IVF 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.

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IVF for single women in St. Petersburg

It is not necessary to have a regular sexual partner to undergo in vitro fertilisation.

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?

From a medical point of view, there are no restrictions to IVF cycles other than the presence of contraindications to the procedure itself.

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?

Most of the procedures that are used in in vitro fertilisation are completely painless.

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 chances of success depend on various factors. The age of the woman is decisive.

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.

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Content

Possible risks
Indications for IVF
Infertility in Women
Infertility in Men
Examinations before IVF
Contraindications
IVF steps
Ovarian stimulation
Egg collection
Fertilisation
ICSI
Embryo culture
PGT
Embryo cryopreservation
Embryo transfer
Success rates

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:

Multiple pregnancy

High-performance clinics as Delta Fertility recommend transferring only one embryo. Even then, there is a small risk of "identical twins", when one embryo splits into two. This usually occurs in couples who have a family history.

Ovarian hyperstimulation syndrome

OHSS can develop as a complication of ovarian stimulation when too many follicles grow. The development of the syndrome can be prevented. In case of prevention, the probability is reduced to zero.

Ectopic pregnancy

Even though embryos are transferred into the uterine cavity, there is still a 2-5% risk of ectopic pregnancy. After transfer, the embryo is "looking" for a place to attach for several days and can sometimes get into a fallopian tube. Such a complication requires termination of pregnancy with further repeated IVF attempts. In most cases, ectopic pregnancies in IVF cycles occur in patients with impaired fallopian tube patency and inflammatory diseases.

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.

IVF in St. Petersburg and other cities of Russia is carried out according to this document.

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

It is characterised by menstrual irregularities that are caused by a lack of ovulation.

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

Characterised by impaired tubal patency, which prevents the sperm from entering the abdominal cavity and the fertilised egg from reaching the uterine cavity.

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

It develops in various congenital or acquired uterine diseases.

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

Endometriosis is one of the most common gynaecological diseases, when the endometrium from the uterine cavity gets through the fallopian tubes into the abdominal cavity and grows there.

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.

This may be surgical treatment, hormone therapy or an IVF cycle.

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

It is associated with the disruption of spermatogenesis.

This type may be temporary (develops with short-term exposure to provoking factors) and permanent.

Excretory infertility

When the process of passing the ejaculate through the genital tract is disturbed.

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 first step involves a consultation with a gynaecologist (for women) and an andrologist (for men).

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.

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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;

Доброкачественные опухоли матки или яичников

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).

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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.

Due to the absence of hormonal stimulation, it can be used in women for whom stimulation is contraindicated.

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.

It is carried out by ovarian puncture.

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.

Before the semen donation, the man is advised to abstain from ejaculation for 2-7 days, and to avoid taking a hot bath for 2 weeks before the procedure. Semen sample is provided by masturbation into a sterile container. In case of azoospermia or cryptozoospermia, spermatozoa may be obtained by puncture or biopsy. The quality of the sperm will determine the choice of a fertilisation method - IVF or ICSI.

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

For aneuploidy

It assesses the quantitative set of chromosomes and allows to select for transfer into the uterus only those embryos that can lead to pregnancy (they are called euploid embryos). Transferring such embryos results in pregnancy in 65-70% of cycles (i.e. twice as often as without testing).

PGT-M

For monogenic disorders

It is performed when one of the partners has genetic monogenic diseases or a predisposition to them. The analysis allows the selection of embryos that do not have the risk of carriage or disease.

PGT-SR

For chromosomal rearrangement

It is performed for genetic causes of non-pregnancy when one partner has "mixed up" parts of chromosomes that can interfere with carrying a pregnancy to term.

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.

взятие клеток для генетической диагностики

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)

Криоконсервация (витрификация) эмбрионов

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

Some women achieve pregnancy with their first embryo transfer, while others have several unsuccessful attempts. In IVF, it is believed that pregnancy should occur after a maximum of 3 embryo transfer attempts. Sometimes the fertility specialist has to choose other protocols or prescribe additional procedures.

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.

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Verified article

Dr. Inga Gorelova

Ph.D. of Medical Sciences, Fertility Specialist

Doctors
Clinic
Prices

Fertility Specialists

The clinic for reproductive solutions in St. Petersburg

The cost of IVF treatment in Delta Fertility

In vitro fertilization program

2500 €

Ovulation stimulation, anesthesia, follicle puncture, in vitro fertilization, embryo cultivation, embryo transfer. Additionally paid for: medications, tests, ICSI of up to/more than 10 eggs - 500/700 euro. Vitrification of up to 5 embryos - 450 euro, each subsequent one - 50 euro. 3 months of embryo storage - free of charge. Trophectoderm biopsy of up to 5 embryos - 450 euro, each subsequent embryo - 50 euro. PGT-A of each embryo - 400. Embryo thawing - 400 euro.

Second In Vitro Fertilization Program

1920 €

Second ovulation stimulation, anesthesia, follicle puncture, in vitro fertilization, embryo culture, embryo transfer. Repeated in vitro fertilization program without embryo transfer - 1570 euro

Natural cycle IVF program

1820 €

Anesthesia, follicle puncture, in vitro fertilization in the natural cycle, embryo cultivation in the natural cycle, embryo transfer. Program without transfer - 1470 euro.

Mini stimulation IVF program

1970 €

Ovulation stimulation, anesthesia, follicle puncture, in vitro fertilization, embryo cultivation, embryo transfer. IVF program with minimal stimulation without embryo transfer - 1620 euro.

Intrauterine insemination

600 €

Preparation of ejaculate, insemination procedure

Frozen embryo transfer

1000 €

Embryo/s thawing, transfer into the uterine cavity

IVM program

2120 €

Anesthesia, follicle puncture, IVM (pre-cultivation), IVF/ICSI fertilization, embryo culture and vitrification. Storage is charged additionally.

IVM program with egg freezing

1390 €

Anesthesia, follicle puncture, IVM (pre-cultivation), oocytes vitrification. Storage is charged additionally.

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IVF in St. Petersburg

WE WILL HELP YOU

Content

Possible risks

Multiple pregnancy

Ovarian hyperstimulation syndrome

Ectopic pregnancy

Other complications associated with IVF include bleeding after puncture, pelvic inflammatory diseases, allergies to medications, termination of pregnancy, and others.

Indications for IVF

Infertility in Women

Hormonal (endocrine) infertility

Tubal factor infertility

Uterine factor infertility

Endometriosis-associated infertility

Infertility in Men

Varicocele

Hypogonadism

Cryptorchidism

Antisperm antibodies

Testicular tumours

General/systemic diseases

Erection/ejaculation disorder

Idiopathic infertility

Asthenozoospermia

Oligozoospermia

Azoospermia

Teratozoospermia.

Secretory infertility

Excretory infertility

Immunologic infertility

Idiopathic infertility

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.

Examinations before IVF

Contraindications

IVF procedure

Ovarian stimulation

The first group includes only one protocol - a natural cycle IVF. In this case, the follicle grows on without medication.

Hormonal ovarian stimulation is used in most IVF cycles to increase the treatment efficiency.

Ovarian puncture and egg retrieval

Fertilisation

ICSI

Embryo culture

Preimplantation genetic testing (diagnosis) of embryos (PGT or PGD of 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

The cells are taken from the trophectoderm (outer cell mass) from which the placenta will later form.

After the trophectoderm biopsy, the embryo is frozen (cryopreserved).

In our clinic, genetic testing is performed by NGS (next generation sequencing).

Embryo cryopreservation (vitrification)

In our clinic, the embryo thawing rate is 99.6%

Embryo transfer

On the day of transfer, the embryo is thawed and the embryologist assesses its viability. Then the embryo is transferred into the uterine cavity.

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.

Success rates

Dr. Inga Gorelova

Fertility Specialists

Dr. Inga Gorelova

Dr. Aleksander Makolkin

Dr. Aleksandra Nazarova

Dr. Irina Menshikova

The clinic for reproductive solutions in St. Petersburg

The cost of IVF treatment in Delta Fertility