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DEIVF in St. Petersburg
In vitro fertilisation (IVF) is one of the most effective treatments for infertility.
The procedure includes ovarian puncture to obtain eggs, fertilisation of eggs with semen by IVF or ICSI. After fertilisation comes the stage of embryo culturing which lasts from 2 to 7 days, after which the embryos can be transferred into the uterine cavity or cryopreserved.
When should one see a fertility specialist? If pregnancy does not occur during 6-12 months of regular intimate life without the use of contraception, it is likely that medical help is needed. In this case, it is necessary to consult a fertility specialist and explore the options.
IVF for single women in St. Petersburg
Single women are not restricted in any way. In this case, IVF is performed using donor material. This can be either donor semen (if the woman's eggs are suitable for fertilisation), donor eggs or embryos.
How many times one can do IVF?
The efficiency of IVF is 35-65%. This means that most couples get pregnant in the first three attempts at embryo transfer. Unfortunately, there are situations when a longer treatment may be necessary.
The number of ovarian stimulations is not limited, according to Russian recommendations, a break of 1 month between the cycles is required. Frozen embryo transfer is not accompanied by hormonal changes, so in this case no breaks are necessary.
Is IVF painful?
Injecting medications may be unpleasant, but many drugs are injected with syringe pens subcutaneously into the anterior abdominal wall, making their use almost painless. Only one procedure requires anaesthesia - ovarian puncture - and this is performed under intravenous anaesthetic.
What is the success rate of IVF?
The efficiency also depends on the number of IVF attempts, the equipment of the clinic and the experience of fertility specialists. Therefore, the success rate of IVF varies from clinic to clinic. On average, the success rate of the first attempt in young women with a relatively favourable course of infertility is between 30 and 50%. In women aged 42+, the first attempt leads to pregnancy in a maximum of 10% of cases. It is possible to increase the success rate by transferring PGT-a tested embryos.
Possible risks
Like any other kind of treatment, IVF has certain risks, even if it is carried out in the best clinic in St. Petersburg. The main ones are:
Other complications associated with IVF include bleeding after puncture, pelvic inflammatory diseases, allergies to medications, termination of pregnancy, and others.
Even when infertility treatment is carried out in a well-equipped clinic with the best doctors, it is impossible to completely eliminate these risks, only to minimise them.
Indications for IVF
The procedure, indications, contraindications and other features of the use of assisted reproductive technologies, including IVF, are prescribed in the Order of the Ministry of Health of the Russian Federation No. 803n of 31.07.2020.
Indications for an IVF cycle categorise in two ways: infertility and situations where an IVF cycle may reduce the risk of complications for the couple or their future children.
Infertility that can be treated more effectively with IVF cycle than with other methods
When treatment for 6-12 months using other methods has not resulted in pregnancy
The presence of genetic diseases or when one of the patients or both of them are carriers of genetic diseases with a high inheritance risk
Habitual miscarriage of pregnancy
HIV discordant couple
Sexual dysfunction that prevents sexual intercourse
Infertility in Women
Infertility in a couple can be due to both female and male factors, and even a combination of both. In women, infertility can be caused by:
- Anovulation due to hormonal disorders, increased prolactin levels, stress, psycho-emotional overstrain or ovarian issues
- Egg quality and quantity decline (usually age-related)
- Fallopian tube disorders
- Pelvic adhesions
- Intrauterine pathology: polyps, adhesions, uterine myomas
- Congenital and acquired malformations of reproductive organs
- Endometriosis
The cause of infertility can not always be identified, even with the most careful examination. In such cases, a diagnosis of "infertility of unclear genesis" is made. If the cause has been identified, the doctor determines the exact form of infertility. It can be:
Hormonal (endocrine) infertility
Endocrine infertility develops as a result of abnormalities in the hypothalamic or pituitary hormones, increased prolactin production, and ovarian disorders (e.g., polycystic ovarian syndrome).
Tubal factor infertility
It may occur in one or both fallopian tubes. The causes of tubal infertility may be inflammatory diseases, infections (chlamydia, trichomoniasis, genital tuberculosis), adhesions, congenital anomalies, and endometriosis.
Uterine factor infertility
Congenital anomalies: hypoplasia (underdevelopment) of the uterus, uterine cavity septum, uterine doubling and many others. Acquired pathologies develop due to inflammation inside the uterine cavity (it may be a complication of surgery or abortion), the formation of an endometrial polyp or submucosal uterine myoma.
Endometriosis-associated infertility
The exact mechanism of endometriosis-associated infertility is unknown. It may interfere with the fertilisation of the egg by the sperm, cause inflammation and obstruction of the fallopian tubes, and form cysts in the ovaries, destroying follicles and eggs.
Once the diagnosis is determined, the fertility specialist suggests the suitable method of overcoming infertility.
If the chosen treatment method does not result in pregnancy within 6-12 months, the reproductologist may recommend undergoing an IVF cycle.
Infertility in Men
In men, infertility may develop due to the following causes:
Varicocele
Hypogonadism
Cryptorchidism
Antisperm antibodies
Testicular tumours
General/systemic diseases
Erection/ejaculation disorder
Idiopathic infertility
Due to these, various disorders of spermatogenesis (the process of "maturation" of spermatozoa) may develop, which are detected by a spermogram. Such disorders include:
Asthenozoospermia
Asthenozoospermia is characterised by a decrease in the number of progressively motile spermatozoa below 32%.
Oligozoospermia
A decrease in the number of spermatozoa in the ejaculate of less than 15 million/ml or a decrease in the total sperm count of less than 39 million.
Azoospermia
No sperm in the ejaculate
Teratozoospermia.
An increase in the percentage of abnormal sperm in a sperm sample
The following types of male infertility are distinguished:
Secretory infertility
This type may be temporary (develops with short-term exposure to provoking factors) and permanent.
Excretory infertility
This may be caused by inflammatory diseases of the male genital organs, trauma, etc.
Immunologic infertility
In this form, a man's body produces anti-sperm antibodies that can interfere with pregnancy.
Idiopathic infertility
There are no known reasons.
As in women, it is not always possible to determine the exact causes of male infertility. Nevertheless, this unpleasant fact does not negate the need for a comprehensive examination of both partners.
Treatment of male infertility may also include surgical procedures, hormone therapy or assisted reproductive technologies. In other words, IVF is not always performed when a woman is infertile. Male infertility is also an indication for different types of assisted reproductive technologies, including in vitro fertilisation.
Examinations before IVF
Both partners should be examined prior IVF, regardless of who has been diagnosed with infertility.
The doctor collects an anamnesis, finds out about any complaints, asks questions about menstrual function, the presence of genetic and any other diseases. If the couple has been previously examined or treated for infertility, they should provide the specialist with medical records.
Contraindications
The list of contraindications in the Order of the Ministry of Health of the Russian Federation No. 803n of 31.07.2020 includes:
Infections and parasitic diseases - active forms of tuberculosis, HIV infection (except for subclinical stage or stages of secondary diseases in remission), acute viral hepatitis or chronic viral hepatitis in the exacerbation phase, active forms of syphilis;
Any type of malignant tumours - without the permission of the attending oncologist;
Benign tumors of the uterus or ovaries that require surgical treatment;
Blood diseases (leukaemia, lymphoma, lymphogranulomatosis, severe anaemia, acute porphyria, severe antiphospholipid syndrome, haemorrhagic vasculitis with severe recurrent course);
Mental illnesses (affective disorders, psychoses, dementia) with severe persistent manifestations or a high probability of exacerbation due to pregnancy and childbirth;
Severe diseases of the nervous system with marked motor and mental disorders;
Diseases of the circulatory system (chronic rheumatic heart disease accompanied by marked circulatory insufficiency, pulmonary hypertension or thromboembolic complications, heart defects, certain types of cardiomyopathy, aortic diseases, vascular aneurysms, hypertension stage 2B-3 in the absence of effect from therapy);
Severe respiratory failure;
Diseases of the digestive system (liver failure, liver cirrhosis in the presence of portal hypertension with risk of bleeding, fatty liver dystrophy, complicated forms of Crohn's disease, complicated non-specific ulcerative colitis, celiac disease with impaired absorption in the small intestine, hernias of the anterior abdominal wall and intestinal fistulas without the possibility of surgical correction);
Diseases of the genitourinary system (acute glomerulonephritis, chronic glomerulonephritis in the acute stage, renal failure with creatinine level over 200 µmol/l).
Obstetric pathology (vesicular calculus (including less than 2 years ago), chorionepithelioma);
Diseases of connective tissue and musculoskeletal system (rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, systemic scleroderma, Sjögren's syndrome - severe course with rapid progression);
Congenital anomalies of uterine development in which implantation of the embryo is impossible, complicated heart defects with marked circulatory insufficiency pulmonary hypertension, some anomalies and malformations of other systems;
Traumatic injuries to the uterus that make it impossible to become pregnant or carry a pregnancy to term.
Not all contraindications are absolute reasons for refusing IVF. In some cases, treatment may be given to treat a specific condition or to stabilise the patient's condition. After this, in vitro fertilisation may be considered again.
IVF procedure
First, the doctor selects an ovarian stimulation protocol for the woman. Then sex cells are obtained from both partners. At the next stage, the fertilisation of the egg is performed and the embryos are cultured. The last step of the IVF procedure may be embryo transfer and subsequent monitoring of the pregnancy or cryopreservation of the embryos. If necessary, additional procedures and steps may be applied.
Depending on the type of chosen treatment, the following additional steps may take place: ICSI fertilisation, embryo cryopreservation, trophectoderm biopsy and pre-implantation genetic testing of embryos (PGT or PGD).
Ovarian stimulation
All protocols can be divided into two groups - without and with hormonal stimulation of ovulation.
The first group includes only one protocol - a natural cycle IVF. In this case, the follicle grows on without medication.
However, it requires increased supervision and has a number of disadvantages. Firstly, only one, maximum two eggs can be obtained in a natural cycle. Secondly, there is a possibility of spontaneous ovulation, so that the puncture will have to be cancelled. Thirdly, due to the fact that the egg is most often received only one, there is a risk that it will not fertilise, or the embryo will not develop properly. Therefore, IVF in the natural cycle is performed most often in patients with a very low ovarian reserve.
Hormonal ovarian stimulation is used in most IVF cycles to increase the treatment efficiency.
There are several varieties of hormonal stimulation protocols, and all protocols use three types of medications:
- To ensure follicle growth;
- To block premature ovulation;
- To trigger the ovulation.
Ovarian puncture and egg retrieval
After stimulation and the ovulation trigger, the next stage is egg retrieval.
This operation is a minor surgical intervention, does not require hospitalisation and is performed quickly. Nevertheless, this stage is very important because the quality of the oocytes will depend on the correctness of the puncture. Also the quality of the oocytes can be affected by improper preparation. The exact fulfilment of the doctor's instructions at the stage of hormonal stimulation is of decisive importance. Injections of drugs should be done strictly at the specified time and strictly according to the schedule. Exactly the same time you need to come to the clinic for puncture. In most cases, the procedure is carried out under anaesthesia, so it is necessary to come to the clinic on an empty stomach (do not eat or drink anything for 6 hours before the puncture).
Fertilisation
The next IVF step is fertilisation of retrieved eggs.
At this point, the male patient becomes involved in the treatment process.
On the same day as the puncture, the male partner provides a semen sample.
ICSI
In case of low sperm counts or after sperm have been obtained surgically, intracytoplasmic sperm injection (ICSI) into the egg should be used.
An embryologist "manually" selects the most "correct" sperm and then injects it into the egg. Special microscopes with micromanipulators are used for ICSI. They allow the egg to be fixed and the sperm to be precisely inserted in the right place using a microscopic glass needle. The egg is then transferred to a special embryo culture medium.
Embryo culture
The IVF procedure necessarily includes embryo cultivation.
Embryos are cultured in special incubators that create conditions as close as possible to the natural environment of reproductive organs: temperature, humidity, gas composition.
Embryos are placed in cups with a special medium that contains all the necessary nutrients. In modern embryology, single step cultrure media are used, in order to avoid additional actions such as transferring the embryo from one cup to another, allowing it to remain in comfortable conditions. Culture in the incubator lasts from 2 to 7 days. On the 5th to 7th day after fertilisation, the embryos become blastocysts. At this stage, the blastocyst can be biopsied for genetic testing, frozen or transferred into the uterus.
Preimplantation genetic testing (diagnosis) of embryos (PGT or PGD of embryos)
Once the embryos have become blastocysts, a few cells can be safely taken from them for genetic testing. There are three types of genetic testing for embryos:
PGT-A
PGT-M
PGT-SR
There are medical indications for each type of PGT. The most commonly used method is embryo testing for aneuploidy (PGT-A). The indications for this test are:
The age of the woman is over 35 years
Sex-linked inherited diseases in patients
Previous unsuccessful IVF attempts
Severe spermatogenesis disorders
A history of habitual miscarriage
Desire to improve the efficiency of embryo transfer
In order to perform genetic testing, a few cells must be taken from the embryo. At the blastocyst stage, this is a safe procedure that does not affect the further development of the embryos.
The cells are taken from the trophectoderm (outer cell mass) from which the placenta will later form.
The inner cell mass (from which the fetus will grow) remains untouched.
After the trophectoderm biopsy, the embryo is frozen (cryopreserved).
This must be done because genetic testing takes an average of 14-21 days. Samples taken during the biopsy are also frozen and can be sent to the lab any time.
In our clinic, genetic testing is performed by NGS (next generation sequencing).
It is a last generation technology that provides the most reliable results.
Embryo cryopreservation (vitrification)
Embryos at the blastocyst stage tolerate cryopreservation (freezing) very well.
We use vitrification technology used for embryo freezing. Cryopreserved embryos can be stored for any length of time without losing their quality.
In our clinic, the embryo thawing rate is 99.6%
Cryopreservation ensures that none of your embryos are lost.
Embryos are frozen on a special carrier - a cryotope - and then placed in a specially equipped and protected storage where the temperature is maintained at -1960C. The cryopreservatory is located in the clinic and is reliably protected from power fluctuations and other emergency situations.
Embryo transfer
Our fertility specialists recommend single embryo transfer to reduce the risk of multiple pregnancies.
Embryo transfer into the uterine cavity can be done in the same cycle ("fresh" transfer) on day 5 after follicle puncture. If the embryos have been frozen, the procedure of preparing the endometrium and transferring the thawed embryos is called Frozen Embryo Transfer (FET)
On the day of transfer, the embryo is thawed and the embryologist assesses its viability. Then the embryo is transferred into the uterine cavity.
FET can be performed in the natural cycle (without hormonal preparations or with a minimal amount of them) or with the hormonal therapy. In both cases, the transfer is performed in the middle of the second half of the menstrual cycle, during the opening of the implantation window.
Pregnancy testing is performed in 10-14 days after embryo transfer.
A woman takes a blood test for chorionic hormone (hCG). If its level is higher than 50ME/ml, it means that pregnancy has occurred.
Then, 21 days after the embryo transfer, the woman will have a pelvic ultrasound scan. During the examination, the doctor will see whether the fetal egg is attached in the uterus and rule out an ectopic pregnancy.
Success rates
At Delta Fertility Clinic, 90% of IVF cycles are performed with preimplantation genetic testing, which increased the pregnancy rate to 58.1% in 2021. If we compare this with the overall pregnancy rate in Russia, it was 32.3% in 2019.
