success of the subsequent obtaining of a full-fledged and ready for fertilization oocyte depends on the competent choice of the time of injection of the CG drug. At the same time, the spouse must donate sperm.
• Collection of an egg ready for ovulation. Produced in a reproductive clinic by ovarian puncture under ultrasound control. This should be done 32-36 hours after hCG administration, which is sufficient to prepare the oocyte for ovulation.
• Fertilization of the egg and subsequent cultivation of the resulting zygote under incubation conditions. At the same time, to increase the likelihood of success, ICSI is often performed, which is necessary when the quality of spermatozoa is poor. Also, according to the indications and with the consent of the woman, donor sperm can be used for fertilization.
• Embryo replanting is usually performed 2-3 days after fertilization.
• Waiting period. 12 days after replanting, the level of hCG in the blood is determined. If this analysis confirms the onset of pregnancy, the IVF protocol in the natural cycle is considered successful.

2 weeks after the first analysis for hCG, a woman is recommended to undergo an ultrasound scan to exclude an ectopic pregnancy.

Advantages and disadvantages of IVF without stimulation

Expectant management in the preovulatory period with IVF in the natural cycle is the main advantage of this protocol. After all, this ensures the safety of a woman's natural rhythm of hormone production.
What are the disadvantages of such a “sparing” IVF option? Due to the preservation of the natural cycle and the physiological work of the ovaries, the doctor has the opportunity to receive only one egg for subsequent fertilization. Indeed, in the vast majority of women, only one follicle matures and ovulates at the same time. It is called dominant. And the rest of the Graafian vesicles that have begun active development in this natural cycle undergo regression and atresia at different stages of their growth, and there can be up to 10 such unclaimed immature oocytes. Simultaneous or alternate ovulation of 2 or more follicles in humans is quite rare.

Getting only one egg is a factor that reduces the overall effectiveness of IVF without stimulation. After all, even a mature functionally complete oocyte that does not contain genes with critical mutations may not give a developing pregnancy. At the same time, a failure, as in natural conception, can occur at various stages: during fertilization, during the period of the primary active development of the formed zygote, at the time of implantation and shortly after it ... Statistics show that only 40% of replanting single embryos give rise to pregnancy.

Of course, with IVF, specialists have the opportunity to influence some processes, increasing the likelihood of a successful conception. And yet, obtaining an egg is even very good quality is not yet a guarantee of unequivocal success, despite all the achievements of modern reproduction.

With standard protocols, the chance of pregnancy is additionally increased by replanting several promising embryos, which is impossible with IVF in the natural cycle. That is why ICLINIC doctors usually advise couples who enter this protocol to be patient. After all, even with regularly occurring full-fledged ovulation, pregnancy can occur far from the first cycle. And the neurosis-like reactions of the future mother can lead to functional disorders in the work of her hypothalamic-pituitary system, which will negatively affect the likelihood of quickly achieving the desired goal.

ICLINIC does not perform IVF in the natural cycle for couples whose infertility is due to a pronounced male factor. After all, the fertilization of a single mature egg with low and very low quality sperm means a low probability of a successful onset and subsequent prolongation of pregnancy. In this case, it is more appropriate to obtain and fertilize several eggs, that is, to carry out standard IVF protocols.

Where to go for IVF in the natural cycle?

Conducting IVF without a hyperovulation stimulation stage requires no less professionalism and clinical flair from the doctor than with standard protocols. After all, the possibility of obtaining a single maturing egg and its quality depends on the literacy and timeliness of his actions. And any mistake at the subsequent stages of the protocol is fraught for a woman with the loss of the prospect of becoming pregnant in the current cycle. And although IVF protocols without stimulation can be repeated many times, few couples have the financial means to do so. Therefore, the choice of a reproductive center and a doctor is a very responsible decision.

The clinic of reproductive medicine ICLINIC in St. Petersburg rightfully belongs to the leading medical institutions in its field. Our virtues are modern equipment, well-equipped laboratory, own bank of donors, experienced highly qualified and constantly improving their skills doctors, using only technologies and drugs with proven effectiveness. According to the results of 2017, with an assessment of the effectiveness of IVF, ICLINIC took first place among other reproductive clinics in St. Petersburg. We not only help infertile couples, but also train doctors from other medical centers.

IVF in the natural cycle is the use of modern high-tech techniques for artificial insemination with the least possible impact on the functioning of the ovaries. And it is worth trusting such "jewelry" work to professionals - such as doctors at ICLINIC.