Pregnancy with in vitro fertilization. IVF in the natural cycle (EC): how it goes, the algorithm for the procedure

The Medical Center "For Birth" provides married couples and single women with IVF in the natural cycle in Moscow. This procedure differs from conventional in vitro fertilization in that there is no artificial hormonal ovarian stimulation used to obtain more embryos. In this case, medical intervention in the female body is minimal, which reduces the likelihood of complications.

How does IVF work without stimulation in the natural cycle?

This method is similar to conventional in vitro fertilization and includes all the main steps:

Consultation with a fertility doctor, where he provides future parents with all the information on this program, possible risks and chances of successfully conceiving a child;
Examinations of both parents, necessary to establish the causes of infertility, identify possible pathologies of the reproductive systems, hereditary diseases of the future father and mother, determine the likelihood of successful conception;
Collection of germ cells from both partners for subsequent placement in an incubator, where the conception and cultivation of the resulting embryos will be carried out;
Transfer of embryos into the mother's body for further bearing and birth of a child.

The absence of a hormonal stimulation stage in IVF means that only 1 egg will be received in one menstrual cycle. This reduces the chance of conception the first time and may require additional attempts.

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Indications for IVF in the natural cycle

This in vitro fertilization program is assigned to couples in the following cases:

If there are contraindications to the use of hormonal drugs due to the high risk that they carry for the woman's body;
Insufficient number of eggs obtained from past in vitro fertilization procedures using hormonal stimulation;
Poor quality of eggs obtained by stimulating the ovaries with hormonal drugs.

Also, IVF without stimulation in the natural cycle can be used at the request of the patient herself, if she wants to protect herself from the risks that the use of hormones carries. In this case, our specialists warn of a lower chance of a successful pregnancy and the possible need to repeat the procedure until the desired result is achieved.

Advantages of IVF in the natural cycle

This type of in vitro fertilization has several advantages over the procedure with hormonal ovarian stimulation:

Security. To stimulate the production of more eggs in the ovaries for 1 menstrual cycle, hormonal preparations are used. In some cases, their administration in large doses can lead to various pathologies that threaten the health and life of the woman herself. IVF in the natural cycle allows you to exclude this stage from fertilization, thereby increasing its safety.
Natural selection. Without the use of hormonal stimulation, 1 egg is formed from the oocytes, the most mature and adapted for conception. By stimulating the ovaries, the doctor achieves the appearance of a larger number of female gametes, from which he chooses the most suitable one himself. However, in this case, errors are possible, and eggs that are less suitable for this will be used for conception.

Another advantage of the natural cycle IVF protocol is the lower cost compared to a procedure that uses ovarian stimulation. In addition, the exclusion of taking hormonal drugs can reduce the time of in vitro fertilization.

Efficiency of IVF in the natural cycle

Without hormonal stimulation of the ovary, the female body produces only 1 egg per menstrual cycle. The efficiency of successful conception and subsequent pregnancy after 1 procedure in this case is only 16%. This is due to the following reasons:

In a small number of women (10-15%), the release of eggs from the follicle occurs even at the stage of its maturation, which does not allow viable embryos to be conceived from them;
Of all the eggs selected for in vitro fertilization, only 80% lead to successful conception;
Even if the baby is successfully conceived in an incubator, when it is transferred to the uterus, it is not always able to reliably implant in the endometrium.

To increase the expectant mother's chances of getting pregnant, without stimulation, a second collection of germ cells may be required, but without stimulation, this can only be done at the next ovulation. Also used is a method such as artificial implantation of sperm into the egg (ICSI). To do this, the selected male reproductive cell is immobilized, then a puncture is made in the membrane of the female gamete using a microneedle and a spermatozoon is injected through it.

The cost of IVF programs in the natural cycle

What determines the price of IVF in the natural cycle?

The cost of this procedure is determined by the number of attempts to obtain a viable egg and the availability of additional services that increase the likelihood of successful conception and childbearing - ICSI, cryopreservation of squamous cells or embryos, preimplantation genetic testing, etc. In case of an unrecoverable pathology of the reproductive system of one or both parents, the following can be used methods:

Use of donor eggs, spermatozoa or ready-made embryos- usually prescribed when parents are unable to produce viable germ cells;
Surrogacy- implantation of an embryo to a woman who is not the genetic parent of the unborn child, for subsequent bearing. It is prescribed in the case when the biological mother cannot endure and give birth due to pathological disorders of her reproductive system.

IVF is a real breakthrough in reproductive medicine. In these three letters lies the hope for a happy parenthood for thousands of couples with a variety of types of infertility, even the most severe ones.

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What is IVF in the natural cycle

Conception in the laboratory with subsequent replanting of the finished embryo into the uterine cavity is prescribed if other methods of treatment are not suitable for an infertile couple. This is the most complex and costly, but effective way to get around even the most serious obstacles to pregnancy.

To understand how the preparation for IVF in the natural cycle differs from the standard version, let's look at the very essence of the method and consider the principles of its application.

The essence of in vitro fertilization is that conception occurs outside the mother's body, "in vitro", or in vitro. And the already fertilized egg is planted directly into the uterus, where its chances of taking root are as great as possible.

At the same time, the body of the expectant mother undergoes a thorough and complex preparation. First of all, in order to make it possible to select eggs for the procedure. To this end, women go through various IVF protocols - a series of manipulations aimed at stimulating ovulatory function.

This is a rather lengthy process that takes up to 40-50 days. At this time, the patient receives large doses of hormonal drugs, is constantly under the control of reproductive specialists. Their main goal is to track the moment of egg maturation and select as many viable, high-quality and healthy ones as possible. At the same time, this is a great stress for the woman's body and a test for the nervous system - under the influence of unusually large doses of hormones, the mood of the patients at times leaves much to be desired.

But preparation for IVF in the natural cycle does not require such strong interventions in the female body. The program maximally corresponds to the natural course of events in the female reproductive system.

Note! Natural IVF, as it is also called, involves the independent maturation of the follicles and the release of the egg. Until this moment, the patient is simply observed, keeping ultrasound under constant control.

How IVF in the EC differs from the standard

Before the procedure of classical in vitro fertilization, the medical team determines the tactics of its implementation and decides which protocol is best to use in this particular case.

Important! IVF protocol - a set of stages of the procedure, which includes the sequence of administration of hormonal stimulants for superovulation, follicle puncture, transfer of the resulting embryos into the uterine cavity and further control. Depending on the circumstances and the woman's history, a long, short, cryo (long-term storage of eggs/embryos until the right moment) or natural protocol may be used.

The main difference between IVF in the EC and the usual one is that there is no need to stimulate the patient's body with shock doses of gonadotropic hormones. In both long and short protocols of standard in vitro fertilization, this is a key task. Natural IVF is a more gentle method; in the long term, it has a much smaller effect on a woman's body.

The only process that requires the intervention of doctors during IVF in a natural cycle is the fusion of the genetic materials of the mother and father and the receipt of the embryo in vitro. The maturation of the egg occurs naturally, which means that its quality will most likely be higher.

Benefits of IVF in the natural cycle

The natural IVF cycle has a number of undeniable advantages. When choosing it, doctors rely not only on efficiency, but also on taking care of the condition of the body of the expectant mother as a whole.

Main advantages:

closest to the natural process of fertilization - the same egg is used that should naturally have been released in the current cycle;
the ovaries do not experience a colossal load of gonadotropic hormones, there is no risk of developing the so-called hyperstimulation syndrome, which causes serious damage to a woman's health;
multiple pregnancy is almost completely excluded, since only one embryo is placed in the uterus - it is a little more difficult to bear after IVF than with the usual method of conception, there are always risks of fetal fading, premature birth;
there is no problem with the storage or destruction of "unnecessary" embryos - during stimulation, more embryos are often obtained from the received eggs than are needed for replanting, while it is emotionally difficult for many couples to make a decision about the fate of those that will not be implanted, especially acute questions of a religious nature arise ;
due to the absence of a drug load, several protocols in a row can be carried out at once, if pregnancy did not occur the first time, then, as with IVF with stimulation, at least a two-month break will be needed (more is better);
without “shock” stimulation by gonadotropes, the endometrium of the uterus accepts the embryo better.

Not the main, but also an important advantage is the price of the medical program. It is cheaper to carry out IVF in a natural cycle, because the lion's share of the costs is associated with the stage of hormone therapy, the collection of a large number of eggs, and the selection of material suitable for implantation.

Disadvantages and risks

With all the obvious advantages of IVF in the natural cycle, fertility doctors prefer to do it much less frequently than procedures with conventional stimulation protocols. There are good reasons for that. Although the most natural, the natural IVF protocol still comes with significant risks:

it may not work at once - the main disadvantage of this protocol remains low efficiency, only about 7% for all protocols and 16% for transplants;
couples sometimes have to go through the procedure three or four times to achieve the result;
Often the failure of the protocol occurs due to the early release of the egg - at the time of puncture, the follicle is already empty.

The issue of IVF cost in the EC refers not only to the advantages of this protocol, but also to the disadvantages. The fact is that although the natural method is cheaper, due to its minimal efficiency it can be repeated more than once, which ultimately increases the overall price.

Indications and contraindications for IVF in the EC

A prerequisite for conducting a natural IVF cycle is the good health of the couple (high-quality spermogram of the husband, a regular cycle for the wife).

Among the main indications:

situations where factors such as the young age of the couple (up to 35 years), sufficient ovarian reserve, male factor infertility or obstruction of the tubes in a woman are simultaneously present;
a high risk of complications when using hormone stimulation, in particular, in patients with a history of cancer, with benign neoplasms in the mammary glands;
unsuccessful attempts to stimulate ovulation in the past - if the ovarian response remains unchanged, it makes no sense to load the body.

Note! Often, when conducting IVF in the natural cycle, reproductologists recommend using the ICSI technique to increase the likelihood of successful conception. The fact is that this method involves the manual selection of the egg and the best sperm, its introduction through the shell of the oocyte with a thin needle. Considering that only one or two eggs will be received at the EC, the use of ICSI is a kind of insurance against failure.

There are many contraindications for IVF in the natural cycle. In addition to IVF protocols common to all protocols (infections, acute inflammations, pathologies of the structure of the uterus), they include cases when a woman has anovulatory cycles, menstruation is irregular.

Is it possible to do IVF in the EC for women after 40

Often the need to resort to artificial insemination arises in couples who have crossed the threshold of optimal reproductive age. Most of the risks and doubts are around the pregnancies of women who have reached the age of forty. This figure is not unreasonable - it is in the fifth decade that most women deplete the supply of eggs, hormonal changes begin in the body. Although slowly, the processes of preparation for the “curtailment” of the reproductive function are being launched.

The advisability of IVF after the age of forty can only be judged by a reproductive specialist, having carefully studied the patient's history, assessing her state of health. This question becomes more complicated when it comes to carrying out the most risky of the protocols - the natural one.

As you know, IVF requires only high-quality oocytes. Any, even the slightest violations, threaten early spontaneous abortion. This is how natural selection works - the body gets rid of a deliberately unviable embryo with genetic disorders. The problem is that the quality of oocytes after the age of 40 is rapidly deteriorating. The eggs age before the woman herself, and the ovarian reserve decreases.

This does not mean at all that there are no chances for successful artificial insemination in the physiological cycle. To achieve a positive result, the reproductologist will have to work hard - it will be mandatory:

determination of ovarian reserve - based on these data, a decision will be made on the preferred protocol;
careful monitoring of the follicles to make a timely puncture;
close monitoring of the general condition of the body - the load on organs and systems after 40 becomes more noticeable.

So, in order to get a “go-ahead” from a clinic specialist for IVF in a natural cycle, a patient over forty needs to be in excellent health and have a normal supply of her own oocytes. Long IVF protocols with a strong hormonal load are also not welcome - they create an excessive load.

Note! If a woman has already started menopause, the only way out will be IVF with a donor egg (if there is no own cryostock).

Procedure steps

If the decision is made to conduct IVF in the natural cycle, the couple will go through several standard steps:

Thorough examination of both partners. It includes both general body screening and more detailed reproductive studies - hormonal levels, partner compatibility, and possible genetic abnormalities. Hardware diagnostics are used, analyzes are carried out.
From the beginning of a new cycle, the woman will be under the vigilant supervision of physicians - they will carefully monitor the maturation of the follicle so as not to miss the ideal moment for puncture. It is important to do this before he ovulates, but not too early, because the immature oocyte will be unsuitable for conception. The patient will undergo ultrasound, measure basal temperature, and do tests.
A day and a half before the expected ovulation, a woman receives an individually adjusted dose of the hCG hormone - it is needed for the body to “work” correctly.
One of the most important stages is egg retrieval. Puncture in the vast majority of cases is carried out under the influence of local anesthetics.
At the same time, it is time for a man to hand over his “biomaterial”. If there is no problem with ejaculation, a semen sample is collected through masturbation. In cases of the presence of sexual disorders or other problems, microsurgical sampling of seminal fluid is possible.
Pre-treatment of eggs and sperm cells includes close supervision by specialists and viability testing.
The culmination of the process is conception itself in vitro or by ICSI.
The next few days (up to one week) the embryo will grow in the laboratory under the supervision of a physician.
The final stage is the implantation of the embryo into the uterus. It is a completely painless and fast procedure. Now it’s up to nature, doctors can only support the patient’s body with the help of progesterone preparations, the “pregnancy hormone”.

After one to two weeks, you can check the patient's blood for the level of hCG. If it grows in dynamics, everything was successful, pregnancy has come.

On an individual basis, doctors decide on further actions. Sometimes the expectant mother should remain under close supervision in order to avoid a miscarriage.

Varieties of programs

The IVF procedure in the natural cycle is associated with a number of difficulties, the main of which are the risk of premature release of the egg from the follicle, the maturation of only one, rarely two oocytes, and the danger of an anovulatory cycle.

Sometimes, in order to “insure”, reproductive specialists prefer to use hormone therapy. It will not be the same “shock” portion of stimulant drugs as with a long IVF cycle. Rather, drugs will only correct some processes.

Within the natural IVF protocol, several common schemes can be distinguished:

"pure" cycle - there is no interference in the natural course of events, the oocyte matures completely on its own;
modified natural cycle - the quality of the egg is artificially increased with special preparations that the doctor selects;
short IVF protocol at EC.

Separately, it is worth highlighting the program with donor sperm. It is recommended for women without a partner, as well as in cases where the quality of the man's sperm does not allow using the ICSI method.

There are chances for success with each scheme - the main thing is to trust an experienced reproductologist who will select the optimal path that will lead a woman to a long-awaited pregnancy.

The IVF procedure in the natural cycle is not possible for every patient. Most often, it is prescribed to women who, due to individual contraindications, cannot take hormonal stimulants. As well as couples with an exclusively male factor of infertility. In vitro fertilization in a natural cycle is performed less frequently than other types of protocols.

What is IVF in the natural cycle

The IVF program in the natural cycle is carried out as close as possible to the usual processes occurring in the female body. This is a procedure that does not involve the use of stimulant drugs. Until the moment of maturation of the follicle, natural IVF does not provide for any manipulations, except for doctors' observation of what is happening in the woman's genitals.

With in vitro fertilization in a short and long protocol, the ovaries are stimulated to produce multiple follicles. When performing natural IVF, loading doses of gonadotropic hormones are not used. The only process in which doctors intervene during such a protocol is the mechanism of the fusion of the egg and sperm.

To do IVF in a natural cycle or to prefer a more popular type of protocol (short or long), is determined during a preliminary examination. To prescribe such a procedure to a patient, the reproductologist must have good reasons.

IVF carried out in a natural cycle has a lesser impact on the functioning of the body. At the same time, manipulation allows artificial insemination with subsequent replanting of embryos. It is assumed that such a procedure has a lot of advantages in comparison with a short or long in vitro fertilization protocol.

Read about others in a detailed article.

Indications

IVF in the natural cycle assumes a woman's good health and a regular menstrual cycle, the duration of which should be in the range of 26 to 35 days. Reproductive function is confirmed by ultrasound and hormone tests. If the patient has hormonal diseases, then the procedure is not performed. It is also contraindicated to do artificial conception in a natural cycle for women after 35 years of age and for patients with anovulatory cycles.

The possibility of carrying out the in vitro fertilization procedure at the EC is provided under the following conditions:

the age of the patient does not exceed 35 years;
the cause of infertility is the absence or obstruction of the fallopian tubes;
there is a male factor of infertility;
it is not possible to use stimulant drugs (for oncology, diseases of the adrenal glands, bleeding disorders);
failure of the protocol with stimulation;
inadequate response of the gonads to stimulation.

For each IVF protocol, indications and possible limitations are considered individually. The reproductologist compares them with each other and decides which method of artificial insemination will be the most successful in this particular case.

Advantages and disadvantages

IVF in the natural cycle, like many programs of the standard IVF procedure, has its adherents among patients.

The first thing women like is the minimal risk of complications from the reproductive system. If we evaluate the procedure in aggregate, taking into account the work of the ovaries, the consequences, risks and success, then we can find a lot of advantages of this technique.

Maximum naturalness. The natural protocol does not use hormonal drugs to stimulate ovulation. This allows the reproductive organs to feel as comfortable as possible and does not create a strong psychological burden.
Efficiency. Clinical trials have shown that the resulting egg has better characteristics. After fertilization, there is a high probability of getting a healthy embryo, which will be more viable than in the case of stimulation.
No negative impact on organs. Hormonal stress can negatively affect the functioning of the kidneys and heart, and also does not go unnoticed by the liver. In the absence of ovarian stimulation, these factors are excluded. What is very important, in the natural cycle, there can be no failure of the protocol due to the development of the hyperstimulation syndrome.
There is no risk of multiple pregnancy. With the fertilization and transfer of several eggs at the same time, the load on the body increases, as a result of which a miscarriage can occur. When planting a single embryo, the probability of pathology will be lower.
Elimination of problems with the need to store embryos. If stimulation is not carried out, only one oocyte matures, and the couple does not need to perform cryopreservation. Often, religious concepts do not allow spouses to refuse "extra" embryos.
Price policy. The cost of IVF in the natural cycle is approximately one and a half times lower than when performing stimulation.

Carrying out the procedure of in vitro fertilization without stimulating superovulation also has negative aspects. All processes occurring in the body of a woman are regulated by their own hormonal background. They are beyond the control of fertility doctors.

If something goes wrong during the formation of the follicle, then it will not be possible to correct the situation. There are cases when an empty sac matured or the egg was of inadequate quality. Also, the follicle can covulate until the moment of puncture. There is a risk that the resulting single embryo will die for some reason or will not take root after replanting.

The psychological state of the patient can have a serious impact on the functioning of the reproductive system. It is impossible to exclude anovulation in the natural protocol, even with regular egg maturation in previous cycles.

Therefore, the effectiveness of IVF in the EC is significantly lower than the effectiveness of other protocols.

“When using the EC, the possibility of choosing embryos is excluded, moreover, the resulting cell may be unsuitable for its further use,” he says. - On the other hand, the cost of the protocol is lower, there are no negative consequences of hormonal stimulation. Also, the protocol in the EC is used for operated ovaries, the age factor - when the probability of getting more eggs is very low. This protocol can be used quantum satis, i.e. as many times as needed. Of course, oocyte sampling is also carried out under intravenous anesthesia. In any case, the choice of the protocol is carried out by the reproductive specialist.

Preparing for IVF at the EC

IVF in the natural cycle involves more thorough preparation than in traditional protocols. The fact is that during the manipulation, hormones are not taken, and this creates a need for the body to work as efficiently as possible. The task of the hormonal background is a clear regulation of the work of the sex glands and the mucous layer of the uterus. The main recommendations for the patient are to comply with the following rules:

stop smoking, including electronic cigarettes, hookahs, and also minimize passive smoking;
exclude alcohol, including low-alcohol drinks;
not exposed to radiation and x-rays;
normalize physical activity (reduce when doing heavy sports and increase with a sedentary lifestyle);
eliminate stressful situations;
be checked for infections, and if they are found, undergo preliminary treatment.

The preparatory stage includes instrumental and laboratory diagnostics: ultrasound, colposcopy, folliculometry, hormonal testing.

Protocol steps

When conducting IVF in a natural cycle, the protocol scheme may differ depending on which program the procedure is performed on:

standard program (observation, puncture, fertilization, transfer);
program without transfer (observation, puncture);
with donor sperm (observation, puncture, fertilization with donor material, transfer);
with donor sperm without transfer (observation, puncture, fertilization with donor material, vitrification);
program with ICSI (observation, puncture, intracytoplasmic injection, transfer);
cryoprotocol (observation, cryotransfer).

At the initial stage of any program, the maturation of follicles is monitored using ultrasound. Some time before the moment of ovulation comes, a puncture is performed, and an injection of chorionic gonadotropin (hCG) is first performed for the correct formation of the corpus luteum. It is important to accurately track the time of "readiness" of the egg, since early selection will not allow artificial insemination. Oocyte maturation is monitored on average once every 2-3 days.

The puncture time is set for each patient individually, since the length of the first phase of the cycle in women is different. After the egg is released from the follicle, it is fertilized. This process can be performed in a standard way or by ICSI, which will increase the cost of manipulation by 10-20 thousand rubles. If the program provides for the transfer of a frozen blastocyst, then the puncture is not performed.

The embryo is transferred into the uterus 3-5 days after the puncture. After that, the woman remains in the clinic under the obligatory supervision of doctors for another 2 hours. If she feels well, she can go home the same day, following individual recommendations. After the embryo transfer in a natural cycle, it is necessary:

exclude sexual intercourse and strong physical exertion;
do not take a hot bath, do not visit the sauna and swimming pool;
drink plenty of fluids and eat well;
if possible, observe bed rest and psychological rest;
rest more;
take prescribed medications;
from 3 days after the transfer, walk in the fresh air.

7-10 days after the procedure, it is recommended to conduct a pregnancy test at home. If the result is positive, make an ultrasound scan in 2-3 weeks to confirm the implantation of the embryo in the uterine cavity.

Protocol efficiency

Conceiving a child with in vitro fertilization in a natural protocol is possible only if the woman is healthy. With diseases such as endometriosis, endometritis, uterine fibroids and others, the effectiveness of the procedure will tend to zero.

Despite the fact that the program in the natural cycle allows you to get more viable embryos than in the stimulated one, the chances of a successful conception for it remain minimal.

The chances of getting a quality egg in the EC is only 7%. This means that out of 100 women who have entered the natural IVF protocol, only 7 will be able to produce genetically suitable material. The remaining patients are deprived of the possibility of embryo transfer. And the chances of conceiving a child after embryo transfer is only 16%. That is, out of 100 women who have had an embryo implanted, they will become pregnant and will soon feel the first signs of a new situation, only 16 lucky ones.

The reasons for the failure of IVF in the natural cycle are due to the following circumstances:

physiological features of the fertilization process (after all, even in completely healthy partners, the probability of natural conception does not exceed 80%);
genetic unsuitability of the resulting embryo (the couple wants to give birth to a healthy child during IVF, so cells with defecation are not intended for transfer);
Premature ovulation occurs in 10-15 patients out of 100 (unplanned egg release due to poor medical center equipment, patient negligence, or spontaneous LH surge).

In case of premature release of the egg from the ovary, the in vitro fertilization protocol is recognized as completed ahead of schedule. The chance of pregnancy in this cycle through assisted reproductive technologies disappears. Conception becomes possible only naturally or in the next IVF protocol.

When a married couple decides on artificial conception, they want the spent forces, nerves and money to justify themselves.

First of all, future parents are concerned about the safety of the girl and child during the IVF program. Therefore, most families, if the state of the mother's health allows, choose in vitro fertilization in a natural cycle, which is considered the safest and fastest.

What is its difference from other types of procedures and to whom is it prescribed? We read in the article.

H what is IVF in a natural cycle

IVF in a natural way is a method of laboratory fertilization, which is prescribed during the period of natural ovulation. With this variant of conception, additional stimulation with the help of hormonal preparations is not used. Medical intervention is carried out only at the stage of in vitro fertilization of the egg, after which all responsibility rests with the woman's body. It depends only on her whether the embryo can take root and fully develop in the mother's body.

The standard protocol involves administering large amounts of gonadotropic stimulants to the woman to help produce the required number of oocytes. But this version of the program has high risks for the health of the patient in the future. Therefore, future parents most often give their preference to insemination in the natural cycle.

With the option of natural chemical conception, the load on the body is minimized. That is, the likelihood of harm to health is minimal. In addition, with this method of in vitro fertilization, there is an option not to take hormonal drugs at all. This method of conception is recommended for women over 40 who do not have health problems, but cannot conceive children naturally. Preparation for the program is no different from preparation for the standard protocol.

The natural OMS IVF protocol is a type of artificial conception in which cells are fertilized in vitro in a natural environment. In this case, do not use hormonal agents that stimulate the production of oocytes.

Doctors help the expectant mother only at the stage of conception, and all other processes before and after this action occur independently in the female body. Therefore, the success of the procedure directly depends on the well-being and health of the expectant mother.

Main differences from the classical procedure

The standard in vitro fertilization program includes the obligatory intake of hormonal agents that stimulate the ovaries.

From the very beginning of the menstrual cycle, the girl begins to take special drugs under the supervision of a specialist. This is necessary in order for the egg to increase in size as much as possible. After that, when menstruation begins (on the 4-5th day), doctors remove the mature egg and fertilize it. With this method of conception, the likelihood that it turned out to become pregnant increases.

When the required number of oocytes matures with the help of stimulation, laboratory assistants manage to isolate several good embryos after fertilization. And this means that when they are planted in the uterus, the chance of getting pregnant increases significantly. In addition, the doctors calculate the day of the patient's ovulation in advance, so the day for the puncture is determined in advance.

How does stimulation occur before insemination?

It goes through several stages:

At the first diagnosis, doctors evaluate the girl’s fertility and choose which protocol is right for her (short, long or super long). After that, a course of drugs is prescribed to stimulate the ovaries.
In addition to hormones, the patient is also prescribed receptor agonists, which contribute to the active work of the reproductive organs. Most often they need to be taken from the 2nd to the 5th day of the onset of menstruation.
If necessary, a woman is given an injection of hCG during the period of ovulation.
After successful ovulation, a puncture is performed - the removal of mature eggs from the ovaries.

Due to the large number of drugs and artificial stimulation of the reproductive organs after pregnancy, the girl may develop complications. Therefore, this method is often considered less secure than the second option.

In addition to the standard procedure, the expectant mother may be assigned in vitro fertilization in a natural cycle. What is the difference? The main difference is that with this method of conception, the ovaries are not stimulated with synthetic drugs.

All processes take place on their own. That is, the egg develops without additional help. This is a more gentle way of laboratory conception. The effectiveness of this method is not always positive, there are also negative results, but due to its safety, the procedure can be carried out more than 10 times.

Advantages and disadvantages

Before choosing one or another method of chemical conception, the reproductologist must explain to future parents what are the pros and cons of the procedure. In addition, he is obliged to talk about the possible consequences and complications during the period of bearing the baby and the postpartum period.

The main advantages of the IVF method in the natural cycle include:

reproductive organs are not subjected to artificial stimulation and strong exposure to hormones;
the risk of developing ovarian hyperstimulation syndrome is minimal;
in case of an unsuccessful test, a second event can be carried out, since everything happens naturally and does not negatively affect the body;
after such fertilization, the girl can choose natural childbirth (with standard IVF, only a caesarean section is most often prescribed);
the probability of fertilization of two fruiting eggs at once is minimal, since only one embryo is taken when planting;
no need to decide whether the remaining embryos and eggs should be subjected to cryopreservation;
the patient experiences almost no pain, fear and stress compared to the standard procedure;
high risk of successful replantation, since the endometrium of the placenta is of better quality, because it was not subjected to additional stimulation;
the price of the program is much lower, since medical intervention is minimal and there is no need to use special medications (the cost in different clinics can vary significantly, so you need to specify how much it costs).

The disadvantages include the following:

Whether the fetus can develop in the uterine cavity and whether conception itself occurs depends only on the professionalism of the reproductive specialist. Only a specialist is able to conduct a correct analysis of the girl's health, choose the right day of ovulation for a puncture.
If the follicle during the period of menstruation did not independently grow to the desired size, then the procedure is interrupted until the next ovulation.
Due to the premature release of luteinizing hormone, the follicle may burst even before the puncture.
If the oocyte is damaged, then the doctor will not be able to help.
If a girl has only one gamete, then the embryologist will not be able to fertilize her qualitatively.
There is an increased risk of damage to the internal reproductive organs during the procedure.

Statistics show that the birth rate with the natural cycle is much less than with the usual protocol. This is due to the fact that with this method of treatment there is no synthetic stimulation of the ovaries.

Therefore, the chances of conceiving a child are lower than with a long or short IVF protocol. In addition, an important role is played by: age, the quality of a man's sperm, the activity of the reproductive organs, the health of the parents, genetics and the professionalism of the doctor.

When choosing a method of conceiving a baby, a woman herself must decide which method of treatment suits her best. And is she ready to go through the procedure again if the first one fails. In any case, such a protocol is used repeatedly - usually until the girl becomes pregnant.

Who can count on IVF in natural cycles

This procedure is shown to patients:

whose age is 24–40 years;
with diseases of the liver and/or kidneys, cardiovascular system and pancreas;
with an abnormal structure of the fallopian tubes;
who have a congenital low number of eggs;
whose reproductive organs are actively working;
with a regular and full menstrual cycle (27–34 days);
when hormone therapy is contraindicated.

How IVF is done in a natural cycle

Such a protocol is carried out according to the following scheme:

Diagnosis of the rate of formation and development of the follicle (from 8–9 days of menstruation).
Establishing the period of maximum production of LH (luteinizing hormone) - the girl takes urine tests and undergoes an ultrasound scan, which helps determine the day of the puncture.
Carrying out a puncture.
Taking a semen sample.
Basic IVF or ICSI procedure.
Observation of laboratory development of the embryo.
Insemination into the uterus on the 3rd-4th day of embryo development.
Observation of the future mother, if necessary, auxiliary drug therapy.

How to behave after the procedure

After the implantation of a fertilized egg in the uterus, the girl needs to lie down for 1.5–2 hours. It is advisable not to move and not roll over to one side.

for 10-14 days to observe constant bed rest;
control the temperature (if it has risen sharply, call a doctor);
protect yourself from physical and emotional stress;
adjust your diet (nutrition should be balanced, full of vitamins and microelements);
start observing the daily routine (eat 4-5 times a day, get enough sleep, rest);
temporarily refrain from sexual activity;
do not visit baths and saunas, bathe in warm water at home;
do not take any drugs without the knowledge of the attending physician.

Such measures are necessary in order to minimize the risks of an unsuccessful pregnancy. Only one embryo is implanted into the uterine cavity, so the probability of fertilization is relatively low. Therefore, it is important in the early stages of pregnancy to protect yourself from any stress, excitement, physical and emotional stress. Only with a positive atmosphere, proper nutrition and daily routine, there are chances to become parents with the help of insemination.

When not to opt for a natural protocol

if a woman is over 35;
patients with unstable periods;
if the male factor is low even with IVF or ICSI;
if a woman does not naturally ovulate.

With such indications, the likelihood of becoming pregnant with the help of insemination is minimal. Therefore, reproductologists do not recommend this protocol if there are any deviations in the health of the couple.

When it is shown to do IVF in the EC, and what it is, the video will tell in more detail.

Conclusion

IVF in a natural cycle is a safer method of artificial insemination.

Every girl has the right to choose it, if her health allows it. In addition, it can be done every month if previous attempts were unsuccessful.

IVF program in natural cycle

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IVF program in natural cycle

IVF in the natural cycle is a type of assisted reproductive technology. This technique consists of a number of stages, the leading of which are ultrasonic monitoring of follicle growth, oocyte sampling in a natural, that is, unstimulated menstrual cycle, an embryological stage, and embryo transfer into the uterine cavity. Unlike the standard IVF program, no drugs are required to stimulate ovarian function (superovulation stimulation).

Stages of the IVF program in the natural cycle

The growth of the follicle and the maturation of the oocyte occurs in absolutely natural conditions, in the body of a woman. Careful ultrasound monitoring of follicle growth is necessary, and it may be necessary to measure certain hormonal parameters by taking blood from a vein. To obtain a mature oocyte, 36 hours before its collection, an intramuscular injection of a preparation of chorionic gonadotropin (hCG) is performed.

Egg retrieval is performed during a transvaginal ovarian puncture. It is possible to perform this surgical procedure under short-term intravenous anesthesia or without anesthesia (the choice of anesthesia method is always agreed with the patient).

Further, on the day of the expected ovulation, with the help of transvaginal puncture of the ovary, an oocyte is taken, which is fertilized already in vitro. For fertilization, it is possible to use the biological material of a spouse / partner or a donor. Next, the resulting embryo is cultured to the blastocyst stage (within 5 days) and transferred into the woman's uterine cavity under conditions completely identical to the standard IVF program.

The structure of the IVF program in the natural cycle

consultation, examination, ultrasound examination at the beginning of the menstrual cycle
Ultrasound monitoring of follicle growth
transvaginal follicle puncture without anesthesia / under general anesthesia (short-term intravenous anesthesia)
stay in the ward of temporary stay up to 2 hours
embryological stage
embryo transfer to the uterus and management in the post-transfer period

Who is shown the IVF program in the natural cycle

Women of different age groups (the program is also possible for women under 37 years old and for women of late reproductive age over 37 years old) with ovulatory menstrual cycles (menstrual cycle with confirmed ovulation)
Indicators of levels of follicle-stimulating hormone (FSH) on the 2nd-4th day of the menstrual cycle are less than 15-18 mIU / ml, estradiol is above 75 pmol / l
Tubal and male factors of infertility
Couples who want to avoid the extra cost of ovarian stimulation drugs (always used as part of standard IVF programs)
Women who, according to experts, are not recommended or contraindicated for hormonal stimulation of superovulation (cancer patients, women with a high risk of thromboembolic complications, etc.)
Couples who want to avoid the additional cost of embryo cryopreservation. Upon receipt of 1 embryo of good quality, suitable for transfer to the uterine cavity, there is no need to “freeze” the remaining embryos. This issue is faced by patients undergoing treatment under the standard IVF program, during which more than 1 oocyte is obtained, and in the future, after cultivation, there may often be embryos suitable for cryopreservation.
The natural cycle IVF program is suitable for patients who, for ethical reasons, do not want to select (select) the best embryo from all received embryos suitable for transfer (selective transfer of one embryo is basic in a standard IVF program).

The natural cycle IVF program can serve as an alternative for women with a history of unsuccessful standard IVF attempts (in the absence of an ovarian response to ovarian stimulation, poor quality oocytes, reduced ovarian reserve).

With a pronounced decrease in ovarian reserve (assessed on the basis of the level of anti-Müllerian hormone, FSH and estradiol levels, as well as the number of antral follicles visualized during transvaginal ultrasound), the couple / partners are offered the opportunity to use donor oocytes (IVF program in a natural cycle using donor oocytes).

Benefits of the IVF program in the natural cycle

IVF in a natural cycle is one of the safest methods that ensures minimal use of drugs. In addition to limiting the drug load, there is also a reduction in economic costs, taking into account the high cost of drugs used to stimulate superovulation as part of standard IVF programs.

IVF program in natural cycle

Given the lack of stimulation of ovarian function during the IVF program in the natural cycle and as a result of the transfer of only one embryo, the risk of multiple pregnancy is minimal, and the likelihood of developing ovarian hyperstimulation syndrome is significantly reduced.

There are a number of studies that have shown that the quality of embryos obtained during standard IVF programs with the appointment of drugs to stimulate ovarian function are inferior in characteristics to embryos obtained during IVF programs in the natural cycle. The literature describes the negative impact of pharmaceuticals (prescribed gonadotropins) on the quality of eggs, as well as the receptive properties of the endometrium (characteristics of the endometrium necessary for successful implantation).

If during the IVF program in the natural cycle it is not possible to obtain a high-quality oocyte or an unsatisfactory quality embryo is obtained during cultivation, the corresponding part of the already paid program is returned to the patient. The cost of the IVF program in the natural cycle is lower than the standard IVF program.

An important advantage of the IVF program in the natural cycle is the possibility of its implementation in several consecutive menstrual cycles.

Disadvantages of the IVF program in the natural cycle

In some women (10-15%), during ultrasound monitoring before the stage of transvaginal puncture, premature ovulation may be recorded. It is also possible to take an egg that has not reached sufficient maturity or its absence in the fluid aspirated from the follicle. However, in most patients, when performing a transvaginal puncture, it is possible to obtain an egg.

When fertilizing the resulting egg, it is not always possible to obtain a good quality embryo. Some of the embryos obtained in IVF programs in the natural cycle do not continue their development under conditions of artificial cultivation in vitro and are not suitable for transfer into the uterine cavity.

Therefore, in general, the effectiveness of the IVF program in the natural cycle is not high, it is 10-20%.

Contraindications

Contraindications for conducting an IVF program in the natural cycle do not differ from the requirements for standard IVF programs. The presence / absence of contraindications for the IVF program in the natural cycle can be assessed by a reproductologist, in some cases it may be necessary to consult related specialists (general endocrinologist, oncologist, mammologist, nerologist, hematologist, etc.).

The list of examinations before the IVF program coincides with the list of tests required for the standard IVF program.

The choice of the optimal tactics for managing a married / partner couple and the possibility of conducting an IVF program in the natural cycle is discussed with a reproductologist. It is also possible to conduct an IVF program in a natural cycle with minimal stimulation and the so-called mini-IVF protocols in the department.

FSBI “National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Ak. V.I. Kulakov” of the Ministry of Health of Russia You get a unique opportunity to receive FOR FREE IVF procedure