What ways to get pregnant exist besides eco. How does artificial insemination take place? Methods and types of artificial insemination

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 they 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 saving fertilization outside the body - (In Vitro Fertilization). In vitro fertilization can be used in all cases of infertility. In in vitro fertilization, the previously extracted egg is fertilized artificially "in vitro". The embryo develops for about 5 days in the clinic's incubator. Following 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 35-37 years old, a child is born in 30%.
3. In patients aged 38 to 40 - in 20% of cases.
4. At 40, 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 one of the assisted reproductive technologies. IUI is the introduction of pre-obtained sperm from a man, rather than an embryo, into the uterus of a woman.

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 for IVF. According to the law, there are no contraindications for IVF for men's health. 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 receive more than one egg during one menstrual cycle. The effectiveness of the method of artificial insemination 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 the measures of preparedness on your part to quickly identify dangerous symptoms. Be aware of how to respond when they occur. Also at this stage, the endometrium is prepared for embryo transfer a few days later.

• Sperm:

A man independently receives sperm by masturbation according to medical instructions. In cases where this is not possible, surgical methods are used: aspiration or biopsy. It is best to receive sperm on the day of fertilization. But it is also possible to freeze and store previously obtained sperm. Under laboratory conditions, on the day of transfer, the spermatozoa are separated from the seminal fluid. The highest quality of the gum will be used in fertilization.

Cryopreserved sperm

• Fertilization:

Embryologists carry out the in vitro method or the ICSI method (intracytoplasmic sperm injection). During insemination, one out of 100,000 spermatozoa completely independently penetrates the egg. This fertilization takes about 2-3 hours. With the quality of sperm, microsurgical instruments come to the rescue in fertilization. Then the ICSI method is used, which involves the mechanical introduction of the sperm into the egg.

From the moment of fertilization, the embryo is stored for up to 6 days in an incubator. Embryos are kept in plastic Petri dishes or Nunk dishes. There they are 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 in repeated transfer to the uterus. In this case, additional embryos are frozen, which is called cryopreservation. Embryos will be stored until used. This allows you to try again if the first transfer did not continue with a 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, anesthesia is not required. The transfer process only takes a few minutes. To increase the chances of pregnancy, 2 embryos are usually transferred. With the help of a thin elastic catheter, they are transferred directly to the uterus. How artificial insemination occurs, the video is presented below.

Video: The process of artificial insemination

Every married couple sooner or later comes to the conclusion that they want to have a baby. If earlier women became mothers already at the age of 20-23, now this age is greatly increasing. Representatives of the weaker sex decide to have offspring after 30 years. However, things don't always go as planned at this point. This article will tell you about how IVF is done (in detail). You will learn the main steps of this procedure. It is also worth mentioning the indications and limitations of this manipulation.

What it is?

Before you find out how IVF is done (in stages), it is worth saying a few words about the manipulation itself. In vitro fertilization is a way to conceive a child outside the female body. Babies born subsequently are called "test-tube babies." The procedure was first performed several decades ago. It took a lot of effort and expense.

Now it is no longer something unnatural. You can do it for a fee or on a special quota. For this, a man and a woman must have certain indications.

When is IVF done?

There are many indications for this procedure. However, only some of them involve free manipulation. In this case, the couple is allocated a quota, and all expenses are covered by the state and the insurance company.

Pipe factor

One of the most common reasons for in vitro fertilization is tubal infertility. In this case, a woman may not have a fallopian canal at all. More often it is a consequence of surgical interventions. Also, obstruction can be attributed to the tubal factor. Before IVF is done, such channels are removed.

male infertility

The indication will be poor-quality partner sperm. Find out the state of the material during the spermogram. In this case, the main factor will be that sperm reduces its quality in vivo (in the female genital organs).

endometriosis

When is IVF done? One of the indications for manipulation is the growth of the endometrium outside the uterus. This pathology affects mainly women of reproductive age. In this case, treatment can be long and include surgical methods, as well as hormonal drugs. In the absence of a positive effect, experts advise not to delay, but to resort to the procedure of artificial insemination.

Age changes

Many women are interested in the question of up to what age they do IVF. In fact, there are no specific limits. Many couples, on the contrary, turn to assisted reproduction methods only because they cannot conceive a child on their own due to their age (usually after 40 years).

Problems with ovulation

Every woman may have two or three anovulatory cycles during the year. This is not some kind of pathology. When less than 5-6 ovulations are carried out within 12 months, then this is already a deviation. Usually this problem is easily eliminated by hormonal drugs. However, if this method is ineffective, doctors advise IVF.

Contraindications to be aware of

Before IVF is done, a woman must be carefully examined. If any contraindications to manipulation are revealed, then it must be abandoned. These include the following situations:

• therapeutic and psychological pathologies incompatible with pregnancy;
• deformation of the uterine cavity, in which the attachment of embryos is unlikely;
• tumors of the uterus and ovaries, which can grow with hormonal preparation;
• malignant diseases even in the stage of regression;
• inflammatory processes in the genitals of a woman or a man.

In each situation, the couple is considered individually. If contraindications are determined, then the specialist will definitely inform about this.

How is IVF done?

The fertilization process itself takes quite a long time. Depending on the length of the protocol, the couple may need from one to three months. During the procedure, a woman has to take many drugs. Some of them have unpleasant side effects.

The in vitro fertilization procedure consists of several stages. The doctor will definitely tell you about them at the first visit. Many couples wonder how quickly they do it. With a free procedure, spouses have to wait for a quota for some time. Usually this issue is resolved within a few months. When carrying out artificial insemination in a private clinic, it is possible to start the protocol within a few weeks after treatment.

Preparation and analyzes

Before IVF is done, a woman must be examined. Her partner must also pass certain tests. Standard tests are tests for hepatitis, HIV, syphilis. A man must pass a spermogram. It determines by what method artificial insemination will be carried out.

Also, the representative of the weaker sex must visit some doctors. This is a neurologist, cardiologist, ophthalmologist, therapist. A conversation is being held with a psychologist.

Prescribing drugs: choosing a protocol

Before IVF is done, experts determine the length of the protocol. It may be short. In this case, stimulation begins immediately after the next menstruation. A woman is prescribed hormonal drugs, which she must take daily according to a strict scheme. Often the drugs are in the form of injections. Medicines can be administered in a hospital or self-administered. The doctor will definitely tell you all the subtleties of manipulation.

With a long protocol, before the start of stimulation, the woman is introduced into the so-called menopause. This is often done in the presence of hormonal pathologies, including endometriosis. After a break that lasts from two weeks to a month, stimulation begins. Further actions will be the same in both protocols.

Follicle Growth Tracking

So how is IVF done? In the process of taking hormonal drugs, a woman must definitely visit the ultrasound diagnostic room. Typically, such a study is scheduled for the 5th, 9th and 12th day. However, if necessary, the doctor may recommend additional days. During an ultrasound, a specialist evaluates the growth of follicles and the condition of the uterus with the endometrium. The reproductive organ should be as ready as possible to receive the embryo.

At the last study, the date and time of the puncture is assigned. At this stage, stimulation ends.

Egg selection

We continue to explore the topic of how the IVF procedure is done. For a puncture, a woman must be placed in a hospital. Here she is given a separate place and all the conditions. The puncture can be made through the abdominal wall or by the vaginal method. The second option is chosen more often. It is considered more natural and less traumatic.

A disposable sharp needle pierces the back wall of the vagina and is brought under the sensor to the ovary. I must say that the doctor must be extremely careful so that there are no complications. After egg collection, the patient must remain under close medical supervision for at least two hours. During this period, the condition of the woman is monitored and intra-abdominal bleeding is excluded.

Fertilization

You already know that before IVF is done, a man's sperm must be examined. The course of the next stage will depend on the quality of the seminal fluid. At normal rates, normal fertilization is performed. The required amount of sperm is simply combined with the selected eggs.

If there are pathologies of spermatozoa or there are very few of them, then they resort to the ICSI method. In this situation, embryologists select the best and highest quality spermatozoa, after which they combine them with eggs.

in vitro

After fertilization, each zygote is placed in a separate container. There, conditions are created that are as close as possible to those that are in the body of a woman. It is worth noting that at this stage (immediately after the extraction of the follicles), the woman continues to take hormonal drugs. Usually these are drugs based on progesterone. They help maintain the work of the corpus luteum and prepare the uterus for pregnancy as much as possible.

The time period for growing embryos may vary. Usually it is from 2 to 5 days. Many blanks die already on the third day. Only the strongest survive. Reproductologists are trying to bring the embryos to the point where they will have from 4 to 8 cells. After that, they move on to the next stage.

Cell transfer

If you are interested in how IVF is done, the photo of the procedure is presented to your attention. Embryo transfer is carried out within the walls of the hospital. This does not require anesthesia. The woman is located on a thin silicone tube is inserted into the cervical canal. Through it, the embryos move into the cavity of the reproductive organ.

In recent years, experts have tried not to implant more than two embryos. However, according to some indications, this number can be increased. Note that in this case a special contract is concluded that informs the patient of her rights and obligations. If viable embryos remain after the transfer, they can be frozen. You can use them at any time. This procedure does not affect the quality and genetic condition.

Expectation

Perhaps the most exciting and painful moment is two weeks after the transfer. It is after this period that the outcome of the procedure will be determined. All this time, the woman receives progesterone and human chorionic gonadotropin preparations.

You can find out the result 10-14 days after the transplant. The patient is offered to take a blood test to determine the amount of chorionic gonadotropin. It is this hormone that is secreted during pregnancy, increasing in quantity every day.

Result of manipulation

If the amount of chorionic gonadotropin increases, then this indicates pregnancy. After reaching the mark of 1000 IU, it is necessary to do an ultrasound examination. It will show the number of attached embryos. If there are more than two fetal eggs in the uterus, a woman is offered to use a procedure called reduction. During it, the doctor removes excess embryos. It is worth noting that this manipulation is very dangerous. It can lead to miscarriage or miscarriage. Therefore, many couples refuse it. However, carrying more than two babies at once is also unwise. After all, premature birth may begin or pathologies of the development of babies can be detected. In any case, the final decision remains with the couple.

If the result was disappointing and pregnancy did not occur, the woman should stop taking all drugs. In this case, the first question that interests patients is formulated as follows: how often is IVF done? Most couples want to try to become parents again as soon as possible. However, doctors do not advise to rush. In the process of preparing for artificial insemination, the woman's body endures the strongest loads. He needs time to recover. Reproductologists usually recommend refraining from trying to conceive for up to six months. Also, the couple is assigned additional examinations that can find out the cause of the failure.

The final stage of the procedure

How IVF is done is described in detail in this article. If the procedure ended positively, then the woman is offered to register at the place of residence. In some cases, the clinic takes responsibility for the management of pregnancy until a certain period. This is usually required in multiple pregnancies.

Hormonal support is provided for up to 15-20 weeks. After that, all drugs are gradually canceled. At this time, the placenta, which supplies the fetus with everything it needs, is already formed and works in full force.

Delivery: what determines the choice of method

You already know how IVF is done. The procedure is quite complicated and requires the patient to follow all the rules. You can talk about the successful outcome of the manipulation after the birth of the child. Often this issue is dealt with by specialists from the same clinic in which artificial insemination was performed.

In the normal course of pregnancy and the absence of contraindications, a woman can give birth on her own. Natural childbirth is welcome in singleton pregnancies. If there are two or more babies, then doctors insist on a caesarean section. In this case, you will be sure that the kids will not get a birth injury when passing through the birth canal, which often happens with multiple pregnancies. Doctors will help the children in time.

Results

From the article, you learned how the in vitro fertilization procedure takes place. If you are interested in additional details, please contact a specialist. The doctor will tell you how and what you need to do for a positive outcome. In each individual case, individual recommendations are possible.

An important role in this process is played by the mood of the couple. Think positive, eat right, spend more time outdoors. Follow all specialist instructions. Have a good result!

We want to support married couples and single women who decide to undergo a procedure such as intrauterine insemination (hereinafter referred to as IUI or AI). Unfortunately, not everything in life is always simple and smooth: some people experience loneliness when they have long wanted to find a family, while others experience illness, loss of loved ones, and other misfortunes. No need to think that it was you who were unlucky - everyone has some kind of trouble. And do not be ashamed that you have to go to the doctors - we do not hesitate to go to the doctor if, for example, we broke our leg in order to get rid of the pain and be able to walk in the future.

Just artificial insemination of a person, intrauterine insemination, going to doctors in order to have a child, is less familiar to us, that's all. This is less familiar to the people who surround us. Methods of artificial insemination (including intrauterine artificial insemination) in Moscow and the regions every year help an increasing number of couples. Artificial insemination - donor, or husband's sperm will give you the desired result - your child. However, if you are not ready or do not want to meet wariness, skepticism, and even ridicule from those around you - natural human reactions to something new and unusual - and do not feel confident in convincing people and achieving their understanding of the situation, then you probably should not tell loved ones that you have resorted to such a procedure as intrauterine artificial insemination.

The results after insemination - a successful pregnancy - will please you and your loved ones. Conceiving a child is an intimate, personal matter, and concerns only you. You can answer questions from loved ones in this way or smile mysteriously. The methods of artificial insemination used in this case are up to you, your spouse and your doctor.

The misfortune that has piled up is sometimes so depressing that complete despondency comes. But over time, you realize that the problem will not be solved by itself and life will not get better on its own. Artificial human insemination is a medical method of treatment, there is nothing obscene in it. The problem of artificial insemination is largely contrived by people uninformed in this matter. If you are shown this procedure, artificial insemination - donor or husband's sperm - you need to think carefully about everything and act. Trouble must be overcome, not surrendered to it. There are always ways to solve a problem. Perhaps not always easy, not always easy to accept something psychologically, not always enough patience and will. Sometimes you just don't know how to solve a problem, or which way is best.

Artificial insemination. Indications:

• couples where not everything is in order on the part of the man (sexual disorders or bad sperm)
• single women (if there are no problems "on the female part")

Many single women really want to have a baby. But what if there is no suitable partner nearby? Women will learn what artificial insemination is, who became pregnant after artificial insemination, where artificial insemination is done, how much artificial insemination costs - in Moscow and the regions. Having clarified all the questions, women turn to a selected clinic where artificial insemination is performed. If intrauterine insemination is successful, long-awaited pregnancy occurs after insemination. And it doesn't matter how much artificial insemination costs; the result is a new life, your child is in your arms. I would like to wish single women good luck and understanding and help from loved ones with raising a child.

Let's take a closer look at men's issues. These or those problems in the reproductive sphere are now found in men, including young men, quite often, and, unfortunately, are not always treatable. The problem of artificial insemination for men is quite acute. This is a heavy blow to male pride and just a human misfortune. Often this also disrupts the harmony in the pair.

It is completely pointless not to do anything in this situation, to get away from it - sooner or later the problem will have to be solved, somehow determine one's fate, and delay usually leads to the proliferation of problems.

In this situation, it is important to collect complete information, how modern medicine can help you, where exactly and how successfully. It is also important to visit clinics and doctors in person to get answers to your questions and doubts. If artificial insemination is indicated for you, tests will help you choose the right treatment tactics.

I would like to mention separately that bad sperm is not a diagnosis, it is an analysis. If a man has not been examined and there is no conclusion about the diagnoses, causes of poor sperm and the possibility of treatment, it is too early to predict whether pregnancy is possible naturally or whether artificial intrauterine insemination or another ART method is needed.

With serious sperm pathologies, if this cannot be corrected, insemination with the husband's sperm cannot help solve the problem. In these cases, medicine can only help with insemination with donor sperm or IVF / ICSI with husband's sperm.

The role and importance of a man in conception, if you have to resort to artificial methods, not only does not become lower, it becomes much higher and more responsible. Even if donor sperm is used, this is your child, thanks to you a new life is born, and he will be the way you raise him.

Artificial insemination (AI) is a method of assisted reproduction (along with IVF, IVF / ICSI), in which, as with other methods, a certain stage of conception of a child occurs artificially.

General information

Insemination is the introduction of sperm into the genital tract of a woman by artificial means. The whole further process occurs naturally: spermatozoa run from the uterus to the fallopian tubes, where they meet the mature egg that has left the ovaries and also entered the fallopian tubes, fertilizes it, and then the fertilized egg enters the uterus, where it attaches to the wall of the uterus and gives rise to pregnancy.

Insemination is carried out near the time of ovulation (the release of a mature egg from the ovary), approximately in the middle of the menstrual cycle.

Previously, the introduction of sperm into the vagina was used, but more recently, the introduction of sperm into the uterus, the so-called intrauterine insemination (IUI), has been used more successfully.

With intrauterine insemination, the sperm is pre-treated, making it similar to the composition that the sperm acquires in the vagina on its way to the uterus during natural intercourse, and selecting the "squeeze" from the most fertile spermatozoa. The introduction of raw sperm directly into the uterus is unacceptable.

Artificial insemination. Indications

Insemination is performed on single women and is used to achieve pregnancy in spouses in a barren marriage, if treatment to achieve a natural pregnancy has not been successful.

Artificial insemination. Results: Pregnancy as a result of insemination can occur in a woman only when there are no diseases that prevent pregnancy. In case of obstruction / absence of fallopian tubes, high endometriosis, absence of ovaries or uterus, insemination is not carried out.

As a method of assisted reproduction distinguish:

• artificial insemination with husband's sperm (IISM)
• artificial insemination with donor sperm (IISD)

Artificial insemination with husband's sperm (IISM)

ISIS are indicated and can overcome infertility only in those cases when the artificial introduction of sperm bypasses that / those obstacle / I, due to which / s pregnancy did not occur, namely:

• with sexual disorders, vaginismus, irregular sexual life,
• with cervical (cervical) factor of infertility, when the husband's spermatozoa die in the wife's vagina,
• with slight deterioration in sperm quality compared to normal,
• with infertility of unknown origin, when the couple went through a full list of examinations, and the cause was not found, however, the use of IVF is seen as premature, insufficiently justified or too expensive.

In all cases, except for the first one, it is assumed that the couple has undergone a full examination for infertility according to the full list of examinations, and there is a conclusion about the causes of infertility. If a couple is indicated for artificial insemination, tests will help choose the right treatment.

All of the cases listed above are quite rare and account for only a small percentage of cases of infertility.

When inseminating with the husband's sperm, fresh (native) sperm is used, which is donated at the clinic immediately before insemination on the same day in a few hours. For insemination, the husband must be examined for at least all sexually transmitted infections.

The child born as a result of such insemination is genetically related to the woman and her husband.

Artificial insemination with donor sperm (IISD)

I believe that before resorting to IVF, it is worth taking advantage of the chance of AI with donor sperm (IISD). Why??

It is important to understand that if pregnancy does not occur from insemination with donor sperm, nothing will prevent IVF from being applied. If you first follow the path of IVF and pregnancy does not occur after several attempts, there is a risk that the reproductive health and mental state of the woman will worsen as a result of IVF, and the use of insemination with donor sperm will then turn out to be inappropriate, that is, there will be no other way.

Insemination with donor sperm has advantages over IVF/ICSI:

• there are no strong hormonal stimulations that can negatively affect the health of the unborn child,
• the transmission of male infertility to the next generations is excluded (possible transmission during IVF / ICSI has not been studied by medicine),
• there is no risk to the health of the mother, unlike the IVF procedure.

IISD are applied:

• with poor quality of the husband's sperm (as an alternative to IVF, IVF / ICSI) or the absence of a sexual partner / husband in a woman.

In this case, the sperm of an anonymous donor from the clinic's donor sperm bank can be used, or the sperm of a donor that you bring yourself - it can be the husband's closest relative (brother, father), a person you know or unfamiliar, but who agrees to act as a donor.

The child born as a result of such insemination will be genetically related to the woman and the donor, but the real father of the child - officially and in fact - becomes the woman's husband, if he exists. Doctors keep medical secrecy, and pregnancy after insemination is carried out as a normal pregnancy. The donor has no paternity rights and obligations.

More about donors.

According to the order of the Ministry of Health of the Russian Federation, in order to avoid the transmission of infections, medical institutions are allowed to use only cryopreserved donor sperm that has been frozen and kept in quarantine for at least six months to detect latent infections.

Since far from every man's sperm can withstand freezing/thawing without a serious deterioration in its quality, only men whose sperm has this property (cryotolerant) are accepted as anonymous donors.

Anonymous donors are examined for all sexual infections, the absence of mental abnormalities and congenital deformities is also mandatory.

Other requirements for anonymous donors depend on the clinic: the most stringent requirements are genetic tests for potential heredity, the presence of 2 healthy children of their own.

Carefully choose a clinic where to do artificial insemination! Clinics search and attract anonymous donors themselves. The number of donors whose sperm makes up a donor sperm bank may be only 2-3 people, or there may be dozens. About the donor, general data about appearance, nationality, blood type, the presence of their children, education and occupation are provided.

When inseminating with the sperm of a donor that you bring yourself, as an exception, not cryopreserved for half a year, but fresh sperm can also be used. If artificial insemination is carried out in this mode. The cost of the procedure will be lower, the waiting time will be reduced, and the likelihood of pregnancy after artificial insemination will also increase.

Insemination requires examination of the donor, which you bring yourself, at least for all sexually transmitted infections.

Where to do artificial insemination. official registration

Inseminations are carried out in clinics that deal with reproduction problems, in the same place where IVF is performed (see the list on the website). Insemination is carried out by a reproductive specialist (a separate specialization in gynecology) with the participation of an embryologist who prepares sperm.

For artificial insemination, an official agreement is signed with the clinic - consent to insemination, with passport data.

If a woman is officially married, then both the wife and the husband sign the official consent for insemination both for insemination with the husband's sperm and for insemination with the donor's sperm.

When carrying out insemination with the sperm of a donor whom you bring yourself, his official consent is also signed. At the same time, his passport data and passport data of spouses or a single woman for whom he/she agrees to become a donor are indicated.

Insemination procedure

Before carrying out insemination, a woman should be examined for sexually transmitted infections and an ultrasound scan should be done to exclude possible gynecological diseases that may be an obstacle to the onset or bearing of pregnancy.

Insemination is carried out near the time of ovulation - the release of a mature egg from the ovary, approximately in the middle of the menstrual cycle. Ideally, if in the time interval "a day before ovulation - a few hours after", since this is the most favorable time for conception. Although insemination a day or two or three before ovulation can also lead to pregnancy.

In order to determine the time of ovulation with an accuracy of at least a day, and to make sure that the egg is mature, ultrasound monitoring is performed: from the beginning of the menstrual cycle in which AI is supposed to be performed, ultrasound is done several times to monitor the work of the ovaries and the growth of one or more follicles (oocytes). Follicle growth is usually 2 mm/day and ovulation occurs when the follicle reaches a size of 18-22 mm.

In addition to ultrasound, ovulation tests (similar to urine pregnancy tests) sold in pharmacies are used to accurately determine the time of ovulation.

IS can be performed using hormonal stimulation of the ovaries. Hormonal stimulation is carried out with the same drugs as for IVF (see page "pharmacology in eco" >>>), but usually in significantly lower doses.

Stimulation can produce multiple follicles/eggs and some better quality, which increases the chance of pregnancy. It should be mentioned that drugs with the active ingredient "clomiphene" (clostil, clostilbegit) are outdated drugs with many side effects and less efficiency.

With a pre-ovulation size of the follicle / s, an ovulation provocateur - human chorionic gonadotropin (hCG) can be prescribed.

Two days after ovulation, hormonal support for the second phase of the cycle can be prescribed with duphaston and utrozhestan, which contributes to the onset and maintenance of pregnancy.

In addition to mature follicles / eggs, an important factor for the onset of pregnancy is the thickness of the endometrium in the uterus at the time of ovulation. During ultrasound monitoring, the growth of the endometrium is also monitored, and if the growth is insufficient (by the time of ovulation it must be at least 9 mm), additional hormonal preparations are prescribed to build up the endometrium (estrophem, proginova, divigel).

Insemination can be carried out without the appointment of any medications.

In one menstrual cycle, 1 or 2-3 inseminations can be carried out. It depends on whether one or more follicles / eggs mature and when each of them ovulates (follicles can ovulate with an interval of 1-2 days) and depending on how accurately you can predict the time of ovulation.

In the case of using cryopreserved donor sperm, 2-3 inseminations can be carried out with an interval of a day.

When fresh (native) semen is used, it should be assumed that good semen quality requires sexual abstinence, ideally 3-5 days. Therefore, insemination is carried out either 1 time - on the day of the expected ovulation, or 2 times with an interval of 2-3 days - for example, 2 days before ovulation, and a few hours before or after ovulation. Ultrasound monitoring is carried out until it is established that ovulation has occurred (!).

Preparation of sperm for AI takes about 2 hours: about an hour is spent on the so-called liquefaction, then the sperm must be processed without delay (otherwise its quality deteriorates). Processed semen can be stored for several hours without losing its quality. If cryopreserved sperm is used, then more time is required to thaw the sperm.

The very procedure of insemination (introduction of sperm) takes several minutes, is carried out on a gynecological chair.

Sperm is injected through a special catheter directly into the uterus. The procedure is painless, you can only feel a slight pull. After the procedure, you may feel some uterine tension (tonus) for several hours. After the introduction of sperm, you must remain on the chair in the same position for 15 minutes, then you can get up. A little fluid leakage is normal.

On the day of insemination, physical activity should be limited and the same regimen should be maintained as on critical days (menstruation). Since insemination directly interferes with the uterus, which increases the risk of infections, more thorough hygiene and caution should be observed. Mode of life in the following days - without restrictions.

Consults, conducts ultrasound monitoring, makes all appointments and conducts the actual insemination by the same doctor - a reproductive specialist. The embryologist is engaged in the storage and preparation of sperm for insemination.

Hormonal support for the second phase of the cycle with utrozhestan, duphaston does not allow menstruation to begin, even if pregnancy has not occurred. Therefore, if hormonal support is used, 2 weeks after ovulation, you need to take a blood test for pregnancy (blood for hCG).

In case of a negative analysis, support is canceled, in case of a positive analysis, support is continued until a consultation with a doctor.

Cost of insemination

Artificial insemination. Price. The cost of AI consists of several components: the initial consultation with a doctor, the cost of ultrasound monitoring, the insemination procedure itself, the preparation of sperm for insemination, the cost of donor sperm (if sperm from the clinic’s donor sperm bank is used), the cost of the drugs used.

Thus, the cost of insemination depends on the chosen clinic, whether ovarian stimulation drugs and other drugs are used, whether a donor sperm bank is used.

In some clinics, when artificial insemination is carried out, the price is set for everything that is carried out during the cycle - for ultrasound monitoring and insemination, regardless of whether 1 or 2-3 procedures are required. There are clinics where payment is made for each type of service - separately for ultrasound monitoring, or even each ultrasound, separately - for each insemination procedure.

Therefore, when finding out the cost of insemination in this clinic, you should separately ask how much the entire necessary set of services costs.

The cost of donor sperm from the donor sperm bank is paid separately. Medicines are bought independently in a clinic or pharmacy, the cost of modern stimulation drugs is comparable to the cost of medical services for insemination.

A higher price than other clinics for a "kit" or directly for the insemination procedure does not always mean that this clinic has a better result. Carrying out insemination in clinics in Moscow and St. Petersburg on average costs several hundred ye per menstrual cycle.

Artificial insemination. Who got pregnant? Probability of success and possible reasons for failure.

Pregnancy as a result of insemination occurs less frequently than during natural sexual life in healthy couples, and than during IVF. That is, the probability of pregnancy in one cycle during insemination is less than 30%. Therefore, you should tune in to at least 3-4 cycles of insemination.

If pregnancy does not occur after 3-4 cycles of insemination, it is recommended to change the method of treatment or the donor.

This limitation is partly due to the fact that it is undesirable to stimulate the ovaries for more than 3-4 cycles, and partly because there is a more effective method - IVF (however more expensive and less harmless to health). However, more than 3-4 cycles of insemination without the use of ovarian stimulation, simulating a natural sexual life, may be quite reasonable.

Possible reasons for failure:

a) insemination is carried out not according to indications, there are obstacles to the onset of pregnancy,

b) the insemination was carried out insufficiently qualified or negligently,

c) bad luck.

More details about each of the reasons:

a) Indications.

If a woman has not been tested for fertility, it cannot be ruled out that she has diseases that prevent pregnancy. It is also important to understand that a mature and covulated follicle does not mean that a full-fledged, good-quality egg has matured. If a woman has hormonal disorders, ovarian problems, or is older than 35, poor egg quality may be a possible reason for the failure.

It should be noted separately IISM with a decrease in sperm counts. To decide whether insemination is advisable, 2-3 spermograms are needed, since sperm counts can vary greatly. When preparing sperm for insemination, the embryologist gives an independent opinion on the quality of the sperm and the prognosis of how pregnancy is possible - it is important to know this conclusion in order to decide on further treatment if pregnancy does not occur.

b) The professionalism of doctors.

The whole scheme of actions for the insemination cycle is described above. Thus, the reason for failure may be:

• delay in sperm preparation,
• low quality of biological media used in semen processing in this clinic,
• insufficiently accurate time of ovulation and insemination not at the optimal time, lack of verification that ovulation has occurred, the appointment of an ovulation provocateur with an undergrown or overgrown follicle / s,
• thin (undergrown) endometrium in the uterus.

If you feel negligence, contradictions in the actions of the doctor, you should think about changing the clinic or doctor.

c) Bad luck.

If you do not find reasons for failure in reasons a) and b) and have only done 1-2 cycles of insemination, most likely you are just not lucky yet.

You can apply ovarian stimulation, if it was absent, change stimulation drugs, carry out 2-3 inseminations in a cycle, if only 1 was carried out, increase the time of sexual abstinence for a man before donating sperm (up to 5 days). The absence of pregnancy during even several cycles of inseminations does not mean that a woman cannot become pregnant during natural sexual activity with a healthy man.

Based on the information collected and the experience of those who have gone through insemination, consultations with many fertility doctors, try to understand whether it is worth resorting to AI in your case and how to do it all. Maybe AI is your chance!

Submit your good stories! They will give real hope to those who are thinking and doubting or afraid of failure!

Unfortunately, not every woman is given to experience the happiness of motherhood through natural insemination. Due to various physiological and psychological reasons, many of the fair sex experience certain difficulties in conceiving. In this case, various methods of artificial insemination may be the only possible way to defeat diagnosed infertility. What is the difference between artificial insemination, in vitro fertilization and other types of ART? Which method is the most reliable and safe? A small medical educational program will help you understand the features of the most popular procedures and make an informed decision that will help the couple experience the thrill of parenthood.

When should you consider artificial insemination?

Assisted reproductive technologies used in medicine are relevant in the case of diagnosed infertility in a woman or her partner, which could not be stopped by medical and surgical therapy. Suspicion of a disappointing diagnosis may arise if a couple of childbearing age has an active and regular sex life without the use of contraceptives, but the desired pregnancy does not occur within one year or more. This period can be extended depending on the age of the partners: for example, women over 35 and men over 40 may take longer to successfully conceive, despite full fertility.

And even after the diagnosis of "infertility" is made, one should not despair and consider artificial insemination methods as the only possible option - most of the causes of infertility are successfully treated with proper therapy. With a decrease in fertility, not only the woman, but also her partner will have to undergo a thorough examination, because, despite the prevailing stereotype, in about 30% of cases the cause of infertility lies precisely in the man, and another 15-20% are due to combined factors, in which an equal contribution both partners contribute to the emergence of a pathological situation. And only if infertility treatment does not bring the desired result, you will have to think about assisted reproduction.

Fertilization methods: classification and features

Modern approaches to assisted reproductive technologies are not limited to in vitro fertilization - there are many different ways to help desperate spouses have a child, it all depends on the diagnosis, the causes of infertility, and the characteristics of the patient's history. The most common types of ART are:

• artificial insemination;
• various types of IVF, including short and long protocols, using donor material (spermatozoa or eggs), additional manipulations that increase the chance of successful implantation (ixie, pixie, etc.).

Let's take a closer look at each of the proposed methods.

artificial insemination

Such medical manipulation is one of the simplest and most natural methods of assisted reproduction. In this case, the previously cleaned and processed partner's ejaculate is injected directly into the woman's uterus through a thin catheter, which significantly increases the chance of successful fertilization. The high efficiency of the proposed method in comparison with the natural process is explained by the fact that the seminal fluid does not have to independently overcome the fallopian tubes, and the special processing of sperm before insemination makes it possible to increase the concentration of active germ cells and enrich the seed with nutrients necessary for fertilization.

Artificial insemination can be done for many reasons, but the most common ones are:

• seminal fluid pathologies that are not amenable to drug therapy;
• problems of an excretory nature in a man, in which the ejaculate cannot enter the uterus on its own;
• the special structure of the cervix, which makes it difficult for the seminal fluid to pass;
• irregular sex life.

If it is difficult to obtain a semen sample for the procedure (for example, with erectile dysfunction or obstruction of the seminal ducts), a puncture may be required to obtain ejaculate. If this procedure is also useless, you can use donor material.

Stages of artificial insemination

As before any serious medical procedure, before artificial insemination, a thorough examination of future parents is carried out for hidden pathologies and contraindications. Both a man and a woman must pass swabs for STIs and blood tests without fail. In addition, the patient may be assigned an ultrasound of the pelvic organs, and her partner - a triple spermogram.

After excluding contraindications, the attending physician conducts ultrasound monitoring of ovulation, which allows you to determine the most optimal moment for artificial insemination. As soon as the eggs are ready for fertilization, the centrifuged semen is directly introduced into the uterine cavity. If the expectant mother has reproductive problems (for example, lack of ovulation or disturbed hormonal levels), mild pharmacological stimulation may first be required.

The procedure itself is absolutely painless, and therefore does not require anesthesia or subsequent hospitalization. It will be possible to evaluate the effectiveness of the artificial insemination carried out no earlier than after 14-16 days (using a conventional pregnancy test). It is possible and necessary to confirm the result in 3-4 weeks with the help of ultrasound.

All about in vitro fertilization

To date, IVF is one of the most effective methods that allows you to cope with diagnosed infertility that is not amenable to either medical or surgical treatment. The process of in vitro fertilization itself implies that the conception will be carried out "in vitro", that is, outside the body of the expectant mother. The standard IVF method includes several key steps:

• hormonal stimulation with pharmaceuticals;
• Ultrasound monitoring, which allows you to track the process of maturation of follicles;
• puncture of the mature germ cells of a woman and obtaining the seminal fluid of a man (by any suitable method);
• artificial insemination of the obtained eggs with partner (or donor) sperm and cultivation of zygotes;
• transfer of embryos into the uterine cavity;
• hormonal support that allows the embryo to take root;
• diagnosis of the effectiveness of the manipulations.

This list can vary significantly depending on the history and condition of the patient, so the necessary IVF protocol is determined only by the attending physician after detailed diagnosis and research.

Hormonal stimulation before IVF

Stimulation of ovulation before in vitro fertilization can be carried out according to a short and long protocol. The first method is usually recommended for women under 35 years of age with primary replanting. Short hormone therapy is carried out with relatively small doses of drugs, rarely causes side reactions, but is less effective than a long one.

A long protocol significantly increases the number of mature eggs capable of fertilization, allows you to control the process of ovulation, and therefore increases the likelihood of successful fertilization. However, a long course of high doses of hormones in this case increases the risk of pituitary complications in the expectant mother. This method is usually prescribed for older patients or women with a history of unsuccessful IVF attempts.

Ultrasound monitoring of ovulation

Ultrasound examination allows you to evaluate the effectiveness of hormonal stimulation, determine the number and degree of maturation of follicles. If the woman's reproductive system does not respond to hormones (or does not respond enough), the cycle is considered unsuccessful, and the doctor either interrupts the protocol or adjusts the dosage of the drug. If everything goes according to plan, an egg puncture is scheduled for artificial insemination.

Fertilization "in vitro"

When the ultrasound shows that the follicles are in the final phase of maturation, the patient undergoes aspiration of the eggs. The procedure itself is slightly painful, and therefore requires local anesthesia or general anesthesia. After the extraction of the follicular fluid, the most promising eggs are released from it, which are involved in the subsequent fertilization.

At the same time, the man must provide a fresh ejaculate sample required for the procedure. If the husband's sperm are absolutely not viable, donor material can be used in agreement with both patients.

Fertilization itself is carried out in the laboratory by the standard method of insemination or with the help of ixi, when the spermatozoon is introduced into the egg. The resulting zygotes are placed on a nutrient medium and sent to a thermostat for further cultivation. After 3-5 days, the most viable embryos are examined for the absence of various pathologies, after which they are prepared for replanting.

Transfer of the embryo into the uterine cavity

Usually, the time interval between puncture and replanting takes from 2 to 5 days, depending on the rate of embryo development and the condition of the expectant mother. To increase the success rate of in vitro fertilization, 2-3 most promising embryos are implanted - that is why the chance of multiple pregnancy after IVF is significantly higher than with natural conception.

The process of moving the embryos is carried out using a special catheter that passes through the cervical canal. The procedure is quite simple and usually takes no more than an hour, so the patient can be discharged home the very next day. However, for the onset of pregnancy after replanting, a woman will need a two-week hormonal therapy, which will allow her to maintain the desired phase of the cycle in the body.

The effectiveness of IVF is assessed only after 3-4 weeks by ultrasound, since standard pregnancy tests can give erroneous results due to hormone therapy.

The choice of one or another method of artificial insemination should be carried out after a thorough diagnosis of both spouses and in accordance with the recommendations of doctors, however, basic knowledge will allow you to make an informed decision. Only a thorough and scrupulous approach will help you overcome infertility and experience true happiness, holding a long-awaited baby in your arms!

Very often, when it comes to artificial methods of pregnancy, one of the most common methods is presented - IVF (in vitro fertilization of the egg). Indeed, the effectiveness of IVF has been proven by time. At present, they do not just agree to it, but stand in line so that the long-awaited pregnancy occurs. In addition to the fact that there is in vitro fertilization of the egg, few people know that there are other methods of artificial insemination. Each of the methods is carried out under certain conditions, has indications and contraindications, etc. Let us consider in more detail the most common types of artificial insemination, which include: ISM, ISD, ICSI, IVF, IVF OD, ZIFT, GIFT.

ISM

Intrauterine insemination with the husband's sperm, abbreviated as ISM. This fertilization of the egg is used in cases: when there are no changes in the reproductive system of a woman, that is, her fallopian tubes are passable and do not have convolutions, adhesions, etc. Artificial insemination with the help of ISM is carried out when the ability of sperm to fully conceive is reduced. With ISM, special conditions are created that give spermatozoa sufficient properties and fertilization, after the introduction of sperm into the uterus by artificial means, is successful. ISM is also used for incompatibility of spouses, the reason for which is the negative effect of uterine mucus on spermatozoa. The process of introducing spermatozoa directly into the uterus prevents the sperm from coming into contact with the vaginal mucus, which increases the chance of a favorable fusion of the egg with the spermatozoon. How many times can you inseminate? In one menstrual cycle at a favorable time for conception, insemination can be carried out 2 to 4 times.

ISD

In the event that it is found that the spouse's sperm is of poor quality or the barrier of incompatibility is insurmountable, the couple is offered artificial insemination with donor sperm on the basis of joint consent. In short, this fertilization is called ISD. The process of introducing sperm from a donor is not much different from the introduction of sperm from a husband. ISD and ISM occur under the same conditions. How many times can an ISD be done? Exactly as much as ISM - from 2 to 4 times in one menstrual cycle. They do artificial insemination, having previously prepared the woman's body. On the day of a favorable conception, prepared donor sperm is introduced into the uterine cavity. One ISM procedure is equivalent to a perfect sexual intercourse. According to statistics, the effectiveness of ISM is on average 40%, and ISD in 70% of cases.

GIFT

GIFT - artificial insemination, in which mixed sperm and an egg previously taken from a woman are transferred into the fallopian tube. The conditions under which successful fertilization occurs: the timeliness of the manipulation of the GIFT method, as well as the full patency of the fallopian tubes. Indications for carrying out are the same as for male infertility. How many times can you make attempts to connect the egg and sperm using the GIFT method? Given that ovulation occurs once in one menstrual cycle, then, accordingly, only one attempt can be made.

ZIFT

The ZIPT method is the fertilization of an egg outside the body of a woman, after which the embryo is transferred into the fallopian tube. It is believed that the ZIPT method greatly increases the likelihood of a new pregnancy. ZIFT and GIFT methods are done in a hospital using laparoscopy under ultrasound control.

The difference between the two methods is as follows. With the GIFT method, the introduction of a mixture of sperm and egg occurs from the side of the abdominal cavity (a small puncture is made), and with the ZIPT method, the formed embryo is inserted through the cervix.

How many times in one cycle can ZIPT be done? It is believed that only once, after ovulation in the woman's uterus prepared by hormonal preparations.

It is noteworthy that the last two methods are practically not done in our country.

ICSI

ICSI is a procedure for the fertilization of an egg, during which an intraplasmic injection of a spermatozoon is made. Just one single spermatozoon, the most active and viable, is placed in the thinnest needle and injected into the egg. The method is used when IVF attempts, as well as other methods of fertilization, have remained ineffective. This method also carries out artificial insemination in case of male infertility, when there are very few "full" spermatozoa in the semen. They are removed from the testicles by puncture and connected to the egg. The ICSI method is considered quite effective, since after it the fertilization of the egg occurs in every third woman.

ECO

IVF is the most common fertilization performed under artificial conditions outside the body of a woman. Indications for IVF: complete obstruction of the fallopian tubes or their absence (congenital, acquired), in which fertilization of the egg can never occur and the embryo can never enter the uterine cavity naturally; hormonal disorders; endometriosis; infertility of unknown origin, etc. The effectiveness of IVF has been proven by numerous successful pregnancies.

How is the IVF procedure carried out? First, with the help of special hormonal preparations, the hormonal background of a woman is rebuilt. With their help, you can suppress secretion and make the process of egg maturation manageable. During the preparation, the woman is at home and only visits a specialist as necessary. After that, the maturation of eggs in the ovary is stimulated. Mature oocytes under ultrasound control are extracted by puncture. At this time, the husband donates sperm, which, under special conditions, combines with the egg and is placed in an incubator for several days. After the fertilization of the egg has come, the embryologist monitors the development of the embryos. The most viable are transferred using a special catheter into the uterine cavity. After that, already at home, the woman is waiting for the results of a successful fusion of the sperm and the egg. A woman is prescribed hormonal drugs to consolidate the pregnancy and after 15 days you can do a pregnancy test. The appearance of two stripes on it indicates the production of hCG - human chorionic gonadotropin. Its presence indicates the onset of a long-awaited pregnancy. In the case when a woman does not have the maturation of full-fledged eggs, you can try the IVF OD method, which uses a donor egg. All other stages are exactly the same as in the IVF method.