Artificial insemination. How often is IVF used?
In vitro fertilization (from lat. extra - outside, outside and lat. corpus - body, that is, fertilization outside the body, abbr. ECO) is an assisted reproductive technology used in case of infertility. Synonyms: “in vitro fertilization”, “in vitro fertilization”, “ artificial insemination", in English language abbreviated IVF (in vitro fertilization). This technology allows women to become mothers in the most hopeless cases. IVF is carried out in all developed countries of the world and every year several thousand “test tube babies” are born. For believers, among whom there are also childless people, the question quite reasonably arises: is this method acceptable from the point of view of the Orthodox Church? Let's try to understand how IVF happens and what consequences it leads to.
A bit of history
During IVF, the egg is removed from the woman's body and fertilized artificially in "in vitro" ("in vitro") conditions, the resulting embryo is kept in an incubator, where it develops for 2-5 days, after which the embryo is transferred into the uterine cavity for further development.
For the first time successfully medical technology was applied in the UK in 1977, resulting in the birth of Louise Brown in 1978, the first human "conceived in a test tube". The first child (girl) conceived through IVF in the Soviet Union was born in February 1986. The procedure was performed in Moscow, at the Center for Maternal and Child Health, now called Science Center obstetrics, gynecology and perinatology (SC AGiP). A little later, in Leningrad, in the same 1986, the boy Kirill was born. These events were preceded by serious research, which began to be purposefully carried out in the Soviet Union since 1965. At this time, a group of early embryogenesis was created, which in 1973 grew into a laboratory of experimental embryology (headed by Prof. B. Leonov). According to 1994 data, more than 1.5 thousand children were born in this laboratory. In 1990, there were over 20,000 test-tube babies on our planet. In 2010 - about 4 million. The IVF procedure reaches the highest intensity in Israel, where there are 3400 IVF procedures per 1 million inhabitants per year.
Indications:
Indications for the IVF procedure are various forms male and female infertility. According to order N67 of the Ministry of Health of the Russian Federation, an indication for IVF is “infertility that is not amenable to therapy, or the likelihood of overcoming it with IVF is higher than with other methods. In the absence of contraindications, IVF can be carried out at the request of a married couple (a woman who is not married) with any form of infertility.
Contraindications: Contraindications for IVF are the conditions of a woman in which pregnancy and childbirth threaten the health of the mother or child, namely:
somatic and mental illness, which are contraindications for carrying pregnancy and childbirth;
congenital malformations or acquired deformations of the uterine cavity, in which it is impossible to implant embryos or carry a pregnancy;
ovarian tumors;
benign tumors of the uterus requiring surgical treatment;
sharp inflammatory diseases any localization;
malignant neoplasms of any localization, including history.
There are no contraindications for IVF by a man.
Technology
IVF technology is carried out in specialized medical institutions in conditions outpatient treatment. To carry out the in vitro fertilization procedure, it is necessary to obtain eggs, obtain spermatozoa, carry out in vitro fertilization, grow an embryo, and insert the embryo into the woman's uterine cavity.
As a rule, for in vitro fertilization, they try to get several eggs, as this increases the effectiveness of infertility treatment by this method. Since it is normal for a woman for one menstrual cycle If one egg matures, then in order to obtain several eggs, the so-called “superovulation stimulation” procedure is carried out. For this, the patient is prescribed injections of hormonal drugs.
Oocyte maturation cannot be directly determined by non-invasive methods. Therefore, the maturation of eggs is judged indirectly by the growth of ovarian follicles. The growth of follicles is observed using ultrasound machines. Upon reaching dominant follicle of a certain size (16-20 mm), an egg retrieval procedure is prescribed - a puncture of the ovarian follicles. Follicle puncture is carried out under general (more often) or local (less often) anesthesia, the needle is carried out transvaginally, the course of the needle is controlled by an ultrasound machine. The purpose of the puncture is to aspirate (suction) the contents of the follicle (follicular fluid). The resulting fluid is examined using a microscope to detect eggs.
The detected eggs are washed from the follicular fluid and transferred to a laboratory dish with a culture medium. Petri dishes or culture plates are used as laboratory glassware. Dishes with eggs are placed in incubators, where they are kept until fertilization.
Usually, the use of hormonal drugs and follicle puncture does not cause negative reactions in the patient, but sometimes complications may occur. A complication of superovulation stimulation is ovarian hyperstimulation syndrome (OHSS), which can develop several days after the end of stimulation. OHSS occurs when a large number of follicles mature, which, transforming into corpus luteum, secrete a large number of estrogen. At severe course OHSS may require hospitalization of the patient. A complication of follicle puncture may be ovarian hematoma.
If it is impossible to obtain eggs from the patient (lack of ovaries, menopause, etc.), it is possible to use donor eggs (that is, the eggs of another woman). An unselfish donor (relative, friend) or a paid donor can act as an egg donor. The conditions for working with an egg donor are regulated by order N67 of the Ministry of Health of the Russian Federation
If it is impossible to use the husband's sperm (according to medical indications) or if the patient does not have a sexual partner, it is possible to use donor sperm. The use of donor sperm is subject to the mandatory written consent of the spouse and is regulated by Order N67 of the Ministry of Health of the Russian Federation. According to this order, the donor's sperm is used no earlier than after 6 months of storage in a frozen state in order to obtain data on the absence during this period infectious diseases from a sperm donor.
IVF is directly carried out by embryologists in the conditions of an embryological laboratory. Fertilization itself is carried out in one of two ways:
1) insemination in vitro;
2) intracytoplasmic sperm injection (ICSI, ICSI).
At first, more easy way a suspension of spermatozoa is added to the eggs that are in a nutrient medium. Spermatozoa are added at the rate of 100-200 thousand per egg. Within 2-3 hours, one of the sperm enters the egg and thereby fertilizes it. In the second method (ICSI), the spermatozoon is introduced into the egg "manually" using microsurgical instruments. ICSI is used when sperm quality is very poor, when fertilization cannot be obtained even in a cup.
After the penetration of the sperm, the egg is considered an embryo. The probability of successful fertilization is 60-70%. The embryos contain artificial conditions 2 to 6 days
The transfer of the embryo into the uterus is carried out 2-5 days after the fertilization of the egg. The procedure does not require anesthesia (pain relief) and is performed on a gynecological chair within a few minutes. The embryo is transferred to the uterus by passing a special elastic catheter through the cervix. According to order N 67 of the Ministry of Health of the Russian Federation, it is not recommended to transfer more than 4 embryos into the uterine cavity in order to avoid multiple pregnancy. Modern practice IVF in Russia is such that they usually transfer 2 embryos.
The effectiveness of in vitro fertilization (IVF) in general is about 30-35%. The value may vary depending on age, the causes of infertility, the qualifications of doctors and the level of the clinic (due to the fact that material and technical equipment is of no small importance). Of the 20 pregnancies that have occurred, an average of 18 will end in childbirth. After the introduction of embryos once every 3 days, it is necessary to control the level of hormones in the blood. After 12 days, a pregnancy test is performed.
In the case of multiple pregnancy, at the request of the woman, reduction is performed - the removal of unwanted embryos. Reduction is carried out for a period of 5 to 13 weeks, the best period is considered to be 8 and 9 weeks. In its meaning, reduction is the same abortion, only with it not all conceived children are destroyed, but one or several, and one, two or (rarely three) remain to live and develop.
For up to 6 weeks, reduction is performed using a vacuum aspirator, which is introduced into the uterine cavity to the "unnecessary" embryo and sucked off. For a period of 7-8 weeks, a special needle penetrates invaginally into chest cavity embryo and make an injection of calcium chloride, after which the baby dies and his body dissolves. At periods of 9 to 13 weeks, exactly the same needle remains the reduction tool, only it is inserted through the pregnant woman's stomach. This method is considered the most convenient and safest for the rest of the fetus and the woman herself.
childbirth
Childbirth during pregnancy after IVF is no different from normal. In cases where the cause of infertility is a woman's disease, childbirth is carried out taking into account a specific disease and this has nothing to do with the method of fertilization.
According to doctors, children conceived in a test tube are no different from the rest. Nevertheless, there is an opinion that such children learn better, but are much more impulsive and get sick more often. Some doctors believe that this may be due to overprotection of the desired child.
Church opinion
In her white paper "Fundamentals of the Social Concept" (2000), Russian Orthodox Church considers various problems bioethics, which include issues of overcoming infertility. The morally acceptable methods of overcoming infertility include "artificial insemination with the husband's reproductive cells, since it does not violate the integrity of the marriage union, does not fundamentally differ from natural conception, and occurs in the context of marital relations."
The church gives a disapproving assessment of those in vitro fertilization options that use donor sperm, donor eggs or a surrogate mother: “The use of donor material undermines the foundations of family relationships, since it implies that the child, in addition to “social”, also has so-called biological parents. “Surrogate motherhood”, that is, the carrying of a fertilized egg by a woman who, after giving birth, returns the child to “customers”, is unnatural and morally unacceptable ... ". The Church also opposes those IVF options in which they can be obtained knowingly large quantity embryos than is necessary for transfer to the uterus: “Morally unacceptable with Orthodox point of view are also all varieties of in vitro (out of body) fertilization, involving the preparation, conservation and deliberate destruction of "excessive" embryos. It is on the recognition of human dignity even for an embryo that the moral assessment of abortion, condemned by the Church, is based. It is the reduction procedure that forces you to say “No” to IVF, since the destruction of live embryos is considered murder.
The Church also draws attention to the fact that: “The use of reproductive methods outside the context of a God-blessed family becomes a form of theomachism carried out under the guise of protecting human autonomy and misunderstood individual freedom.”
Artificial insemination
Artificial insemination
Artificial insemination is the process of fertilization, which is carried out by introducing sperm directly into the uterus (artificial insemination) or by the in vitro method (outside the body, "in vitro"), i.e. extracorporeal (IVF).
Types of artificial insemination:
- artificial insemination with husband's or donor's sperm (IISM/IISD);
- in vitro fertilization (IVF).
Depending on the testimony of a woman, an artificial insemination program is selected.
- Intrauterine insemination is the introduction of specially prepared sperm using a special catheter directly into the uterine cavity.
So sperm doesn't pass barriers acid environment vagina and dense protective mucus of the cervix, and immediately enters the neutral environment of the uterine cavity.
After that, the spermatozoa independently move to the fallopian tubes and the egg is fertilized in the same way as during natural sexual contact.
According to the literature, artificial insemination of a woman as a treatment for infertility has been used for more than 100 years. This procedure carried out only in specialized medical clinics under the condition complete examination men and women.
It is mandatory to study the condition of the uterus and fallopian tubes - hysterosalpingography ( x-ray examination using contrast agent) or laparoscopy (examination of the uterus using optical instrument- laparoscope) to verify the patency of the reproductive tract.
For insemination, both native ("live") and cryopreserved sperm (previously thawed) can be used. Sperm before artificial insemination is cleaned and concentrated.
Artificial insemination is recommended for women with increased viscosity of cervical mucus or acidity of the vaginal environment. On the part of the partner, there may be indications such as erectile dysfunction, a decrease in the number of motile spermatozoa, or increased viscosity sperm etc.
The procedure is carried out in the operating room of the clinic, on a gynecological chair with a special syringe with a catheter, through which the sperm is introduced into the uterine cavity. After this procedure, you must lie down for 15-20 minutes. The procedure does not require anesthesia.
- IVF - in vitro fertilization - is a method of artificial insemination, in which male spermatozoa and female eggs (previously extracted from the ovaries) are combined outside the body, in vitro (in "glass", i.e. in a laboratory test tube).
There, independent fertilization takes place, and the resulting embryos (1 or 2) are transferred a few days later to woman's uterus, where one or both are implanted in the endometrium (the lining of the uterine cavity) and develop over 9 months.
Ovulation stimulation is carried out for 2-3 weeks to obtain eggs hormonal drugs. After several eggs mature at once, the reproductologist removes them from the ovaries (performs a puncture of the follicles) and transfers them to the embryological laboratory.
Artificial insemination by ICSI- This is one of the varieties of IVF. In this case, the embryologist, using special instruments under a strong magnification of the microscope, injects the most fertile spermatozoon into the egg.
The embryo obtained after such fertilization is no different from the embryos conceived naturally, and also, after a few days, it is transferred to the woman's uterus and develops for 9 months. This method successfully used in patients with male factor infertility, when there are deviations from normal indicators semen or after a TESA biopsy for azoospermia.
Donor programs for artificial insemination
If one of the spouses does not have their own healthy sex cells, IVF can also be carried out with donor sperm, a donor egg. Before donating their germ cells, a donor undergoes a thorough medical genetic examination. Artificial insemination with donor sperm is carried out only after a double examination with an interval of 3 months.
For couples where it is contraindicated for a woman to bear a child (for example, with severe heart disease) or it is physically impossible (due to the absence of a uterus), IVF is used with a surrogate mother.
Another great advantage of IVF is that during the cultivation of embryos in the embryological laboratory there is the possibility of preimplantation genetic diagnosis of the embryo. This method allows you to identify (if any) genetic diseases, chromosomal abnormalities, developmental anomalies (malformations). Unlike many other clinics, VitroClinic performs PGD on the entire set of human chromosomes (that is, on all 46 chromosomes). After such an analysis, only healthy embryos will be transferred to the uterus.
Before any IVF program, the couple undergoes a thorough medical examination to identify possible contraindications. The list of such examinations is regulated by the Order of the Ministry of Health and is strictly observed in our clinic.
Where to do artificial insemination?
Before consulting a doctor about overcoming infertility, any married couple asks the question: “Where can artificial insemination be done at a high professional level?”
Before choosing such a clinic, adhere to the following recommendations:
- The clinic should employ narrow specialists specifically in the treatment of infertility: gynecologists-reproductologists, urologists-andrologists, embryologists and geneticists.
- The artificial insemination center should use in its work only high-quality and original medicines and expendable materials for IVF.
- True professional reproductive specialists work with each couple individually, i.e. choice of method, stimulation schemes and support early dates pregnancy is selected by a specialist only after a thorough study of the anamnesis of the spouses, past IVF experience (if any), age, health status at this moment and many others
- Experienced reproductologists use sparing hormonal stimulation schemes, taking care of the health of their patients and avoiding hyperstimulation.
- To exclude multiple pregnancy, the reproductologist should transfer only one or two embryos (according to indications). Three or more is not allowed.
- The specialists of the clinic you have chosen must be proficient in all the most modern techniques in reproductive medicine: ICSI, PICSI, assisted hatching, genetic diagnostics of the embryo, etc.
- Semen analyzes should be carried out in the laboratory of the clinic itself by specialist embryologists who evaluate not only the morphology of the spermatozoa, but also their fertility.
- Choose a clinic that cooperates with a clinical diagnostic laboratory certified according to international standards ISO. The quality of the analyzes performed essential role in preparation for IVF.
- Make sure in advance that from the initial consultation to the end of the entire IVF program or artificial insemination You will be guided by the same reproductologist (except for force majeure situations). This indicates the responsibility and focus of the doctor and the clinic on a positive result.
- Give preference to those clinics where doctors leave their contacts to patients for communication. You will be able to call or write to email your doctor if you need any clarification or have questions.
- It is good if in the same clinic where you will do IVF there is an opportunity to stay to observe the pregnancy. Doctors, knowing all the nuances of your pregnancy, and having continuity among themselves, will do everything to bring it to the end - the birth of a healthy child.
- The price in Moscow for artificial insemination programs in different clinics can vary significantly. Be sure to check with the manager how much artificial insemination costs and what exactly is included in each program you are interested in, whether it is possible to add some additional services there, for example, ICSI or hatching, whether there are options with donor cells and embryos. A wide range of different programs is a big plus for the clinic. This means that in this artificial insemination center, doctors are proficient in all modern ART techniques and can afford to choose any program for each couple.
Artificial insemination is not a method of treating infertility, but a method of overcoming infertility. Thus, it overcomes obstacles to achieve pregnancy. Currently, artificial insemination is used to overcome almost any cause of infertility and allows you to bypass many problems with conception.
32. Fertilization of eggs outside the body of the animal (in vitro)
A positive value - despite the low yield of oocytes, with each extraction the possibility of repeated use of the animal.
33. Features of in vitro fertilization of eggs in females different types s.-x. animals
Development of a system of fertilization and provision early stages The development of mammalian embryos outside the animal body (in vitro) is of great importance in solving a number of scientific problems and practical issues aimed at increasing the efficiency of animal breeding.
For these purposes, embryos in the early stages of development are needed, which can only be extracted surgical methods from the oviducts, which is laborious and does not give a sufficient number of embryos to carry out this work.
Fertilization of mammalian eggs in vitro includes the following main stages: maturation of oocytes, capacitation of spermatozoa, fertilization and provision of early stages of development.
Oocyte maturation in vitro. Big number germ cells in the ovaries of mammals, in particular in cattle, sheep and pigs with high genetic potential, represents a source of enormous potential for the reproductive ability of these animals in accelerating genetic progress compared to using the possibilities of normal ovulation. In these animal species, as in other mammals, the number of oocytes that ovulate spontaneously during heat is only a small fraction of the thousands of oocytes present in the ovary at birth. The rest of the oocytes regenerate inside the ovary or are commonly said to undergo atresia. Naturally, the question arose whether it was possible to isolate oocytes from the ovaries by appropriate processing and carry out their further fertilization outside the body of the animal. Currently, no methods have been developed for using the entire stock of oocytes in the ovaries of animals, but a significant number of oocytes can be obtained from cavitary follicles for their further maturation and fertilization outside the body.
At present, only in vitro maturation of bovine oocytes has found application in practice. Oocytes are obtained from the ovaries of cows after the slaughter of animals and by intravital extraction, 1-2 times a week. In the first case, the ovaries are taken from animals after slaughter, delivered to the laboratory in a thermostated container for 1.5-2.0 hours. In the laboratory, the ovaries are washed twice with fresh phosphate buffer. Oocytes are extracted from follicles with a diameter of 2-6 mm by suction or cutting the ovary into plates. Oocytes are collected in TCM 199 medium with the addition of 10% blood serum from a cow in heat, then they are washed twice and only oocytes with compact cumulus and homogeneous cytoplasm are selected for further maturation in vitro.
AT recent times a method has been developed for intravital extraction of oocytes from the ovaries of cows using an ultrasonic device or a laparoscope. In this case, oocytes are aspirated from follicles with a diameter of at least 2 mm, 1-2 times a week from the same animal. On average, 5-6 oocytes per animal are obtained once. Less than 50% of oocytes are suitable for in vitro maturation.
A positive value - despite the low yield of oocytes, with each extraction the possibility of repeated use of the animal. Sperm capacitation. An important step in the development of the method of fertilization in mammals was the discovery of the phenomenon of capacitation of spermatozoa. In 1951 M.K. Chang and at the same time G.R. Austin found that fertilization in mammals occurs only if the sperm is in the animal's oviduct for several hours before ovulation. Austin coined the term capacitation based on observations on the penetration of rat spermatozoa at various times after mating. It means that some physiological changes must occur in the spermatozoa before the spermatozoon acquires the ability to be fertilized.
Several methods have been developed to capacitate ejaculated sperm from domestic animals. A medium with high ionic strength was used to remove proteins from the surface of spermatozoa that appear to inhibit spermatocapacitation.
However, the method of capacitation of spermatozoa using heparin has received the greatest recognition (J. Parrish et al., 1985). Straws with frozen bull semen are thawed in a water bath at 39°C for 30–40 s. Approximately 250 µl of thawed semen is layered under 1 ml of capacitation medium. The capacitation medium consists of a modified Tyroid medium, without calcium ions. After incubation for one hour upper layer medium with a volume of 0.5-0.8 ml, containing the majority of motile spermatozoa, is removed from the tube and washed twice by centrifugation at 500 g for 7-10 minutes. After 15 minutes of incubation with heparin (200 µg/ml), the suspension is diluted to a concentration of 50 million spermatozoa per ml.
Fertilization in vitro and provision of early stages of embryo development. Fertilization of eggs in mammals takes place in the oviducts. This makes it difficult for the researcher to study the environmental conditions in which the process of fertilization takes place. Therefore, an in vitro fertilization system would be a valuable analytical tool for studying the biochemical and physiological factors involved in the successful mating of gametes.
Apply the following scheme of in vitro fertilization and cultivation of early embryos of cattle. Fertilization in vitro is carried out in a drop of modified Thyroid medium. After in vitro maturation, the oocytes are partially cleared of the surrounding expanded cumulus cells and transferred in a microdroplet of five oocytes each. A sperm suspension of 2-5 µl is added to the medium with oocytes to achieve a sperm drop concentration of 1-1.5 million/ml. 44-48 hours after insemination, the presence of oocyte crushing is determined. Then the embryos are placed on a monolayer of epithelial cells for further development within 5 days.
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So, if the conception of a child traditional way(when fertilization occurs in the fallopian tubes of a woman with the sperm of a man that got there as a result of sexual intercourse) is impossible due to:
obstruction or absence of the fallopian tubes;
endometriosis;
male factor infertility (decrease in sperm motility and sperm count, up to total absence spermatozoa in the ejaculate);
immunological factor of infertility -
and given that previous attempts to overcome infertility within 12-18 months have been ineffective, it may be worthwhile to resort to the opportunities that ECO.
The necessary conditions for ECO:
consent of both partners;
the absence at the time of the start of treatment of signs of acute and chronic inflammatory processes in the genital organs of women and men;
absence pathological changes in the uterine cavity;
absence pathological formations in the ovaries.
Before the procedure, a thorough examination of the spouses is necessary - to increase the chances of pregnancy and reduce the risk possible complications.
For woman Exploratory survey includes:
consultation and examination by a gynecologist-endocrinologist;
ultrasound procedure; consultation of a therapist and other specialists - as prescribed by the attending physician;
colposcopy (examination of the cervix);
examination for infections: toxoplasmosis, cytomegaly, herpes, chlamydia, syphilis, gonorrhea, hepatitis A and B, vaginal smear for purity, bacteriological analysis of discharge cervical canal;
hormonal examination.
For a man, a preliminary examination includes:
consultation and examination by an andrologist;
ultrasound examination (if necessary);
extended spermogram with determination of spermatozoa morphology, bacteriological analysis of semen, hormonal examination, biochemical research sperm (fructose, citric acid, zinc).
How it's done?
1. Stimulation of superovulation. On the first or third day of the cycle, a woman begins to take medicinal product(for example, menogon), stimulating the activity of the ovaries. The fact is that usually one egg matures in one cycle. Under the influence of stimulant drugs, several eggs mature, and this increases the chances of success ECO. Developing follicles ("vesicles" in which the egg matures) are under constant control: based on ultrasound data, their size is estimated, the level of estrogens, progesterone and luteinizing hormone is determined in the blood 2
, the condition of the cervical mucus (i.e., the mucus in the cervix) is assessed. Usually, the follicles reach the required size within 8-10 days, after which the woman is injected with a hormone chorionic gonadotropin, which ensures the final maturation of the eggs.
2. Extraction of eggs. An ultrasound probe with a special puncture needle attached to it is inserted into the vagina. The doctor carefully pierces the largest follicles and collects mature eggs. The entire procedure is performed on an outpatient basis. During egg collection, the woman is in a state of mild medication sleep (intravenous drugs are used for anesthesia, soothing and relaxing nervous system).
3. Obtaining spermatozoa. Spermatozoa are either extracted from the ejaculate, or, in the absence or insufficient number of spermatozoa in the ejaculate, they are “extracted” directly from the testicle or from the epididymis. Spermatozoa do not have to be used immediately after being removed from the body: they can be frozen and stored in special tanks - while after thawing, all their properties are restored.
4. Sorting of eggs and sperm. The most mature and high-quality eggs are selected under a microscope. The spermatozoa are placed in an aquatic environment, and the most viable and mobile ones immediately “rush into the swim” (then they are caught), while the inactive ones remain in place.
5. Fertilization of eggs and cultivation of embryos. After the eggs have lived for 4-6 hours in an incubator, in special culture dishes with a nutrient medium, prepared spermatozoa are planted on them (moreover, from 50,000 to 100,000 spermatozoa fall on one egg). Spermatozoa stick around the egg and secrete an enzyme that helps them get inside. Everyone strives, but only one succeeds. As soon as one of the spermatozoa is inside, the barrier is activated, blocking access to the remaining “outside”. The infiltrated spermatozoon (male gamete) and the nucleus of the egg unite. Fertilization has occurred - two cells have merged into one. The cell starts dividing. After 48-72 hours, the embryos consist of 4-8 cells and are ready for transfer to the woman's body.
6. Transfer of embryos into the uterine cavity carried out using a special catheter. To increase the chances of success, 2-3 embryos are usually introduced. This procedure is painless. After a successful transfer, the doctor prescribes drugs that support the development of embryos (progesterone, human chorionic gonadotropin - hCG). Two weeks later, the level of hCG in the blood is determined. In three weeks fertilized egg can be seen with an ultrasound.
After transferring several embryos into the uterine cavity, it is possible to freeze the remaining ones and store them for a long time for later use if it is not possible to save this pregnancy. The use of frozen embryos allows a woman to avoid repeated ovarian hormonal stimulation, as well as ovarian puncture procedures.
The effectiveness of the procedure ECO depends on the laboratory where it is carried out. On average in the world it is from 20 to 40%. However, pregnancy ECO has its own characteristics. First, often when female infertility the hormonal mechanisms of the female reproductive system are unable to properly support pregnancy, and it is necessary to prescribe an appropriate replacement during most, if not the entire pregnancy hormone therapy. However, it remains increased likelihood spontaneous abortion. Second, after ECO more often than usual, multiple pregnancies occur. This is due to the fact that several embryos are transferred into the uterine cavity in order to increase the likelihood of implantation. Multiple pregnancy quite often (up to 50% of cases) is complicated spontaneous miscarriages and premature births. In order to reduce the likelihood of miscarriage, after a period of 10 weeks of pregnancy, the reduction of "extra" fetuses can be carried out (stopping the development of the fetus by puncture of the fetal sac under ultrasound control).
As you can see ECO is a complex multi-stage process, the success of which depends on many factors.
History of Louise Brown
Spouses Brown (Great Britain) always wanted to have children. Boy and girl. But despite their best efforts, Mrs. Brown could not get pregnant. Just at this time, British doctors announced the creation of a revolutionary method for overcoming infertility. Mrs. Brown decided that this was her last hope. Doctors took an egg from her ovary and fertilized it in a test tube with sperm obtained from Mr. Brown. After making sure that everything was in order with the fertilized egg and she began to divide, the doctors moved her to the uterus of Mrs. Brown. Nine months later, Mrs. Brown gave birth to a daughter, who was named Louise.
Before the birth of Louise Brown (in 1978), women with blocked fallopian tubes and men with insufficient sperm count were doomed to infertility. The "test tube conception" method has given a chance to many couples who previously had no hope of having a baby.
The development of the in vitro fertilization method began with artificial insemination, the first successful case of which dates back to 1799, when the husband's sperm was injected into his wife with a warm syringe. For many, the birth of Louise Brown was a sign that scientists had gone too far, that they had decided to equal themselves with God, to interfere in the very process of creation.
"Bottlenecks" of fertilization
In order for the conception and subsequent development of pregnancy to be successful, it is necessary that the “solitaire” made up of many “cards” converge. For example:
in the brain, hormones that stimulate the development of the egg should be formed and released in time;
the resulting egg must be “high-quality” and not have chromosomal defects;
the egg must mature;
must be formed in the brain enough luteinizing hormone, which stimulates the final maturation of the egg;
the egg must successfully exit the follicle (the moment of ovulation);
the fallopian tube must "catch" the egg;
sperm must enter the vagina alive, quickly pass through it, overcome the mucous barrier of the cervix, reach the fallopian tube and find the egg there;
spermatozoa must be able to get through the membranes of the egg;
the spermatozoon must undergo a number of biochemical transformations and "introduce" its DNA (23 chromosomes) into the egg;
a fertilized egg must have the ability to divide;
a newly formed embryo should divide and develop normally;
after three days after fertilization, the embryo must reach the uterus;
the embryo should turn into a two-layer embryo;
this embryo must "hatch" from its shells;
the endometrium - the lining of the uterine wall - must be ready to receive the embryo;
the embryo must "stick" to the wall of the uterus and "introduce" into it ...
Then follows a series of mysterious and important events associated with the subsequent development of the child.
Egg donation
The use of a donor egg is an effective method of treating infertility in all women, except for those whose infertility is caused serious illness uterus. ECO with an egg donor may be recommended for women whose own eggs are of poor quality or cannot be obtained through ovarian stimulation.
Procedure:
1. A female egg donor, chosen by an infertile couple, undergoes a thorough comprehensive examination to identify infectious and genetic diseases.
2. An agreement is signed between all parties involved.
3. The infertile female recipient is taking drugs that prepare the endometrium to receive the fetus.
4. Mature donor eggs are retrieved from the ovary and laboratory conditions fertilized with sperm obtained from the partner of an infertile woman.
5. Within three days, the embryos develop "in vitro" and then transferred to the uterus.
ICSI - ICSI - Introcytoplasmic sperm injection - injection of sperm into the cytoplasm of the egg
ICSI involves the introduction of one sperm directly into the egg (rather than placing the eggs and sperm in the same culture dish with nutrient medium). To begin with, as always ECO, the ovaries of a woman are subjected to drug stimulation, then the eggs are removed from them. For the introduction of spermatozoa, special microscopes, needles and micromanipulation equipment are used. The spermatozoa are extracted from the ejaculate. In the absence of spermatozoa in the ejaculate, they resort to a variation of the ICSI method, “extracting” spermatozoa directly from the testicle (TESA) or from the epididymis (MESA). 
Who is shown ECO with ICSI?
All couples with severe male infertility who refuse insemination with donor sperm.
ICSI procedure:
1. A mature egg is held with a special pipette.
2. A single spermatozoon is held and immobilized with a thin and sharp hollow needle.
3. With the same needle, the ovum membrane is carefully pierced and injected into the cytoplasm of the ovum.
4. The spermatozoon is injected into the cytoplasm and the needle is carefully removed.
ICSI provides more likely fertilization and, according to some reports, the onset of pregnancy than in general with ECO. This is due, in particular, to the fact that couples with male infertility usually resort to ICSI, while the eggs are of good quality, and the woman's body is ready for pregnancy. However, it should be borne in mind that male infertility is often associated with genetic defects of the Y chromosome, which, of course, are transmitted to offspring. male. This should be taken into account when choosing ICSI as a method of assisted reproduction, if possible, conducting appropriate genetic studies.
The frequency of birth of children with gross malformations, conceived by the method ECO and ICSI, no higher than with conventional conception.
Sperm donation
Insemination with donor sperm is an effective method of treatment male infertility(it should be noted, however, that the recently developed ICSI method allows, even with very low sperm counts, i.e. in cases where donor sperm was previously required, to still achieve fertilization with the husband’s spermatozoa) or a solution to the problem for a single woman who plans to pregnancy.
Procedure:
1. All donors are carefully screened by the sperm bank for infectious diseases such as AIDS, hepatitis and other infections. Sperm is frozen and stored for 6 months, after which it is re-examined.
2. The donor is selected according to the desired external characteristics: ethnicity, eye color, hair color, height, weight, blood type, etc.
3. Frozen donor sperm is removed from the sperm bank and delivered in a special container to medical clinic where it is planned to be used.
4. A woman determines the moment of ovulation (there are many methods for determining ovulation - a wide variety).
5. On the day of ovulation, the processed sperm containing the purified fraction of motile spermatozoa is introduced into the uterine cavity using a thin and soft catheter. This operation is completely painless.
6. The success of donor insemination depends on the age of the woman and her reproductive health.
How to assess the "quality" of embryos
Unfortunately, there is no single accepted system for assessing the "quality" of the embryo in the world. As a rule, the following indicators are taken into account: the number of cells, the orderliness of their arrangement, the degree of fragmentation, the thickness of the membranes around the embryo, etc.
Usually the quality of the embryo is assessed no earlier than 48 hours after egg retrieval. By this time (by the end of the second day) there should be at least two cells, it is better if the embryo consists of 3-4 cells. After 72 hours (by the end of the third day), the embryo should consist of at least from 6 cells, and preferably from 7 or more. In general, embryos with more cells, in an orderly arrangement, and without fragmentation are more likely to survive. Embryo quality is assessed under a microscope ECO-laboratory, which allows predicting the likelihood of pregnancy after embryo transfer. However, in this process many more factors intervene, which at the present level of development of science cannot be taken into account, therefore the forecasts obtained do not always come true.
Surrogacy
Surrogate motherhood is a way to overcome the infertility of a woman who herself cannot bear and give birth to a child (due to the absence of a uterus, habitual miscarriage).
In this case, the egg of an infertile woman, fertilized by the sperm of her husband, is introduced into the uterus of a woman who is able to bear and give birth to a child. The biological parents of a child are considered to be a couple who gave an egg and sperm for the formation of an embryo, and the woman who carried their child was called a surrogate (“auxiliary”, “replacement” mother).
Initially, surrogate mothers were most often relatives of a childless couple, but recently surrogate motherhood has become a profession - biological parents pay money healthy woman, consonant to the implantation and bearing of someone else's embryo.
Surrogacy is the most complex (and, accordingly, expensive) program in the ECO. Attracting a third person to the birth of a child, made possible as a result of almost fantastic progress medical science, made it possible to feel the joy of motherhood for women whose infertility was previously insurmountable, but at the same time posed a number of new ethical and legal problems for doctors and patients.
