Types of artificial insemination in humans. Artificial intrauterine insemination with husband's or donor's sperm - indications, preparation for surgery and price. Tracking follicle growth

(Insemination Artificial) is a combination of several methods, the essence of which boils down to the introduction of male seed or a 3-5-day embryo into the female genital tract during medical procedures. Artificial insemination is performed to achieve pregnancy in women who cannot conceive naturally for various reasons.

In principle, methods of artificial insemination come down to various methods and options for fertilizing an egg outside a woman’s body (in vitro in the laboratory) with subsequent implantation of the finished embryo into the uterus for the purpose of its engraftment and, accordingly, the further development of pregnancy.

During artificial insemination, germ cells are first removed from men (sperm) and women (eggs), followed by their artificial union in the laboratory. After the eggs and sperm are combined in one test tube, fertilized zygotes, that is, embryos of the future person, are selected. Then such an embryo is implanted into the woman’s uterus and the hope is that it will be able to attach to the wall of the uterus, resulting in the desired pregnancy.

Artificial insemination - the essence and brief description of the manipulation

For an accurate and clear understanding of the term “artificial insemination,” it is necessary to know the meaning of both words of this phrase. Thus, fertilization means the fusion of an egg and a sperm to form a zygote, which, when attached to the wall of the uterus, becomes a fertilized egg from which the fetus develops. And the word “artificial” implies that the process of fusion of an egg and a sperm does not occur naturally (as provided by nature), but is provided purposefully by special medical interventions.

Accordingly, we can generally say that artificial insemination is a medical way to ensure pregnancy in women who, for various reasons, cannot conceive in the usual way. When using this method, the fusion of the egg and sperm (fertilization) does not occur naturally, but artificially, during a specially designed and targeted medical intervention.

Currently, the term “artificial insemination” at the everyday colloquial level usually means the procedure of in vitro fertilization (IVF). However, this is not entirely true, since specialists in the field of medicine and biology by artificial insemination mean three techniques (IVF, ICSI and insemination), which are united by a common principle - the fusion of an egg and a sperm does not occur naturally, but with the help of special medical technologies, which ensure successful fertilization with the formation of a fertilized egg and, accordingly, the onset of pregnancy. In the further text of the article, by the term “artificial insemination” we will mean three different fertilization techniques performed using medical technologies. That is, the term will have its medical meaning.

All three methods of artificial insemination are united by one common principle, namely, fertilization of an egg with a sperm does not occur completely naturally, but with the help of medical manipulations. The degree of interference in the fertilization process during artificial insemination using various techniques varies from minimal to very significant. However, all methods of artificial insemination are used to ensure pregnancy in a woman who, for various reasons, cannot conceive in the usual, natural way.

Artificial insemination to ensure conception is used only in cases where a woman is potentially capable of bearing a child throughout her pregnancy, but is unable to become pregnant in the usual way. The causes of infertility for which artificial insemination is indicated are different and include both female and male factors. Thus, doctors recommend resorting to artificial insemination if a woman has no or obstructed fallopian tubes, has endometriosis, rare ovulations, infertility of unknown origin, or other treatment methods have not led to pregnancy within 1.5 - 2 years. In addition, artificial insemination is also recommended in cases where a man has low sperm quality, impotence or other diseases due to which he is unable to ejaculate into a woman’s vagina.

To carry out the artificial insemination procedure, you can use your own or donor germ cells (sperm or eggs). If the partners’ sperm and eggs are viable and can be used for conception, then they are used for artificial insemination techniques, having previously been isolated from the genitals of a woman (ovaries) and a man (testes). If sperm or eggs cannot be used for conception (for example, they are completely absent or have chromosomal abnormalities, etc.), then donor germ cells obtained from healthy men and women are taken for artificial insemination. Each country has a donor cell bank where those wishing to obtain biological material for artificial insemination can apply.

The artificial insemination procedure is voluntary, and all women and married couples (in both official and civil marriages) over 18 years of age can use this medical service. If a woman who is officially married wants to resort to this procedure, then the consent of her spouse will be required to carry out fertilization. If a woman is in a civil marriage or single, then only her consent is necessary for artificial insemination.

Women over 38 years of age may immediately request artificial insemination to achieve pregnancy without prior treatment or attempts to conceive naturally. And for women under 38 years of age, permission for artificial insemination is given only after documented confirmation of infertility and the absence of effect from treatment carried out for 1.5 - 2 years. That is, if a woman is under 38 years of age, then artificial insemination is resorted to only when pregnancy has not occurred within 2 years, subject to the use of various infertility treatment methods.

Before artificial insemination, a woman and a man undergo an examination, the results of which determine their fertility and the ability of the fair sex to bear a fetus during 9 months of pregnancy. If everything is in order, then the procedures are carried out as soon as possible. If any diseases have been identified that can interfere with the normal development of the fetus and pregnancy, then they are first treated, achieving a stable condition for the woman, and only after that artificial insemination is performed.

All three methods of artificial insemination are short in time and well tolerated, which allows them to be used several times without interruption to ensure pregnancy.

Methods (methods, types) of artificial insemination

Currently, specialized medical institutions use the following three methods for artificial insemination:

• In vitro fertilization (IVF);
• Intracytoplasmic sperm injection (ICSI or ICSI);
• Artificial insemination.

All three of these methods are currently used very widely for various types of infertility of both couples and single women or men. The choice of method for artificial insemination is made by a reproductive specialist in each case individually, depending on the condition of the genital organs and the cause of infertility.

For example, if a woman has all her genital organs functioning normally, but the mucus in the cervix is ​​too aggressive, as a result of which sperm cannot liquefy it and enter the uterus, then artificial insemination is performed by insemination. In this case, sperm is injected directly into the uterus on the day of ovulation in a woman, which leads to pregnancy in most cases. In addition, insemination is indicated for low quality sperm, in which there are few motile sperm. In this case, this technique allows sperm to be delivered closer to the egg, which increases the likelihood of pregnancy.

If pregnancy does not occur against the background of any diseases of both the genital area (for example, obstruction of the fallopian tubes, lack of ejaculation in a man, etc.) and somatic organs (for example, hypothyroidism, etc.) in a man or woman, then For artificial insemination, the IVF method is used.

If there are indications for IVF, but in addition the man has very few high-quality and motile sperm in his sperm, then ICSI is performed.

Let us take a closer look at each method of artificial insemination separately, since, firstly, the degree of interference in the natural process when using different methods varies, and secondly, in order to get a holistic idea of ​​the type of medical intervention.

In Vitro Fertilization - IVF

IVF (in vitro fertilization) is the most famous and widespread method of artificial insemination. The name of the method "IVF" stands for in vitro fertilization. In English-speaking countries, the method is called in vitro fertilization and is abbreviated IVF. The essence of the method is that fertilization (fusion of sperm and egg to form an embryo) occurs outside the woman’s body (extracorporeal), in a laboratory, in test tubes with special nutrient media. That is, sperm and eggs are taken from the organs of a man and a woman, placed on nutrient media, where fertilization occurs. It is because of the use of laboratory glassware for IVF that this method is called “in vitro fertilization.”

The essence of this method is as follows: after preliminary special stimulation, eggs are taken from a woman’s ovaries and placed on a nutrient medium that allows them to be maintained in a normal, viable state. Then the woman’s body is prepared for pregnancy by imitating natural hormonal changes. When the woman's body is ready for pregnancy, the man's sperm are obtained. To do this, a man either masturbates with ejaculation of sperm into a special cup, or sperm are obtained during puncture of the testicles with a special needle (if ejaculation of sperm is impossible for some reason). Next, viable sperm are isolated from the semen and placed in a test tube under the control of a microscope on a nutrient medium with eggs previously obtained from the woman’s ovaries. They wait for 12 hours, after which fertilized eggs (zygotes) are isolated under a microscope. These zygotes are introduced into a woman's uterus in the hope that they will be able to attach to her wall and form a fertilized egg. In this case, the desired pregnancy will occur.

2 weeks after the embryos are transferred into the uterus, the level of human chorionic gonadotropin (hCG) in the blood is determined to determine whether pregnancy has occurred. If the hCG level increases, then pregnancy has occurred. In this case, the woman registers for pregnancy and begins to visit a gynecologist. If the hCG level remains within normal limits, then pregnancy has not occurred and the IVF cycle must be repeated.

Unfortunately, even if a ready-made embryo is introduced into the uterus, pregnancy may not occur, since the fertilized egg will not attach to the walls and will die. Therefore, several IVF cycles may be needed to achieve pregnancy (no more than 10 are recommended). The likelihood of an embryo attaching to the uterine wall and, accordingly, the success of an IVF cycle largely depends on the woman’s age. So, for one IVF cycle, the probability of pregnancy in women under 35 years of age is 30-35%, in women 35-37 years old - 25%, in women 38-40 years old - 15-20% and in women over 40 years old - 6-6. 10%. The probability of pregnancy with each subsequent IVF cycle does not decrease, but remains the same; accordingly, with each subsequent attempt, the total probability of becoming pregnant only increases.

Intracytoplasmic sperm injection - ICSI

This method is the second most frequently used after IVF and, in fact, is a modification of IVF. The abbreviation of the name of the ICSI method is not deciphered in any way, since it is a tracing paper from the English abbreviation - ICSI, in which the sounds of the letters of the English language are written in Russian letters that convey these sounds. And the English abbreviation stands for IntraCytoplasmic Sperm Injection, which is translated into Russian as “intracytoplasmic sperm injection”. Therefore, in the scientific literature, the ICSI method is also called ICSI, which is more correct, because the second abbreviation (ITSIS) is formed from the first letters of the Russian words that make up the name of the manipulation. However, along with the name ICSI, the not entirely correct abbreviation ICSI is used much more often.

The difference between ICSI and IVF is that the sperm is precisely introduced into the cytoplasm of the egg with a thin needle, and is not simply placed with it in the same tube. That is, with conventional IVF, eggs and sperm are simply left on a nutrient medium, allowing male gametes to approach female ones and fertilize them. And with ICSI, spontaneous fertilization is not expected, but is achieved by introducing a sperm into the cytoplasm of the egg with a special needle. ICSI is used when there are very few sperm, or they are immotile and are unable to fertilize an egg on their own. Otherwise, the ICSI procedure is completely identical to IVF.

Intrauterine insemination

The third method of artificial insemination is insemination, during which a man’s sperm is injected directly into a woman’s uterus during ovulation using a special thin catheter. Insemination is used when sperm cannot enter a woman’s uterus for some reason (for example, when a man is unable to ejaculate in the vagina, when sperm motility is poor, or when cervical mucus is excessively viscous).

How does artificial insemination occur?

General principles of artificial insemination using the IVF-ICSI method

Since all IVF and ICSI procedures are performed in the same way, with the exception of the laboratory method of egg fertilization, we will consider them in one section, if necessary, clarifying the details and distinctive features of ICSI.

So, the IVF and ICSI procedure consists of the following sequential stages that make up one cycle of artificial insemination:
1. Stimulation of folliculogenesis (ovaries) in order to obtain several mature eggs from a woman’s ovaries.
2. Retrieval of mature eggs from the ovaries.
3. Sperm collection from a man.
4. Fertilization of eggs with sperm and production of embryos in the laboratory (with IVF, sperm and eggs are simply placed in one test tube, after which the strongest male gametes fertilize the female. And with ICSI, sperm are injected using a special needle into the cytoplasm of the egg).
5. Growing embryos in the laboratory for 3 – 5 days.
6. Transfer of embryos into a woman's uterus.
7. Monitoring pregnancy 2 weeks after embryo transfer into the uterus.

The entire IVF or ICSI cycle lasts 5–6 weeks, with the longest stages being the stimulation of folliculogenesis and the two-week wait to control pregnancy after transfer of embryos into the uterus. Let's look at each stage of IVF and ICSI in more detail.

The first stage of IVF and ICSI is stimulation of folliculogenesis, for which a woman takes hormonal drugs that act on the ovaries and cause the growth and development of several dozen follicles at once, in which eggs are formed. The goal of stimulating folliculogenesis is the formation of several eggs in the ovaries at once, ready for fertilization, which can be selected for further manipulation.

For this stage, the doctor chooses a so-called protocol - a regimen of taking hormonal drugs. There are different protocols for IVF and ICSI, differing from each other in dosages, combinations and duration of taking hormonal drugs. In each case, the protocol is selected individually, depending on the general condition of the body and the cause of infertility. If one protocol was unsuccessful, that is, after its completion the pregnancy did not occur, then for the second cycle of IVF or ICSI the doctor may prescribe another protocol.

Before stimulating folliculogenesis, the doctor may recommend taking oral contraceptives for 1 to 2 weeks in order to suppress the production of a woman’s own sex hormones by the ovaries. It is necessary to suppress the production of your own hormones to prevent natural ovulation, in which only one egg matures. And for IVF and ICSI, you need to obtain several eggs, not just one, which is why folliculogenesis is stimulated.

Next, the actual stage of stimulation of folliculogenesis begins, which is always timed to coincide with the 1st - 2nd day of the menstrual cycle. That is, you need to start taking hormonal drugs to stimulate the ovaries on the 1st – 2nd day of your next menstruation.

Ovarian stimulation is carried out according to various protocols, but always involves the use of drugs from the group of follicle-stimulating hormone, human chorionic gonadotropin and agonists or antagonists of gonadotropin-releasing hormone agonists. The order, duration and dosage of using drugs from all of these groups are determined by the attending fertility specialist. There are two main types of ovulation stimulation protocols – short and long.

In long protocols, ovulation stimulation begins on the 2nd day of the next menstruation. In this case, the woman first makes subcutaneous injections of follicle-stimulating hormone preparations (Puregon, Gonal, etc.) and agonists or antagonists of gonadotropin-releasing hormone (Goserelin, Triptorelin, Buserelin, Diferelin, etc.). Both drugs are administered daily as subcutaneous injections, and once every 2–3 days a blood test is performed to determine the concentration of estrogen in the blood (E2), as well as an ultrasound of the ovaries to measure the size of the follicles. When the concentration of estrogen E2 reaches 50 mg/l, and the follicles grow to 16–20 mm (on average, this happens in 12–15 days), stop the injections of follicle-stimulating hormone, continue the administration of agonists or antagonists of gonadotropin-releasing hormone and add injections of human chorionic gonadotropin ( hCG). Next, ultrasound monitors the response of the ovaries and determines the duration of human chorionic gonadotropin injections. The administration of gonadotropin-releasing hormone agonists or antagonists is stopped one day before the cessation of human chorionic gonadotropin injections. Then, 36 hours after the last injection of hCG, mature eggs are removed from the woman’s ovaries using a special needle under general anesthesia.

In short protocols, ovarian stimulation also begins on the 2nd day of menstruation. In this case, the woman simultaneously administers three drugs daily - follicle-stimulating hormone, agonist or antagonist of gonadotropin-releasing hormone and human chorionic gonadotropin. Every 2 - 3 days, an ultrasound is performed to measure the size of the follicles, and when at least three follicles of 18 - 20 mm in diameter appear, the administration of follicle-stimulating hormone and gonadotropin-releasing hormone agonists or antagonists is stopped, but they are administered for another 1 - 2 days human chorionic gonadotropin. 35 - 36 hours after the last injection of human chorionic gonadotropin, eggs are collected from the ovaries.

Egg retrieval procedure It is performed under anesthesia, therefore it is completely painless for the woman. The eggs are collected using a needle that is inserted into the ovaries through the anterior abdominal wall or through the vagina under ultrasound guidance. The cell collection itself lasts 15–30 minutes, but after the manipulation is completed, the woman is left in a medical facility under observation for several hours, after which she is sent home, recommended to refrain from work and driving for 24 hours.

Next, sperm is obtained for fertilization. If a man is able to ejaculate, then the sperm is obtained by regular masturbation directly in a medical facility. If a man is not capable of ejaculation, then sperm is obtained by puncture of the testicles, performed under anesthesia, similar to the manipulation of collecting eggs from a woman’s ovaries. In the absence of a male partner, the donor sperm selected by the woman is retrieved from storage.

The sperm is taken to a laboratory where it is prepared by isolating the sperm. Then according to the IVF method Eggs and sperm are mixed on a special nutrient medium and left for 12 hours for fertilization. Typically, 50% of the eggs that are already embryos are fertilized. They are selected and grown in special conditions for 3 to 5 days.

According to the ICSI method, after preparing the sperm, the doctor selects the most viable sperm under a microscope and injects them directly into the egg with a special needle, after which he leaves the embryos on a nutrient medium for 3 to 5 days.

Ready 3-5 day embryos are transferred to the woman’s uterus using a special catheter. Depending on the age and condition of the woman’s body, 1–4 embryos are transferred into the uterus. The younger the woman, the fewer embryos are implanted into the uterus, since the likelihood of their implantation is much higher than that of older representatives of the fair sex. Therefore, the older the woman, the more embryos are implanted into the uterus so that at least one can attach to the wall and begin to develop. Currently, it is recommended that women under 35 years old transfer 2 embryos into the uterus, women 35–40 years old – 3 embryos, and women over 40 years old – 4–5 embryos.
After embryo transfer to the uterus You must monitor your condition and consult a doctor immediately if the following symptoms appear:

• Foul-smelling vaginal discharge;
• Abdominal pain and cramps;
• Bleeding from the genital tract;
• Cough, shortness of breath and chest pain;
• severe nausea or vomiting;
• Pain of any localization.

After transferring the embryos into the uterus, the doctor prescribes progesterone medications (Utrozhestan, Duphaston, etc.) and waits two weeks, which are necessary for the embryo to attach to the walls of the uterus. If at least one embryo attaches to the wall of the uterus, the woman will become pregnant, which can be determined two weeks after the embryo is implanted. If none of the implanted embryos attach to the wall of the uterus, then pregnancy will not take place, and the IVF-ICSI cycle is considered unsuccessful.

Whether pregnancy has taken place is determined by the concentration of human chorionic gonadotropin (hCG) in the blood. If the hCG level corresponds to pregnancy, then an ultrasound is performed. And if the ultrasound shows a fertilized egg, then pregnancy has occurred. Next, the doctor determines the number of embryos, and if there are more than two, then reduction of all other fetuses is recommended to avoid multiple pregnancies. Embryo reduction is recommended because in multiple pregnancies the risks of complications and unfavorable pregnancy completion are too high. After establishing the fact of pregnancy and embryo reduction (if necessary), the woman goes to an obstetrician-gynecologist for pregnancy management.

Since pregnancy does not always occur after the first attempt of IVF or ICSI, several cycles of artificial insemination may be required for a successful conception. It is recommended to carry out IVF and ICSI cycles without interruptions until pregnancy (but no more than 10 times).

During IVF and ICSI cycles, you can freeze embryos that turned out to be “extra” and were not transplanted into the uterus. Such embryos can be thawed and used for the next attempt to become pregnant.

Additionally, during the IVF-ICSI cycle, you can perform prenatal diagnostics embryos before they are transferred into the uterus. During prenatal diagnosis, various genetic abnormalities are identified in the resulting embryos and embryos with gene disorders are culled. Based on the results of prenatal diagnostics, only healthy embryos without genetic abnormalities are selected and transferred into the uterus, which reduces the risk of spontaneous miscarriage and the birth of children with hereditary diseases. Currently, the use of prenatal diagnostics makes it possible to prevent the birth of children with hemophilia, Duchenne myopathy, Martin-Bell syndrome, Down syndrome, Patau syndrome, Edwards syndrome, Shershevsky-Turner syndrome and a number of other genetic diseases.

Prenatal diagnosis before embryo transfer into the uterus is recommended in the following cases:

• The birth of children with hereditary and congenital diseases in the past;
• The presence of genetic abnormalities in the parents;
• Two or more unsuccessful IVF attempts in the past;
• Hydatidiform mole during previous pregnancies;
• A large number of sperm with chromosomal abnormalities;
• The woman is over 35 years old.

General principles of artificial insemination using the insemination method

This method allows conception to occur in conditions that are as close to natural as possible. Due to its high efficiency, low invasiveness and relative ease of implementation, artificial insemination is a very popular method of infertility treatment.

The essence of the technique artificial insemination involves the introduction of specially prepared male sperm into the woman’s genital tract during ovulation. This means that for insemination, the day of ovulation in a woman is calculated based on the results of ultrasound and disposable test strips, and based on this, the date of introduction of sperm into the genital tract is determined. As a rule, to increase the likelihood of pregnancy, sperm is injected into a woman's genital tract three times - one day before ovulation, on the day of ovulation and one day after ovulation.

Sperm is taken from a man directly on the day of insemination. If a woman is single and does not have a partner, then donor sperm is taken from a special bank. Before injection into the genital tract, the sperm is concentrated, pathological, immobile and non-viable sperm, as well as epithelial cells and microbes are removed. Only after processing, sperm containing a concentrate of active sperm without impurities of microbial flora and cells is introduced into the woman’s genital tract.

The insemination procedure itself is quite simple, so it is carried out in a clinic on a regular gynecological chair. For insemination, the woman sits on a chair, a thin elastic flexible catheter is inserted into her genital tract, through which concentrated, specially prepared sperm is injected using a regular syringe. After introducing the sperm, a cap with sperm is placed on the cervix and the woman is left to lie in the same position for 15 to 20 minutes. After this, without removing the cap with sperm, the woman is allowed to get up from the gynecological chair and do normal business. The cap containing sperm is removed by the woman herself after a few hours.

Depending on the cause of infertility, the doctor can inject prepared sperm into the vagina, cervix, uterine cavity and fallopian tubes. However, most often sperm is injected into the uterine cavity, since this option of insemination has an optimal balance of efficiency and ease of implementation.

The artificial insemination procedure is most effective in women under 35 years of age, in whom pregnancy occurs in approximately 85–90% of cases after 1–4 attempts to introduce sperm into the genital tract. It must be remembered that women of any age are recommended to make no more than 3 to 6 attempts at artificial insemination, since if all of them fail, then the method should be considered ineffective in this particular case and move on to other methods of artificial insemination (IVF, ICSI).

Lists of medications used for various methods of artificial insemination

Currently, the following medications are used at various stages of IVF and ICSI:

1. Gonadotropin-releasing hormone agonists:

• Goserelin (Zoladex);
• Triptorelin (Diferelin, Decapeptyl, Decapeptyl-Depot);
• Buserelin (Buserelin, Buserelin-Depot, Buserelin Long FS).

2. Gonadotropin-releasing hormone antagonists:

• Ganirelix (Orgalutran);
• Cetrorelix (Cetrotide).

3. Preparations containing gonadotropic hormones (follicle-stimulating hormone, luteinizing hormone, menotropins):

• Follitropin alfa (Gonal-F, Follitrop);
• Follitropin beta (Puregon);
• Corifollitropin alfa (Elonva);
• Follitropin alfa + lutropin alfa (Pergoveris);
• Urofollitropin (Alterpur, Bravelle);
• Menotropins (Menogon, Menopur, Menopur Multidose, Merional, HuMoG).

4. Chorionic gonadotropin preparations:

• Chorionic gonadotropin (Chorionic gonadotropin, Pregnyl, Ecostimulin, Choragon);
• Choriogonadotropin alfa (Ovitrel).

5. Pregnene derivatives:

• Progesterone (Iprozhin, Crinon, Prajisan, Utrozhestan).

6. Pregnadiene derivatives:

• Dydrogesterone (Duphaston);
• Megestrol (Megais).

The above hormonal drugs are used in IVF-ICSI cycles without fail, since they provide stimulation of follicle growth, ovulation and maintenance of the corpus luteum after embryo transfer. However, depending on the individual characteristics and condition of the woman’s body, the doctor may additionally prescribe a number of medications, for example, painkillers, sedatives, etc.

For artificial insemination, the same drugs can be used as for IVF and ICSI cycles if it is planned to introduce sperm into the genital tract against the background of induced rather than natural ovulation. However, if insemination is planned during natural ovulation, then, if necessary, only preparations of pregnene and pregnadiene derivatives are used after introducing sperm into the genital tract.

Artificial insemination: methods and their description (artificial insemination, IVF, ICSI), in what cases they are used - video

Artificial insemination: how it happens, description of methods (IVF, ICSI), comments from embryologists - video

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List of tests for artificial insemination

Before starting IVF, ICSI or insemination In order to select the optimal method of artificial insemination, the following studies are carried out:

• Determination of the concentrations of prolactin, follicle-stimulating and luteinizing hormones and steroids (estrogens, progesterone, testosterone) in the blood;
• Ultrasound of the uterus, ovaries and fallopian tubes via transvaginal access;
• The patency of the fallopian tubes is assessed during laparoscopy, hysterosalpingography or contrast echohysterosalpingoscopy;
• The condition of the endometrium is assessed during ultrasound, hysteroscopy and endometrial biopsy;
• Spermogram for the partner (in addition to the spermogram, a mixed antiglobulin reaction of sperm is performed if necessary);
• Tests for the presence of sexually transmitted infections (syphilis, gonorrhea, chlamydia, ureaplasmosis, etc.).

If any deviations from the norm are detected, the necessary treatment is carried out, ensuring the normalization of the general condition of the body and maximizing the readiness of the genital organs for upcoming manipulations.

• Blood test for syphilis (MRP, ELISA) for a woman and a man (sperm donor);
• Blood test for HIV/AIDS, hepatitis B and C, as well as herpes simplex virus for both women and men;
• Microscopic examination of smears from the vagina of women and the urethra of men for microflora;
• Bacterial culture of smears from the genital organs of men and women for Trichomonas and gonococci;
• Microbiological examination of the discharge of the genital organs of men and women for chlamydia, mycoplasma and ureaplasma;
• Detection of herpes simplex viruses types 1 and 2, cytomegalovirus in the blood of women and men using PCR;
• General blood test, biochemical blood test, coagulogram for women;
• General urine test for women;
• Determining the presence of type G and M antibodies to the rubella virus in a woman’s blood (if there are no antibodies in the blood, a rubella vaccine is given);
• Analysis of a smear from a woman’s genital organs for microflora;
• Cytological smear from the cervix;
• Ultrasound of the pelvic organs;
• Fluorography for women who have not had this examination for more than 12 months;
• Electrocardiogram for a woman;
• Mammography for women over 35 years of age and breast ultrasound for women under 35 years of age;
• Consultation with a geneticist for women whose blood relatives have had children with genetic diseases or congenital malformations;
• Spermogram for men.

If the examination reveals endocrine disorders, the woman is consulted by an endocrinologist and prescribed the necessary treatment. If there are pathological formations in the genital organs (uterine fibroids, endometrial polyps, hydrosalpinx, etc.), laparoscopy or hysteroscopy is performed to remove these tumors.

Indications for artificial insemination

Indications for IVF are the following conditions or diseases in both or one of the partners:

1. Infertility of any origin that is not amenable to treatment with hormonal drugs and laparoscopic surgical interventions performed over a period of 9 to 12 months.

2. The presence of diseases in which pregnancy without IVF is impossible:

• Absence, obstruction or structural anomalies of the fallopian tubes;
• Endometriosis that cannot be treated;
• Lack of ovulation;
• Ovarian exhaustion.

3. Complete absence or low number of sperm in the partner’s sperm.

4. Low sperm motility.

Indications for ICSI are the same conditions as for IVF, but with the presence of at least one of the following factors on the part of the partner:

• Low sperm count;
• Low sperm motility;
• A large number of pathological sperm;
• The presence of antisperm antibodies in semen;
• A small number of eggs received (no more than 4);
• Inability of a man to ejaculate;
• Low percentage of egg fertilization (less than 20%) in previous IVF cycles.

Indications for artificial insemination

1. From the man's side:

• Sperm with low fertilization ability (small quantity, low mobility, high percentage of defective sperm, etc.);
• Low volume and high viscosity of sperm;
• Presence of antisperm antibodies;
• Impaired ability to ejaculate;
• Retrograde ejaculation (release of sperm into the bladder);
• Anomalies in the structure of the penis and urethra in men;
• Condition after vasectomy (ligation of the vas deferens).

2. From the woman's side:

• Infertility of cervical origin (for example, too viscous cervical mucus, which prevents sperm from penetrating the uterus, etc.);
• Chronic endocervicitis;
• Surgical interventions on the cervix (conization, amputation, cryodestruction, diathermocoagulation), leading to its deformation;
• Unexplained infertility;
• Antisperm antibodies;
• Rare ovulation;
• Allergy to sperm.

Contraindications for artificial insemination

Currently, there are absolute contraindications and restrictions to the use of artificial insemination methods. If there are absolute contraindications, the fertilization procedure cannot be performed under any circumstances until the contraindication factor has been removed. If there are restrictions on artificial insemination, it is not advisable to carry out the procedure, but it is possible with caution. However, if there are restrictions to artificial insemination, it is recommended to first eliminate these limiting factors, and only then carry out medical procedures, as this will increase their effectiveness.

So, according to the order of the Ministry of Health of the Russian Federation, contraindications for IVF, ICSI and artificial insemination are the following conditions or diseases in one or both partners:

• Active tuberculosis;
• Acute hepatitis A, B, C, D, G or exacerbation of chronic hepatitis B and C;
• Syphilis (fertilization is delayed until the infection is cured);
• HIV/AIDS (at stages 1, 2A, 2B and 2B, artificial insemination is postponed until the disease enters a subclinical form, and at stages 4A, 4B and 4C, IVF and ICSI are postponed until the infection enters the remission stage);
• Malignant tumors of any organs and tissues;
• Benign tumors of the female genital organs (uterus, cervical canal, ovaries, fallopian tubes);
• Acute leukemia;
• Myelodysplastic syndromes;
• Chronic myeloid leukemia in the terminal stage or requiring treatment with tyrosine kinase inhibitors;
• Blast crises in chronic myeloid leukemia;
• Severe aplastic anemia;
• Hemolytic anemia during periods of acute hemolytic crises;
• Idiopathic thrombocytopenic purpura, refractory to therapy;
• An acute attack of porphyria, provided that the remission lasted less than 2 years;
• Hemorrhagic vasculitis (Henoch-Schönlein purpura);
• Antiphospholipid syndrome (severe);
• Diabetes mellitus with end-stage renal failure if kidney transplantation is not possible;
• Diabetes mellitus with progressive proliferative
• Polyarteritis with pulmonary involvement (Churg-Strauss);
• Polyarteritis nodosa;
• Takayasu syndrome;
• Systemic lupus erythematosus with frequent exacerbations;
• Dermatopolymyositis requiring treatment with high doses of glucocorticoids;
• Systemic scleroderma with a highly active process;
• Sjögren's syndrome in severe cases;
• Congenital defects of the uterus that make pregnancy impossible;
• Congenital defects of the heart, aorta and pulmonary artery (atrial septal defect, ventricular septal defect, patent ductus arteriosus, aortic stenosis, coarctation of the aorta, pulmonary artery stenosis, transposition of the great vessels, complete form of atrioventricular communication, common truncus arteriosus, single ventricle of the heart

Limitations for IVF, ICSI and artificial insemination are the following conditions or diseases:

• Low ovarian reserve according to ultrasound or the concentration of anti-Mullerian hormone in the blood (only for IVF and ICSI);
• Conditions for which the use of donor eggs, sperm or embryos is indicated;
• Complete inability to carry a pregnancy to term;
• Hereditary diseases linked to the female sex X chromosome (hemophilia, Duchenne muscular dystrophy, ichthyosis, Charcot-Marie amyotrophy, etc.). In this case, it is recommended to perform IVF only with mandatory pre-implantation diagnostics.

Complications of artificial insemination

Both the artificial insemination procedure itself and the medications used in various techniques can, in very rare cases, lead to complications, such as:

To carry out any artificial insemination technique, the sperm of both the woman’s partner (official or common-law husband, cohabitant, lover, etc.) and the donor can be used.

If a woman decides to use her partner's sperm, then he will have to undergo an examination and submit biological material to the laboratory of a specialized medical institution, indicating the necessary information about himself (full name, year of birth) in the reporting documentation and signing an informed consent to the desired method of artificial insemination. Before donating sperm, a man is advised not to have sex or masturbate with ejaculation for 2–3 days, and also to refrain from drinking alcohol, smoking and overeating. Typically, sperm donation occurs on the same day that the woman's eggs are collected or the insemination procedure is scheduled.

If a woman is single or her partner cannot provide sperm, then you can use donor sperm from a special bank. The sperm bank stores frozen sperm samples from healthy men aged 18–35 years, from which you can choose the most preferable option. To facilitate the selection of donor sperm, the data bank contains template cards that indicate the physical parameters of the male donor, such as height, weight, eye and hair color, shape of the nose, ears, etc.

Having chosen the desired donor sperm, the woman begins to make the necessary preparations for artificial insemination procedures. Then, on the appointed day, laboratory staff thaw and prepare the donor sperm and use it for its intended purpose.

Currently, only donor sperm is used from men with negative tests for HIV and herpes simplex virus in the blood;

Determination of antibodies types M, G to HIV 1 and HIV 2;

Determination of antibodies types M, G to hepatitis B and C viruses;

Examination of smears from the urethra for gonococcus (microscopic), cytomegalovirus (PCR), chlamydia, mycoplasma and ureaplasma (bacteria culture);

Spermogram.

Based on the results of the examination, the doctor signs permission to donate sperm, after which the man can donate his sperm for further storage and use.

For each sperm donor, in accordance with Order 107n of the Ministry of Health of the Russian Federation, the following individual card is created, which reflects all the basic and necessary parameters of the man’s physical data and health status:

Individual sperm donor card

FULL NAME.___________________________________________________________________
Date of birth________________________Nationality______________________
Race__________________________________________________________
Place of permanent registration _____________________________________________________
Contact number_____________________________
Education_________________________Profession___________________________
Harmful and/or dangerous production factors (yes/no) Which:_________
Marital status (single/married/divorced)
Presence of children (yes/no)
Hereditary diseases in the family (yes/no)
Bad habits:
Smoking (yes/no)
Drinking alcohol (frequency___________________)/I don’t drink)
Use of narcotic drugs and/or psychotropic substances:
Without a doctor's prescription
(never used/with frequency ______________________)/regularly)
Syphilis, gonorrhea, hepatitis (not sick/sick)
Have you ever had a positive or indeterminate response when tested for HIV, hepatitis B or C virus? (Not really)
Is/is not under dispensary observation at the dermatovenerological dispensary/psychoneurological dispensary________
If so, which specialist?________________________________________________
Phenotypic traits
Height Weight__________________
Hair (straight/curly/curly) Hair color___________________________
Eye shape (European/Asian)
Eye color (blue/green/gray/brown/black)
Nose (straight/humped/snub/wide)
Face (round/oval/narrow)
Presence of stigmas______________________________________________________________
Forehead (high/low/regular)
Additional information about yourself (not required to fill out)
_________________________________________________________________________
What have you been sick with in the last 2 months___________________________________________
Blood type and Rh factor ________________(________) Rh (________).

Artificial insemination of single women

According to the law, all single women over the age of 18 are allowed to use artificial insemination to have a child. To perform artificial insemination in such cases, as a rule, they resort to the use of donor sperm.

Price of procedures

The cost of artificial insemination procedures varies in different countries and for different methods. So, on average, IVF in Russia costs about 3–6 thousand dollars (including medications), in Ukraine – 2.5–4 thousand dollars (also including medications), in Israel – 14–17 thousand dollars (including medications) ). The cost of ICSI is approximately 700 - 1000 dollars more expensive than IVF in Russia and Ukraine, and 3000 - 5000 in Israel. The price of artificial insemination ranges from 300 – 500 dollars in Russia and Ukraine, and about 2000 – 3500 dollars in Israel. We have given prices for artificial insemination procedures in dollar terms to make it convenient to compare and also easy to convert into the required local currency (rubles, hryvnias, shekels).

When it comes to artificial insemination, patients are most often offered the IVF procedure. However, reproductive medicine also has other methods that are more effective in certain cases. Each artificial insemination has its own characteristics, indications and contraindications.

Conventionally, methods of assisted reproductive medicine are divided into inseminations and injections. Inseminations are not expensive, but the chances of successful conception are lower and the list of indications is shorter. In vitro conception is more expensive, but it is more effective and is possible even in severe cases of female and male infertility.

Artificial insemination has long become familiar and normal. People can constantly debate the ethics of such conception, but one thing cannot be denied - a medical procedure is often the only way to have natural children.

Artificial insemination allows you to control and regulate the process of fusion of germ cells. This phrase is usually used to refer to the IVF procedure, although there are other methods of assisted reproductive medicine. There are three methods that combine all varieties: IVF and insemination. All of them lead to the fusion of the egg and sperm, but under different conditions.

Artificial insemination is possible only if the woman is potentially capable of bearing and giving birth to a child. Drastic measures are usually recommended after 1.5-2 years of infertility treatment (except for cases that cannot be treated).

Artificial insemination is legal in Russia. Official registration of marriage is not required, but if it exists, confirmation of the spouse is required. Patients must be over 18 years of age. Every country has donor cell banks.

Women under 38 years of age must receive official confirmation of the diagnosis and ineffectiveness of treatment before artificial insemination (usually 1.5-2 years). Women over this age can undergo the procedure immediately and without prior treatment.

If the examination reveals any diseases that may interfere with any of the stages of artificial insemination, pregnancy or childbirth, the procedure is postponed. Patients are prescribed treatment and undergo manipulations only when their condition is stable.

All methods of artificial insemination are short-lived and are well tolerated by patients. Therefore, it is possible to repeat the procedure without long breaks.

IVF and its modifications, ICSI, IISM and IISD, donor programs and surrogacy are classified as assisted reproductive technologies. They are used in cases where there is no chance of pregnancy occurring naturally or the probability is less than with the use of reproductive technologies. All methods of artificial insemination can be divided into two groups: artificial insemination and intracytoplasmic injections. Insemination involves the fertilization of an egg within the female body, and with IVF and ICSI - outside the body.

Donor programs and surrogacy

In cases where partners have problems directly with the germ cells, it is possible to use donor material. All donors undergo a full medical and genetic examination, which eliminates the risk of inheriting dangerous diseases.

Women who are unable to bear a child can turn to. Donor sperm is used only after it has been examined twice with an interval of three months. Before IVF, preimplantation genetic diagnostics are performed, which identifies genetic pathologies, chromosome abnormalities, and possible developmental anomalies.

Intracytoplasmic injections

The injection method is more complex than insemination; it requires certain conditions to be met and is divided into several stages. First, the woman is prescribed hormonal drugs to stabilize the endocrine system and prepare the body for ovulation and fertilization. The doctor regularly checks the maturation of the eggs. Stimulation helps to grow a few good eggs.

After the eggs are retrieved and combined with sperm, the cells are placed in an incubator at a specific temperature that will facilitate conception. This process takes several days. Artificial insemination can be carried out using the ICSI or IVF method.

In Vitro Fertilization

The IVF procedure is the most popular method of artificial insemination. In this case, conception occurs outside the woman’s body under artificially created conditions. IVF is a fairly new method, which nevertheless has already become the gold standard of reproductive medicine. The procedure was first performed in 1978 in England. According to statistics, IVF reduces the risk of fetal pathologies.

In vitro fertilization is considered the most effective and reliable method of assisted reproductive medicine. The egg is removed from the woman's body and fertilized "in vitro" using the sperm of her husband or donor. After the cells fuse, the embryo is placed in the uterus. Subsequent pregnancy is no different from pregnancy after natural conception. Children born this way do not suffer from any specific diseases and do not have any abnormalities.

Indications for IVF

• endocrine disorders;
• complete obstruction of the fallopian tubes;
• absence of fallopian tubes;
• endometriosis;
• unknown causes of infertility.

Doctors manage the process of egg maturation by monitoring hormone levels. During this period, a woman can lead her usual lifestyle, but taking into account doctors’ recommendations on nutrition, physical activity and emotional state.

After hormonal therapy, the maturation of eggs is stimulated, then they are removed from the ovaries using puncture and ultrasound scanning. At this time, the partner donates sperm, it is processed and prepared. Then, under special conditions, the spouses' materials are mixed and placed in an incubator to allow natural cell union to occur.

After fertilization, the embryologist analyzes the development of the embryos. The most viable ones are transferred to the uterus. Typically, several fertilized cells are used to increase the chances of at least one attaching. Therefore, twins and triplets are often born after IVF. The resulting embryos can be cryopreserved for use in the future or if there is no pregnancy after the procedure. If several embryos are implanted, some can be removed, but the woman must make this decision.

Contraindications to IVF

• psychical deviations;
• uterine deformation;
• inability to bear a child;
• ovarian tumor;
• benign formation in the uterus;
• malignant pathologies;
• acute inflammation.

If the patient has serious problems with egg maturation, donor cells can be used. In vitro fertilization is much more effective than insemination. The first procedure is successful in 33% of cases. The disadvantages of IVF are long-term hormonal therapy and high cost. Prices start at 80 thousand rubles, but on average an IVF procedure costs 120-200 thousand rubles. The final figure is determined by the complexity of the chosen technique, the degree of stimulation, the need to use donor sperm and additional services in each specific clinic.

Injection of sperm into the egg

The ICSI procedure is the fertilization of an egg through intraplasmic infection of the sperm. Typically, the method is recommended for male infertility caused by a violation of the quantity and quality of sperm composition. This method is a real salvation for many patients, since it requires only one sperm. The doctor selects the most mobile and viable one and injects it into the egg. After a few weeks, the uterus and the attachment of the embryo are checked using an ultrasound. Often, during artificial insemination, a woman is prescribed hormonal drugs to maintain pregnancy.

ICSI is recommended when IVF and other methods are ineffective. The procedure is indicated for female and male infertility, even in the most severe cases. According to statistics, pregnancy occurs in every third woman as a result of ICSI (60-70% chance of successful fertilization).

Compared to IVF, the procedure is more delicate: one sperm is selected, which is injected into one egg using an ultra-thin glass needle. ICSI offers hope even in the most severe cases of infertility, especially male infertility. After several days, the doctor selects the most viable embryos.

Stimulation of folliculogenesis

The goal of this event is to produce several normal eggs so that doctors have a choice. Hormone dosing regimens are called protocols. They differ for different methods of artificial insemination and are selected and adjusted individually for each patient. All protocols are divided into short and long.

Usually, before stimulation, a course of oral contraceptives is prescribed for 1-2 weeks to suppress the secretion of sex hormones. This is necessary to prevent natural ovulation, when one cell matures.

The protocol usually begins on days 1-2 of the menstrual cycle. The patient is prescribed follicle-stimulating drugs, human chorionic gonadotropin, agonists or antagonists of gonadotropin-releasing hormone agonists. The woman is given injections of follicle-stimulating hormone (Gonal or Puregon) and gonadotropin-releasing hormone (Buserelin, Goserelin, Diferelin). The drugs are administered daily. Every few days, a blood test is performed to determine the concentration of estrogen, and an ultrasound is performed to measure the follicles.

Follicle-stimulating hormone is canceled when the concentration of estrogen E2 is 50 mg/l and the follicle size is 16-20 mm. Typically, such indicators are available on days 12-15 of stimulation. On this day, injections of human chorionic gonadotropin are added. Gonadotropin-releasing hormone is canceled the day before hCG is discontinued. The duration of the course is determined by the doctor based on the results of the ultrasound. 36 hours after discontinuation of hCG, cells are collected.

The short protocol also begins on the second day of the cycle. The woman is administered all three drugs every day, analyzing the growth of follicles every 2-3 days. If there are three follicles of 18-20 mm each, the drugs are discontinued (hCG is administered for another 1-2 days). 35-36 hours after the last injection, the eggs are collected.

Sex cells are obtained using a needle that is inserted into the ovaries through the peritoneum or vagina. The woman is under anesthesia, so she does not experience discomfort. The procedure takes up to 30 minutes. Sperm is obtained by masturbation. If there are difficulties, male reproductive cells are removed through similar manipulations.

Insemination

Insemination methods involve the introduction of sperm into the uterine cavity using a catheter. Conception occurs in almost the same way as during natural fertilization. For artificial insemination, sperm from a partner or donor is used.

Indications for insemination

• absence of a partner;
• vaginismus (spasm of the vaginal walls, during which sexual intercourse is impossible);
• potency disorders;
• ejaculation disorders;
• insufficient number of active sperm;
• cervicitis that cannot be treated;
• immunological incompatibility of spouses (presence of antisperm antibodies in cervical mucus).

Before insemination, both partners need to undergo a full examination and identify the causes of infertility. Preparation for the procedure includes a consultation with a therapist and gynecologist, a blood test (HIV, viral hepatitis, syphilis and other infections), and a smear test. It is necessary to determine the blood type and Rh factor of the partners and evaluate their compatibility. The man must submit a sample for a spermogram, and the woman must determine the time of ovulation and examine the uterus and fallopian tubes.

If no contraindications are identified, you can begin preparation. According to indications, doctors may prescribe drug stimulation of ovulation. Sperm collection is carried out in advance (2-3 hours before). When choosing donor material, frozen sperm is used.

The sperm is processed and the sperm are separated from the seminal fluid. The resulting mixture is injected into the uterus through a catheter. The procedure takes a few minutes and does not cause discomfort to the patient.

Contraindications to insemination

• pathologies of the uterus that make bearing a child impossible;
• ovarian tumor;
• malignant pathologies;
• acute inflammation;
• psychical deviations.

On average, artificial insemination costs from 30 thousand rubles when using partner’s sperm and from 40 thousand when using donor sperm.

Artificial insemination with husband's sperm

The IISM procedure is recommended in cases where the woman’s reproductive system has not been subject to pathological changes, there are no adhesions, erosions, or convolutions, and the fallopian tubes are passable, but the partner’s sperm has insufficient characteristics for natural conception. The sperm is processed and given the properties necessary for fertilization. During the procedure, the partner's processed sperm is artificially introduced into the uterus.

IISM can be appointed if partners are incompatible. The reasons for this phenomenon are different, but usually it is an aggressive effect of the flora of the vagina or uterus on sperm. Injecting sperm directly into the uterus eliminates contact of the seed with the vaginal microflora, which significantly increases the chances of successful fertilization. The insertion procedure is painless; the embryos are passed through a thin catheter.

During one menstrual cycle, intrauterine insemination can be performed 2-4 times. It is necessary to undergo an examination and tests to calculate the most favorable time.

Artificial insemination with donor sperm

The IISD procedure is recommended if the partner’s sperm count is poor. Donor sperm should also be used in cases where the reason for the incompatibility of the spouses is not clear, there is a high risk of blood conflict, or there were dangerous hereditary pathologies in the family. IISD is carried out only with the joint consent of the partners.

The procedure itself is not much different from insemination with the husband’s sperm. IISD and IISM are similar procedures that are carried out under the same conditions. You can also repeat it 2-4 times per cycle, but the effectiveness of the procedure is 30% greater (according to statistics, with IISM the chances of success are 40%).

The IISM and IISD methods are recommended for male infertility, sexual disorders, and immunological conflict. During preparation, the patient should visit the clinic regularly to monitor the number of maturing follicles and the growth of the endometrium in the uterus.

Transplantation of germ cells into the fallopian tubes

GIFT (gamete intrafallopian transfer) is a procedure for transplanting egg and sperm gametes into fallopian corpses. Artificial insemination using this method requires special preparation and the fulfillment of certain conditions. Gametes can only be placed in patent fallopian tubes and at a strictly selected time. Since only one ovulation occurs per menstrual cycle, GIFT can only be performed once a month.

ZIFT (zygote intrafallopian transfer) is a procedure for transplanting a zygote into the fallopian tubes. In this case, fertilization of the egg is carried out outside the body, after which the embryo is placed in the fallopian tubes.

The GIFT and ZIFT procedures are performed in a hospital. The doctor uses a laparoscope and ultrasound scanning. If during the placement of gametes the mixture is introduced from the peritoneum through a small puncture, then the embryo is implanted through the cervix. The ZIFT procedure is carried out after ovulation and hormonal preparation of the uterus. The methods of GIFT and ZIFT are extremely rarely used in reproductive clinics in Russia, since they are inferior in effectiveness to standard IVF.

Any married couple can face the problem of conceiving a child naturally. If the cause of infertility is identified, then you can resort to artificial fertilization of eggs.

You need to approach this procedure with all responsibility, because this is an important decision for everyone. The result - a long-awaited pregnancy and the birth of a new life - depends on the correct implementation of the procedure and compliance with the necessary conditions. We will talk about the features of IVF in this article.

The essence of artificial insemination

Artificial insemination is a complex of several procedures whose goal is to achieve pregnancy. The essence of the methods is that, with the help of medical manipulations, a man's seed or embryo is introduced into the woman's genital tract. Fertilization does not occur naturally, but artificially, hence the name.

Any woman who cannot get pregnant in the usual way and is able to carry a child throughout the entire period of pregnancy can resort to artificial insemination.

Reasons why you might want to consider IVF:

We invite you to watch a video about what in vitro fertilization is:

How does conception occur?

Conception - how does it happen? Natural conception is a rather long process. After completion of sexual intercourse, sperm have to overcome many obstacles.

1. Initially, the acidic environment of the vagina “weeds out” the weak ones within two hours, and this is mainly the majority of sperm.
2. The mucus plug in the cervix then prevents further progress, but during ovulation the amount of mucus decreases, thereby allowing the strongest sperm to move further.
3. Then you have to deal with the epithelial cilia of the fallopian tube, and only then, having encountered the egg, does the attempt to get inside it begin. And when the strongest sperm succeeds, it loses its tail and unites with the egg into one whole - a zygote.

   The path of a fertilized egg through the fallopian tubes is considered very dangerous. Since the tube may narrow due to adhesions, the zygote will begin to implant where it stopped. This will lead to ectopic pregnancy, ruptured tubes and other sad consequences.

4. When the egg passes through the fallopian tube again and enters the uterus, it attaches to its wall. From this moment pregnancy begins.

Important, that during artificial insemination, the sperm enters the uterus much faster. Depending on the reason why pregnancy does not occur, the desired method of conception is selected. On the day of ovulation, sperm can be delivered medically directly to the uterus, closer to the egg, or ready-made zygotes (fertilized eggs) are placed in the woman’s uterus, where they should attach and form a fertilized egg.

We invite you to watch a video about how IVF is performed:

Types of artificial conception operations

The most common types of artificial insemination are:

1. IVF (in vitro fertilization).
2. ICSI or ICSI (intracytoplasmic sperm injection).

Which method to use is determined by the reproductologist, based on the state of health and the cause of infertility of those who want to get pregnant.

In Vitro Fertilization

IVF is used in cases where conception does not occur due to some diseases of the genital area or in case of diseases of the somatic organs. The essence of this procedure is that, using a certain stimulation, eggs are taken from a woman and then placed in an environment that supports their viability. Sperm are placed there for 12 hours.

After this time, zygotes are found under a microscope and introduced into the woman’s uterus. After the procedure, the fertilized egg can only attach to the wall of the uterus, after which the long-awaited pregnancy occurs.

The advantage of this type of artificial insemination is that the sperm does not have to overcome all the obstacles that exist after sexual intercourse. However, there is also a disadvantage of the method - the procedure is very expensive, and the guarantee of getting pregnant the first time varies from 6% to 35%, depending on the woman’s age. You may need to repeat the procedure more than once.

ICSI

Fertilization using the ICSI method is performed when there are indications for IVF and there are very few motile and high-quality sperm in the man’s sperm. After obtaining and preparing the sperm using a needle, the sperm are injected directly into the cytoplasm of the egg, thereby fertilizing them. And after this, the zygotes are placed in the uterus to attach to the walls.

The disadvantage of the method is also the high price and the fact that conception cannot always occur after the first procedure.

The stages of IVF and ICSI are very similar. The time required for the entire procedure takes up to 6 weeks.

We invite you to watch a video about the ICSI method for IVF:

How is the procedure done?

Risks

During artificial fertilization of an egg, there are some risks that are worth considering, as the procedure can result in complications.

Today, approximately twenty percent of couples have to deal with the problem of infertility, that is, the inability to conceive a child for a long time (a year) with regular sexual intercourse without the use of contraceptives.

Depending on the cause, appropriate treatment is given to one or both partners. In some cases, infertility cannot be eliminated. Such couples still have the opportunity to become biological parents - artificial insemination.

Methods

Depending on the reason for the impossibility of natural conception, experts offer one of the following methods:

• In vitro fertilization (IVF). This type of artificial conception is the most common.
• Intracytoplasmic sperm injection (ICSI). A type of IVF. It is used for male infertility - with a minimum number of sperm in the ejaculate, their low mobility, and structural defects. Doctors select viable germ cells. Under a microscope, using special instruments, the sperm is injected into the egg, and artificial insemination occurs.
• Artificial insemination. Used in case of male sexual weakness. The seminal fluid is purified in a special apparatus. The concentration of motile sperm increases. Inferior ones are removed. Sterile sperm with a high content of active cells and enriched with nutrients is injected into the patient’s uterus, ready for fertilization.
• Sperm donation. It is used for patients who have no sexual partner, whose husband is incurably infertile, or who has serious hereditary diseases.
• Egg (oocyte) donation. A type of IVF. This type of artificial insemination is used for female infertility, when one’s own eggs do not mature for some reason.

IVF: essence, preparation

Artificial insemination is used if infertility cannot be cured. For example, if a woman has her fallopian tubes removed or their patency is impaired after an ectopic pregnancy. It is also indicated for various forms of infertility in men.

Contraindications for IVF are:

• Diseases of a woman (including mental ones) that interfere with normal gestation or childbirth.
• Defects of the uterus that prevent the embryo from implanting.
• Tumors of the ovaries and uterus.
• Inflammatory diseases of women, regardless of the location of the lesion.
• Malignant neoplasms, regardless of location, including in the past.

At the preparatory stage, an examination is necessary. A woman undergoes a blood test to determine hormone levels, as well as for rubella, herpes, toxoplasmosis, chlamydia, a smear from the cervix for cytology, an ultrasound of the female organs, mammary and thyroid glands, and colposcopy. Both partners are examined for urogenital infections, RV, viral hepatitis, HIV. The man needs to have a spermogram.

Before donating sperm, the future father needs sexual abstinence for about 3-5 days. The material may be frozen for use at a later date. If viable sperm cannot be obtained naturally, they are collected through surgery or puncture under anesthesia.

The patient is prescribed hormonal drugs that stimulate the maturation of several follicles at the same time (superovulation). Their development is monitored using ultrasound, their diameter and endometrial thickness are measured. They are then removed from the ovaries under ultrasound guidance using a needle through the vagina. This is a safe procedure, does not cause complications, and is done under anesthesia.

Fertilization occurs in a special liquid in a test tube under laboratory conditions. After a few days, the embryo is examined to determine the presence of chromosomal diseases. Modern technologies make it possible to determine the gender of the unborn child already at this stage. Then, to achieve the best result, not one, but 2-3 eggs are implanted into the uterine cavity using a flexible catheter under or without anesthesia.

Pregnancy and childbirth

After the egg is inserted, you need to monitor your hormone levels twice a week (using a blood test). After about 14 days, they check whether pregnancy has occurred. Usually they do a test. In some clinics, a blood test is given for this purpose. Three weeks after embryo transfer, an ultrasound can be performed. The probability that an artificially fertilized egg will implant is about 35%. That is, in one case out of three, pregnancy occurs.

Patients who did not succeed the first time can try again. IVF is considered a safe procedure. Sometimes pregnancy occurs only on the tenth attempt. Unfortunately, experts cannot give a 100% guarantee that artificial insemination will be successful.

The reasons for failure may be different. For example:

• non-ripening of follicles (this circumstance makes cell collection impossible);
• adhesions prevent follicle cells from being collected;
• premature ovulation occurs;
• absence of eggs in the follicles;
• low sperm quality;
• embryos do not take root, stop developing, and grow incorrectly.

Complications with IVF occur very rarely in the form of ectopic pregnancy (up to 3% of cases), the development of infections (up to 2%), bleeding during egg retrieval. In 2-15% of cases, ovarian hyperstimulation syndrome occurs as a reaction to drugs that accelerate follicle maturation. Accompanied by poor health, bloating, and pain. If detected in a timely manner, it can be successfully corrected.

The most common side effect of IVF is multiple pregnancy. Develops in every 3-4 patients. The reason is that to increase the likelihood of embryo attachment, several of them are planted (usually 2-3). There is a chance that they will all take root. Specialists can remove the “extra” ones, but in this case the risk of rejection of the remaining ones later (miscarriage) increases.

9 out of 10 women who become pregnant through artificial insemination successfully carry their children to term. Childbirth after IVF is the same as normal. The method depends on the condition of the woman, the fetus, and the presence of pregnancy complications.

Children conceived through artificial insemination are no different from other babies. There is an opinion that they are more intelligent, but get sick more often. Experts conclude that this is due to special parental attention and guardianship over such children.

Donation

When collecting material from a patient, there may be more eggs than needed. This circumstance makes donation of female germ cells possible. This is very important for patients who, for some reason, do not have eggs, for example, after surgery to remove the ovaries, during menopause. In order for women to agree to be donors, the cost of IVF is usually reduced for them.

Men can become sperm donors. The person who gave it has no rights to a child conceived artificially from a cell. Donation is anonymous. They take germ cells only from absolutely healthy people.

The cost of IVF is not affordable for everyone, but this is a chance to deceive nature. Modern reproductive technologies provide it to infertile women and married couples who dream of becoming parents. There are many options; specialists select the appropriate one individually in each case.

The basic principle for choosing artificial insemination methods is individuality

Artificial insemination methods, developed by reproductologists, give hope and the opportunity to experience the ecstasy of motherhood and fatherhood for those who are physiologically incapable of this. There are several treatment options and each has its own characteristics and indications.

In order to decide which method should be used in each specific case, the doctor needs data from laboratory and instrumental studies. In addition, if you are about to undergo artificial insemination, prepare for a detailed questioning (collecting an anamnesis). During the consultation, you need to ask all the questions that concern you, which are best written down in advance, and tell in detail about the diagnosis and treatment performed (if any).

Exploratory survey

Using ultrasound diagnostics, internal inflammatory processes are detected. As all concomitant diseases are identified and appropriate treatment is prescribed, the need for artificial insemination disappears in 45% of women.

Assisted reproduction methods

Based on the examination data and identified female or male functional disorders, the specialist will offer a treatment option - one of methods of artificial insemination, suitable for your couple.

Artificial insemination

If the sperm is unable to travel its path and reach the egg (this may occur due to an obstacle - an increased concentration of cervical mucus or other reasons), the method is used. This procedure involves introducing concentrated sperm into the uterus, purified from “weak” sperm that are incapable of fertilization. It is performed during ovulation (induced or natural).

Subsequently, the process of natural conception is expected. Women under the age of 30, without, have a higher chance of getting results. This method can be recommended in case of immunological incompatibility of the couple and low sperm motility, poor sperm count.

GIFT and ZIFT methods

Many experts consider methods of intratubal transfer of zygotes (ZIFT) or gametes (GIFT) to be very effective, although recently they have been in little demand, despite their closer relationship to the natural process of fertilization. The essence of the GIFT method is the transfer of male and female germ cells into the lumen of the fallopian tubes, where fertilization should occur. The ZIFT method is based on the same principle, only unlike GIFT, eggs that are already fertilized are transferred into the fallopian tubes.

Such artificial insemination program gives time to the female body to prepare to accept the implanted zygote or gamete, since the transfer of the egg and sperm occurs in the fallopian tubes, and not in the uterus itself. The only condition for such a procedure is the usefulness of at least one fallopian tube.

The use of the intratubal transfer method is indicated:

• with, other pelvic organs;
• in case of immunological incompatibility of spouses;
• at .

IVF method

One of the most popular methods of assisted reproduction is considered. The origin of life occurs outside the female body, in a test tube, followed by transfer to the uterus. This process is gradual and lasts for two weeks.

At the first stage, the growth of a woman’s germ cells is stimulated to suppress natural hormonal activity. This procedure helps control the timing of maturation and accurately calculate the onset of ovulation.

Indications for IVF may include:

• hormonal imbalance in a woman’s body;
• donor eggs, ), surrogacy

  Contraindications

  Artificial insemination cannot be performed if it is impossible to carry a child to term. Such contraindications include: pathologies of the uterus, inflammatory, infectious, and hereditary diseases. It is in such cases that surrogacy is recommended.

  Those born using assisted reproduction methods do not have distinctive features. Their behavior and appearance are completely normal. Women who despair of becoming pregnant naturally have an excellent opportunity to become mothers, and the latest medical technologies and in vitro fertilization methods successfully help them with this.