Eco Contraindication procedure. Than bad extracorporeal fertilization

The date: 03.04.2019

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Feel free to ask your questions and our regular specialist will help to figure it out!

The method of extracorporeal fertilization (ECO) allows childless married couples to conceive and give birth to a genetically own child without a danger to mother health. This method of conception is not effective for all married couples. There are contraindications that make the use of the method impossible.

The decision on the possibility of non-utilized fertilization is taken by a doctor after consideration by all for both the procedure and conducting all measures for the treatment of diseases that prevent the onset of pregnancy.

The main indication for participation in the ECO program is the inability to cure infertility of one of the spouses. Indication to the procedure serve:

obstruction uterine pipes;
violation of ovulation;
endometriosis;
the anatomical features of the uterus that prevent conception.

For men, the testimony for eco is sperm pathology or disruption of seed fluid.

When spouses may refuse to participate in the program

The procedure is not prescribed with the inability of a woman for health a pregnancy. There are absolute and temporary (relative) contraindications.

Temporary obstacles to artificial fertilization

Temporary contraindications are corrected, and after appropriate treatment, the woman will be able to become pregnant and give birth to the baby. Procedure artificial fertilization Delay in case:

pronounced adhesive process in a small pelvis;
clusters of fluid in uterine pipes that prevent embryo implantation;
chronic diseases of the appendages, exacerbated in the current year;
benign tumor In the uterus, ovaries.

After treatment, the doctor may resolve participation in the program. An obstacle to ECO is some congenital or acquired women's diseases, such as heart defects, bone fragility, no kidney lone.

It is not always possible to extrietic fertilization due to genetic diseases women. These disease belongs to hemophilia, Miodistrophia Duzhenna. In this case, before the procedure of artificial fertilization, there is preimplanting genetic diagnostics.

Conditions that increase the chance of pregnancy

One of the conditions of Eco's effectiveness is the mass of the body of a woman. It is desirable that the weight of the woman was more than 50 kg, but did not exceed 100 kg.

Weight deficiency can lead to difficulties associated with the introduction of a fertilized egg in the uterus. Overweight It is able to lead to premature birth, adversely affect the health of the baby.

The relative contraindication to participate in the artificial fertilization program is smoking. Frequency of pregnancy at smoking women below. There is another contraindication that affects the efficiency of the method, it is age. Although the procedure is carried out and after 45 years, the chance to conceive and endure the child with age decreases.

In what cases eco do not spend

Extracorporeal fertilization is contraindicated to women whose health status does not allow to endure a child without risk for their own health.

Absolute contraindications:

tuberculosis, HIV, hepatitis, syphilis;
malignant tumors of any localization;
blood disease;
diabetes;
heart disease, vessels;
hypertension, non-controlling drugs;
mental diseases.

Do not resort to artificial fertilization with congenital malformations of uterus, deformations capable of preventing the introduction of the embryo into the wall of the uterus, and childbirth. The use of an extracorporeal fertilization method is not shown in chronic somatic diseases that are non-treatable, such as intestinal fistula, renal failure.

Contraindicated Eco with benign tumors in genitals. Reception hormonal drugs During the program, it can provoke a transition of a benign neoplasm in a malignant tumor.

The decision to conduct an eco for the treatment of infertility to the marital couple, the doctor takes after a comprehensive survey of spouses. Eco is used with the impossibility of other methods of treating infertility.

Video from a specialist

Before Eco, a married couple passes an impressive spectrum of surveys. We wrote about him earlier in our blog (see).
The surveys have passed help the doctor of the Eco clinic eliminate restrictions and contraindications To conduct an ATC, which allows you to predict the potential efficiency of ECO, prevent the risks of complications of the course of pregnancy and childbirth. Also, pairs planning a child may face a number of questions about possible contraindications Social character, and today we will talk to talk about it.

Contraindications to eco can be absolute and relative. In accordance with paragraph 22 of the order of the Ministry of Health of the Russian Federation No. 107n of August 30, 2012 Restrictions The use of the ECO program is:

reducing the ovarian reserve (according to the ultrasound of the ovaries and aMG level in blood);
states in which treatment using the Base Program Eco is ineffective and the use of donor and (or) cryopreserved sex cells and embryos, as well as surrogate motherhood;
hereditary diseases lucked with floors, in women (hemophilia, Duzhenna muscular dystrophy, ichthyosis associated with X-chromosome, Amiotrofia Neural Charcot Marie and others) (on the conclusion of genetics, it is possible to conduct a basic ECO program using its own oocytes when mandatory preimplantational genetic diagnostics).

Scroll Contraindications For ECO, attached to Appendix N 2 to the above order.
I would like to make a reservation that some absolute contraindications to which the aggravation of chronic diseases, injuries, congenital defects after successful treatment for the decision of the Consulius of doctors may no longer interfere with the conduct of Eco.
With a complete spectrum of absolute contraindications, you can read by clicking on the link: http://www.garant.ru/products/ipo/prime/doc/70218364/#5000.
Also, pairs planning a child may face a number of issues, about possible social contraindications, and today we will give a number of the most frequently asked questions.

Is it possible to plan an eco pair that is not a registered marriage?
Fundamentals of the Russian Federation on the protection of citizens from 22.06.93 N 5487-1 in article 35 "Artificial fertilization and implantation of the embryo" declare: "Each adult female of childbearing age has the right to artificial fertilization and implantation of the embryo. Artificial fertilization of a woman and embryo implantation are carried out in institutions that have licensed medical activities, in the presence of written consent of the spouses (lonely woman). "Thus, official registration is not obligatory.

What age is women unacceptable for Eco?
Of the above legislative decree it becomes clear that for a woman planning Eco necessarily achieving an adult age, but the upper age limit in the legislation is not defined. It is determined by the attending physician, according to the results of the survey spectrum. And if the age of a woman in a concrete situation is critical, you can consider the ECO version with donor egg cell. If a age peculiarities Requests not only the volume of the follicular apparatus, but also the ability to endure the embryo, then you can consider the ECO version with a donor egg cell with Surmama.

Can TIP same-sex couples, lonely women, men?
In this case, there are no restrictions, for the implementation of plans, becoming parents need to assume the help of surrogate mom, donors of egg and / or spermatozoa.

Can a couple in which one of the HIV partners is infected, go to Eco?
Maybe only after passing additional examination In order to eliminate the acute process. With HIV's high activity, you must first undergo treatment and further decide on the admissibility of Eco.

Is there anything to hold an eco woman (married couple) without personal housing and with a low earnings?
Yes, in this case, it is especially important to talk about Eco on OMS, i.e. Free holding eco.
In October 2012, D.A. Medvedev signed the Decree of the Government of the Russian Federation "On the program of state guarantees of free provision of citizens medical care For 2013 and on the planning period 2014 and 2015. ".
This document has opened the possibilities for a very large group of citizens for which the cost of Eco is too high to take advantage of the ACT and carry out its most cherished dream - to become parents.
The topic of ECO for OMS is very capacious and relevant, contains many nuances that it is important to know the pairs planning pregnancy with the help of Eco. More detailed ECO information block on OMS can be read in the previous message posted in our blog.

If you have questions about contraindications for Eco, ask them in the comments.

The emergence of children with artificial fertilization is no longer extraordinary. The ECO procedure is often perceived as not an easy, but the common way of conception available to everyone. At the same time, as any medical intervention, the procedure has its testimony and contraindications for conducting.

Indications for Eco in women

Absolute indication to the conduct of Eco is, which is not amenable to therapy. In addition, the conduct of Eco is shown in the presence of diseases or related pathologies that lead to reduced work reproductive system organism. The procedure is carried out in cases where conservative and surgical treatment are unsuccessful.

pipe-peritoneal factor that may be due to:

violation of the patency of uterine pipes due to the presence of related STIs or dressing of uterine pipes;
the lack of uterine pipes, which may be congenital or acquired as a result of operational intervention.

anguulatory menstrual cycles;
immunological incompatibility to form antispermal antibodies;
inexplicable infertility in the absence of the effect of the therapy.

Please note that in Russia women can get the quota for the federal program.

Indications for Eco in men

Indications for Eco in men are associated with spermatogenesis pathology:

oligospermia. This pathology characterized by a decrease in ejaculate below 2 ml;
asthenospermia. With this pathology, the number of movable sperm and less than 50% is reduced in the ejaculate;
turatoSPERMIA. In this case, there is no change in spermatozoa, while healthy remains less than 30%.

Contraindications to Eco

Absolute and relative contraindications can be allocated.

Absolute Contraindications to Eco

In the presence of absolute contraindications to the conduct of eco, only possible alternative methods, such as surrogate motherhood and adoption of the child.

Among absolute contraindications are distinguished:

congenital defects of reproductive organs, such as aplasia or lack of uterus; hypoplasia or underdevelopment of the uterus; Curry uterus; doubling of the uterus; transverse partition in the uterine cavity, etc.
lack of uterus as a result of operational intervention;
oncological diseases in a woman. If there is a woman malignant neoplasm In the history, in which it is considered to be cured, the solution of the issue of conducting Eco is solved jointly with a gynecologist and an oncologist.
extgazenital diseases in which pregnancy and childbirth are contraindicated - in case of an offensive, they can provoke complications and lead to a fatal outcome. Among the concomitant diseases are a special place:

blood diseases such as leukemia, lymphoma, lymphogranulomatosis;
diseases of cardio-vascular system in the decompensation stage arterial hypertension severe, cardiomyopathy;
diseases endocrine system: diabetes mellitus in the decompensation stage or with the presence of complications and damage to the kidneys, eye;
mental diseases;
diseases of the nervous system;
insufficiency by any organs and systems.

Relative contraindications

In the presence of relative contraindications to Eco, the procedure is possible after eliminating the cause of the disease.

Among the relative contraindications to the conduct of extracorporeal fertilization is distinguished:

benign reproductive neoplasms. In the presence of a benign tumor of the uterus or myoma, there is a threat of the effectiveness of attaching the embryo and tooling pregnancy, especially when the uterine cavity is deformed by a myomatous node. If the myomatous node is less than 30 mm, conducting ECOs perhaps followed by the removal of the node. If a node is more than 30 mm, the patient's tactics are selected by a doctor individually. The presence of a benign tumor of reproductive organs when prescribing hormonal drugs to stimulate ovulation can provoke their growth.
infectious diseases. In the presence of an infectious disease, the procedure is possible after recovery or presence in a patient with a stealing remission in chronic pathology.
chronic extragenital diseases in the aggravation stage.

Extracorporeal fertilization (ECO) is a reproductive technology. With its help from the body, the egg extraction is extracted, which is fertilized by artificially. The embryo is then developing in a special incubator for several days and placed in the uterus.

Indications for Eco in women - this is the absence of pregnancy for 12 months or the presence of diseases in which conception natural way It is impossible. So, in what cases do Eco make?

Endocrine

Violation of the hormonal background may result in the following pathologies:

The lack of lutein phase (developing insufficient progesterone).
Lack of ovulation (shortage in the body of a follicularity-linguing or luteinizing hormone).
Polycystic ovarian (violation of the functional operation of the ovaries and an increase in the body of a woman's level of men's hormones).

If, despite treatment with hormonal drugs for 6 months, pregnancy does not occur, is an indication for Eco.

Pipe-peritoneal

50% of women with disturbed reproductive feature infertility arises as a result wrong structure Or the work of the uterine pipes. The consequence of pathology is that the fertilized egg cannot reach the uterine cavity on time, so the pregnancy does not occur.

The cause of pipe and peritoneal infertility becomes hormonal violations or inflammatory processes in the field of small pelvis. Also provoke pathology can surgical operation, as a result of which spikes were formed.

In which cases do Eco? If a medicia treatment does not give the necessary results or with the loss of uterine fallopian pipes As a result of ectopic pregnancy.

Immunological

For this type of infertility, the development of antispermal bodies attached to spermatozoa and prevent them from entering the egg. They can appear in the body, both in men and women.

The reason for this pathology is not fully clarified. But in the event that eliminate the problem by treating hormonal and antihistamine drugs It fails, resort to extra-stranded fertilization.

Age

Women with a fascinating reproductive function stimulate ovulation with hormonal drugs and use oocytes of the patient itself. Also, if necessary, donor material can be applied.

Eggs can be frozen in liquid nitrogen and store for a long time. It is resorted to this method if there is a threat to the health of a woman or its reproductive function.

Without indications

Many women have a question, can I do eco without indications? Yes, it is possible, but you need to consider several factors:

Hormonal preparations that are used to stimulate ovulation can adversely affect the body of the woman.
Some malformations in the kids, conceived by extra-stranded fertilization, appear more often than other children.

Contraindications

Contraindications to Eco in women are the following:

Mental diseases in which the patient becomes incapacitated and cannot care for the child.
Congenital disadvantages of uterus.
The deformation of the uterus at which it is impossible to put the embryo or to carry out the fruit.
Neof formation in the uterine cavity or ovarian area requiring surgical intervention.
Inflammatory diseases in aggravated form.
Malignant diseases.

Order of the Ministry of Health No. 107N (video)

Times, when the obstruction of the uterine pipes, the absence of ovulation in a woman, a too small amount of viable spermatozoa in a man or age over 40 became a sentence of childlessness, have long passed. Invented in the 70s of the 20th century, the technology of extracorporeal fertilization (ECO) on this moment Maximum improved. It allows you to get pregnant and give birth healthy child (The absence of gene anomalies is controlled) after certain preparation stages.

In some cases, the extracorporeal technique can be performed not with its own, but with a donor egg. It can be held with donor sperm, if there is indications for it. This method makes it possible to become parents, even if the woman herself for some reason is unable to endure the child (the program of surrogate motherhood).

The cost of Eco Various. On average, without the rule program, in 2016 it exceeds 107 thousand rubles and depends on what protocol (that is, the stages of drug and instrumental support) will be chosen which additional methods Need. At the policy of the OMS, it is free, but only:

according to strict indications;
up to 39 years old women;
the policy applies only to 2 attempts in extracorporeal conception.

Although Eco and bypass obstacles that nature put on the way in pregnancy a particular pair, its effectiveness is not approaching 100, but only to 50%. In some cases, it is necessary to re-conduct it, and it is usually carried out by methods (Ixi Ixi, Ixi Pixie), increasing the chances of success.

What is eco

This technique is called "conception in the tube." It lies in the release of an egg, followed by the introduction of a male cell outside the female organism into it. Next, under the microscope, the development of embryos is monitored. When they reach the necessary stage of development, they are introduced into the Women's uterus, whose prepared in advance and is on the most favorable conception of the stage. Some time is a thorough ultrasound observation of developing germs: their adheated is controlled, may, in agreement with the woman, their number is adjusted.

In 2-3 trimesters, the pregnancy obtained using this reproductive technique is carefully protected from possible negative influences.

Eco is carried out when there is no possibility of fusion of the egg and spermatozoa in vivo. Children born in this way do not differ from conceived physiologically; Extracorporal fertilization is not reflected on health or mental or intellectual qualities. On the contrary, with the help of this technique, you can avoid the birth of a disabled child or having a heavy genetic pathology.

Statistics

The method of extracorporeal fertilization began to be developed back in the 70s of the 20th century. The first child in the USSR, the stosen by this method, was born in 1986. The technique of manipulation was gradually improved, and since 2010, more than 4 million children were born in the world from extracorporerally received embryos, of which every 160th appeared in Russia.

ECO efficiency depends on many factors. Among them, the number of attempts to introduce embryos (the more submissions, the higher the probability of success), hormonal and structural features concrete woman. One of the factors affecting efficiency is the age:

up to 25 years old chance of embryo engraft is 48%;
in 27-35 years - about 33%;
in 35-40 years - about 25%;
40-45 years - 9%;
over 45 years old - 3%.

If the embryo has taken place (several of them are somewhat angry), pregnancy ends with childbirth or cesarean cross section In 70-76% of cases.

Indications to manipulation

Eco is held according to the testimony of medical and social character, if a woman wants to have children under such circumstances when:

violation of uterine pipes;
the absence of uterine pipes - congenital or during surgery, for example, in the treatment of tubular (ectopic) pregnancy;
severe stage of endometriosis when the combination of hormonal and operational treatment did not allow to get pregnant during the year;
states at which no ovulation occurs (donor eggs are used);
genetic diseases transmitted through an egg or spermatozoa (with X- or Y-chromosome);
the desire to give birth at the age after 40 years: Eco gives more opportunities to protect themselves from the birth of a child with genetic anomalies (for example, with Down syndrome): Before the attachment, the embryo passes genetic diagnostics;
the poor quality of the seminal liquid of a man (little active spermatozoa or they are completely absent), non-treatable treatment;
when infertility came due to endocrine diseases of a woman: the thyroid, pancreas, pituitary glands, and, despite their treatment, did not get pregnant;
antibodies against spermatozoa in a woman: In the test tube there is an opportunity to introduce a men's cell directly into female, avoiding immune reactions;
infertility of an unexplained reason. Such a state is detected from each tenth pair, which during the year can not conceive a child.

If there are no contraindications, the procedure can be carried out:

women who are not married when they wish to give birth to a child;
non-traditional sexual orientation women;
men who want to have a child without intercourse using surrogate motherhood service;
women suffering from vaginism - a state when any penetration into the vagina (even a tampon or mirrors for gynecological inspection) accompanied by a spasm of his muscles (this can be comparable to the muscle spasm of the century while trying to introduce foreign bodies into the eye).

How many attempts may be

Positive results of Eco are rarely obtained from the first time. Often, several attempts are required before at least one of the entered embryos will be able to gain peace in the uterus mucosa. There are cases of successful implantation only with 6 or 9 attempts. The limit on the attempts of extracorporeal fertilization as such is not. It is believed that after 10 attempts there is no point in continuing to try further.

Reproductologists do everything possible to ensure that it happens as early as possible. For this, they tell what preparation for Eco should be carried out, which in its framework there should be examined in order for their results the necessary protocol of manipulation is selected.

Which reduces the chances of successful eco

The price paid for the procedure may become "discharged" money, if a woman has at least one of the following situations:

Often there were inflammatory diseases of the small pelvis organs

That is, the appendages of the uterus, blind, sigmoid or rectum, bladder. In this case, spikes are formed in a small pelvis, which make it difficult for the normal movements of women's reproductive organs. There is a second complication of frequent inflammatory processes Small pelvis. PH drops, which are necessarily present at such states, modify the structure of the uterus and its appendages (in particular, the endometrium becomes thinner). As a result, the embryo embryo will be difficult to implanted (implemented) and take root in the mucous membrane of the uterus (endometrial).

There were abortions or scraping uterine

Interventions implying violation of the integrity of the endometrium and the uterus subject to layers are very dangerous for planning conception in the future.

When a pregnancy began to develop an artificially, it produces a "hit" on the hypothalamus - the main endocrine body:

first, due to a sharp change in the balance of sex hormones;
secondly, due to stress, which is any operational intervention.

A negative impact on the hypothalamus leads to the fact that it ceases to give "fully correct" teams and this may affect the preservation of pregnancy obtained with the help of ECO, the preparation for which does not quite physiological doses of hormones.

In addition, abortions and scraps lead to the formation of adhesions in a small pelvis, can cause or form polyps in the uterine cavity, or non-cervical of the cervix. Both leads to the formation of Eastic and cervical insufficiency, which can cause miscarriage at the coming pregnancy.

Disposal of partner sperming

Reduces chances successful eco The deterioration in the quality of the seed fluid, which can be the cause of one of the following states:

long-term toxic effect on the body of industrial, drug toxins, cigarette resins, alcohol;
low testosterone level;
insufficient level of vitamins E, A, B, C, affecting spermatogenesis (sperm formation) men;
cells that are engaged in the formation of sperm are very sensitive to the effects of infections falling in sexual means.

Low follicular reserve

Egg (oocytes) Women are laid when the future woman still is in the intrauterine. Before birth, their number decreases, if the childbirth fell hard, then quite strongly. Next, oocytes must be consumed gradually, ripening almost every menstrual cycle. If a woman transfers the inflammation of the ovaries, the peritoneum in a small pelvis, it develops endmetry caused or it has to be often influenced by production or food poisons, egg cells are consumed faster. Than older ageThe less normal follicles remain, of which a full-fledged cell can develop. This means that the chance of eco with its own egg is reduced, and already by 40 years may have to use a donor oocyte.

Preparation for Eco woman necessarily evaluates a follicular reserve. For this, it is held:

follicleometry - Transvagal ultrasound, performed on certain days of the cycle, designed to visually assess the state of the follicles - "bubbles", of which the eggs are developing;
definition in the blood of AMG (hormone anti-mullerist). If it is low, it means that there are few "decent" follicles that have less than 8 mm in diameter;
definition in the blood of FSH (follicle-sufficient hormone). It is produced in a pituitary gland located in the skull cavity. Its main function is to "include" the ripening of the follicle for the occurrence of pregnancy. High level FSH means that a sufficient answer from the ovaries of the pituitary gland does not receive, that is, the follicles in them are a bit.

Chronic diseases of women

Diseases of the gastrointestinal tract, vessels and hearts, lungs and brain have a toxic effect on the ovaries, and also worsen their blood circulation. And the more damaged ovary (it is not always possible to appreciate the ultrasound or other studies), the harder it is to get a healthy egg for Eco.

Who will not be able to get a chance to conceive "in a test tube"

The following contraindications to the ECO procedure can be called when it does not take it a single reproductologist: the main disease can begin to progress, threatening the life of the mother, or the manipulation will be unscrewed. These are absolute contraindications:

anomalies of the structure of the uterus or its acquired deformations (twin, infantile uterus, its absence or doubling), when or cannot be implanted with an embryo, or there is no guarantee that the uterus will be able to endure it;
body cancer or cervix, ovarian, uterine pipes;
heavy pathology of internal organs:
- heart defects;
- malignant blood diseases: leukemia, lymphoma, lymphogranulomatosis, aplastic anemia;
- heavy Stage Schizophrenia;
- transferred stroke;
- increased work of the nearby glands;
- severe flow of diabetes;
- cardiomyopathy;
- multiple sclerosis;
- renal failure;
- mental diseases that can create a threat to navigate the fetus;
- tumor diseases of ovaries.

There are also relative contraindications when manipulation can be performed after a certain preparation. It:

tuberculosis in the active stage;
benign uterus tumors. If such an education does not exceed 30 mm in diameter, eco can be performed, and the tumor is deleted after delivery. The embryo subfolder in this case should be carried out taking into account the location of the tumor focus so that it does not become an obstacle to carry pregnancy;
hepatitis;
syphilis;
aggravation of chronic diseases that can be corrected by drug or operational;
transferred cancer (sarcoma) of any localization;
sharp inflammatory pathologies any organ.

HIV is a relative contraindication to Eco. There are separate protocols for conducting manipulation of women supporting enough necessary immune cells on antiretroviral therapy.

In any case, the decision on the possibility of holding a "punching" conception takes a consultation of doctors, which can offer a childless pair and alternative options: Adoption of a child, surrogate motherhood.

Contraindications exist only by women. Men will only have to postpone Eco:

for a year - if radiation or chemotherapy was carried out for the treatment of any cancer;
2-3 months after complete curable inflammatory disease any reproductive organ (eggs, prostate, urethra, cavernous bodies);
for 2-3 months, if a man who should pass his own seed fluid, got sick infectious disease: wind shelter Or hay herpes, leptospirosis, angina, cortem, rubella. After hepatitis B or C period, when it is necessary to refrain from sperm donation, the infectious behavior is determined based on the tests. Usually this time interval takes more than a year.

Types of extracorporeal fertilization

In essence, Eco is the creation of conditions in a test tube for the merger of sperm and egg. If there are problems from the seed liquid of a man, as well as men after 40 years, auxiliary methods are applied. It:

Eco Ixi (intracitoplasmic sperm injection): the introduction of a spermatozoa directly into the egg cell with a special needle.
Ixi ISS is the subspecies of the previous method. In this case, under a 6000 times, an increasing microscope ("just Ickey" assumes only a 400-fold zoom) a morphologically mature spermatozoa is selected, it will also be introduced into the oocyte. "Morphologically mature" means that its ability and readiness for fertilization is estimated under the microscope, the eyes of the doctor, only by its structure (without testing any tests). The word "morphologically mature" is encrypted in the abbreviation "IMSI": "intracitoplasmic injection of morphologically mature spermatozoa".
Ixi Pixie. In this case, the maturity of the spermatozoa is determined by the test with a protein (protein, which gives the letter "P" in the abbreviation "Pixie"). The men's cell is placed in a solution where the protein is hyaluronic acid. This substance is contained inside the skin of a person, in the vitreous body his eyes, and also - surrounds the egg, creating a protective layer around it. If the spermatozoa is ready for fertilization, it will safely pass through a layer with hyaluronic acid and will not be damaged. When he immatched, it will be damaged by this substance.

Positive aspects of vitro fertilization

Extracorporeal fertilization procedure:

makes it possible to conceive at any infertility;
allows you to check the embryo for the presence of genetic diseases and viruses before it is introduced into the uterine cavity;
you can "order" the floor of the future child;
as a result, children are born, mentally and mentally not different from peers.

Than bad extracorporeal fertilization

Eco has its drawbacks. It:

such a method is born more often than a twin-triple than one child. This is due to the fact that to increase the chance of embryo engraftment, they are injected into the uterus in the amount of several pieces;
stimulation of maturation of several eggs at once, which is carried out at Eco necessarily, may cause complications, for example, the ovarian hyperstimulation and some other pathologies;
as well as natural conception, the embryo can not entitle in the uterus, but in the uterine tube.

Preparation for eco

Since extracorporeal fertilization is an extremely responsible and expensive procedure, it is held after preparatory stage, mandatory both for a woman and for the future father of the child. The ECO preparation time is defined individually - in the case of the presence or detection of temporary contraindications to the procedure. In the absence of those, it takes from 3 months to six months from both partners.

Preparation for Eco: where to start? Both spouses simultaneously adjust their own lifestyle and pass the assigned analyzes. If it turns out that the treatment of a detected disease is required, or a woman's ovarian reserve does not allow to use their own egg, forced maintenance healthy image Life is extended. How much time it will take, depends on the situation and negotiates with the attending reproductologist.

Laboratory and instrumental diagnostics

Woman gives such tests in front of Eco:

general blood and urine tests;
determination of hepatic samples, renal slags, glucose, glycosylated hemoglobin, protein and fat fractions in venous blood;
coagulogram (analysis of blood coagulation);
blood on RW;
determination of progesterone and estrogen in the blood;
a smear with the definition of trichomonodes, candidium fungi, mycoplasma, gonococcus, chlamydia, ureaplasma, which is carried out by the bacteriological method and with the help of PCR reaction;
determination of antibodies (serological diagnostics of blood) to:
- rubella;
- hepatitis E, A, B, C;
- HIV virus;
- herpetic viruses, which are transmitted through the placenta and can cause congenital fetal infections: viruses of a simple herpes 1.2 types, cytomegalovirus, Epstein-Barr virus;
determination of the vaginal microflora, cervix and urethra bacteriological and cytological methods;
detection of atypical (cancer, precancerous) cells using the study of strokes from urethra, cervix and vagina in the cytological laboratory.

It passes such instrumental research:

lung fluorography;
electrocardiogram;
transvaginal ultrasound uterus and ovaries;
ultrasound (up to 35 years) or x-ray mammography;
colposcopy (inspection of the cervix with a special microscope);
if necessary, hysterosalpingography (X-ray after administration to the cavity of the contrast uterus, is used to estimate the patency of the uterine pipes), laparoscopy, biopsy of the endometrial (if a cytological study gave the result "atypical cells", or a transvaginal ultrasound discovered an incomprehensible node);
Ultrasound of those organs that may affect pregnancy: adrenal glands, thyroid and pancake glands.

If necessary - the presence in the family of miscarriage, cases congenital defects Development or generic diseases - a married couple advises a geneticist, which also assumes an analysis of karyotyping (study of the quality and number of chromosomes of each spouse). This will determine the discrepancy between their chromosomes, calculate what the likelihood of a baby is born with genetic disease or defects of development.

Preparation of a man to Eco includes passing such tests as:

blood for antibodies to syphilis;
spermogram;
blood on antibodies to HIV, hepatitis B and C, viruses of herpes group;
sowing a stroke from the urethra for the growth of Trichomonad, Miko- and Ureaplasm, Chlamydia, Candid, Gonokokkov;
cytological study of smear from urethra for atypical and tuberculosis cells;
Ultrasound scrotum organs;
transrectal prostate ultrasound;
study of fragmentation of DNA sperm;
consultation genetics, urologist, andrologist.

Learn how much the analysis is suitable, lay the order on the sheet, in which you will pass them;
Find out where it will be cheaper to pass tests and whether it is necessary to write in advance there;
Ask where you can pass free tests.

Correction of lifestyle

Before Eco, it is not only important to pass the tests, but also to debug your own routine and diet, refuse harmful habits, treat those diseases about which a person knew or who were identified as a result of a survey.

Lifestyle

To reduce the risk of possible negative consequences Eco, both spouses need 2-3 months before joining the Protocol:

abandon alcohol;
quit smoking
drink no more than 1 cups per day of coffee;
stop to test the temperature drops on their own vessels (baths, saunas);
cure chronic diseases, including carious teeth;
sleep for 8-9 hours a day;
to prepare morally, creating a comfortable and harmonious environment: to communicate more with friends and relatives, to pay time to yourself, his hobby, beloved business. It is not necessary to carry out all the time in search of information and thoughts on Eco: so the chances of the prosperous enression of the embryo decrease.

Diet

And a woman and a man as a preparation for Eco need to go to healthy nutrition. This implies a refusal of fried and oily, products with preservatives, chemical additives, too sharp or sweet. It is worth moving on a 5-6 one-time meal in small portions.

The diet also implies the normalization of the weight, from which directly depends hormonal background. Therefore, it is necessary to consult with a nutritionist and a therapist, which must be incorporated into the diet: fatty acids, proteins, slow carbohydrates.

Drink

Even at the stage of passing tests, it is necessary to try to get used to drinking 2-3 liters of fluids (this implies that the kidneys and her heart are healthy). This will make it possible to clean the body from toxins, and when ovulation stimulation with drugs (one of the ECO stages) will allow preventing ovarian hyperstimulation syndrome. It consists in increasing blood lungs, fluid exit from vessels in fabric (associated with ripening large number egg cell).

Medicine

Load female organismpreparing to become a donor of an egg and a male, in which healthy spermatozoa must coat, impracticable medications. It is necessary to consult with that doctor who has appointed you for a permanent (long) reception on the subject, can it be canceled if it is impossible, then how it can affect pregnancy. If there is no such obstacle, you can proceed to the implementation of the ECO protocol.

As preparations for the procedure, medicines are often appointed, whose task is to facilitate the perception by the body. medicinal preparationsWith which the protocol is held. They are as follows:

Pumpkin. This is an antioxidant derived from pumpkin oil. It will protect the liver, which will receive a significant drug load during preparation for an egg generation.
Folic acid. This is a vitamin, which, taken before the start of the eco-protocol, is very useful for the normalization of blood formation and immunity of the future mother. It is also applied after the embryo substrate, reducing the likelihood of developing malformations.

Sport

At the stage of preparations for Eco Sport, especially oriental dances, in which the active movement of the belly is an indispensable thing. With it, it is physiologically improving the blood circulation in a small pelvis, which will continue to improve the implantation and tooling children.

Vaccination

To protect yourself and a child from severe diseases, Consult with an infectious doctor about performing vaccinations from:

rubella;
hepatitis B;
polio;
influenza;
tetanus;
diphtheria.

You need to fulfill them 2-3 months before joining the eco-protocol.

If ICSI, ISS, Pixie is planned

In this case, a man is preparing, whose task is a multiple passing of seed fluid so that the doctor can find several best cells for fertilization in it. Therefore, before surrendering sperm, he will have to refrain from sex for 7-8 days, quit smoking, not drink alcohol and caffeine-containing drinks, do not eat products with preservatives.

If, despite all efforts, there are still few viable forms in sperm, a man will have to transfer one or more pieces of eggs. In the event that it does not lead to the find of the necessary cellsCan be used donor sperm.

Preparation of discordant steam to eco

The risk of birth of a HIV-infected child in a discordant pair (where only one spouse is infected with HIV infection) is 1-2% with natural conception. In the case of eco, it is possible to check the embryo for this virus before entering it into the uterus.

The situation is most safe when the woman is infected. It can become pregnant without risk for HIV-negative husband, but only - not on subclinical (when there are no symptoms) of the stage of the disease and only after conducting specific therapy, overwhelming the immunodeficiency virus (it is called antiretroviral).

If HIV positive is a man, preparation is needed more, but it is fulfilled by medical workers. After the course of antiretroviral therapy, a man gives cum, which is centrifuged in the laboratory. This reduces the risk of a woman's infection, as the virus will leave in that layer that will be separated from the sperm film. Next, spermatozoa is repeatedly cleaned, and then - checked for HIV. For fertilization of the egg, only one men's cell is taken.

Stages of extracorporeal fertilization

There are various protocols of the procedure that differ in the number of steps: short, long, superlinnal. The longer the protocol is, the more physiological. Nevertheless, in each case the number of stages is appointed by a reproductist physician individually; It is negotiated with a woman who wants to become a mother.

Consider how the procedure eco-step on the basis of a long and short protocols. The superdiline protocol is characterized by the duration of the first stage - more than 2 weeks, whereas with a long it lasts less than 2 weeks

Long protocol

It lasts 4-6 months; ends with the introduction of the embryo to the uterine cavity. It consists of several stages:

1. Suppression of ovarian work

It is necessary that further preparation for the introduction of the embryos now under the complete control of doctors. To "turn off" the work of the ovaries, you need to enter the body of a woman with a drug that block the hypophysis of luteinizing (LH) and follicle-suicurating hormones (FSH) into the body. If there are no commands from the pituitary gland to do, the ovaries will turn off.

FSH and LG blockers are prescribed 7 days before the intended menstruation. They need to drink 2-3 weeks until natural ovulation is completely suppressed (this is judged by the maximum decrease in estrogen in the blood).

2. Stimulation of ovarian

After suppressing the natural operation of the ovaries, the pituitary function will take on the drug laboratory created (recombinant) FSH. It takes 8-12 days, while every 1-3 days perform an ultrasound, where they look at the size of the follicle. In the same time intervals, the level of estradiol in the blood is monitored.

3. Inclusion Follicula

This is the final stage of the egg formation, which will be used to introduce a spermatozoa to it. The "Run" of the follicle is produced when in the ovary ripe (their size reached 5-8 mm) at least 2 follicles. This is performed using the drug of chorionic gonadotropin, which can:

evidence;
to form a yellow body - the gland that the follicle becomes after the mature eggs came out of it. It produces progesterone necessary for the onset and formation of pregnancy;
HCG is also needed to form a normal placenta.

During the long protocol, such doses of drugs that will be proportioned by the abilities of the ovaries are applied.

4. Puncture

36 hours after the start of the follicle, it is carried out by its puncture (puncture) in order to obtain an egg. ECO puncture is held for 12-15 days menstrual cycle. The procedure is carried out as follows:

the woman is in the operating room, on the operating table;
she put a catheter in Vienna, according to which drugs for anesthesia are injected;
above the belly is the sensor for the ultrasound;
the vagina introduces a device equipped with a needle;
under the control of ultrasound, the follicle is punctured, the egg cell is embroidered through the needle, falls into a special reservoir;
after that, the anesthesia immediately ends.

The procedure lasts about 10 minutes

5. Transferring a reservoir to the nutrient medium

From a sterile tank, the content obtained as a result of the puncture is transferred first under the microscope, where eggs are released from it. They are transferred to the nutritional substrate, which is placed in the incubator. There, oocytes are preserved, usually, usually a few hours, before merging with spermatozoa.

6. Obtaining sperm

Seed fluid is obtained by masturbation. If the conception is not carried out from her husband or sexual partner, you can use sperm from the cum bank. Consent to this husband's procedure is fixed by a special protocol.

7. Fertilization

Here are two main options:

egg cells and spermatozoa are placed on nourishing mediumwhere they independently find each other;
the introduction of a spermatozoa is carried out inside the egg (Ixi, IMSI) after the preliminary test (Pixie).

8. Ripening of embryos

Introduced into the oocyte, spermatozoa begins to make a single organism with it, called the zygote. She, placed on Wednesday, rich in microelements, vitamins and nutrients, begins to actively share. Incubator where this happens, has hardware control equipment, CO2 level, pH.

9. Preplantation diagnostics

When the zygota contains from 4 to 10 the same (this is 5 days of development) cells, you can take one of them and explore for gene, chromosomal anomalies, as well as viral load. Paul baby can also be defined, but his choice is prohibited Federal law №323-FZ dated 21.11.2011 "On the basis of the health of citizens in Russian Federation" You can only "order", for which the floor will be the child if there can be diseases (for example, hemophilia) with x or y-chromosomes).

Pre-implantation diagnostics is possible, only if then it is planned to conduct ICO ICSI or Ixi ICI.

10. Transfer of the embryo in the uterus

Before the procedure take blood to estradiol.

With the help of a long and thin elastic catheter, without anesthesia, 1-3 embryo is introduced into the uterus cavity. A woman needs to lie down a few hours, after which you can go home.

Even in the operating room can introduce a drug that improves blood flow - fragmin or crack. It is performed for the prevention of complications associated with increased coagulationIf suddenly develops the ovarian hyperstimulation syndrome.

Fragmin / Kleksan introduces at least 5 days, under blood clotting.

11. Supporting therapy

To make embryos, doctors prescribe progesterone drugs are the main "hormone of pregnancy". Usually it is "Uropozhantan" in Candle. You need to enter the candles lying on the back, putting a pillow under the buttocks, so deep as possible.

12. Control of engraft

The results of Eco are estimated at the level of hCG in the blood, as well as on ultrasound. Ultrasound procedure It is carried out 2-3 weeks after the transfer; The results of HCG after Eco should be assessed after 4-6 days after implantation. At first, the hormone grows slowly, after 2-3 weeks it starts to add 1.5-2 times every day.

On average, the HCG table looks like this:

Day after puncture	If a 3-day embryo was suitable, hgch	If there was a 5-day embryo, the level of hCG	Scatter hCG
7	4	2	2-10
8	5	3	3-18
9	6	4	3-18
10	7	5	8-26
11	8	6	11-45
12	9	7	17-65
13	10	8	22-105
14	11	9	29-170
15	12	10	39-270
16	13	11	68-400
17	14	12	120-580
18	15	13	220-840
19	16	14	370-1300
20	17	15	520-2000
21	18	16	750-3100
22	19	17	1050-4900
23	20	18	1400-6200
24	21	19	1830-7800
25	22	20	2400-9800
26	23	21	4200-15600
27	24	22	5400-19500
28	25	23	7100-27300
29	26	24	8800-33000
30	27	25	10500-40000
31	28	26	11500-60000
32	29	27	12800-63000
33	30	28	14000-68000
34	31	29	15500-70000
35	32	30	17100-74000
36	33	31	19000-78000
37	34	32	20500-83000

Short protocol eco

It is applied if the woman poorly reacted to the first stage of the long protocol, and also if its age exceeds 35 years. Lasts short protocol Less than 4 weeks.

The short protocol begins not with the suppression of the ovaries, but with the stimulation of the growth of follicles FSH and LH preparations. Reception of these drugs begins for 3 days of the menstrual cycle. And at least a short protocol is not such a physiological, it also has advantages:

the duration of the course is less;

the price is lower.

Cryo-Protocol Eco

This term denotes the subfolder pre-frozen to temperature liquid nitrogen embryos. They are preserved when fertilization of greater than necessary, the number of eggs. Frost germ coordinate with a married couple.

Frozen embryos are planted for 2-3 days after ovulation. This is usually possible for women who have less than 35 years and whose menstrual cycle is regular. The subfold can be done both after short and after a long eco protocol.

Donor eggs

If the production of own oocytes is not possible due to:

lack of ovaries - congenital or during surgery, for example, on the treatment of purulent melting of their tissue;
women's accession during menopause.

Any healthy woman can perform a donor of the egg cell: both a relative or friend of women and a donor on a fee basis. To receive donor Oocyte. It is necessary to synchronize the menstrual cycles of both women, after which it is punctured a donor follicle puncture.

Complications and consequences of extracorporeal fertilization

Usually eco does not have consequences for a woman: she has a pregnancy, similar to the natural on early timing Support hormonal medicines in doses imitating physiological levels hormones. But in some cases there may be complications of the procedure. It:

multiple pregnancy. Diagnosed on time, it can be adjusted: the puncture of "extra" embryos is carried out, a drug is introduced through the puncture, which contributes to their independent dying;
ectopic pregnancy;
bleeding from the ovary after its puncture;
twisted ovary;
syndrome hyperstimulation of ovaries. It is associated with the ripening of many follicles instead of one, under the influence of drugs. It enhances the production of estradiol many times, which is why the coagulation increases, microtromb is formed in the vessels, and the liquid part of blood comes into the pleural, abdominal cavityCandy bag. It is formed in women with a tendency to allergic reactionsThose who have polycystic ovarian facilities that have increased activity of estradiol, as well as those who used the HCG to support the second phase of the menstrual cycle. It is manifested by syndrome in a few hours after puncture of follicles. Symptoms: severity in the lower parts of the abdomen, nausea, frequent urination, breathing difficulty, interruptions in the heart of the heart. It is treated by the introduction of protein drugs to Vienna, in food of animal proteins.

As for the consequences of health in the future, the opinions of scientists were divided. Some believe that eco can cause tumors of the ovaries and the mammary glands. Obvious Opinion - What these things are unrelated that those problems initially force a woman to go on an extracorporeal fertilization, and are factors for the development of cancer.

Influence of the procedure for a child

The consequences of Eco for children are also subject to the dispute of scientists. Some believe that they can be such:

raising the risk of fetal hypoxia;
violation of the cardiovascular system;
neurological disorders;
vices of development.

Pregnancy, developing way extracorporeal fertilization, maybe, like natural, leak with a detachment of the placenta, premature childbirth or "fret" fetus.

To pregnancy after eco flowed normally

It is very important in the first 12 days very strictly, then - a little less strictly observe the following rules:

To avoid physical Loads: Fitness, strength training, running.
Do not smoke.
More walking out in the fresh air.
Limit sex life.
It is less likely to be indoors where there are many people.
Use at least 30 ml / kg of fluid per day.