Follicle puncture during IVF. Preparation for follicle puncture. Pregnil during IVF: what is it for? How to puncture follicles

Introduction.
It is important to remember that no two patients are identical, there is no single examination and treatment regimen suitable for everyone, several IVF attempts can differ significantly even in the same patient. The tactics of conducting each IVF attempt, preparation for it, and the choice of drugs are determined individually. This is why you may find that, for example, your second IVF attempt will differ from the first, as well as from what may be offered to other patients. It is precisely because of this that you should not compare the results of the examinations and the methods used with what is recommended for other patients, even if, as you think, a lot is the same. We should not forget that for many patients the need to resort to IVF is a strong psychological stress, and discussing such problems can be very unpleasant for them.

What can increase the effectiveness of treatment

For women:

For men:

Some explanations on infertility treatment using IVF:
Oddly enough, treatment may begin a month earlier than the planned treatment cycle. The preparation methods described below are not mandatory; their use is determined individually.

How to prepare medicine and give an injection

1. Wash your hands well.

Preparation for follicle puncture.
The next 3-4 days before the puncture - sexual rest. The day before the puncture, have a light lunch and tea in the evening. In the morning on the day of the puncture, you cannot eat or drink. It is advisable not to smoke or chew gum on this day.

On the day of the puncture
At the clinic, you will be taken to a room where you will change clothes, an anesthesiologist will talk to you, after which you will be taken to the operating room. Follicular puncture is performed under general intravenous anesthesia. On average, a puncture takes 15–40 minutes, depending on the response of the ovaries and the number of follicles.

• Increased belly size
• Severe bowel movements
• Nausea, vomiting
• Unusual back pain

• Intimate relationships
• Sports activities
• Mastering new sports
• Lifting weights

Pregnancy test.

• Lost pregnancy
• Laboratory error.

Introduction. We advise you to familiarize yourself with these recommendations before starting your IVF treatment. This will save you from having to ask yourself a lot of questions, the answers to which can be difficult to find.
It is important to remember that no two patients are identical, there is no single examination and treatment regimen suitable for everyone, several IVF attempts can differ significantly even in the same patient. The tactics of conducting each IVF attempt, preparation for it, and the choice of drugs are determined individually. This is why you may find that, for example, your second IVF attempt will differ from the first, as well as from what may be offered to other patients. It is precisely because of this that you should not compare the results of the examinations and the methods used with what is recommended for other patients, even if, as you think, a lot is the same. We should not forget that for many patients the need to resort to IVF is a strong psychological stress, and discussing such problems can be very unpleasant for them.
With a high degree of probability, we can assume that you will be assigned some kind of preliminary examination. To optimize your visit to the clinic for these tests, it is recommended to find out in advance what tests will be needed, whether an appointment is required, what time you need to be at the clinic, whether these tests are performed on an empty stomach, and whether the results of these examinations depend on the day of the menstrual cycle.
Infertility treatment using assisted reproductive technologies is carried out on the basis of your written statements, as well as informed consents, which must be filled out by you before the start of treatment.

What can increase the effectiveness of treatment

For women:

• Stop taking medications and bioactive food supplements on your own (“for general health”). If you are prescribed any treatment, please inform us before starting your IVF cycle.
• take multivitamins, preferably designed for pregnancy (prenatal vitamins), vitamin E, folic acid (necessity and dosage regimen - at the discretion of your doctor).
• limit or stop smoking and drinking alcohol, as these factors can reduce the likelihood of pregnancy and increase the risk of miscarriage.
• Limit your intake of drinks containing caffeine.
• Do not start a new diet or try to lose weight during an IVF treatment cycle. During this period, it is best to eat a balanced, nutritious diet.
• abstain from sexual activity 3-4 days before follicular puncture, as well as during the period after embryo transfer until pregnancy is diagnosed. If pregnancy occurs, sexual rest should be maintained for several more weeks.
• Avoid significant physical activity and intense sports. It is better to avoid extreme sports, horse riding or cycling during this period. Moderate physical activity and walking in the fresh air will be beneficial.
• Refuse to visit the bathhouse, sauna, or take baths for this period.

For men:

• An increase in temperature for several days due to any illness, such as a cold, can negatively affect the sperm count. If you have had a fever or if you have had an illness, even in a mild form, at the beginning or during treatment, notify your doctor.
• Visiting a sauna or taking a hot bath before treatment is not advisable due to the negative impact of high temperatures on spermatogenesis, as well as on sperm quality. Refrain from visiting a bathhouse or sauna 1 – 2 months before starting IVF.
• Try to stop smoking and drinking alcohol 2-3 months before starting IVF infertility treatment.
• If you are a carrier of any viral infection, then if the viral process worsens, if external manifestations appear, notify your doctor.
• If you visit a sports club, then you should not start a new program or learn new sports.
• American experts recommend limiting recreational running to a total of 35 kilometers per week during IVF treatment.
• Despite the lack of a reliably proven relationship between wearing tight underwear and poor sperm quality, experts from the WHO and the American Society for Reproductive Medicine recommend refraining from wearing such underwear during the IVF program.
• Sexual rest for at least 3, but no more than 6-7 days, before the day of transvaginal puncture of the follicles and, accordingly, sperm donation.

Some explanations on infertility treatment using IVF:

Oddly enough, treatment may begin a month earlier than the planned treatment cycle. The preparation methods described below are not mandatory; their use is determined individually.
You may be recommended to take hormonal contraceptives belonging to the class of monophasic combined oral contraceptives (eg, Logest, Silest, Femoden). These drugs are prescribed to suppress ovulation in this cycle, prevent the appearance of ovarian cysts, better prepare the endometrium for treatment, and make the onset of menstruation more predictable, which allows for more accurate treatment planning.
If hormonal contraceptives are not prescribed, an ovulation test (clearplan, ovuplan, frau test) may be recommended. A few days after confirmation of ovulation, you will be asked to undergo an ultrasound examination to assess the quality of the endometrium and the condition of the ovaries.
It is also common to perform a trial “embryo transfer” in the previous cycle. Of course, no embryos will be used in this case. To ensure that the actual embryo transfer procedure is as effective as possible, in the middle of the second phase of the menstrual cycle, the doctor simulates the embryo transfer procedure by passing a special embryo catheter through the cervical canal. This will allow you to clarify in advance the direction of the cervical canal, possible bends, and determine the likely difficulties during its passage. Some clinics do this for all patients without fail, some do not use this manipulation, this is largely determined by the preference of your doctor, as well as your medical history and the condition of the cervix.
All medications used to stimulate the ovaries are produced in the form of injections. Every day, preferably at the same time, you will need to make subcutaneous injections into the abdomen in the navel area if medications such as diferelin, decapeptyl, puregon, gonal-f, follistim, orgalutran, cetrotide or antagon are prescribed. You will have to master intramuscular injections if you are prescribed one of the following drugs: Pergonal, Menogon, Metrodin, Bravel, Repronex.
When you buy these medications, the package will contain an ampoule with sterile water and a bottle of powder. To avoid confusion, ask the nurse at the clinic to explain how to dilute the powdered medicine and give the injection.
During this course of injections, you will need to come to the doctor every 2-3 days for an ultrasound examination to assess how the ovaries react, how many follicles have appeared and how they are growing. This is called ultrasound monitoring. This is done so that you receive the minimum necessary dose of medication, sufficient to obtain several good mature eggs.
Gradually, closer to the end of the stimulation, you may begin to feel heaviness in the lower abdomen, a feeling of fullness in the abdomen may appear - these are quite likely consequences of treatment, because the ovaries often enlarge. If this happens, be sure to inform your doctor.

How to prepare medicine and give an injection

1. Wash your hands well.
2. Prepare everything you need for the injection: medicine, an alcohol wipe for injections (sold in all pharmacies), a separate needle from the syringe, an insulin or regular syringe.
3. Open the ampoule with sterile water, put a needle on the syringe, draw water into the syringe. To collect all the water from the ampoule, lower the syringe needle to the bottom of the ampoule.
4. Remove the plastic plate from the lid of the medicine bottle, pierce the rubber stopper with the needle without removing it from the syringe and inject water inside.
5. The powder dissolves almost instantly, resulting in a clear solution, without foam or clots. If the solution is cloudy or dissolves unevenly, it is better not to use this portion.
6. Without removing the needle, turn the bottle over, pull out the needle so that only the tip of the needle remains inside the bottle and pull the solution with the medicine into the syringe.

   If you are prescribed several ampoules of medicine at the same time, for example, 3 ampoules of Puregon, then simply repeat steps 4 – 6 with the same water for injection. This way, you will have a small volume of liquid containing the required amount of medication and you will be spared the need to administer excess water with the medication.

7. Disconnect the syringe from this needle and attach a new sterile needle to it.
8. Turn the syringe vertically with the needle up and, after gently tapping the syringe with your finger (so that air bubbles collect at the needle), carefully and lightly press the syringe plunger so that the air comes out of the syringe.
9. Select the injection site. For subcutaneous injections, use areas of the abdomen on both sides of the navel, right and left, alternating sides every day.
10. Wipe the selected area with an alcohol wipe several times.
11. Take the syringe with one hand and hold it at an angle to the skin of the abdomen, with the thumb and forefinger of the other hand, grab the fold of skin of the treated area near the navel.
12. Quickly insert the needle into the skin to the base, slowly inject the solution with the medicine.
13. Release the skin and apply pressure to the injection site with an alcohol pad before removing the needle.

Remember that the last injection, the final stage of controlled stimulation of superovulation - an injection of human chorionic gonadotropin (pregnyl, prophasy, choragon) necessary for the final maturation of eggs, as well as to prevent ovulation, should be done 34 - 37 hours before the puncture. In this case, the effect of the drug is most optimal. This is a very important condition, which largely ensures the production of high-quality eggs. Accordingly, this injection is done in the evening the day before the puncture. For example, if the puncture is scheduled for 09.00 on Monday morning, then the optimal time for the injection will be 23.00 on Saturday.

On the day of the puncture.

At the clinic, you will be taken to a room where you will change clothes, an anesthesiologist will talk to you, after which you will be taken to the operating room. Follicular puncture is performed under general intravenous anesthesia. On average, a puncture takes 15–40 minutes, depending on the response of the ovaries and the number of follicles.
During the puncture or after, your spouse donates sperm.
After the puncture, you will be taken to the ward, where you will spend 1 – 2 hours. During this time, you will finally “wake up” after anesthesia, come to your senses, your doctor will tell you how the puncture went, how many eggs were obtained, what the quality of the sperm is, and you will be given further recommendations. Your spouse must wait for a message that the collected sperm is suitable for further embryological work, otherwise a second sperm donation may be required.
Some time after the puncture, when you already feel normal, you can eat and drink tea. On this day, given the anesthesia, patients are not allowed to drive on their own.
This evening, in addition to driving, it is not recommended to drink alcoholic beverages, make important decisions, or be sexually active.
At home after the puncture, it is better to rest and lie down. This evening you may have tension, pain in the lower abdomen, there may be slight bleeding from the genital tract, and there may be a slight increase in temperature.

Tell your doctor immediately about the following symptoms:

• Significant and prolonged increase in temperature
• Severe vaginal bleeding
• Severe or increasing feeling of discomfort, feeling of fullness in the abdomen
• Increased belly size
• Difficulty or painful urination, burning sensation when urinating
• Severe bowel movements
• Nausea, vomiting
• Sharp or shooting pain in the lower abdomen
• Unusual back pain

From the day of the puncture, you will be prescribed new medications aimed at maintaining the second half of the menstrual cycle, promoting the progression of the pregnancy.

Embryo transfer is usually carried out 2-3 or 5-6 days after puncture. Transfer time is not as important as puncture time. This painless procedure is performed with a special soft, thin catheter. Before the manipulation, in case of anxiety, you can take a sedative; often, in addition, no-shpa is prescribed.
After you sit on the chair, a speculum will be inserted into the vagina, the vagina and cervix will be treated with sterile water or saline, then under ultrasound control a catheter will be inserted into the uterine cavity, through which your embryos will be delivered to the uterine cavity. The number of embryos transferred in each case is discussed individually and must be agreed with you. After the transfer, the embryologist must examine the catheter under a microscope to check that there are no embryos left in the catheter.
After the embryo transfer has been completed, you can be sent home immediately, as it has been proven that this does not reduce the likelihood of pregnancy. although most clinics still prefer to give you the opportunity to lie down for 1–2 hours after the procedure. On the way home or already at home, you may have slight bleeding - you should not be afraid of this, of course, this is not the “loss” of embryos from the uterine cavity.

• Take a hot bath or go to a swimming pool for the first 2 days after the transfer
• Use sanitary tampons
• Intimate relationships
• Sports activities
• Mastering new sports
• Take any non-prescribed medications
• Lifting weights

Try to keep yourself busy during the two-week period between embryo transfer and pregnancy test.

Pregnancy test.
Delivered 13–14 days after embryo transfer. To do this, you need to come to the clinic on an empty stomach and donate blood from a vein. Mostly, clearly positive or negative results are obtained.
If you receive a negative (negative) answer, this means that, unfortunately, pregnancy did not occur in this attempt. The first thing you need to do is not to despair and remain confident that you will still get pregnant, for example, in your next attempt. And this time you stop taking all prescribed medications, wait for your menstruation and after a while you come for a second consultation for further recommendations. Menstruation that occurs during the withdrawal of these drugs may differ from normal menstruation - be longer, more painful, more abundant, or may pass as usual.
If the answer is positive, please accept congratulations on your pregnancy. You definitely need to continue taking all medications. After a week or 10 days – depending on the clinic’s policy – ​​you come for an ultrasound examination. This is extremely important, since in this case the fertilized egg will be detected, its location will be determined (uterine or ectopic pregnancy), and also, if several embryos were transferred, how many embryos have “taken root” and are developing.
But sometimes there are “weakly positive” answers. This may be due to the following:

• Late but normal embryo implantation
• Lost pregnancy
• Ectopic (ectopic) pregnancy
• Laboratory error.

In all of the above cases, further ultrasound and hormonal monitoring is extremely important to clarify this situation.

We recommend that you fully familiarize yourself with the information provided when making your final decision about starting treatment. , making notes in the margins near those sections (if you printed this document) where you have questions, i.e., which you do not entirely understand. We recommend that as you progress through treatment, you re-read those sections that you previously read when you first read the instructions and about which you had questions, so that as you move on to the appropriate stages of treatment, you will have the opportunity to ask to the treating doctor with any questions that concern you and resolve any problems that arise in a timely manner. This will protect you from receiving too much unfamiliar and not entirely understandable information in response to immediately asked questions on sections that interest you, which will allow you to consistently understand the specific situation at hand.

It is important to remember that each patient has her own individual response to the medications received during treatment and that each subsequent treatment cycle is different from the previous one. This means that in reality, not only can and will your response differ from the response of other patients to the same drugs, but also that you yourself may respond differently to each subsequent treatment cycle, i.e., not the same , as on the previous one. In this regard, your examination, treatment and, accordingly, its results may differ from those of other patients. We kindly ask you not to compare the results of your examination and treatment, as well as planned future treatment, with the results of examination and treatment obtained from other patients. Although you may find many similarities with them, please remember that IVF/ICSI treatment is a private matter and that most patients feel uncomfortable and embarrassed discussing their personal problems publicly.

The information you read here should help you navigate your treatment cycle. To more fully individualize each cycle of treatment for your couple, some changes may be made to the examination and treatment plan.

If you decide to use the IVF method, we recommend that before starting the cycle chosen for IVF/ICSI, i.e., the previous cycle, you consult a doctor to resolve in advance all the questions that interest you and remain unclear for some reason. During this time, you will be given all the necessary preparatory examination procedures, issued prescriptions for the purchase of medications, and given directions for payment for treatment. Moreover, you will receive an agreement for one or another type of proposed treatment for review and subsequent execution. For each specific type of treatment (IVF, ICSI, etc., including freezing of oocytes, sperm and embryos), separate forms of agreements have been specially developed. All agreement forms must be signed by you and your partner before the start of the treatment cycle. You will be informed when you will meet with the doctor and nurse to review all the collected documents and receive answers to any new questions that arise and clarification of those that are not completely clear to you or your partner.

One of the main requirements for starting treatment is protection from pregnancy in the cycle in which treatment begins using barrier methods of contraception (condom) rather than hormonal ones.

Activities that help increase the chances of success in this treatment cycle:

For women:

1. Avoid, if possible, taking any medications other than regular aspirin tablets. If you are prescribed any other medications by another doctor, you must inform your doctor before starting treatment.
2. Avoid smoking and drinking alcohol.
3. Limit your intake of coffee and caffeine-containing drinks as much as possible (no more than 2 cups per day).
4. Avoid changes in diet and weight loss diets during an IVF cycle.
5. Abstain from sexual intercourse for 3 or 4 days before follicular puncture until subsequent embryo transfer and tests to establish pregnancy.
6. Ordinary physical activity, as well as physical exercise, are not contraindicated until the enlarged ovaries as a result of treatment do not create some discomfort.
7. Avoid hot baths, baths and saunas.

For men:

1. Increased body temperature above 38 0 C 1 or 2 months before the IVF / GIFT procedure can negatively affect sperm quality; If you are sick, please measure your body temperature and report any increase (any illness or illness accompanied by an increase in body temperature).
2. Visiting baths and saunas is not recommended, as elevated temperatures can adversely affect sperm quality; please refrain from visiting them at least 3 months before the intended start of treatment. Medicines, alcohol and cigarette smoking should be avoided before starting IVF/ICSI treatment.
3. If you have a genital herpetic infection, you must report the appearance of symptoms preceding the disease (general malaise, general weakness, unmotivated fatigue), acute manifestations of the disease or healing herpetic lesions. Regardless of whether a man or woman suffers from genital herpes, any of these stages of herpes infection will require immediate cessation of IVF/ICSI treatment.
4. Do not start any new sports activities or marathon running for 3 months before starting IVF/ICSI. If you are a sprinter or jogger, please try to progress to an easy trot or walk, averaging no more than 37 km per week.
5. Refrain from wearing tight underwear.
6. Avoid sexual intercourse for at least 3 days, but no more than 7 days, before sperm collection (before follicular puncture) and during treatment.

IVF/ICSI

On the eve of the start of treatment, 7-10 days before menstruation, you need to make an appointment with your attending physician to conduct an ultrasound of the pelvic organs and assess the condition of the ovaries and the thickness of the endometrium. After the doctor ascertains the normal condition of the ovaries (absence of ovarian cysts) and endometrium, he, in the presence of the necessary official documents (a contract for the provision of medical services, an application for this method of treatment, signed by both partners, a therapist’s conclusion about the patient’s health condition and the possibility of pregnancy her pregnancy and a document confirming payment for treatment of at least the first stage of the upcoming treatment - ovulation stimulation) introduces the patient into the program (IVF/ICSI treatment cycle), i.e., fills out and hands over to the patient a prescription sheet, explaining in detail in advance , which drug, how, where (intramuscular, subcutaneous), how often and for how long should be administered and how to behave during treatment. The patient should come to each subsequent appointment with this appointment sheet. The appointment sheet indicates the full name. the patient, her age, outpatient card number and the entire treatment regimen is described in detail: the name of the drugs, daily doses, frequency, route and sequence of their administration and the date of each subsequent visit to the doctor to monitor the effectiveness of treatment. This is the so-called “monitoring”, including ultrasound and hormonal blood tests.

So, what is IVF and ICSI treatment?

The main goal of these methods is to obtain a large number of eggs from a woman, followed by their in vitro fertilization (outside the female body, in specially created artificial conditions) with the sperm of a husband or donor and transplantation of the resulting embryos into the woman’s uterine cavity. The IVF/ICSI treatment cycle lasts 15 - 30 days and consists of 4 consecutive stages.

During the treatment cycle, both spouses must strictly follow all prescriptions and recommendations of the attending physician and appear for appointments at the appointed time. Treatment is carried out with hormonal drugs strictly in accordance with the prescribed regimen.

The first stage is stimulation of superovulation.

Its goal is to increase the chances of pregnancy. For this, the woman is prescribed special medications. They cause the simultaneous maturation of several follicles in her ovaries. Several eggs are extracted from them, and after their fertilization, several embryos are obtained. The more embryos were obtained, the greater the chances of successful development of pregnancy after their transfer to the patient’s uterus.

The main drugs at the first stage are gonadotropin-releasing hormone (GnH) agonists, human menopausal gonadotropins (hMG) and human chorionic gonadotropin (hCG) preparations. They are introduced according to the developed treatment regimens or “protocols for stimulating superovulation.” Currently, several technologies have been developed and successfully used throughout the world. such “stimulation protocols”, providing for the joint or sequential use of drugs from these groups to achieve the main goal of ovarian stimulation in IVF/ICSI cycles - multiple development of ovarian follicles.

As a rule, it is first assigned a - GRG for 1.5 - 2 weeks from the middle of the second phase of the previous cycle to suppress spontaneous ovarian activity. This is not the stimulation itself, but only the preparation of the ovaries for its implementation with HMG drugs. It is very important because... increases the effectiveness of subsequent stimulation and allows reducing the doses of prescribed HMG drugs and, accordingly, the cost of treatment. This is an important argument, since all stimulation programs used in IVF/ICSI are carried out exclusively with expensive hormonal drugs.

The start of administration of a-GRG usually occurs on the 21st day in a 28-day cycle or the 23rd in a 30-day cycle and lasts, on average, 10-14 days, but possibly longer if the need arises. This regimen is the most traditional, most widespread and most effective ovulation stimulation regimen offered today. It's called “long” stimulation protocol. Although there are other schemes (“short” or “ultra-short” protocols), they are used much less frequently and, mainly, when standard “long” modes are ineffective. During these 10 - 14 days, the patient will need to come to see the doctor only twice: before starting the administration of a-GnRH (1st appointment) and after this period (2nd appointment). Of course, unless there are any other unforeseen reasons for an additional visit to the doctor.

After the required degree of ovarian suppression is achieved under the influence of a-GnRH (as judged by the doctor at the 2nd appointment by a sharp decrease in the concentration of estradiol in the blood and a characteristic ultrasound picture), the doctor makes additional prescriptions for the patient, he halves the dose of a -GRG and prescribes injections of a new drug - HMG in addition to a-GRG for 12 - 14 days. Now directly for stimulation of “suppressed” ovaries.

This stimulation continues until a single appointment in the middle of the cycle of the 3rd drug - hCG at a dose that causes ovulation of many follicles, which allows them to be prepared for puncture at the second stage of treatment (the stage of puncture of the obtained follicles). The scheme described above is a-GHRH + HMG complex allows you to significantly increase the number of follicles in the ovaries. This, in turn, improves the quantity and quality of the resulting embryos and allows you to plan the treatment cycle taking into account the wishes and needs of the patient: “bring closer” or, conversely, “pushing back” the puncture of the follicles for several days to obtain the eggs that have matured in them without fear that this will worsen treatment results.

The first day of administration of gonadotropins is considered the first day of the cycle and further counting is carried out from this day. This makes IVF/ICSI treatment cycles different from other (non-IVF) stimulated cycles used in assisted reproduction (intrauterine insemination or insemination with donor sperm), in which stimulation begins on the 3rd - 5th day of the menstrual cycle and without prior administration of a-GnRH .

All forms of agreement between the parties for treatment with this method must be signed in advance - before the start of drug treatment and receipt of instructions regarding subsequent treatment. By the beginning of each next stage of treatment, it must already be paid. So, before ovulation stimulation is carried out, this stage of treatment must be paid for. The ongoing treatment can be stopped at any stage if, in the opinion of the doctor, the chances of successfully completing it and obtaining good results are extremely low and exceed the cost of subsequent treatment and its expected outcomes. In this case, the patient will be given a refund for the uncompleted stages of treatment.

Stage I of treatment- ovulation induction

Our company uses several drugs from each group: a-GRG - “Decapeptyl - daily”, “Decapeptyl - depot” (most often) and “Zoladex” (less often); drugs HMG - “Humegon”, “Pergonal”, “Neo-Pergonal” and “Menogon” and preparations hCG - “Prophasy”, “Pregnil” and “Choragon”.

GnRH agonists.

Some drugs are administered daily, others - once every few days (the so-called deposited forms or “depot” drugs), most - in the form of subcutaneous injections, some - in the form of intramuscular ones. These drugs are usually produced in the form of ready-made syringes, each accompanied by detailed instructions from the manufacturer about the features of the use and storage of this drug, its side effects, which greatly facilitates their administration by the patients themselves. However, due to the fact that these drugs have their own characteristics of administration, we strongly recommend that patients have the very first injection of one or another prescribed drug given to them by a specially trained nurse in the treatment room, so that the patient does all subsequent injections herself. how this first injection was carried out.

Of the agonist drugs, we most often prescribe “ Decapeptyl-daily”.

The active principle of the drug is the compound triptorelin - a synthetic analogue of GnRH or gonadotropin-releasing hormone (its other name). The latter causes the release of gonadotropic hormones in the female body, which, in turn, have a direct effect on the production of female sex hormones, the growth of follicles and the maturation of eggs in the ovaries.

The drug is available in the form of ready-made syringes of 2 types: “Decapeptyl - daily 0.5 mg”- each syringe contains 1 ml of solution with 525 μg of triptorelin acetate (478.1 μg of triptorelin itself) and “Decapeptyl - daily 0.1 mg”- each syringe contains 105 mcg of triptorelin acetate (95.6 mcg of triptorelin itself). Each such syringe looks very much like an insulin syringe, which is used by patients with diabetes - a very thin needle (no thicker than a hair for painless subcutaneous administration of medication). We usually prescribe the second one (“Decapeptyl Daily 0.1 mg”) as a daily subcutaneous injection. One package contains 7 or 28 syringes with the drug. The drug is stored in a place protected from light at 2 - 8 C (in the refrigerator). Shelf life - no more than 3 years. One syringe is enough for one injection (if prescribed in the first 10-14 days of treatment); when the doctor reduces the daily dosage (the next 12-14 days of administration of a-GHRH - already together with HMG drugs), it is enough to administer not the entire syringe, but only half of its contents per day, and it is recommended to store the remaining medicine in the syringe (0.5 ml) in refrigerator until the next dose (after putting the cap on the needle). Immediately before administering the drug, there is no need to warm it up further by removing it from the refrigerator.

Side effects of the drug do not occur often and are associated mainly with a decrease in the level of sex hormones in the blood: a decrease in libido, rapid mood swings, hot flashes, and rarely depression. But all of these manifestations are transient in nature and indicate the effectiveness of the drug, paradoxically, because they are associated with a temporary decrease in the level of sex hormones (estradiol) in the body. All of these symptoms associated with a decrease in estrogen saturation disappear after the start of HMG administration (“Humegon”, “Menogon”), due to increased production of estrogen in the woman’s stimulated ovaries.

The drug “Decapeptyl - Daily” does not accumulate in the body and all side symptoms disappear without a trace. Sometimes there is slight soreness, redness or, less commonly, itching at the injection site (injection site). This is a local allergic reaction, which usually does not require the prescription of additional medications and the abolition of Decapeptyl - Daily, but its occurrence, as well as other possible side effects of the drug, should be reported to your doctor in a timely manner.

The drug should be administered at the same time, preferably in the evening. If the time of its administration changes (the difference is more than an hour), you must inform your doctor about this and discuss with him the time of the subsequent administration of the drug.

Instructions for administration of "Decapeptyl-Daily 0.1 mg":

1. Open the package and take the syringe from the package.
2. Remove the plastic cap from the syringe needle.
3. Take the syringe in your left hand and a cotton ball soaked in 95% alcohol in your right hand.
4. Select a subcutaneous injection site (on the shoulder or on the anterior abdominal wall); It is advisable to change injection sites daily. Gently clean the injection site with a cotton ball moistened with alcohol.
5. Holding the syringe in your right hand like a throwing spear, at an angle relative to the surface of the skin, quickly insert the syringe needle under the skin.
6. Smoothly, without jerking, squeeze out the entire contents of the syringe, then remove the needle, treat the injection site with a new cotton ball with alcohol and throw away the used syringe.
7. When you start administering “Menogon” or “Humegon” or other HMG drugs, the dose of “Decapeptyl - Daily” is reduced by exactly half; the syringe is not thrown away, and the second half of the contents of the syringe remaining after injection is stored until the next injection in the refrigerator, for which the cap is put on the needle again and the syringe is placed in the refrigerator.

Preparations of human menopausal gonadotropins (HMG).

Injectable HMG drugs “Humegon”, “Pergonal”, “Neo-Pergonal”, “Menogon”, “Metrodin” are available in the form of a dry substance (powder) and an accompanying solvent (in ampoules) and are injected once a day into the muscle - 3 or 4 ampoules of dry substance are diluted with the contents of one ampoule of solvent. The drugs act on the ovaries and stimulate the maturation of follicles. The dose of the administered drug to stimulate follicular growth is selected individually, taking into account the woman’s age, her weight and the initial state of the ovaries (their functional reserve) and depends on the response of the ovaries to the treatment. This reaction is assessed periodically by the level of sex hormones in the blood serum (estradiol) and the ultrasound picture (the number and size of follicles in each of the ovaries, as well as the thickness of the endometrium). Carrying out an ultrasound and determining the concentration of estradiol during treatment with hormonal drugs is called “ultrasound and hormonal monitoring”.

Ultrasound monitoring is carried out by the attending physician at the appointment, and a blood test for estradiol is carried out by the doctor in a diagnostic laboratory. Monitoring is not paid separately, since its cost is included in the cost of this stage of treatment. The frequency of monitoring is set by the doctor depending on the results obtained (ultrasound and estradiol concentration). The date and time of each subsequent doctor’s visit for monitoring is entered by him on the appointment sheet held by the patient. As a rule, the number of visits does not exceed 4 or 5. This procedure (monitoring) is outpatient and does not require hospitalization of the woman. The time must be chosen taking into account the wishes of the patient, because most of them continue to work. There is no need to make an appointment with a doctor in advance for monitoring. On the appointed day, the patient should first contact the reception desk and say that the purpose of the visit is monitoring (or show the appointment sheet), after which the registrar will immediately inform the doctor about her arrival.

Usually patients give themselves injections, sometimes they involve their relatives or friends who know how to do intramuscular injections. In any case, you can always count on our help - injections can be done by a nurse in the treatment room. We strongly recommend that she give the first injection in order to teach the patient or whoever will give them to her how to prepare the medicine for intramuscular administration and how to administer the injections. It is advisable that all injections are carried out at the same time of day, preferably in the 2nd half of the day. The first ultrasound is usually performed on the 5th or 6th day of treatment to assess the response of the ovaries (dynamics of follicle growth) and endometrial thickness in order to select the most optimal dose of the drug and determine the date of the next visit. Before the active growth of follicles begins (until they reach sizes of 10 mm and above), an ultrasound scan is performed once every 4-5 days, then the ovaries are examined more often - once every 2-3 days, and when the leading follicle reaches a size of 15-16 mm in diameter inspections are carried out daily. Blood tests for estradiol are taken either with the same frequency or somewhat less frequently (depending on the specific situation). A potentially mature follicle against the background of stimulation is a follicle measuring 18 - 20 mm.

In our center, ultrasound is performed with a vaginal sensor (cavitary ultrasound), which is significantly more informative than conventional ultrasound through the abdominal wall. Before performing a abdominal ultrasound, you will need to empty your bladder to improve the quality of the resulting image. The nurse then invites you to go to a special room where the ultrasound is performed. You will be asked to undress as if for a gynecological examination in a chair. The nurse places a sterile diaper on the chair, after which you lie down on the chair and a doctor is invited to conduct ultrasound monitoring. The transvaginal sensor is inserted by the doctor into the patient’s vagina; a sterile condom is first put on it (by the doctor or nurse), which is discarded after use. The vaginal ultrasound procedure is completely painless and safe. Some patients may experience a feeling of discomfort or tightness, and there may be a slight vaginal discharge after the end of the ultrasound procedure, mainly due to the use of gel during the ultrasound to improve the quality of the resulting image.

Of the drugs used for ovarian stimulation in IVF/ICSI cycles, HMG is the most commonly used.” Humegon" “Humegon” is produced by the company “Organon”, Holland, in the form of ampoules (1 ml each) with freeze-dried medicinal substance, complete with attached solvent ampoules (1 ml each) for dissolving the powder; the drug is intended for intramuscular administration. One package contains 5 or 10 ampoules of the main substance and solvent. To dissolve powder from several ampoules, a solvent (water) from one ampoule is sufficient.

The active principle of the drug is the two main gonadotropic hormones of the pituitary gland, necessary for the normal functioning of the ovaries (maturation of germ cells - oocytes and the production of sex hormones - estrogens): follicle-stimulating hormone (FSG), responsible for the growth and development of ovarian follicles, and luteinizing hormone (LG), responsible for the final maturation of the dominant follicle and its ovulation in the middle of the cycle (rupture of the leading follicle and release of a mature egg suitable for fertilization).

The use of the drug is completely safe from the point of view of the risk of developing an immune reaction against “foreign” hormones. The preparations “Menogon” and “Pergonal” do not differ in composition from “Humegon”, their only difference is the manufacturer (“Menogon” - Ferring company, Germany and “Pergonal” - Serono company, Switzerland) and the price.

Instructions for IVF/ICSI patients on the administration of the drugs "Humegon", "Menogon" and "Pergonal":

1. Prepare in advance: one sterile syringe with a needle for intramuscular injection, 2 cotton balls moistened with 70% alcohol, one ampoule of solvent and 3 or 4 ampoules of the drug (in accordance with the prescription sheet).
2. Treat the index and thumb of your right hand with an alcohol ball and quickly (in one motion) uncork the ampoules.
3. Remove the cap from the needle and draw 1 or 2 ml of water (the proposed sterile solvent) into a syringe and dissolve this amount of solvent alternately in each of the 3-4 ampoules with a dry substance, sequentially transferring the contents of the previous one (already dissolved) into the next ampoule (with dry matter not yet dissolved); the substance dissolves almost instantly; the needle should be inserted into the ampoule as deeply as possible.
4. Draw the dissolved contents of all ampoules into a syringe (usually 3 or 4 at a time); Hold the syringe vertically and lightly press the plunger to remove all air bubbles from the syringe.
5. Take the syringe and the new alcohol ball in your right hand.
6. Select the injection site; preferably, it does not coincide with the site of the previous (yesterday) injection. Gently grab the skin in this area with your left hand. Take a comfortable position and leaning on the leg opposite to the one where the injection is to be made, try to relax the muscles of the latter as much as possible.
7. Apply an alcohol ball to the injection site and hold the ball under your left thumb.
8. Holding the drawn syringe like a throwing spear, pierce the skin with the needle (the depth of penetration should be at least 1/2 the length of the needle) and quickly insert the needle into the muscle.
9. Smoothly press the plunger to squeeze out the contents of the syringe, then quickly remove the needle.
10. Treat the injection site with an alcohol ball.
11. All used material (cotton balls, used syringes, etc.) is thrown away (in regular waste containers - no special equipment required).

Side effects of these drugs are infrequent and include abdominal discomfort, flatulence (bloating), mood swings, fatigue or restlessness, which in most cases improve or disappear completely after follicular puncture. One of the possible complications of therapy with HMG drugs is the risk of multiple pregnancy.

Finally, when your doctor decides that you are ready for follicle puncture (more precisely, the follicles are mature enough for puncture to collect oocytes), you will be given an injection of hCG. In practice, several hCG drugs are used, most often - “Profasi” and “Choragon”. As a rule, this drug is prescribed 35 - 36 hours before the puncture itself. HCG injection is intended for the final maturation of oocytes and induction of ovulation; if the puncture is not performed, ovulation occurs 42 - 48 hours after the time of hCG injection. Many patients experience abdominal discomfort after an HCG injection due to enlarged ovaries and believe that they are ovulating. In fact, careful monitoring of patients during treatment and the hormonal drugs used (a combination of a-GnH and HMG) almost completely eliminate the risk of premature ovulation, i.e., ovulation before follicle puncture. The main and mandatory conditions for prescribing hCG are a certain degree of follicular development according to ultrasound (at least 3 mature follicles, each with an average diameter of at least 18 mm), a sufficient level of estradiol in the blood. Long-term sexual abstinence (more than 5 days) or, conversely, sexual intercourse 24 hours before puncture, may possibly reduce sperm quality. If you have not had contact the day before the proposed puncture, we allow an hCG injection. If your husband has low sperm quality, you may need a 4 or even 5-day period of sexual abstinence, and therefore this problem should be discussed with your doctor in advance, before starting treatment.

Chorionic gonadotropin (hCG) - a hormone similar to luteinizing hormone (LH), which causes ovulation of the leading follicle in the middle of the menstrual cycle. An ovulatory dose of hCG (5000 units in the natural cycle) causes follicular changes leading to ovulation approximately 42 - 48 hours after its administration.

The puncture must be performed before ovulation, otherwise the follicles will be empty at the time of puncture. Therefore, hCG is prescribed 35 - 36 hours before the puncture. So, when the puncture time is scheduled for 9 a.m. the next day, the hCG injection should be performed in the evening of the previous day at 11 p.m.

HCG preparations are available in the form of a dry substance (powder), which, immediately before administration, is diluted with a solvent and administered intramuscularly. The side effects of hCG are similar to those of hMG drugs. HCG is produced by different companies under different commercial names. The most commonly used are “Horagon”, “Profasi” and “Pregnil”. The hCG injection is performed only once during the entire treatment cycle, the injection is painless and, as a rule, the patient gives it to herself. Before the scheduled puncture time (written down on the appointment sheet), the patient does not need to visit the doctor or take blood tests for hormones.

Instructions for IVF patients on the administration of "Choragon":

"Horagon" is produced by Ferring (Germany), each ampoule contains 1500 and 5000 IU of the active substance. The drug looks like a white powder. Each Choragon ampoule comes with 1 ampoule of solvent. The package contains 3 ampoules with 1500 IU of dry matter + 3 ampoules of 1 ml of solvent, or 3 ampoules of dry matter with 5000 IU of dry matter + 3 ampoules of 1 ml of solvent.

1. The timing of hCG administration is a decisive factor in treatment, so the drug must be administered exactly at the calculated time.
2. Wash and dry your hands thoroughly.
3. Prepare in advance: a disposable syringe with a needle, 2 cotton balls moistened with 70% alcohol, and medicine (ampule with dry substance).
4. Take the ampoule with the dry substance from the package; remove all plastic protective coverings.
5. Place the needle on the syringe.
6. Treat each ampoule with an alcohol ball.
7. Remove the cap from the needle, insert the needle straight and firmly into the center of the rubber cap of the solvent ampoule.
8. Turn the ampoule upside down.
9. Lower the plunger of the syringe to withdraw sterile solvent (in an amount of 3 ml), and then disconnect the empty ampoule.
10. Remove air bubbles from the syringe by lightly flicking it or shaking it with your fingers, then squeezing out the air with the syringe plunger.
11. Select the injection site in the same place as for Humegon and Decapeptyl-Daily. Stretch the skin in the selected area with your left hand.
12. Take the ready-to-use syringe and a cotton ball soaked in alcohol in your right hand.
13. Treat your skin with alcohol and hide the used ball under your left hand.
14. Holding the syringe like a throwing spear, insert the needle into the muscle at an angle, then quickly expel its contents with sharp pressure on the piston and just as quickly remove the needle from the injection site.
15. Clean the injection site with alcohol.
16. Place used instruments and medications in a waste container.

P.S. . We recommend purchasing medical supplies in the center itself. Because they are quite expensive, you avoid two things. Take the wrong dosage as prescribed by the doctor (and pharmacies do not accept returns on medications) or, on the contrary, purchase an extra number of ampoules that you do not need. If you purchase medical supplies in the center itself, you will in any case save money that you may need during the adaptation period after the puncture.

Stage II of treatment- puncture of follicles

The purpose of this stage is to obtain eggs from the follicles of stimulated ovaries by puncturing them with a hollow needle (puncture). This intervention is performed under ultrasound guidance, under sterile conditions and under good local anesthesia by a doctor and nurse specially trained to perform this procedure.

No special preparation is required on the part of the patient before the puncture. It is recommended to stop eating and drinking, if possible, 8 hours before the puncture and local sanitation of the vagina several days before the puncture in order to reduce the risk of infection during puncture. The time for the puncture is planned by the doctor in advance and according to the standard scheme: 48 hours after the administration of the ovulatory dose of hCG ("Choragon", 10,000 units intramuscularly). The date and time of the proposed puncture are recorded on the patient’s appointment sheet and once again the patient is explained in detail when and where to go for the puncture. By the time of the puncture, all stages of treatment completed and the puncture itself must be fully paid for by the patient.

Instructions for IVF/ICSI patients before follicle puncture.

DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT!

You must arrive 15-20 minutes before the appointed hour of the day on which you are scheduled for the puncture (the corresponding date and time - 10 a.m., are indicated on the appointment sheet) and inform the registrar of your arrival - that you have come specifically for the puncture and specifically for what time. If the day of the puncture falls on a holiday or, for some reason, a day off, then the time of the puncture and, accordingly, your arrival is postponed to a later time (not 9 a.m., but 11 or 12 p.m.), which is also recorded on the sheet appointments; in this case, the patient changes the time of hCG injection (it is moved from 11 pm to midnight). We strongly ask that you come to the puncture without makeup, contact lenses, manicure or jewelry. You don't have to take off your wedding ring. The registrar informs the nurse of the IVF laboratory about your arrival and approximately half an hour before the puncture she invites you to the preoperative IVF laboratory, where she begins to prepare you for the puncture procedure: she offers you to completely empty your bladder and change into sterile clothes and shoes, after which she escorts you to the manipulation room (the operating room where the puncture itself will be performed) and helps you lie down on the gynecological chair for the puncture, treats the patient’s external genitalia, asks about your well-being and then invites the doctor to the procedure. By the time the doctor arrived, the IVF laboratory nurse had already checked and made sure that the ultrasound machine was ready, put a sterile condom on the vaginal ultrasound probe and set up a sterile table with the necessary sterile instruments that the doctor would need to perform the puncture.

In some centers, laparoscopic rather than transvaginal puncture access is widely practiced, especially abroad. We believe and are deeply confident that the general anesthesia required for laparoscopic puncture can negatively affect the quality and viability of eggs and embryos obtained from them. Therefore, it seems to us that the safest is the maximum limitation of taking any medications (including anesthetics) until the very last minute before the puncture, and the most appropriate is the use of local anesthesia and puncture of the follicles with an access that would not require strong anesthesia - just like this The method of pain relief is local anesthesia with lidocaine, which we practice. Before the puncture, the nurse prepares 2 insulin syringes with a 2% lidocaine solution, 1 ml each, for local paracervical anesthesia. The doctor exposes the patient’s cervix in the speculum and, after processing it, makes a so-called “paracervical” blockade - local injection of lidocaine into the tissue near the cervix, which provides an adequate and safe level of pain relief. The entire follicle puncture procedure lasts, on average, 10-15 minutes. By the time the puncture is completed, your husband must donate sperm for subsequent analysis, special processing and fertilization of the resulting eggs. Therefore, he should come with you on the day of the puncture and stay in our company until the results of the puncture and spermogram are received. The procedure for taking a puncture (despite all the worries and fear of the patients - is absolutely painless, and after the puncture the patient remains for 40 - 60 minutes under the supervision of medical personnel. After the nurse makes sure that your condition is satisfactory and you are feeling well, you will be allowed get up and it is recommended to go to the doctor who performed the puncture, together with your husband, in order to discuss the results of the puncture and agree on the time of the next appointment for the transfer of the resulting embryos.We do not allow patients to leave after the puncture unaccompanied.

After the puncture, you can eat and drink as you see fit, depending on how you feel. In order to prevent the occurrence of an infectious process after puncture, you will be recommended to take antibiotics (a single loading dose of a broad-spectrum antibiotic - 1 capsule of doxycycline). If sperm counts are poor, the husband will need to donate sperm again. The day after the puncture, in the morning, you will need to call your doctor to find out whether there are signs of fertilization or not (the first signs of fertilization appear 16 - 18 hours after insemination or 22 - 24 hours after the puncture). If fertilization of eggs and sperm using the standard method of artificial insemination (standard IVF) in your couple for some reason (low quality of the husband’s sperm or immature eggs obtained during puncture) did not occur, the doctor will tell you about it by phone, you and your husband You must immediately visit the doctor again to decide on further tactics for managing your couple: repeat sperm donation and/or switching to microinsemination (ICSI) instead of the unsuccessful standard ICSI, which will require additional payment for ICSI. It is advisable from the very beginning, even before the puncture, to discuss the possibility of switching to ICSI if standard IVF has failed.

Instructions for patients after follicular puncture

After puncture of follicles under ultrasound control, you may experience some pain in the pelvic area, feel tired or even drowsy (the latter is usually after anesthesia during the procedure). It is also possible to experience slight bleeding from the genital tract after local anesthesia. As a rule, they are scanty and vary in color from red to dark brown. Taking paracetamol (Paracetamol, Tylenol, etc. tablets) usually relieves these symptoms well and eliminates discomfort. Under no circumstances should you take acetylsalicylic acid (aspirin) or other nonspecific anti-inflammatory drugs of this group (aspirin group) to avoid increased bleeding. In place of punctured ovarian follicles, corpus luteum is formed. Normally, at the site of a mature follicle that “burst” during ovulation (ovulated) in a woman of reproductive age, a corpus luteum is also formed, the main function of which is the production of hormones; the main hormone of the corpus luteum is progesterone, which “prepares” the mucous membrane of the uterus, the endometrium, for the attachment of the embryo . However, in IVF/ICSI cycles, α-GnRH drugs are used to stimulate ovulation, which reduce the function of the corpus luteum. Moreover, the levels of estrogen hormones in stimulated cycles are disproportionately increased compared to progesterone. Therefore, drug support for the function of the corpus luteum and normalization of the ratio of estrogen and progesterone are necessary, starting from the day of follicle puncture. For this purpose, we use repeated administration of hCG or prescribe additional administration of progesterone drugs. This improves the condition of the inner lining of the uterus - the endometrium and thereby increases the chances of successful implantation of embryos. We usually prescribe a 2.5% progesterone solution intramuscularly, 2 ml per day daily, starting from the day of puncture. You can talk directly with the embryologist who works with your cells the next day after the puncture and receive a comprehensive answer from a specialist to your questions about the quality of eggs, sperm, their fertilization, and a little later (not the day after the puncture, but after day) - find out about the quantity and quality of the embryos obtained.

III stage of treatment- embryo cultivation

The day of puncture is considered day zero of embryo culture (0D); The first day of cultivation (1D) is considered to be the day following the puncture. It is on this day that the first signs of fertilization become noticeable for most. They appear, as mentioned above, 16 - 18 hours after mixing eggs with sperm (insemination). Fertilization is re-evaluated 24 to 26 hours after insemination. Control of oocyte fertilization is carried out by a laboratory assistant - an embryologist when viewing dishes with cultured cells under a microscope. However, their presence is not yet sufficient to resolve the issue of the possibility of transferring embryos into the uterine cavity. First you need to make sure that the embryos are splitting and developing normally. This can only be judged based on the quantity and quality of the dividing cells of the embryo and not earlier than one day after fertilization, when the first signs of fragmentation appear.

They appear most clearly only on the second day of cultivation (2D). Only good quality embryos can be transferred. Embryo transfer is usually carried out on the 2nd or 3rd day of cultivation, depending on the rate of their development and the quality of the embryos.

One of the reasons for IVF failure is the lack of fertilization of germ cells. Often the reason for this is not possible to establish, despite the extensive knowledge of scientists in this field (human reproduction). No one is immune from this, and such an outcome is often difficult to predict, but it is necessary to keep it in mind. If fertilization in your couple has not occurred, you need to meet with your doctor and embryologist to decide on further tactics in this case. You must abstain from sexual intercourse for 2 weeks after treatment. It is also necessary to avoid strenuous physical labor and physical activity during these weeks. We do not recommend sunbathing for a long time if you are taking tetracycline, doxycycline or drugs from their groups. If you have any questions about certain activities, you should contact your doctor to have them resolved.

Please inform your doctor (you will definitely have all phone numbers from work to home) if you experience the following symptoms after the puncture:

1. You have a high temperature (over 37 o C).
2. Severe bleeding from the vagina.
3. Unusual or severe pain in the pelvic area.
4. Difficulty urinating or bowel movements.
5. Nausea, vomiting, or diarrhea.
6. Sharp or shooting pain.
7. Pain or sting when urinating.
8. Unusual back pain.
9. Increase in abdominal circumference.

Stage IV- embryo transfer

On the day of transfer of your embryos, you need to come to the transfer in advance, 15 - 20 minutes before the appointed time. The presence of the husband is possible, but not required. The embryo transfer procedure is simple. The patient lies down on a chair. The doctor exposes the cervix in the speculum, after which he inserts a catheter and a guidewire through the cervical canal into the uterine cavity and injects embryos through it from a special syringe into the uterine cavity. The embryologist then examines the contents of the catheter under a microscope to look for any embryos remaining in the catheter. Embryo transfer usually does not take long. The transfer procedure is painless, although sometimes the patient may experience mild discomfort. After the transfer, we do not recommend keeping the patient in a horizontal position for a long time; 20 to 30 minutes is enough. On the day of embryo transfer, we allow patients a light breakfast, but fluid intake should be limited. This will reduce the discomfort associated with a full bladder. After the transfer, you can dress yourself, but we only allow you to go home, especially drive a car, if accompanied by your husband or another person. It is also useful to lie down when you come home and try to relax.

Please remember to continue the progesterone administration (see above) started on the day of the puncture until you receive the results of the pregnancy test. After the transfer, some patients report slight spotting or the release of air bubbles from the genital tract. Please don't worry about this. This does not mean that at this time your embryos are expelled from the uterine cavity. From the moment of transfer until the pregnancy test, you can safely return to most of your daily activities and responsibilities. It is considered absolutely normal that if the pregnancy test results are negative, you will blame yourself for doing something or, conversely, not doing something during this period of time - the waiting time.

In this regard, try not to do anything that you will reproach yourself for if you do not get pregnant, and adhere to the recommendations below:

1. Do not bathe or swim for the first 24 hours after the transfer.
2. Do not shower or splash yourself with water.
3. Don't use tampons.
4. Do not be sexually active until you receive your first pregnancy test.
5. Do not engage in running, aerobics, tennis, skiing, mountaineering or other similar sports.
6. Do not start other sports or physical activities.
7. Don't lift anything heavy.
8. You can return to "work" after 24 hours in bed (rising only to go to the bathroom or eat) and one or two days of moderate physical activity.
9. Do all the necessary household chores before starting the IVF procedure, so that you can subsequently devote time only to yourself and your future baby.
10. Try to do something to distract yourself from waiting for the pregnancy test results, which will help you survive these 12 - 14 days.

You may have some spotting or spotting from your vagina before taking a pregnancy test. Approximately 50% of our pregnant patients after IVF had similar discharge before the test and even after receiving a positive result! Don't lose optimism! You should definitely get your blood tested, even if you think that this discharge is menstruation and pregnancy has not occurred. A quantitative pregnancy test must be done!

At each of its stages. You will be able to find out what regime should be followed, what can and cannot be done at the stage of superovulation stimulation, after puncture and after embryo transfer.

The IVF procedure can be divided into four important stages:

1. Induction of follicular growth
2. Puncture of stimulated follicles
3. Embryo transfer
4. Post-transfer period

This stage takes on average 8-12 days and includes injections of drugs to stimulate follicle growth. Gonadotropin drugs are used (Menopur, Puregon, Gonal-f, Elonva, etc.), as well as drugs to suppress the pituitary gland - gonadotropin-releasing hormone agonists and antagonists (diferelin, decapeptyl, cetrotide, orgalutran).

At this stage, follicle growth is monitored and, if necessary, the dose of prescribed medications is adjusted. Next, when the follicles reach a diameter of 18-20 mm, an ovulation trigger (hCG drug or gonadotropin agonist) and a puncture date are assigned.

While stimulating follicle growth, it is recommended to lead a measured, healthy lifestyle, spend more time in the fresh air, and eliminate physical activity. It is also advisable not to be sexually active. It is important to understand that by prescribing stimulation, we achieve the growth of all existing antral follicles, so sometimes more than 10 of them can grow. The ovaries increase in volume, which can lead to a feeling of heaviness and discomfort in the lower abdomen.

You cannot take laxatives or do a cleansing enema before a puncture without a doctor’s permission.

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Follicle puncture is performed under general anesthesia and takes no more than 20 minutes. After egg retrieval, the woman remains under observation in the ward for 2 hours, then is discharged home with doctor’s recommendations.

Driving after the procedure is prohibited.

On this day, luteal phase support and preparation for embryo transfer are prescribed.

For this purpose, progesterone preparations are prescribed (progesterone, utrozhestan, kraynon, iprozhin), duphaston, in some cases estrogens (divigel, proginova, estogel), and hCG preparations.

On the first day after puncture, a woman may experience moderate pain in the lower abdomen. This is normal, since during puncture the ovarian tissue is injured by the needle, which can cause pain in the future. But if pain occurs, you should not take painkillers, since their therapeutic effect can smooth out the picture of a possible complication, and help may be provided with a delay. If you experience intense abdominal pain, as well as weakness, dizziness, or bleeding, you should contact your doctor.

After the puncture, sexual rest is required for two weeks. At this time, you should also not take a hot bath, visit the sauna, solarium, swimming pool, or gym.

The next day after the puncture, until the moment the blood is tested for hCG, it is recommended to drink a large amount of still water or fruit drink without sugar (up to 3 liters). Food should contain a lot of protein and a minimum of coarse fiber (raw vegetables, fruits, legumes, brown bread excluded). It is also necessary to limit coffee, strong tea, cola, and alcoholic beverages are not allowed.

After puncture of a large number of follicles, sometimes from 2-3 days, complaints characteristic of ovarian hyperstimulation syndrome may appear: a feeling of fullness and bloating, nausea, vomiting, diarrhea, shortness of breath, rapid heartbeat (tachycardia), dry cough. If such signs appear, you should immediately consult your doctor.

The embryo transfer procedure is usually performed in the afternoon and in a standard situation does not require special preparation.

After embryo transfer, you can rest in the room for an hour.

This period lasts 14 days, after which a blood test for hCG is taken to diagnose pregnancy. These days, we recommend issuing a certificate of incapacity for work so that the woman can follow all the necessary recommendations. During this period it is necessary:

• Continue to follow the drinking regime and diet;
• Avoid physical activity, do not engage in fitness, but also do not lie down all day; short walks in the fresh air with a total duration of at least an hour are suitable;
• Do not stay in a forced position for a long time (for example, sitting) - this contributes to stagnation of blood in the pelvis;
• Try to feel only positive emotions and confidence in success.

In some cases, after embryo transfer, spotting and spotting may appear, which does not exclude pregnancy. In this case, you cannot cancel drug support and try to contact your doctor as quickly as possible.

If your blood test is positive for hCG, you must contact your doctor to receive further recommendations on treatment and when to discontinue some medications. In addition, the doctor introduces the woman to the monitoring plan for pregnant women after the IVF program.

In the case of a negative test for hCG (that is, in the absence of pregnancy), support medications are usually discontinued; an appointment with the attending physician is recommended after the next menstruation . After an IVF cycle with stimulation, the ovaries can return to normal within 1-2 months. In some cases, a doctor prescribes combined estrogen-gestagen drugs for therapeutic purposes.

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Follicular puncture is the process of extracting mature eggs from the ovaries with a hollow needle for subsequent fertilization in artificial conditions (in vitro).

The maturation of eggs is stimulated by taking hormonal drugs. Hormones are similar to those produced by the body. “Superovulation” - stimulation of ovulation of several follicles.

Receiving as many good eggs as possible increases the likelihood of pregnancy. If one embryo does not take root, then several more remain in stock.

The process of fertilizing an egg can be done in vitro (IVF), or a single sperm is injected into the egg under a microscope (ICSI). The choice of method depends on the type of infertility.

In IVF, follicular puncture involves the collection of a mature egg, transfer to an incubator until fertilization by sperm, and the subsequent transfer of the embryo to the uterus.

In order for the egg retrieval operation to proceed correctly, all conditions and requirements of the specialist must be met. An individual conversation is held with each patient to determine proper behavior during all stages of this procedure.

To ensure that the retrieved eggs and sperm are of the best possible quality, follow the general recommendations before follicular puncture. Both women and men should:

• Avoid taking medications that have not been approved by your doctor;
• completely eliminate alcohol consumption and smoking;
• avoid diets;
• Avoid drinking coffee and caffeinated drinks;
• abstain from sexual intercourse for 4-5 days before performing follicle puncture and sperm collection;
• do not visit baths, saunas, or take hot baths;
• do not expose yourself to physical stress.

• do not wear tight underwear;
• try not to get sick a month or two before donating sperm, because... elevated temperatures can affect its quality.

Stages of follicle puncture

Conventionally, the follicle puncture operation can be divided into three stages - preparation for it, execution, and the final stage. Each of them is necessary to ensure that the eggs are retrieved with minimal risk to the woman’s health and their further successful fertilization.

Before follicular puncture

To achieve the desired follicle size, injections of hCG (human chorionic gonadotropin) are performed. It stimulates the maturation of follicles. With IVF, follicle puncture is performed before the onset of ovulation.

Therefore, immediately before follicle puncture, the following requirements should be met:

1. The day before the procedure, you should not eat, stop drinking 2 hours before the procedure. This may affect subsequent pain relief and pose a risk of complications.

2. You must arrive at the clinic at the strictly stated time.

3. Already on site, at the clinic, change into sterile clothes, empty your intestines and bladder.

You should also not apply makeup or wear jewelry before attending the procedure; it is recommended to remove contact lenses.

Next, you are taken to the manipulation room and placed on a gynecological chair. The external genitalia are treated. They check the readiness of the ultrasound machine, put a sterile condom on the ultrasound sensor, and set up a medical table with sterile instruments.

The husband also arrives at the clinic at the appointed time for sperm collection.

Follicle puncture

The egg retrieval procedure itself is performed through the vagina and is monitored by ultrasound. A barely noticeable thin needle is attached to the ultrasound sensor. It is used to pierce each follicle to collect fluid containing eggs. The procedure takes 10-15 minutes. Follicular puncture is not performed without anesthesia. Local anesthesia is often prescribed to reduce the effect of anesthetics on egg quality.

The fluid collected from the follicles is transferred to embryologists. The eggs are placed in specially created conditions in an incubator before being inseminated by sperm. A few hours after the procedure, the specialist will tell you about the results of the puncture, the number of eggs obtained, and set the next date for the visit for implantation of embryos into the uterus.

After follicular puncture

After the operation, the woman is monitored in the clinic for several hours. What condition after follicle puncture is considered normal? Weakness and slight dizziness resulting from anesthesia are acceptable. Nagging pain in the lower abdomen and scanty bleeding are typical consequences of follicle puncture. If the pain is severe, then you can use antispasmodics, traditional drugs from the group of non-steroidal anti-inflammatory drugs. To be prepared for these moments, consult your doctor before the procedure about taking pain medications.

But if, within the next 24 hours after the procedure, you suddenly experience weakness, dizziness, rapid heartbeat, loss of consciousness, a sharp decrease in blood pressure, increased pain in the lower abdomen, bleeding, then you should urgently consult a specialist.

Follicle puncture. Reviews

Do not be alarmed if you have been scheduled for follicle puncture. Reviews from most women left on the Internet indicate the ease and success of this operation. The main thing is to adhere to all the recommendations prescribed to you by your attending physician.

After successful donation of eggs and sperm, the following occurs:

• 4-6 hours after receiving the eggs, artificial insemination is carried out in a special laboratory;
• within 2-5 days, the IVF laboratory cultivates embryos and assesses their quality;
• at 2-3 (or 5-6) suitable embryos are transferred into the uterine cavity;
• on days 14-16, the result (positive or negative) for the presence of the pregnancy hormone hCG will be known.

Infertility is not a death sentence. The joy of motherhood is possible for all women who want it. Health to you and your future babies!

After the procedure of artificial insemination and embryo transfer, the woman should follow all doctor’s orders and regularly determine the level of hCG hormone (human chorionic gonadotropin). Monitoring the dynamics of hCG is determined using a blood test; it is this indicator that will help confirm or refute the onset of pregnancy.

What does the hCG test show?

After embryo transfer during IVF, the first hCG test recommended after 14 days. To do this, you can do a urine test or donate blood from a vein. An analysis carried out at home using a test purchased at a pharmacy may give inaccurate results, and even more so will not show the dynamics of hCG by day (the initial indicator of a simple test may be positive, but after a few days - not). Therefore, a blood test would be a better option.

With a successful embryo transfer procedure, human chorionic gonadotropin begins to be produced already on days 7-14, but its dynamics are not particularly noticeable.

As the concentration of the hormone increases, it becomes more pronounced (this happens on days 14-21). The increase in the amount of hCG is clearly visible only during the first trimester, then its concentration decreases. A slight increase in the amount of hCG can be observed after 22 weeks of pregnancy.

After embryo transfer (replantation) during IVF, doctors recommend testing for hCG once every three days. The obtained indicators are compared with data from special tables that take into account the age of the transferred embryo (3 days or 5 days). Determining the dynamics of hCG by day is a very important factor in the successful completion of pregnancy. Since this procedure will help to notice fetal development disorders in the early stages and take timely measures.

Table of hCG values ​​after embryo transfer during IVF

Reduced hCG levels may indicate a missed pregnancy or a threatened miscarriage. The maximum level of the hormone may indicate a multiple pregnancy or early aging of the placenta.

Test result options

After the embryo transfer procedure, patients often use pharmacy pregnancy tests at home. Quite often it happens that such a test shows a negative result, but the hCG test is positive. In this case, there are several possible reasons for this result:

1. Carrying out the test too early (hormone production has already begun, but its concentration is quite low, and the presence of the hormone in the urine has not yet been observed).
2. Taking medications containing hormones.

Pregnancy tests from 7 to 14 days after embryo transfer

There are cases when the pregnancy test is positive, but the hCG test after IVF is negative. In such a situation, it is worth conducting another pregnancy test, preferably using a test from a different manufacturer. In general, doctors recommend conducting at least three simultaneous tests to obtain a true result. It is also worth paying attention to the presence of other signs accompanying pregnancy, such as:

• absence of menstruation;
• the appearance of toxicosis (especially noticeable in the morning);
• the appearance of pain or heaviness in the lower abdomen;
• swelling of the mammary glands.

However, to obtain absolutely accurate confirmation of pregnancy, it is recommended to conduct an ultrasound examination.

When receiving a positive test for hCG after an artificial insemination procedure, in order to give birth to a healthy child, the patient must adhere to the recommendations of doctors:

1. Take a course of taking hormonal medications (only after consultation with your doctor);
2. Do an ultrasound examination to accurately determine pregnancy and exclude pathologies;
3. Regular observations in the clinic, both in the first weeks after the procedure, and at the slightest manifestation of discomfort and pain;
4. Regular analysis for hCG (to prevent abnormalities in fetal development);
5. Compliance with daily routine and nutrition.

HCG injections before embryo transfer during IVF

Often, to stimulate ovarian function and ovulation, patients are prescribed hCG injections before the embryo transfer procedure. Depending on the drug prescribed and the type of injection, women give the injections themselves at home or come to the clinic. There are two types of injections:

• subcutaneous injections are carried out with a thin needle under the skin in the navel area. Such injections are painless and are often well tolerated by patients (an exceptional case may be an allergic reaction to the components of the vaccine - redness, itching). Such injections are sold already in filled syringes;
• intramuscular injections are made with a syringe with a needle of at least 8 mm in the buttock or thigh.

Video instructions for preparing and administering hCG for superstimulation of the ovaries:

In order for the course of injections to be successful and without complications, it is important to adhere to a number of simple rules:

1. Follow the rules of asepsis.
2. Choose the right place for injections (to avoid damage to nerves and blood vessels).
3. Correct injection technique.
4. Injection mode. It is advisable to carry them out at the same time, the maximum permissible deviation is 3 hours.

5-6 days after the start of hCG injections, the first ultrasound is performed - an examination to determine the reaction of the ovaries and the degree of development of the formed follicles. In the future, such examinations are carried out every three days throughout the entire course of injections.

Follicle puncture

An injection of hCG immediately before the embryo transfer procedure is necessary to stimulate the final maturation of the egg and prepare the follicles for puncture. Before this procedure, patients are advised to abstain from sexual activity, drinking alcohol, and visiting the bathhouse (sauna) for three days.

This is how they puncture the follicles and remove the eggs with a needle.

To obtain a more effective result (high-quality eggs), the puncture is carried out 35-37 hours after the hCG injection, but always before ovulation.

Video about follicle puncture during IVF:

The puncture is performed under general anesthesia and takes about 40 minutes. After the procedure, minor pain and discomfort in the lower abdomen may occur. Ingod there is a slight increase in temperature and spotting. At this time, peace and rest are important for the patient. If severe pain, bleeding or other factors occur, you should immediately consult a doctor.

Prescribing hCG injections after the transfer procedure

So that the female body can adapt to new conditions, hCG injections are prescribed at first after the embryo transfer procedure. They are needed to activate and maintain the functioning of the corpus luteum until the patient’s body begins to produce the necessary hormones on its own. In particular, this concerns the hormone progesterone, which is often called the pregnancy hormone.

With the help of hCG injections, a woman’s body quickly understands what it needs and begins to act. This is why hCG is injected after embryo transfer.

HCG injections are also prescribed if the patient’s body perceives the transferred embryo as a foreign body and seeks to reject it. That is there is a possibility of miscarriage. In this case, special medications are also prescribed.

After the transfer, a week after the hCG injections, when implantation has successfully begun, the membrane of the embryo begins to independently produce the hormone it needs. Therefore, when performing a blood test, already on the 14-15th day you can judge the successful outcome of IVF.

Calm down, everything will be fine.

Write comments and tell us about your experience. This will be very useful for those who are planning to do IVF or have already done so. Rate the article with stars and repost it on your social networks using the buttons below the article. Thank you all so much for reading. Let your hCG test show that you are pregnant.