Who is assigned a short eco protocol. What are the chances of getting pregnant in a long IV protocol

In vitro fertilization is a method of artificially stimulated conception. It consists of several stages, which doctors call the protocol. The number and duration of each period is selected for a woman individually. The most common are the short and long protocols.

The scheme of the long IVF protocol by day is much longer than that of the short one. On average, its duration is 40-50 days. It is believed that this time is enough to provide a stable artificial background of hormones and get maximum amount viable oocytes.

Statistics show that after a long protocol, the IVF procedure was successful in 34% of couples.

Since all protocols differ significantly from each other in their duration, number and dosage of the drugs used medical preparations, you should be aware of their features.

In order for in vitro fertilization to be successful, you need to follow a few important conditions. One of them is the maximum number of "extracted" oocytes from which many viable embryos can be grown.

To achieve this goal, specialists must fully control the hormonal background of a woman. This can be done on one condition: to suppress natural production hormones, replacing it with an artificial one. Such a "substitution" allows to exclude malfunctions in the functioning hormonal system, providing the necessary conditions optimal ovarian function.

A long IVF protocol is prescribed if a woman has indications in the form gynecological pathologies(for example, endometriosis), or after an unsuccessful short IVF protocol, when it was not possible to obtain the right amount oocytes.

The features of the long protocol are that the woman's body is carefully prepared before ovarian stimulation. Preparation begins a week before menstruation. This preparation looks like this:

The regulation phase takes two weeks. In the process of taking medication, the natural hormonal background of a woman is suppressed.

The process of stimulating superovulation. In the next 14-18 days, doctors begin hormonal stimulation of the ovaries: the patient takes medications selected in an individual dosage. The drugs reduce and then completely block the production of luteinizing hormone. Through this process, the follicles in the ovaries mature faster.

It will take at least a month to get "quality" oocytes. In this case, the stimulation process itself will take about 14 days. During this period, the patient is under special attention doctors who, using ultrasound control, track how follicles grow.

In some cases, when a woman has pathologies reproductive system, it will take more than long time. In this case, reproductologists prescribe a super-long IVF protocol. The duration of this preparation for in vitro fertilization is several months.

After tests and other examinations (ultrasound) have confirmed that superovulation has occurred, the doctor performs a puncture of mature eggs. Received oocytes, being in laboratory conditions, pass the stage artificial insemination. After they "ripen" for 3-5 days in a test tube, the reproductologist, having chosen the strongest ones, puts them into the woman's uterine cavity. That is, the transfer of embryos takes place.

Indications and restrictions

The long protocol is considered a universal IVF technology. However, first of all, an increased time of the in vitro fertilization procedure is prescribed if the patient has a number of gynecological diseases:

• uterine fibroids;
• Cystic changes in the ovaries;
• endometriosis;
• Violations of the patency of the fallopian tubes;
• Absence of fallopian tubes;
• Increased production of androgen (male hormone);
• Excessive levels of luteinizing hormone resulting from age-related changes ovaries;
• Age over 40;
• Poor quality of oocytes identified as a result of other protocols.

A high hormonal load is not used if the patient has the following violations functioning of the reproductive system:

• Anatomical features of the uterus, due to which the embryo will not be able to attach to the uterine cavity;
• Oncological diseases of the pelvic organs and blood;
• Cardiac pathologies;
• Diabetes;
• Functional disturbances thyroid gland;
• Mental disorders.

It should be noted that there are a number of diseases that significantly reduce the chances of a successful conception with long protocol ECO. These include such violations:

• Poorly treatable inflammatory processes in the pelvic organs;
• Several surgical interventions on the pelvic organs in the past;
• Small supply of oocytes;
• Poor quality of seminal fluid from a partner.

However, each case is individual, so the choice of duration of treatment depends on the results of the examination of the couple and the final diagnosis, taking into account the associated problems.

How long does a long IVF protocol take?

The duration of a long IVF protocol depends on individual appointments reproductive specialist. However, when using it, time limits are defined: at least 30, but not more than 50 days.

The time interval of the stages is also regulated by the reproductologist. In the process of monitoring the hormonal background and the maturation of the follicles, the doctor can change the prescription and dosage of medications.

Scheme of a long protocol by day

The appointments of a long protocol for IVF are carried out by day. At the same time, the sequence and the beginning of each stage are extremely important for the successful outcome of the procedure.

Let's consider what a specific scheme of a long protocol looks like by day:

• For 20-25 days menstrual cycle the stage of blocking the natural hormonal background women. It is necessary to drink the appropriate drugs;
• By the 3-5th day of menstruation, ovulation is stimulated with hormonal drugs. The process is controlled by ultrasound;
• Once dominant follicle reaches 18 mm, the patient is injected with hCG;
• 36 hours after the injection, an ovarian puncture is performed;
• At the same time, the partner donates seminal fluid;
• After obtaining the biomaterial, the eggs are inseminated;
• Another 3-5 days are needed for embryos to grow in laboratory conditions;
• The transfer of embryos into the uterine cavity is appointed after this period;
• For 14 days, a woman should take hormonal drugs, the purpose of which is to support the onset of pregnancy;
• Two weeks after replanting, an hCG analysis is prescribed, which should confirm or refute the onset of pregnancy.

Pink indicates the zone when you can start doing a pregnancy test after insemination, or donate blood for hCG. Purple indicates the days when you can do testing after IVF.

At all stages of the long protocol, the reproductologist controls the condition of the woman, adjusting, if necessary, the intake of medications.

Drugs in the long IVF protocol

During a long protocol, two types of drugs are prescribed. At the stage of regulation, GnRH agonists (gonadotropin-releasing hormone agonists) are used, and during stimulation, ovulation inducers are used.

Decapeptyl in the long protocol is the same as other drugs that have a similar composition with gonadotropic female hormones, performs the following functions:

• Introduces the organs of the reproductive system into a state of artificial menopause;
• “Turns off” the work of the “main” organs of the reproductive system, excluding the “unplanned” start of ovulation;
• Included in the complex of products for the treatment of endometriosis, fibroids and other pathologies that require a super-long protocol.

To stimulate ovulation, support is prescribed in the form of medications, which are taken under the mandatory control of ultrasound (Puregon). They help better maturation of the follicles "Pregnil" and "Ovitrelle", and "Dufaston" and similar preparations containing progesterone support the pregnancy that has already begun.

During in vitro fertilization, very important point is strict observance specialist recommendations. Proper execution stages and protocols of medical influence can significantly increase the chances of a successful conception.

The fertilization protocol is called the sequence intramuscular injections various medicines that allow a woman to prepare for embryo transfer.

Currently, short and long IVF protocols are used. The drugs used in both cases are no different, but the frequency of administration changes. Doctors select each woman an individual way of using drugs. What are their differences?

IVF stages

Before understanding the schemes, the application medicines, it is worth understanding what the in vitro fertilization procedure is.

The whole process can be divided into the following steps:

• The first moment is stimulation in the ovaries of superovulation. This condition implies the simultaneous production of several full-fledged eggs by the body. The phase begins on the third day of the cycle and lasts about two weeks.
• Follicle puncture. Several eggs are taken from the woman's ovary, ready for fertilization. Produced on the 15th day of the cycle after stimulation.
• Embryo incubation. During this procedure, doctors fertilize by injecting sperm into the egg, and then achieve crushing of the zygote.
• Implantation of the egg in the uterus. Transfer is the final step.

After the embryo transfer, its development is supported by the hormone progesterone. And then exercise control for at least 14 days. The whole process can take quite a long time, you need to go through the procedures with qualified specialists.

Diaries and questionnaires of IVF protocols contain reminders of one or another stage of fertilization.

Protocol Differences

How are IVF types different? The following points can be highlighted:

1. In the short version, smaller doses are used medicinal substances.
2. The short protocol is better tolerated and less likely to cause unwanted drug reactions.
3. In the case of a long method, it often occurs severe complication- ovarian hyperstimulation syndrome.
4. The long protocol is carried out within six weeks, and the short one - less than a month.
5. If the woman is less than 30 years old, it is recommended to perform a reliable long option, and if there have been previous IVF attempts, or the age is over 35, it is worth using the short one.

In the long version, there is an additional stage before the stimulating phase. Therefore, it captures the previous menstrual cycle and starts from the third week. This approach provides more precise control over the growth of follicles and endometrium.

Long protocol

Doses of medicinal substances are selected by the doctor individually. In the course of a long scheme, diphereline and decapeptyl preparations, as well as gonadotropic agents, are used.

Long IVF protocol by day, scheme:

• The use of gonadotropic hormone agonists to suppress their own - at the 20th week of the cycle.
• Stimulation of ovulation - 3-5 days of the next menstrual cycle.
• HCG is injected 1.5 days before follicle sampling.
• Direct egg collection in the third week of the cycle.
• Sperm donation by a man on the same day.
• 3 days after collection, the egg is inseminated.
• 3 days after fertilization, the embryo is transferred into the womb of the expectant mother.
• Progesterone for at least two weeks to support the development of the baby.
• After two weeks, blood is taken to determine pregnancy.

Long IVF protocol is performed according to complex scheme Therefore, all procedures are performed under the supervision of specialists.

Short protocol

This method of carrying out the procedure is used to reduce the risks spontaneous ovulation, since drugs that suppress the LH peak are used during the short protocol.

With this method, the function of one's own glands normalizes faster. internal secretion. Reduces the risk of cysts forming inside the ovaries. The shorter duration of the regimen allows the woman to experience more stress. short span time.

How long does it take short protocol ECO? The term depends on the option used. The short protocol is performed in several versions:

1. The classic scheme involves blocking the production of pituitary hormones from the third day of the cycle. Gonadoliberins, glucocorticosteroids and folic acid are used. The puncture is carried out on the 14th day of the cycle. The rest of the procedure has been described above. A short IVF protocol by day takes from 20 to 35 days.
2. The Japanese IVF protocol is an ultra-short regimen that does not include pituitary blockade. In this case, an imbalance between the development of the endometrium and the growth of follicles is possible. However, this scheme allows you to reduce the duration of the procedure by a week.

There are other options for the procedure, but in the current realities, they decided to abandon them.

Diaries of IVF protocols are provided by doctors. These instructions allow you to clearly control the course of the manipulations.

Possible Complications

The IVF procedure cannot be called safe. During this method of conception, invasive methods of cell sampling are used, as well as intervention in the hormonal background of a woman.

Possible complications for the body:

• Depletion of the egg pool in the ovaries.
• Syndrome of hyperstimulation.
• Blocking the work of the glands due to hormonal agents.
• Early onset of menopause.
• Infectious and inflammatory processes.

Strictly follow the instructions of the specialist to avoid complications and failures during the procedure.

If a woman has problems conceiving, she can use in vitro fertilization. There are several types of IVF protocols, one of them is short, characterized by more short period ovarian stimulation. As a result, eggs are produced that can be fertilized. The difference in the protocols is observed only until the period of egg maturation. Then their scheme becomes almost identical.

There are two types of in vitro fertilization: a long protocol and a short one. At the first, drugs are prescribed that are responsible for suppressing the production of luteinizing hormone, and then the doctor prescribes drugs that grow follicles in the ovaries.

With a short protocol, they leave the natural hormonal background and consume medications that help against premature ovulation. Doctors conduct a thorough analysis of a woman's menstruation cycle, collect indicators of blood hormones, on which all the work of the endocrine organs rests.

A short IVF protocol by day begins in the woman's period.

It is divided into 4 stages:

1. Stimulation of superovulation.
2. Performing ovarian puncture.
3. Embryo incubation.
4. The introduction of a fertilized egg into the uterus by artificial means.

It all starts with the stimulation phase on day 3 of the cycle. The body at this time is almost not affected hormonal drugs. The patient is required to visit a doctor and donate blood for analysis. The doctor examines the woman to see if the uterine tissue has thinned after stimulation.

Stimulation, lasting two to three weeks, ends at the puncture stage, which begins 15-20 days after the start of the first phase. The egg follicles mature and are removed for fertilization. Before this stage, three or four days before, a woman is not recommended to have sex. The material obtained during the puncture is carefully examined under a microscope, the eggs are fertilized and transferred to the uterus. They are kept there until the zygote divides into 5-8 cells.

After two or three weeks (at the discretion of the doctor), the function is supported corpus luteum. Progesterone is responsible for this.

After another couple of weeks, the final stage begins, at which the pregnancy process is monitored and the patient's condition is monitored.

Short Protocol Differences

The protocol has such a name, since its duration is only 10-12 days. Its onset falls on day 4 of a woman's menstrual cycle. She starts injecting herself that day hormonal preparations.

During the period of stimulation of superovulation, hormonal drugs are used that stimulate the ovaries.

Their receptors respond to drugs, they are activated, the follicles are exposed to accelerated growth. If both ovaries respond to stimulation, it is perfect option. As a rule, a lot of cells are produced. But their quantity affects the quality and completeness of maturation. Therefore, the completeness of cell formation depends on the correctly selected scheme. A long protocol has an advantage in this regard.

Interestingly, at natural process only one ovum is produced rare cases two. It is located inside the follicle.

Subspecies

Short protocol divided into two subtypes:

• with agonists;
• with antagonists.

The first includes 6 stages. As noted above, the pituitary gland is blocked. The process begins on the third day of the cycle with stimulation. The whole stage takes 14-18 days. Folic acid, Dexamethasone is used. These substances are called agonists. On the 15th day they produce, after another 4 days the eggs are transferred. And then, after two weeks, it remains only to control the pregnancy.

How long is the short protocol? A subtype of the protocol with agonists lasts 30-35 days. It suppresses menstruation to eliminate the risk of cysts. The uterus is shrinking.

The short or ultra-short protocol, which uses antagonists, includes the same steps as the previous one, with the exception of the blockade of the pituitary gland. But there is a significant disadvantage here: the growth of follicles is subject to imbalance. It is either fast or slow. The duration of this period is from 26 to 30 days. An antagonist protocol is needed for women who have a small follicular reserve.

Doctors also allocate a clean protocol, in which there are no analogues of GnRH. Use a scheme that does not block the pituitary gland. Doctors prescribe medicines containing FSH hormones(follicle stimulating). For example, Puregon.

Advantages

With a short protocol, the risk of sudden ovulation is almost zero, since the drugs work to suppress the peak of luteinizing hormone. In this case, the pituitary gland quickly resumes its function. The body is subjected to stress and other negative factors in a much smaller size, so the risk of developing a cyst is significantly reduced. And the patient does not experience such a great psychological burden.

Opinions differ on the use of the short protocol. Someone is happy to shorten the whole process for a couple of weeks, and someone thinks that it is better to do everything slowly so as not to stress the body due to taking hormonal drugs.

The in vitro fertilization procedure involves the use of one or another combination of medical actions that ensure the onset physiological pregnancy through assistive technologies.

Entering the IVF protocol involves a number of special steps that prepare the female body for the implantation of a fertilized egg. Preparation is carried out with the help of hormonal effects on the patient's body and other secondary methods. The main stages of entry will be considered using the example of long and short in vitro fertilization protocols.

Depending on the woman's gynecological history and the presence of comorbidities, medical specialists reproductologists select an individual type of in vitro fertilization protocol for each patient. As indications for the implementation of a short protocol, there are:

• Previous attempts to implement one of the IVF protocols that were unsuccessful;
• The patient has no pathologies of the pelvic organs and problems with ovulation.

The long IVF protocol has the following list of indications for implementation:

• Previously failed fertilization episodes;
• Primary IVF in a patient who does not have functional and organic pathologies of the organs of the reproductive system;
• Uterine fibroids, endometriosis and other hyperplastic processes in the mucosa.

Short

Before you learn about entering the IVF protocol and what it is, each patient will need to prepare the body for this serious intervention. First of all, lifestyle modifications are recommended, and complete failure from bad habits at least 90 days before the start of the IVF protocol.

The next step is to examine the body, both the future mother and the future father. couple recommend doing a series laboratory research and ultrasound examination organs of the reproductive system.

Many patients who are preparing to enter into one of the IVF protocols are prescribed Inofert. This pharmaceutical drug contains folic acid, which reduces the likelihood of anomalies in the development of the neural tube in the unborn fetus. D

The duration of taking Inofert before entering the IVF protocol is at least 90 days. If a woman has problems with the structural and functional state of the endometrium, then reproductive specialists prescribe her a course of therapy with Norkulit.

Only if 100% complete female body to the process of hormonal stimulation and implantation of fertilized eggs, reproductologists begin the consistent implementation of one of the in vitro fertilization protocols.

A short IVF protocol has the following schematic form:

1. In the period from 2 to 12 days of the ovarian-menstrual cycle, the patient is prescribed hormonal stimulation of the body, the duration of which is about 14 days. To implement a short protocol, as a rule, a small amount of stimulant drugs is used. At the same time, reproductive specialists are laboratory control hormonal background of a woman;
2. From the 15th to the 20th day of the ovarian-menstrual cycle, the seminal fluid of the potential father is donated for laboratory analysis for quantitative and qualitative indicators, as well as puncture of the follicle of the expectant mother. The duration of the procedure for extracting female germ cells is no more than 40 minutes;
3. From the 18th to the 23rd day of the ovarian-menstrual cycle, fertilization of previously taken female germ cells is performed. The duration of this period is from 3 to 5 days;
4. From 22 to 28 days of the ovarian-menstrual cycle. The specified time period is used for the implantation of ready fertilized eggs into the uterine cavity of future mothers.

In order to control the effectiveness of the implemented in vitro fertilization protocol, on the 6th day from the moment of implantation of the zygote, the patient undergoes control test for pregnancy.

The average duration of the implementation of a short in vitro fertilization protocol from the moment of entry into it is 45 days. Since this type of IVF algorithm involves the use of minimal dosages of drugs, the patient is not at risk of such side effect like ovarian hyperstimulation. After it happened successful implantation of the finished embryo, in order to support it in the conditions of the mucous membrane of the uterine cavity, are used medicinal medicines based on progesterone.

Long

In order to fully implement this kind of in vitro fertilization algorithms, more than one ovarian-menstrual cycle is required. After completing the preliminary preparation of the female body and successfully passing the laboratory and instrumental methods study, on the 21st day of the cycle, a woman enters a long IVF protocol.

This procedure is characterized by the stage of inhibition of its own hormones in the female body, which allows you to control the process of egg maturation. In order to understand the specifics of this type of assisted reproductive techniques, it is necessary to familiarize yourself with its phased implementation:

1. The start of the IVF protocol occurs from the 21st to the 3rd day of the next ovarian-menstrual cycle. During this period, drug blockade of pituitary functions is carried out. The duration of this stage is from 12 to 15 days;
2. 3rd to 17th day of the cycle. During this period, the female body undergoes hormonal stimulation of the ovaries. The duration of the stage is from 2 to 3 weeks;
3. 36 hours before the follicle puncture, the patient is given an injection of hCG;
4. From the 17th to the 20th day of the ovarian-menstrual cycle, semen is taken from the future father for analysis, as well as the puncture of the finished follicles;
5. From the 20th to the 25th day of the cycle, medical specialists perform the fertilization of the taken eggs and monitor their condition;
6. From the 25th to the 27th day of the cycle, the implantation of the finished zygotes into the uterine cavity of the woman is performed.

The implantation phase is followed by a period of enhanced maintenance hormone therapy during which progesterone is used. aim this stage is to ensure favorable conditions to attach the finished embryo to the uterine endometrium. The duration of maintenance therapy is 14 days.

The successful entry and implementation of a long in vitro fertilization protocol can only be judged on the condition that 12-14 days after the end of the procedure, the woman received positive test for pregnancy.

The reproductive specialist who is responsible for the implementation of this procedure will tell you in detail about the day of the cycle from which the IVF protocol begins.

In vitro fertilization or IVF is a procedure that involves taking an egg from a woman and fertilizing it in a special dish, followed by placing the embryo in the woman's uterus.

There are several IVF protocols that involve different preparation for puncture and embryo transfer. Depending on the condition of the woman, the doctor may prescribe a long or short protocol. The latter is more gentle for the female body, consider how it goes.

Definition

Short protocol IVF is a program in which a woman takes hormonal drugs for only two weeks. The duration of the short protocol is no more than one menstrual cycle.

The main advantage of a short protocol over a long protocol is the need to take drugs in smaller quantities. Therefore, IVF is easily tolerated by women, and the cost of the procedure is lower.

But, unfortunately, the short protocol is not suitable for every woman. For patients with pathologies of the uterus and ovaries, the absence of ovulation, and over the age of 35, such a protocol is most likely not suitable.

In addition, in a short protocol, the doctor cannot affect the condition of the follicles and endometrium of the uterus, so the likelihood of pregnancy after replanting is low. With a short protocol, there is a high risk of spontaneous ovulation, in which case the procedure will have to be repeated in the next cycle.

Stages

A short IVF protocol begins with preparation. For this, a woman undergoes an examination by a gynecologist, a therapist, passes a general and biochemical analysis blood, as well as tests for HIV, syphilis, hepatitis and other infections. A woman must definitely undergo fluorography, ultrasound of the mammary glands and thyroid gland. If everything is in order, then prescribe medication.

Consider a short IVF protocol by day in detail:

• From the 3rd day of the menstrual cycle, gonadotropin-releasing hormone (GnRH) agonists are prescribed. These drugs act on the pituitary gland and cause ovulation to stop.
• The next stage of the short IVF protocol is prescribed follicle-stimulating and luteinizing hormone, which provoke ovarian superovulation. The duration of taking hormones is an average of 2 weeks.
• The next step is to puncture the eggs and donate the husband's sperm, after which they are fertilized for 3-5 days, keeping them in favorable conditions.
• 36 hours before the embryo transfer, the woman is given an injection of the hormone hCG to support the pregnancy.
• The next step is to transfer the embryos into the uterus.
• The protocol ends with the intake of drugs that support pregnancy.

The result of a short IVF protocol can be seen approximately 2 weeks after embryo transfer. To do this, a woman can do a pharmacy pregnancy test, or take an analysis for the level of hCG. Now you know how long the short IVF protocol lasts.