During follicle puncture, a woman can become pregnant. Pain after follicle puncture: norm and pathology. Ultrasound and hormonal monitoring

The follicle puncture procedure is not simple or common. And although it does not imply any special difficulties or complications, it is worth approaching its implementation and the recovery period after it with due attention.

The procedure is aimed at taking mature ones from the ovaries for subsequent artificial insemination and planting the resulting embryos into the body of the uterus of the expectant mother.

After discomfort often occurs and even painful sensations. In addition to them, the following may appear:

• light, spotting discharge with blood;
• pain in the lower abdomen and ovaries;
• increase in body temperature up to 38 degrees;
• bloating;
• feeling of tension and increased tone internal organs.

REFERENCE. If a woman’s condition after puncture does not allow her to work fully, the doctor may issue a sick leave for the period of the patient’s recovery.

Typically, these symptoms do not intensify and disappear within a few days. But sometimes the following complications may occur:

• copious discharge with blood;
• nausea and stomach upset;
• pain in the lower back and back;
• strong increase in body temperature.

All these are signs of hyperstimulation. In this case, it is advisable to immediately consult a doctor.

How you feel after the procedure

Despite the above list of symptoms, Not every woman necessarily exhibits symptoms.

During the puncture, the patient is under the influence of anesthesia so he doesn't feel anything. After waking up, you may experience weakness, drowsiness, and dizziness.

This condition may be accompanied by aching pain in the abdomen, a slight increase in temperature.

GOOD TO KNOW. The procedure is carried out on an empty stomach, and on the day before the puncture it is advisable to adhere to a light diet with a low-fat dinner. This is done to facilitate recovery from anesthesia.

After the procedure, it is advisable to provide the woman with peace. Typically, clinic specialists monitor the patient’s condition for several hours before discharging her.

If your temperature rises

This parameter is not a cause for great concern. This is a normal reaction of the body to the surgery. If the temperature is not high, does not exceed 38 degrees, there is no need to worry. If the temperature rises above 38 degrees, you should immediately go to the hospital.

Condition of the ovaries

Procedure performed doesn't go completely unnoticed for the ovaries. After the puncture, they may swell slightly and increase to 10 cm in circumference.

Due to the heavy load on the internal genital organs Some women experience spotting and bloody discharge, the vascular network may grow. Due to these changes, the stomach begins to hurt and becomes bloated.

Stomach pain - is this normal?

In general, the presence and severity of pain after puncturing depends on the number taken, and on the individual characteristics of the female body.

When performing a puncture using the intravaginal method, the pain stops quite quickly. If laparoscopy was performed, painful sensations may last several days.

In severe cases, pain may be a strong character and accompanied by diarrhea, bloating, back pain, spotting and fever. In this case, the patient’s condition deviates from the norm and requires medical intervention.

How many days does recovery take?

In the absence of complications and following the doctor’s instructions, the lower abdomen stops hurting on the 2nd day of the post-puncture period. During this time, the ovaries have time to recover.

But in some cases, the duration of bed rest and the woman’s unfavorable state of health may be due to her individual characteristics and other reasons. The pain can also be prolonged due to the development of hyperstimulation.

If hematomas occur The recovery process may take up to a week. If they form, the pain lasts up to several months. In both cases, medical assistance is required already at the initial stage of the onset of the disease.

How to relieve unpleasant symptoms?

If the recovery process goes without complications and is tolerated quite easily by the patient; no auxiliary medications are required. To make the post-puncture period a little easier, you can take analgesics.

If the pain is severe, the doctor often prescribes Ketonal, Diclofenac or Voltaren suppositories, rectally.

INFORMATION. It is important to remember that a number of drugs can cause intestinal disorders, which can cause confusion in the course of recovery period and cause suspicion of hyperstimulation. IN in this case It is appropriate to consult your doctor for advice.

To relieve fever, antipyretic drugs such as Panadol are used.

Before taking any of the above medicines consultation with a specialist is required, since some drugs are contraindicated in the period after puncture. Do not self-medicate.

The appearance of discharge

This moment usually associated with vascular damage when the body of the vagina and ovaries is punctured, which causes a small amount of blood to appear.

Spotting is considered a normal consequence of puncture. Their color may vary. If bright blood is added to the daub in copious quantities - this is an alarming sign that requires medical attention.

What happens to the follicles and corpus luteum?

During the puncture process using special therapy artificial and controlled growth is achieved follicle. When the desired size is reached, the eggs are collected.

IMPORTANT. This procedure should not be perceived as a surgical intervention. Essentially, this is just the insertion of a needle into the follicle.

The withdrawal process does not last long; the entire procedure takes no more than half an hour.

The puncture needle is attached to the probe, as a result of which everything that happens is displayed on the monitor. A specialist uses a device to find mature follicles, removes them and places them in a special container. Next, the material is sent to an embryologist.

At the sites of punctured follicles, follicles are formed. The same situation occurs in the normal process, when a corpus luteum appears at the site of the ruptured follicle, promoting the production of progesterone, necessary for embryo attachment.

But During the puncture period, this process is disrupted, which causes an imbalance of hormones. For this reason, additional drug support is provided for the functions of the corpus luteum to normalize the proportional ratio of hormones.

What medications are prescribed?

Utrozhestan

This drug contains the hormone progesterone of natural origin. It is used either orally or vaginally. The second method is preferable because it has the most powerful effect and speed of action, going directly into the uterus, bypassing other organs.

The release form of the drug is capsules for oral and intravaginal administration.

It is prescribed to be taken immediately after the puncture and until 10-15 weeks of pregnancy.

Clexane

Before the puncture, the doctor plans 1 day, during which the patient’s body “rests” and prepares for the operation. On this day, the woman is prescribed hormonal drugs, supporting the general condition of her internal genital organs.

Clexane is one of these drugs. Dosage and rules of administration vary for each patient individually.

The drug is intended to thin the blood and stop the formation of blood clots.

Dostinex

Blocks the production of a hormone that promotes lactation. It is prescribed to bring into balance the hormonal system disturbed by puncture, to restore the menstrual cycle, to normalize the timely maturation of follicles and the onset of ovulation.

It is also used to prevent hyperstimulation.

Antibiotics

In order to prevent the occurrence of an infectious process, an antibiotic is administered during puncture. wide range actions.

It is important to remember that all of the drugs listed can only be used after the recommendation of a doctor and under his supervision.

What to do immediately after the procedure?

After the puncture need to adhere to bed rest. The clinic will give the patient the opportunity to rest after surgery for some time before being discharged.

This usually takes at least 4 hours. During this period, the doctor may prescribe IV drips and will also monitor the patient’s general condition.

After discharge, you cannot drive a car.

What regime to follow and how to behave?

After the puncture It is highly advisable to observe bed rest. You can ask the doctor to issue a sick leave certificate for several days. During the recovery period, you should not be exposed to heavy physical activity or stress.

You should abstain for two weeks from going to the sauna, swimming pools, solariums, it is undesirable to take a hot bath.

After the event Rest and proper nutrition are important. Due to discomfort in the abdominal area and the appearance of bloating, it is advisable to adhere to a certain diet without loading the stomach with heavy food. Usually during this period a protein diet is prescribed, but not every woman can adhere to it without consequences.

If the intestines are unable to absorb a large number of protein, you can help it by diversifying your diet with other foods. Consume oatmeal with the addition of prunes, drink kefir, flavor your dishes with vegetable oils.

The following cold-pressed oils are beneficial:

• sesame;
• walnut oil;
• sea ​​buckthorn;
• pumpkin seed oil.

This product will help solve the problem of constipation. Don't go overboard with fiber-rich foods(raw vegetables, fruits, brown bread and legumes).

Drinks you can drink still water or unsweetened fruit drinks, the amount of liquid consumed per day should reach up to 3 liters. You can't drink coffee strong teas, alcohol.

Is it possible to have sex?

The procedure puts a lot of stress on the female body, requiring considerable effort to recover. Sex can lead to breakup follicle and disrupt the functioning of the ovaries.

Orgasm and arousal are also able to tone the genitals, which may jeopardize the entire therapy process. For these reasons, intimacy is undesirable after the puncture.

Period

After the procedure, if it went without complications, the menstrual cycle begins after 3-4 days. Subsequent cycles may be disrupted, which can be corrected by contacting your doctor.

REFERENCE. If implantation is prescribed after the puncture, and the procedure is successful, menstruation should not occur.

Polycystic disease or hyperstimulation can also manifest itself as disruptions in menstruation, so monitoring by a doctor during this period is important.

Consequences and complications

Usually the puncture proceeds normally, without being complicated by pathologies. In rare cases due to injury blood vessels possible hemorrhage V abdominal cavity, trauma to the pelvic organs. An abscess of the ovaries or pelvis may occur.

If a cyst is present, it may be torsioned or ruptured., inflammation of appendicitis, violation of the integrity of the ureter. But in practice such situations rarely occur.

In most cases the procedure goes well, without complications. Mild ailments are corrected with medications, and the entire recovery process is carried out calmly. You should not worry or be afraid; the thought that all efforts will lead to the birth of the long-awaited baby should be a consolation.

When the egg and sperm cannot fuse into one in natural conditions, they can be helped to do this in a laboratory, and then a ready-made embryo can be implanted into the uterus. But to do this, the couple's genetic material must be extracted somehow. And if with a man there are usually no problems in this regard - he just needs to bring his sperm to the clinic at the appointed time, then with his wife things are a little different. It is no longer possible to obtain her eggs naturally after ovulation. The only way out is to act proactively, that is, while ovulation has not yet occurred and the follicle has not yet burst, extract it from it using a special thin needle. This is follicle puncture during IVF.

The puncture is always preceded by hormonal stimulation. responsible for the maturation of eggs (human chorionic gonadotropin). The amount of hormone secreted by the female body is sufficient for the maturation of one egg. For pregnancy to occur under natural circumstances, this is enough, but if we are talking about IVF, then one oocyte may not be enough. There are many circumstances that can prevent successful in vitro fertilization, so genetic material should always be in stock.

Taking this into account, the standard IVF protocol always begins with ovulation induction - developing a dosage schedule hormonal drugs, forcing the ovaries to work harder and produce not just one or two, but 5-7 (in some cases 15-20) eggs in one cycle. On the eve of the puncture, the woman is given an injection with an additional dose of hCG, which should help the follicles finally mature. After 34 (maximum 36) hours after this, it is necessary to extract the oocytes from them.

Important! On what day to puncture the follicles during IVF and at what time is decided by the doctor. By being late to the clinic and missing the appointed hour, a woman can ruin all her efforts. If the eggs are not retrieved in time, ovulation will occur and they will enter the cavity of the fallopian tube. It will no longer be possible to find them and get them out of there.

Follicle puncture during IVF is a transvaginal operation. It is carried out using a special ultrasound probe, which is inserted into the vagina. All manipulations are visible on the monitor screen. According to the woman’s feelings, this procedure is not much different from a standard transvaginal ultrasound. Having examined internal organs and after making sure that everything is in order, the doctor proceeds directly to the puncture. To do this, he pierces each follicle and sucks out the fluid containing the oocyte.

There is no need to be afraid of this procedure - there is no pain or threat to health. Of course, the doctor manipulates a thin needle, which can touch other organs, but the risk of this is minimized. Firstly, all actions are controlled on the screen of an ultrasound machine, on which you can clearly see the follicle. Secondly, the sensor with the needle is also equipped with a special beacon that highlights the dotted line of the puncture.

Puncture under anesthesia

As for the fear of painful sensations, it is completely unfounded. No one will perform follicular puncture without anesthesia in domestic clinics. Some institutions use full anesthesia, others use only local anesthesia, but in any case, the woman will not feel pain from the puncture.

It is interesting that more and more often women themselves insist on puncture of follicles without anesthesia, and foreign clinics are increasingly willing to accommodate them. Especially if there are few follicles that have matured, and the physiological location of the ovaries allows easy and quick access to them. Refusal to take pain medication is usually triggered by concerns about the quality of the eggs obtained. And I must say that they are not so groundless. Some reproductive specialists actually believe that the effect of anesthetics can negatively affect the quality of the obtained genetic material, and therefore jeopardize the likelihood of a successful pregnancy.

Considering all the risks, most clinics today offer so-called “controlled anesthesia.” It begins to act almost instantly - 30-40 seconds after injection into a vein, and stops pumping it into the blood immediately a minute or two after all manipulations are completed. In this way, the effect of anesthetics on both the woman’s brain and her eggs can be minimized. Within 1-2 minutes the patient will come to her senses, and after two hours she will be able to leave the clinic without any problems. There will be no nausea, dizziness and weakness that are usually present after waking up from anesthesia.

How long does it last

Puncture of follicles during IVF does not last long. For everything about everything, a maximum of 10-15 minutes. It happens that the operation is delayed, but most often this is caused by a large number mature follicles. The liquid obtained from the follicles in a special container is transferred to the laboratory. Now an embryologist will have to work with her. Only he will be able to determine how many eggs were actually obtained during the puncture. It is impossible to examine the oocyte on an ultrasound monitor; when a reproductologist makes a puncture, he sees only the follicle, which, by the way, may turn out to be empty.

You will be able to find out the results of the puncture and the date of the next visit, during which the embryo will be transferred into the uterine cavity, a few hours after the procedure. As a rule, by the time a woman finally comes to her senses and is ready to go home, her attending physician is ready to provide all the necessary information.

Important! Due to the intervention, the quality of the patient’s reaction to what is happening around her slows down significantly for some time. You can't drive in this condition. On the way home from the hospital, a woman must certainly be accompanied by someone.

Puncture of follicles using laparoscopy

This is exactly how eggs were obtained at the dawn of the development of IVF techniques. The first oocyte retrieval operations, carried out in the 80s of the last century, were carried out exclusively by the laparoscopic method, under general anesthesia.

Three small punctures, no more than a centimeter in diameter, were made in the patient’s anterior abdominal wall. A special mini-tool was inserted into each hole. One of them served simultaneously as a flashlight and a video camera - it illuminated the abdominal cavity and displayed the image on the screen in the operating room. With the other two, the fertility specialist made a puncture and pulled out the oocytes from the follicles. Once completed, the manipulators were removed and the remaining holes were stitched or glued.

Due to the traumatic nature of the method, it was soon abandoned and the technology of transvaginal puncture was developed. But nevertheless, even today, circumstances arise in which it is either very difficult or even impossible to extract eggs through the vagina. For example, due to the structural features of the pelvic organs and the difficulty of access to the ovaries. In such rare cases, egg retrieval using laparoscopy is possible.

Important! Puncture is not just for women. In some forms male infertility A partner may also need a similar operation. In particular, we are talking about a situation where sperm are produced in the male body, but due to problems with the ejaculatory ducts they do not enter the seminal fluid. A few years ago, such circumstances forced couples to contact. Today, azoospermia is not a reason to refuse the opportunity to have biological own child, thanks to doctors who have mastered the technology of testicular puncture.

Regardless of the method used to puncture the follicles - transvaginal or laparoscopic - after it, the attending physician will certainly prescribe the patient to take hormonal medications. Their task is to prepare the uterine endometrium for future embryo transfer. The main role in this process is played by progesterone, which is sold in the form of drugs called "", "", "Iprozhin". In some cases, you may also need an additional dose of estrogens - "", "", "Estrogen".

Preparation for follicle puncture

So that all efforts and surgical interventions are not in vain, a woman must be aware that her future motherhood is in her own hands. Much indeed depends on the reproductive specialist who collects the eggs, and on the embryologist who combines them with the husband’s sperm, but, alas, not everything.

Before meeting in the same test tube, oocytes and sperm undergo thorough genetic screening. Only the best of the best will be selected. So, in order for the eggs obtained during puncture to be suitable for fertilization, a woman should follow some recommendations.

1. Do not take any medications without a doctor's prescription.
2. Refuse food additives, canned food and any other food containing chemicals.
3. If possible, limit contact with strangers in order to protect yourself from other people's viruses and infections.
4. Take folic acid and vitamin complex prescribed by the attending physician.
5. Eat nutritiously, eat nuts, vegetable oils and fermented milk products. Eliminate from your diet too salty, spicy and fatty foods, refined carbohydrates, as well as any foods that cause increased gas formation. Drink more fluids.
6. Categorically give up smoking and alcohol, and, preferably, also caffeine.
7. For a while, forget about baths, saunas and solariums. Locked in applies to any extreme heat, even home hot baths. Massage of the lumbar area is also not advisable.
8. The month before the puncture is not the best time for intensive training in the gym or any form of heavy physical labor.
9. You should abstain from sexual intercourse for the last 3-4 days before egg retrieval.
10. The evening before the procedure, have a light dinner and cleanse completely in the morning. bladder and intestines (use of an enema is allowed). You should avoid eating and drinking on the day of the puncture.

By to a greater extent, the same recommendations should be followed by a man. The number and activity of the resulting sperm directly depends on his lifestyle. By joining forces, it will be easier for the couple to overcome the restrictions of the preparatory period.

Consequences of follicle puncture during IVF

After puncture of the follicles, a woman may still feel the side effects of anesthetics (dizziness, drowsiness, weakness) for some time, but it all depends on the general tolerance of the body and the quality of anesthesia. Modern medications practically do not provide such effects. But what you cannot avoid is nagging pain in the lower abdomen and scanty bleeding.

The fact is that it is, in principle, impossible to pierce the vagina and ovarian wall without touching a single blood vessel. The cavity of the follicle, from which all the liquid along with the egg is sucked out through a needle, will inevitably fill with blood and a small hematoma will form. Normally, the pain should be tolerable and completely subside 1-2 days after the puncture. Normal tissue restoration will be facilitated by bed rest - the less physical activity, the less likely it is to bleed.

Important! To help the patient relieve nagging pain, the doctor may prescribe antispasmodics or nonsteroidal anti-inflammatory drugs. Most often, regular paracetamol is sufficient. But you should never take aspirin - it can increase bleeding.

A slight increase in body temperature is also normal. 32.4 – 32.7°C is the usual thermometer reading after any surgical intervention. If the temperature rises above 38°C, then this is a good reason for hospitalization.

It is important to understand that the puncture itself rarely causes any complications. Most often, the cause of intense pain lies elsewhere - in ovarian hyperstimulation syndrome (OHSS). It is provoked not by a puncture, but by taking hormonal drugs on the eve of oocyte collection. Moreover, the more eggs matured in one stimulating cycle, the higher the likelihood of this complication. In addition to severe nagging pain, it can be recognized by a severely swollen abdomen. Even to the touch it becomes noticeably harder.

This occurs due to the significant volume of liquid blood that leaks into the abdominal cavity. It increases and begins to put pressure on the internal organs. In this case, the woman feels not only pain, but also a strong heaviness in the lower abdomen. A mild form of hyperstimulation is usually accompanied by intestinal problems - flatulence, diarrhea or constipation.

Painful sensations after puncture

The more fluid leaks into the abdominal cavity, the worse the patient will feel. Severe forms hyperstimulation manifests itself:

• nausea;
• vomiting;
• discomfort when urinating;
• severe increasing pain in the lower abdomen and back;
• profuse bleeding.

Any of these symptoms is a reason to immediately seek help. medical care, because it can cause severe internal bleeding and cost a woman her life.

Although you shouldn’t worry too much and set yourself up for negativity in advance. Severe forms of OHSS are not common. According to various statistics, the frequency of complications does not exceed 10% of the total number of punctures performed.

Puncture of follicles behind. What to expect?

After both partners have passed successful completion genetic material, they can rest for the next few days - now embryologists get down to business. Best time fertilization of the egg occurs 4-6 hours after puncture. A suitable oocyte and some seminal fluid are placed in a special medium and waited until the most active sperm breaks through the protective layers surrounding the egg.

After this happens, a few more days are needed to observe the resulting embryos in the laboratory and select the best of the best for transfer. On days 2-3 or 5-6 (it all depends on the individual IVF plan), the woman will need to come to the clinic again. This time so that a fertility specialist could transfer fertilized eggs from a test tube to her uterus. Now all that remains is to wait. Whether the embryos have taken root in the maternal endometrium or not can be found out no earlier than in one and a half to two weeks by taking a blood test for hCG levels.

All this time, the woman is advised to try to remain calm and limit any stress - both psycho-emotional and physical. Leisurely walks on fresh air useful, but too much active activities It's better to refuse. Just like from sexual intercourse, hot baths, baths and saunas.

If the long-awaited pregnancy occurs, the gynecologist will give all subsequent recommendations. If the result is negative, hormonal medications are usually discontinued, and the next appointment with the attending physician is scheduled immediately after the end of the next menstruation. Stimulation and subsequent puncture of the ovaries is a serious stress for the body, after which it will need some time to recover. The first 2-3 menstrual cycles may occur with significant delays and disruptions - this is a variant of the norm. In some cases, it may be necessary to take estrogen-progestin drugs as compensatory therapy.

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

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

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

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

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

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

For women:

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

For men:

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

IVF/ICSI

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

So, what is IVF and ICSI treatment?

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

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

The first stage is stimulation of superovulation.

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

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

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

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

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

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

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

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

Stage I of treatment- ovulation induction

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

GnRH agonists.

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

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

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

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

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

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

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

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

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

Preparations of human menopausal gonadotropins (HMG).

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

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

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

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

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

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

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

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

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

Side effects These medications occur infrequently and include abdominal discomfort, flatulence (bloating), mood swings, fatigue or restlessness, which in most cases improves or disappears completely after follicular puncture. One of the possible complications of therapy with HMG drugs is the risk of multiple pregnancy.

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

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

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

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

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

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

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

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

Stage II of treatment- puncture of follicles

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

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

Instructions for IVF/ICSI patients before follicle puncture.

DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT!

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

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

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

Instructions for patients after follicular puncture

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

III stage of treatment- embryo cultivation

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

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

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

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

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

Stage IV- embryo transfer

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

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

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

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

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

Regardless of the diversity of modern families, most of them cannot imagine their life without children. Just 10-20 years ago, the diagnosis of “childlessness” was a lifelong sentence, and there was no way out of it. The possibilities of modern medicine and IVF technology now allow a woman to give birth to her own baby in most different pathologies. Egg puncture is a mandatory procedure for in vitro fertilization. We invite you to learn more about how egg puncture occurs during IVF and all the most important things about its implementation.

Before ovarian puncture, the stimulation stage is mandatory. Normally, one (less often two) eggs mature in the ovaries of each woman every month. And with stimulation, the number of maturing follicles increases to 21 (superovulation).

Hyperovulation will increase the number of mature follicles, which will significantly increase the chances of successful IVF.

A large number of eggs will make it possible to obtain many embryos, which will bring the woman as close as possible to her intended goal of having a child.

A follicle with a diameter of 16-18 mm is considered mature. To cause artificial hyperstimulation, a woman is usually prescribed hormonal medications during the 1-3 days of the menstrual cycle. Then, within 34-36 hours, the long-awaited process of ovulation occurs in the ovaries.

Superovulation can be carried out according to various schemes. Previously, it was carried out by administering HMG (human menopausal gonadotropin) and clomiphene citrate. However, in Lately combinations of gonadotropin analogues are used. The administration of these drugs can be carried out according to two main schemes: long and short.

With a “long” regimen, several hormonal drugs are administered on days 2 and 20-21 of the cycle.

The “short” regimen consists of parallel administration of hormones (or a hormone-releasing hormone antagonist) from the 2nd day of the cycle. Other options for schemes or combinations of using hormonal drugs for hyperstimulation are also possible. All this is determined by the woman’s attending physician.

After stimulation, the doctor monitors the process of follicle maturation. Usually a woman comes for an appointment every other day so that the reproductive specialist can accurately determine the moment of full maturation and completion.

In order to keep follicle development under control, the doctor records the most important parameters:

• follicle size (using transvaginal ultrasound monitoring);
• level of hormones in the blood (,);
• condition of cervical mucus.

The main goal is to perform a puncture before the oocytes ovulate inside the follicle. It is during this period that follicular puncture (retrieval of mature eggs) is prescribed.

Preparatory stage

The preparation stage for egg retrieval is especially important with IVF technology.

Any one is a huge burden for women's health. That is why it is important to reduce these attempts to a minimum and collect follicles the first time.

For a successful IVF procedure, both partners (female and male donor) must prepare and follow important recommendations for several months.

In order for the sex gametes to be as healthy and complete as possible by the time of IVF, it is important to observe the following restrictions:

• abolition or significant limitation of all medications;
• a complete diet;
• quitting smoking and alcohol;
• avoiding drinks containing caffeine;
• refusal of all kinds of “steam rooms”, saunas, baths, hot baths;
• abstinence from sexual contact 3-4 days before puncture;
• exclusion of strong physical activity;
• excluding men from wearing tight and thick underwear;
• absence of illness in the last 2-3 months.

But the woman’s behavior on the day of the puncture is especially important.

Preparation for women

Before ovarian puncture, the anesthesiologist must talk with the patient to clarify the following important details:

• height, weight, blood pressure;
• presence of allergies to drugs;
• previous operations;
• existing chronic diseases.

A woman should not be afraid and “observe” a particularly strict regime on the day of embryo transfer. Later in the day she will be allowed to both drink and eat. However, the patient will still need to comply with several restrictions.

Usually the puncture is performed in the morning. The day before, a woman is prohibited from eating later than 18-00. You can still drink the liquid. In the morning, a woman should neither eat nor drink. The fasting period should be at least 6 hours.

It is advisable for the patient to arrive at the clinic 30-60 minutes before the operation. It is better for her to have an accompanying person with her so that she has someone to take her home after the manipulation. Sometimes after this people are disoriented in time and space.

Before egg puncture, a woman must:

• shave the bikini area (especially the entrance to the vagina);
• take items of clothing ( nightgown, clean socks);
• Avoid wearing makeup.

Training for men

It is important for the male partner to be in the clinic with the woman on the day of the procedure. 3 months before sperm donation, a man is prescribed a course of multivitamins. The partner must donate sperm at the time of puncture (through masturbation).

A man must also observe the following:

• 3 days before the puncture, refrain from alcohol, visiting a bath or sauna, and from sexual intercourse;
• wash the genitals with soap (preferably baby soap) before donating sperm;
• empty your bladder and bowels.

Before donating genetic material, a man should thoroughly wash his hands and penis. The sperm is collected in a sterile container without touching its internal surfaces. The donor's name must be indicated on the container. If part of the sperm could not be collected, this is reported to the attending physician.

Follicular puncture surgery

What is the operation of egg puncture or the procedure for removing mature eggs from a woman’s body? Such manipulation is not considered difficult. Usually 20 minutes is enough for her.

The procedure is performed with a special hollow needle using suction (aspiration) through the vagina.

This surgical intervention is performed under anesthesia with mandatory monitoring of an ultrasound sensor.

The ultimate goal of the manipulation is to extract fully mature eggs from the woman’s ovaries.

The procedure is performed by a gynecologist, assisted by an anesthesiologist, embryologist, and operating room nurse.

During the puncture, the woman falls into a light medicated sleep. This allows you to maintain the patient’s comfort and the effect of “not being present” in the operating room (to minimize stress).

Before the puncture, an ultrasound is performed to determine the size of the follicles. The material is collected when the ovaries contain at least 3 follicles, the size of which is about 18-20 mm.

Egg puncture during eco - sequence of actions

• The woman sits in the gynecological chair, her arms and legs are fixed. Special sensors are connected to the patient to monitor her condition.
• A drug for anesthesia is injected intravenously. The anesthesiologist monitors the woman's condition.
• Gynecologist reveals cervical canal cervix with special dilators. An ultrasound sensor is inserted into the cervix, under the control of which a hollow needle is inserted.
• A specialist, under the control of a monitor, finds and pierces the follicles. The eggs, along with the follicular fluid, are aspirated and collected in test tubes. Occasionally, it is impossible to find eggs in the follicles; they remain empty. This happens with incorrectly selected hormonal therapy. In this case, the woman is recommended to take a 3-month rest and make adjustments in hormonal treatment.

In laboratory conditions, mature oocytes are selected by an embryologist and prepared for fertilization. In this case, the stage of puncturing passes into the stage of fertilization and selection of blastocysts. The eggs obtained after puncture are placed in the necessary nutrient medium in a special sterile container (plate or Petri dish) and placed in an incubator. All dishes containing the material are marked with the number of eggs and the data of the married couple.

It is especially important to perform a puncture at the optimal period, preventing the release of eggs from the follicles (natural ovulation) into the abdominal cavity. If you miss this moment, the follicles will become unavailable for removal.

In special medical situations, a method of obtaining a woman's eggs by laparoscopy (through an incision in the abdominal cavity) is used.

How to behave after a puncture

Slight discomfort or bloody “spotting” is possible after the puncture and this is quite normal.

It is appropriate for a woman to lie down and rest. Patients often experience pain in the ovaries for a month after the puncture. Therefore, in most clinics, at this and subsequent stages, the patient is given a sick leave certificate.

Complications after puncture

At all serious complications after puncture, eggs are rare (less than 1%). However, the possibility of damage to the pelvic organs with infection and bleeding still exists.

Therefore, in some cases, seeing a doctor is simply necessary. Such situations are:

• temperature above 38 degrees;
• the appearance of severe abdominal pain;
• discharge is copious or has an unpleasant odor;
• shortness of breath, nausea or vomiting;
• dizziness, paleness, fog, or loss of consciousness.

You should not be afraid of the egg puncture procedure during IVF. Complications are extremely rare, and modern medical capabilities make this procedure painless and quick. This stage is extremely important for realizing the dream of having a wonderful baby in the family.

Long before deciding on IVF, you need to be prepared in advance for the fact that going through all the stages of this procedure, which is called the “IVF protocol,” will require time and patience. So, before deciding on the possibility of fertilization using this method, using her own cells - egg and sperm, a woman will have to undergo a mandatory follicle puncture procedure.

What is this procedure? Under general anesthesia, the doctor, using a special hollow needle with an ultrasound sensor, inserts it into the ovarian area and then removes mature eggs from the follicle. These eggs are sent for analysis. And at the same time, the man donates his sperm. The condition and quality of the cells are immediately checked, and on the basis of this a conclusion is made about the possibility of fertilization.

Should you be afraid of follicle puncture?

Indeed, when they talk about possible consequences such a procedure, many women are plunged into a state of panic. For example, after puncture of follicles, ovarian hyperstimulation may occur in the body, as a result of which follicular cysts may develop; the ovaries increase in size up to 6 cm (normally after the procedure) and up to 12 cm, when the consequences of hyperstimulation are more severe. At the same time, nausea and vomiting are possible. In this case, the woman is even hospitalized. It is important to understand that ovarian hyperstimulation with all the ensuing consequences may not even occur immediately after the procedure, but even after a couple of days.
In principle, even after a successfully performed puncture, discomfort in the abdomen, back, and the appearance of discharge are inevitable. Therefore, as a rule, after the procedure it is recommended to undergo an ultrasound again. But for those who decide to resort to IVF, avoid this necessary stage the examination will not be possible.

How to properly prepare for the procedure

The duration of the procedure associated with the extraction of cells from the ovaries takes no more than half an hour. However, there are situations when it is necessary to undergo the procedure again. For example, if it was not possible to obtain eggs from the follicle.
To protect the patient as much as possible, before such a puncture and then for a week, it is recommended to adhere to a special diet, giving preference to meat and fish for several days, but avoiding, if possible, the consumption of fermented milk products and vegetables. It is believed that their use can cause ovarian hyperstimulation. The procedure itself is performed on an empty stomach, as it is performed under general or local anesthesia.

In addition to diet, it is recommended to avoid sexual intercourse for several days before and after the procedure.
Two days before the puncture, the woman is given an injection with hCG (the same one that is produced in the body during pregnancy), ideally 36 hours before. And then before ovulation occurs, the eggs are retrieved. Their size should reach 22 mm. It is very important to comply with all time requirements, otherwise after ovulation it will simply be impossible to do this.

Follicle puncture is performed transvaginally. The entire procedure is carried out under ultrasound guidance. The eggs from the follicles are sucked out along with the fluid they contain using a special hollow needle. If the puncture is successful, the eggs are placed in a container for storage and further fertilization. Similarly, men’s sperm are also stored in containers. Almost immediately, specialists fertilize the cells, and then successful outcome Together with the doctor, the date for placing the embryo into the body of the expectant mother is set.

But even at the same time, it is important to know that after the puncture of the follicles, the couple will have to exercise caution, avoid physical activity, stress for some time, and adhere to the previously agreed upon diet.

Of course, for most couples such a procedure seems painful. But when other methods of treating a couple’s infertility have been tried and there is hope of conceiving a child using IVF, you can prepare for this.

Of course, performing such a puncture is a serious test for a woman’s body, which can affect her future health. Therefore, it is extremely important to find a doctor you trust implicitly.

Again, both man and woman should be prepared for the fact that the results of the first IVF may be ineffective, and the risk of pregnancy failure will also be high. However, hope remains. And examples of successful conception even in mature age a lot today.