Every woman can become a mother: everything you need to know about IVF in Russia

The first child conceived with IVF was born in 1978 in the UK. Little Louise Brown became a sensation simply by the fact of her birth. Now that same “test-tube girl” is already over 40, she herself managed to become a mother, and in a natural way. The whole life of Louise Brown is a clear proof that you can become a mother, no matter what, and give birth to an absolutely normal healthy child.

How infertility was treated before

Before IVF appeared, in the USSR it was customary to treat only female infertility. By default, it was believed that if a couple did not have children, then the woman was to blame.

“In about half of the cases, problems with conception are due to the male factor, but almost no one knew about this.”

The conversation about male infertility started only in the late 80s – early 90s of the last century, but only women were still treated for infertility.

The studies that were ordered to diagnose infertility were very painful, so much so that women passed out from the pain in the process. But anesthesia was used very rarely: it was not considered necessary.

When to see a doctor

It is always difficult to admit your own insolvency, even if it does not depend on you. Therefore, many couples pull to the last: they self-medicate, then they try to come up with some kind of infections and be treated for them already. As a result, people come to reproductive specialists when the chances of pregnancy are already reduced.

But time, which traditionally heals, in this case plays against you. The ideal age for pregnancy is 20-24 years, the woman is at the peak of fertility, 90% of the eggs do not have chromosomal abnormalities.

Further, the chances are reduced. Before the age of 29, the probability that a woman will become pregnant within a year is 86%, and the risk of miscarriage is 10%. If a woman is between 30 and 34, the likelihood of losing a child doubles.

After 35 years, a sharp decline begins. At this age, only a third of women can become pregnant on their own. If you wait a little longer, then there will be a very high risk of giving birth to a child with developmental defects – already at the age of 40, a woman has 90% of her eggs – with chromosomal abnormalities.

The first and most important thing to remember: 12 months are allotted for self-planning of pregnancy if the woman’s age is not more than 35 years old, and six months if the woman is older. If conception does not occur during this time, you need to go to the doctor.

Reproductologist, Head of the Department of Assisted Reproductive Technologies, Compulsory Medical Insurance at the Mother and Child St. Petersburg Clinic

“The specialist will check the patency of the fallopian tubes, the number of eggs in the ovaries (this is called the ovarian reserve). The man will be sent for a spermogram. Both partners will be tested for sexually transmitted infections.

Perhaps already at this stage it will become clear what the problem is. And it is not always necessary to do IVF to solve it. Yes, there are situations when this method is irreplaceable. For example, for couples with tubal factor infertility, with severe male factor infertility. But it is often possible to solve the problem not so globally. “

If not IVF, then what?

It all depends on the cause of infertility. For example, if the problem is in the egg that does not mature on its own, then enough slight ovarian stimulation. There is a method inseminationwhen specially prepared sperm is injected into the uterine cavity. It is used when a man has problems such as ejaculation. Or a woman has a cervical factor of infertility, vaginismus.

And it so happens that a couple is all right, but their life schedule simply does not coincide. Well, they just can’t have sex at the right time. Then doctors use a method called programmable conception. In particular, ovulation is monitored using ultrasound, and the days most suitable for intimacy are calculated.

If a fibroid or a polyp in the uterus interferes with pregnancy, the woman will be given laparoscopic surgery… Or – in some cases – they will appoint hormone therapy.

IVF procedure: step by step

IVF is an artificial insemination procedure. That is, the opportunity to extract biomaterial from male and female organisms and “on the shore” to make sure that a new life has arisen. The egg is fertilized in laboratory conditions and the embryo grown in the laboratory is implanted into the uterus.  

The classical IVF program itself consists of several stages.

1. Ovarian stimulation. Several follicles should grow in one menstrual cycle.

2. Follicle puncture. This procedure is done under general anesthesia: eggs are taken from the follicles with a thin needle through the wall of the vagina.

3. Oocyte fertilization and embryo cultivation.

4. Transfer of an embryo (maximum two) into the uterine cavity.

5. The most enjoyable stage is the detection of pregnancy.

In addition, there are IVF programs in which the conception process can be simplified. For example, IVF with ICSI – when a healthy sperm is injected into the egg. This method is used when a man has few sperm. Or IVF with IMSI is a method when the best is chosen from a variety of spermatozoa.

There is also an auxiliary hatching of embryos – the doctor helps them “hatch” from the zona pellucida, in which they are cultured in an incubator. This is done before the transfer. In life, the destruction of the shell is a natural process, but if the embryo fails to break this shell, pregnancy will not occur. Auxiliary hatching is done in exceptional cases. Among the indications, a woman’s age is over 40, an increased level of FSH and a thickened zona pellucida.

Is it possible to do without hormones?

IVF in the natural cycle is a kind of return to basics.

Medical Director of the IVF Reproductive Health Clinic, reproductive physician

“In essence, this is IVF without the use of drugs for the growth of several eggs. That is, several stages are excluded from the IVF protocol at once: stimulation of the ovaries is not needed, there is no need to do a puncture under anesthesia to get an egg. If the procedure does not work the first time, you can try again next month. “

These were the very first IVF programs. It was only later that they were supplanted by cycles using hormonal stimulation, which turned out to be much more effective. But now interest in the natural cycle is growing again.

Natural cycle IVF is recommended for women who have regular periods and ovulation but have low ovarian reserve. Or those for whom hormonal drugs are contraindicated. But you must understand that the method also has its drawbacks: in one cycle you can get only one cell, you cannot choose an embryo. In addition, there is a high risk of premature ovulation.

Indications for IVF

There are tough indications for IVF. Among them:

• endometriosis;

• lack of ovulation, which cannot be cured;

• poor sperm quality in a man;

• unexplained (idiopathic) infertility;

• adhesion of the pelvic organs or the removal of both fallopian tubes are the reasons why the egg cannot enter the uterine cavity on its own.

Many people think that only married couples are allowed to do IVF, but this is not the case. A single woman can also undergo artificial insemination if she has medical problems with conception. In this case, sperm from a donor will be collected for her.

Are there any contraindications?

Of course, as with any other medical procedure. In this case, contraindications are absolute and relative. Either you can never and for nothing, or you can, if you first undergo treatment or comply with a number of conditions.

Immediately, we note that there are many contraindications. This is primarily due to the hormonal load on the body. And these are not only diseases, but also other reasons that affect reproductive functions.

IVF will have to be postponed if:

• the woman is taking certain medications or using methods of treatment – hormonal therapy, chemotherapy, and so on;

• the expectant mother has a disease in the female line, for example, a benign tumor of the uterus. In this case, fertilization is possible only after the problem is eliminated or its consequences are minimized;

• a woman has anomalies of the reproductive system – violations of the anatomical structure of the genitals. For example, adhesions in the vagina or cervix. You may need to have surgery first;

• a woman has an infectious disease: ARVI, tuberculosis, hepatitis, syphilis, HIV. First you need to be cured or, if it is a chronic or incurable disease, to reach the stage of stable remission.

IVF cannot be done if a woman has:

• malignant tumor. Cancer is the reason for the complete rejection of IVF, regardless of its location; 

• malformations of the uterus;

• severe somatic (general) diseases: blood diseases, heart and vascular defects;

• endocrine pathologies, in particular, diabetes mellitus, which gave complications to the kidneys and / or retina; multiple sclerosis, mental illness, and so on;

• mental illness – schizophrenia, clinical depression in a severe stage, difficult to control psychoses.

 Since 2021, hereditary sex-linked diseases in women, such as hemophilia, Duchenne muscular dystrophy, and so on, have been excluded from contraindications. At the same time, a new restriction on the ovarian reserve appeared: IVF according to compulsory health insurance is impossible if AMH (anti-Mullerian hormone) is below 1,2 and the total number of antral follicles, that is, those that are likely to mature and turn into eggs, in the ovaries are less than five.

IVF free – how to get a quote

Since 2016, infertility treatment with IVF has been included in the compulsory medical insurance system, that is, the main stages of the procedure will be done free of charge, within the framework of compulsory health insurance. The woman is sent for the procedure by the attending physician. Previously, he must make sure that the patient has no contraindications and that the methods of treatment have been exhausted. 

4 reasons to refer to IVF

• Tubal-peritoneal infertility.

• Female infertility (+ male infertility).

• Endocrine infertility.

• Infertility according to obstetric and gynecological history.

Getting directions is easy. The fact is that there are federal quotas that the state allocates for each region, and there are regional ones – that is, those that are made at the expense of the local budget. For expectant mothers, it doesn’t matter what kind of quota they receive, most often they don’t even know about it.

What is really important to know is that any woman with Russian citizenship and a valid compulsory medical insurance policy can get a quota. Marital status, social status and so on do not play a role. According to the law, there is not even an age limit. The lower bar is 18 years old. But if you are already menopause, perhaps there is no point in IVF.

At the same time, you have the right to choose any clinic from the list of medical organizations performing IVF and participating in the implementation of territorial compulsory medical insurance programs. And it doesn’t matter in which region you are registered and live.

What you need to do to get a quote

If you have already had all the examinations and is diagnosed with infertility, you can apply for a referral for IVF. Let’s put it bluntly: you can stand in line for a long time, from two months to a year.

In any case, you need to start with a antenatal clinic. Here you will receive an extract from the card and give you a referral to the committee for the selection of patients for IVF. Don’t be alarmed, this is more of a formal procedure. The tests will be checked here, perhaps they will be asked to do additional research.

Someone waits for a couple of weeks, someone for several months. It all depends on the number of quotas allocated to the region and the number of patients in the queue. If the decision is positive, you will be provided with a list of clinics where artificial insemination can be done. Among them there may be commercial ones that work under the compulsory medical insurance program.

The choice is important at this stage. The commission will issue a referral to a specific center, where you will need to come with documents about the history of the disease.

The term of validity of a referral for compulsory medical insurance is valid for three months, for high-tech medical care (high-tech medical care) – 12 months.

We go to IVF – we pass tests

Yes, there are a lot of them. Moreover, there is a smaller list for men and longer for women. Both partners must donate blood for HIV, syphilis, hepatitis B and C, as well as smears for infectious diseases. In addition, a spermogram will be required from the man.

Then only a woman will go to the doctors. She needs to pass a general urine test, as well as blood for:

• group and Rh factor.

• clinical blood test (valid for 1 month).

• hormones.

At the gynecologist, the expectant mother will take swabs for flora and purity, as well as for atypical cancer cells.

In addition, you will need a therapist’s conclusion and an extract from the hospital card, if the patient has had any operations before.

What is included in the free IVF procedure

The basic program includes:

• stimulation of superovulation;

• puncture of ovarian follicles to obtain eggs;

• fertilization of oocytes (germ cells) with specially prepared sperm from a husband or partner;

• if necessary, the ICSI procedure;

• cultivation of embryos;

• intrauterine introduction (transfer) of embryos.

In addition, all medications that are necessary are given free of charge, and after the woman becomes pregnant, they provide all the necessary medical assistance within the framework of the compulsory medical insurance.

By the way, recently cryopreservation of the remaining embryos and the transfer of thawed embryos have been included in IVF under the compulsory medical insurance – this will be done according to the policy, if the woman has a medical indication. And according to the new rules, the indication for this is the patient’s desire, including in the case of “delayed motherhood.”

What you have to pay

It doesn’t always go smoothly the first time. Not every IVF protocol leads to successful conception. And you need to be prepared for the fact that you will have to use additional services, for example, donor sperm, donor oocytes, embryos or services of a surrogate mother. In addition, you will have to pay for the storage of the preserved embryos, because this is not considered a medical procedure. But compared to the cost of conservation itself, this is a very small amount. Also, according to the order of the Ministry of Health, which entered into force on January 1, 2021, genotyping will also be paid.

If the pregnancy has not occurred, you will have a chance to try again. Their number is not limited. Bad – you will have to re-enter the waiting list and collect documents. So the process may be delayed. In this case, you need to know: stimulation of superovulation should not be done more than twice a year. Otherwise, you can harm the health of the woman.

By the way, if you do IVF completely for a fee, that is, without waiting for quotas, then it will cost at least 100-120 thousand rubles, depending on the region. At the same time, the maximum amount for IVF that the insurance company will cover in 2021 is 141 thousand rubles.

How to determine pregnancy and its duration with IVF

About a week and a half after embryo replanting, a woman donates blood for the concentration of hCG – human chorionic gonadotropin. Just as in a normal pregnancy, the growth of hCG means the success of the procedure.

The term for in vitro fertilization is counted from the moment of puncture, but obstetricians add 14 days to the date of embryo transfer, since before it is transplanted into the uterus, it develops within 1-3 days. PDR – the estimated date of birth – is determined from the moment of the first fetal tremors: 140 days are added to this date.

But it’s best to trust the ultrasound results. The gestational age is calculated from the results of measurements of the embryo.

Regardless of how the baby was conceived, if the pregnancy proceeds normally, he will be born at 38-40 weeks.

Side effect: risks of IVF

Let’s not lie that everything goes smoothly and without problems. IVF is a serious intervention in the body. And the consequences can manifest themselves at any of the stages.

Side effects of hormone therapy. From tinnitus to metabolic disorders. You never know where the excess hormones “bomb” the body.

Ovarian hyperstimulation syndrome. One of the most difficult complications.

Risk of intra-abdominal bleeding… It can start after the egg is taken. Doctors say that the likelihood of a complication is extremely low, less than one and a half percent. Nevertheless, the woman’s condition is monitored for several hours after the puncture.

Multiple pregnancy. For some, it may be joy, but for reproductive specialists, it may be a risk. The more embryos have taken root, the more difficult it will be to bear babies. Today the risks are minimized: the law expressly prohibits the transfer of more than two embryos. But for some mothers with twins, walking is very difficult.

Ectopic pregnancy. In a normal situation, the embryo is implanted into the wall of the uterus within a few days after the transfer. But there are times when he does not find a place there and, together with the outflow of fluid, may end up in the lumen of the fallopian tube and implant there – this is how an ectopic pregnancy occurs. Careful control at all stages of the procedure will help to avoid this.

IVF myths

• Did IVF – you will definitely get pregnant

Unfortunately no. Yes, IVF is the most effective method, but it does not give an absolute result either. And this largely depends on age: up to 35 years, the effectiveness of one IVF cycle is estimated at 45–55 percent, after 40 years it is already 3–5 percent. Therefore, it is not worth delaying.

• The more IVF, the fewer eggs

Many believe that stimulation depletes the ovaries. But this is a myth based on ignorance of the physiology of women. In fact, several follicles are consumed in each menstrual cycle. But only one of them is used for ovulation, the rest die. IVF allows you to obtain and use those follicles that would have died in any case in the normal menstrual cycle. So the procedure does not affect the supply of eggs in any way.

• IVF increases the chances of multiple pregnancies

Once upon a time, this was really true, because several embryos were transferred into the uterine cavity at once in order to increase the chances of success. The result was more twins and triplets. But now all over the world they refuse to transfer more than two embryos, and in Russia it is generally prohibited. Experts say that ideally one should strive for a single embryo transfer.

• A child born with IVF is itself infertile

Yes, yes, and also sickly, weak, painful. And there are such opinions, and even some officials do not hesitate to state this out loud. But this is absolutely not true. World studies confirm that IVF does not affect the health of the child in any way. The only possible risks for him in this case are associated with the course of pregnancy, premature birth and the health of the mother – that is, nothing fundamentally different. Well, the percentage of infertility among “eco-women” is the same as among children conceived naturally.

• IVF provokes cancer

The most terrible myth, which is most often readily believed.

Candidate of Medical Sciences, gynecologist, reproductologist at the REMEDI Institute for Reproductive Medicine

“Many years of research worth billions of dollars have been devoted to examining these risks. During the entire study of the consequences of IVF, there was no short-term or long-term relationship between the use of drugs to stimulate ovarian function and the risk of cancer. Absolutely all international congresses in the field of reproduction in recent years only confirm the absence of this connection. “

Doctors will confuse the biomaterial during IVF, and the woman will give birth to someone else’s child

A horror story from the series “children were confused in the hospital.” But sometimes it’s true, they get confused. And here is not even a child, but an egg. Of course it’s dangerous.

Obstetrician-gynecologist, fertility specialist “CM-Clinic”

“It’s almost impossible. First, eggs, sperm, embryos are marked according to certain rules. The patient’s personal data, his medical record number and the corresponding barcode must be indicated. Secondly, the embryologist never works with the biomaterial of several married couples at the same time. One work table – one pair of patients. “

And, thirdly, God takes care of those who are taken care of. When fertilizing eggs or transferring embryos, the conformity of the biomaterial is checked by at least three people – two embryologists and the reproductive specialist himself.

From the history of IVF

1978 year. Great Britain. Louise Brown was born. An ordinary girl, an ordinary family. Only one thing is unusual – this is the first person conceived in a test tube.

Louise is already a mother herself. And technology has since advanced, and even women without a uterus or men without sperm can become parents.

As for our country, we are eight years behind. The first child conceived with IVF was born in February 1986. And before that, for 20 years in the USSR, they conducted research on this topic.

Her eldest son Jean and the youngest daughter Masha have a difference of 28 years. Lera gave birth to a girl at 47.

“It’s already difficult, there are not many eggs, it’s difficult to take out,” said the TV presenter at the show “Alena, damn it”. – Yes, I did IVF. Conception did not work on the first try. Probably from the third. But I would once again go through all this hell, childbirth, if only Masha was born. “

Nicole Kidman

In a marriage with Tom Cruise, the Hollywood actress could not give birth: their children are adopted. Theirs turned out only in marriage with Keith Urban. Kidman gave birth to her eldest daughter in 2008 with the help of IVF. The star was given it very hard, the chances were minimal. Therefore, three years later, the couple’s youngest daughter was born with the help of a surrogate mother.

Elena Borshcheva

The eldest, Martha, the actress and KVN star, became pregnant herself and without any problems. But when they began to plan for the second child, they reached a dead end. Several operations, tests … in the end, I decided on IVF.

“We tried it once. Two. Three. Everything is unsuccessful. How much money was spent is scary to remember. But okay money, I felt on myself how hard it is to experience a state of hopelessness, “Borshcheva said in an interview with Antenna-Telesem.

Another attempt was successful; in 2015, a second daughter appeared in Elena’s family.

Celine Dion

Only two attempts out of seven were successful for the Canadian singer and her husband Rene Angelina. At 33, the artist gave birth to her eldest son, at 42 – twins. Between them, nine years of treatment, miscarriages and feelings of powerlessness.

By the way, the second time Celine became pregnant even with triplets, but one of the babies was born dead.

Anastasia Makeeva

The actress has no children yet. She hasn’t been able to get pregnant for eight years. But the young woman still does not lose hope of becoming a mother.

“I cried a lot when I found out the diagnosis and when I had four IVFs,” Anastasia said in the YouTube show “Empathy Manuchi”. – After each IVF, I gained 9 kg, then lost weight. Because it is very difficult to return hormones. “