Excess weight after three unsuccessful IVFs. How to lose weight after a failed IVF. What to do next if eco is unsuccessful. Diagnosis after IVF. Reasons for unsuccessful artificial insemination

Modern medicine provides numerous methods for performing artificial insemination. However, in some cases, the eco fails, after which you need to decide what to do next. With the help of an experienced doctor, you can understand what tips and actions will contribute to pregnancy in the future.

Causes

Sometimes an unsuccessful protocol is noted even if all the actions were performed correctly and the advice was followed. This is due to reasons related to physiology. Most often, a great deal of responsibility is required to carry out artificial insemination and achieve pregnancy. Pregnancy is diagnosed only in 30–50% of cases.

Why might the first eco-friendly attempt be unsuccessful:

1. low-quality embryos. For a successful procedure, high-quality embryos with high division rates should be used;
2. pathology of the uterine tubes. The presence of fluid in the fallopian tubes always requires effective treatment;
3. hereditary factor;
4. similarity between men and women in HLA antigens;
5. endocrine and hormonal problems;
6. polycystic ovary syndrome, in which the eggs cannot be of high quality;
7. decrease in follicular reserve, which occurs with ovarian depletion and inflammation;
8. chronic diseases of the reproductive system, kidneys, liver, gastrointestinal tract, lungs and other organs and their systems;
9. infectious diseases;
10. influenza, ARVI, injury or exacerbation of chronic diseases during IVF. In this case, the body fights major diseases.

Pathological processes affecting the endometrium. The success of fertilization is guaranteed if the endometrial size is from 7 to 14 millimeters at the time of embryo transfer. Chronic endometritis leads not only to infertility, but also to...

Antibodies in women that make it difficult to get pregnant. In this regard, a woman should undergo tests after an unsuccessful IVF. It is recommended to carry out a comprehensive examination, since problems are often explained by genetic abnormalities.

It is important to note that the second eco after the first unsuccessful first event requires a more thorough approach and consideration of numerous nuances.

Repeated procedure

When can you do a repeat eco after a flight? If the first artificial insemination was unsuccessful and pregnancy did not occur, you should approach the second protocol in a special way. However, before repeating the event, it is advisable to wait a certain time.

The duration of preparatory activities depends on the situation, the necessary examinations, and the characteristics of the female body. Most often, the break is from 2 to 3 months. This period is required not only for re-preparation, carrying out all diagnostic measures, but also for restoration of the ovaries after stimulation. It should be understood that IVF always becomes a strong stress for the female body.

A second attempt can be made only after menstruation has returned and any irregularities have become a thing of the past.

Regular menstruation is a must after an unsuccessful one. Otherwise, the risks of failure will exceed the chances of success.

The doctor carefully evaluates the previous protocol in order to understand how after the unsuccessful first event. Most often, normal ovulation occurs in the first or second menstrual cycle.

Not only physiological, but also psychological rehabilitation is important. The expectant mother should not be in a depressed and depressed mood. In this regard, a woman needs special support from loved ones and her husband. Good mood guaranteed fast recovery body and strengthening the immune system.

Result

Before repeating eco after unsuccessful attempt, it becomes imperative to work with an experienced physician and have a clear understanding of the potential results of artificial insemination.

The doctor draws increased attention on the following aspects:

• endometrial and embryo quality;
• the level of preparation of the female body for a potential pregnancy;
• features of the ovarian response to their stimulation;
• presence or absence of fertilization;
• physical parameters of the female endometrium at the time of its transfer;
• the quality of embryos initially developing in laboratory conditions;
• potential reasons for pregnancy failure that can be taken into account and addressed;
• deviations in the development of the endometrium during fertilization;
• the need for additional diagnostic measures before the second procedure;
• the possibility of changing the protocol for repeated IVF, which consists in the specifics of ovarian stimulation and certain drug therapy;
• optimal timing for a repeat procedure;
• the need to use a donor cell.

After unsuccessful artificial insemination, additional interaction with a doctor becomes mandatory to determine the optimal further actions.

Additional treatment methods are often required: drug therapy with antibiotics, laser therapy, physiotherapy, spa treatment, homeopathy, herbal treatment, hirudotherapy. Supporting the body is a guarantee of a successful pregnancy. Monitoring by a doctor and analysis of an unsuccessful protocol make it possible to understand what results should be expected in the future, and how much the chances of a favorable outcome increase.

Further actions

To increase the chances of pregnancy after a second attempt, it is extremely important to take care of the successful preparation and take into account additional factors.

What to do next after a failed eco? The first attempt allows you to get pregnant only in 30 - 50% of cases. To achieve successful fertilization, many women try to change the clinic and find another doctor. You need to understand that cooperation with an experienced specialist is half the success. At the same time, unsuccessful embryo transfer can be associated not only with incorrect actions of the doctor, but also with the specific state of the female body.

How to prepare for eco after an unsuccessful attempt? Every patient should understand what is the best course of action if IVF is unsuccessful. Proper preparation increases the chances that if the first procedure fails, it will still lead to pregnancy.

To prepare for a repeat procedure, you need:

• It becomes mandatory to undergo a full examination with all necessary tests. Such health monitoring reduces the risks associated with repeated failure;
• It is recommended to return to your personal life “at will.” During the break, adherence to the schedule is not necessary;
• restoration of the body is necessary. At the same time, the ovaries after an unsuccessful IVF must restore their optimal level of functionality;
• getting out of depression is another mandatory task set for a woman.

Before the next protocol, you need to switch to the right lifestyle: light sports, doing gymnastics to improve blood supply to the pelvic organs. Only this approach guarantees a high level of effectiveness of the upcoming event. You need to remember: extra pounds are a serious obstacle to IVF.

Only the right approach to health and emotional state will increase the chances of pregnancy.

Research will make it possible to understand what the cause of failure is and what the consequences may be after repeated IVF. After this, treatment becomes mandatory, which is necessary for complete elimination inflammatory processes and guaranteed conception with further successful pregnancy. The treatment often increases the chances of having a child through artificial insemination.

Many representatives of the fair sex are interested in what to do next after 2 unsuccessful IVFs. Doctors note the absence negative influence IVF procedures on the female body. The required number of procedures is determined individually. Sometimes 8–9 procedures are required, but usually after the 3rd or 4th unsuccessful attempt, alternative options are offered, including the use of a donor egg or sperm.

Modern medicine is developing rapidly, so IVF is no longer the only possible way to achieve pregnancy for couples who have difficulty conceiving and giving birth to a child.

In most cases, the reasons for in vitro fertilization failure can be eliminated, so pregnancy is still a possibility. Every woman has the right to experience the happiness of her mother, but this often requires effort.

Not all patients successfully become pregnant even after several attempts at in vitro fertilization (IVF). This becomes not only a medical, but also a psychological problem. Therefore, before undertaking such a procedure, each married couple should take a realistic approach to its possible results.

Frequency of development of a negative result

It is considered that if the first one is unsuccessful, the chances of success remain the same for the next two attempts. However, on the fourth and subsequent attempts, the probability of pregnancy decreases by 40% and is less than 5%. If the second IVF, and especially the third, are also unsuccessful, it is necessary to change the procedure protocol or take advantage of other possibilities, which are described below (ZIFT and GIFT procedures).

Causes

The main reasons for unsuccessful IVF:

• advanced age of the mother;
• increased levels of follicle-stimulating hormone (FSH);
• negative reaction to medications taken to improve fertility;
• small number of eggs received;
• delay in carrying out fertilization;
• small number of obtained embryos available for;
• a decrease in the quality of embryos, which can occur for a variety of reasons.

Sometimes even multiple IVF attempts fail for an unknown reason.

Other diseases and conditions:

• chronic endometritis;
• after numerous abortions or curettages;
• hydrosalpinx;
• genetic incompatibility of parents;
• diabetes, pathology of the thyroid gland and other endocrine organs, which could be aggravated under the influence of hormonal preparation for the procedure;
• obesity in both mother and father;
• sperm pathology ().

If there is a failure

If IVF fails, close cooperation with your doctor is necessary. Only he can identify the problem and find its solution. The physician should review the procedure cycle in detail and determine if there are any ways to change it to ensure future success. Sometimes it is enough to add 1-2 drugs to achieve pregnancy.

At this time, it is necessary to establish a trusting relationship with your doctor. Only by understanding what is happening to her can the patient improve her chances of treatment success. To do this, she needs to find a specialist who will answer all her questions.

It should be understood that unsuccessful IVF is a common occurrence. An example is the fact that during normal sexual life of healthy spouses, the probability of pregnancy is no more than 7% per month. This figure is significantly lower than the effectiveness of IVF.

What you need to review first with your doctor:

• type of protocol, types and dosages of medications, results of blood tests and ultrasound;
• characteristics of the rate of fertilization in the laboratory, development of embryos, their cryopreservation;
• selection of new technologies, for example, the use of new drugs or embryo cultivation for up to 5 days;
• exclusion of endometriosis, hydrosalpinx, polyps or uterine fibroids or treatment of these conditions;
• diagnosis of polycystic ovary syndrome and appropriate adjustment of therapy.

You need to understand that most often no one is to blame for failure. However, if there is no trust in the clinic where the first attempt was made, it is better to find another hospital.

Signs of a failed attempt

After IVF, you need to wait for 2 weeks. After this, the patient takes a test to determine the level of hCG. If the indicator has not increased compared to the initial one, then the procedure was unsuccessful.

Signs of unsuccessful IVF before taking hCG:

• there are no unusual symptoms, for example: temperature fluctuates, chills appear, or feeling unwell;
• remains at up to 37.2°;
• no manifestations early toxicosis, especially nausea.

After an unsuccessful attempt at in vitro fertilization, most patients are prescribed to identify missed pathological changes in the uterus that could have caused miscarriage. Sometimes, immediately after the first cycle, they try again, and this can contribute to the onset of the desired pregnancy.

Fertility restoration

Recovery after an unsuccessful procedure takes up to 3 months. In this case, it is necessary to pay attention not only to physical, but also to emotional health.

Factors that help you survive stress and recover faster:

• psychological: conversation with a medical psychologist, auto-training, meditation;
• physiological: acupuncture sessions, massage, regular exercise;
• biochemical: balneological procedures, healing mud, bath procedures, swimming, hardening, moderate tanning;
• physical: taking sedative herbs.

• assistance from a psychologist at the Center for Reproductive Technologies;
• improving relationships with your spouse, since trying to get pregnant should not turn into an end in itself for a woman;
• nutritious food, adequate sleep;
• communication with loved ones.

In some cases, a woman develops severe depression - thoughts of her own worthlessness appear, apathy, tearfulness, a constantly depressed state sets in, and the desire to live, work, and even get out of bed disappears. In this case, the help of a psychiatrist and medication are necessary.

When can I try again?

This depends on the individual condition of the patient. She must again gather her courage, undergo all examinations and tests, and cure existing diseases. Typically, a repeat protocol is prescribed after 3 months. The number of attempts is practically unlimited; some women become pregnant only after the 6th – 8th procedure.

In some cases, cryotransfer after unsuccessful IVF is done after just one menstrual cycle, that is, when the first and second menstruation are completed. At the same time, the time required for the procedure is reduced, since there are already frozen embryos obtained in the first attempt. Therefore, oocyte retrieval, fertilization and cultivation are not carried out. At the same time, the quality of the embryos does not suffer.

The cryoprotocol can be supplemented with hormonal therapy to support the process in the endometrium, but medications are usually prescribed only for the endocrine form of female infertility.

To take advantage of this opportunity, it is necessary, immediately after the failure of the first IVF, to undergo a full examination, find out and eliminate the cause of the pathology. In this case, there is a chance of pregnancy on the second attempt without unnecessary hormonal load on the body.

Menstrual cycle and pregnancy

Is it possible to get pregnant naturally after an unsuccessful attempt?

Yes it is possible. After a negative hCG test result is obtained, the woman stops taking hormonal medications.

When does your period start?

Usually menstruation occurs in the first 10 days after hormone withdrawal. If bloody issues appeared literally in the first days after IVF, you must immediately consult a doctor. This may be a sign of miscarriage or ovarian hyperstimulation syndrome.

A delay in menstruation after unsuccessful IVF may be caused by a developed disease. To find out the reasons, you should consult a doctor and do an ultrasound.

It happens that after an unsuccessful attempt, your chest hurts. This is fine. This is how the body reacts to significant hormonal changes that occur during this period. After the cycle is restored, such symptoms should disappear.

The first menstruation can be heavy and long (up to 10 days), sometimes moderate pain occurs. Scanty periods during this period are often a sign of endometrial pathology or hormonal imbalance. Ovulation occurs 12-14 days after the start of menstruation, sometimes later. At this time, natural pregnancy may occur. If this does not happen, subsequent menstrual bleeding should be normal for the patient.

In about a third of cases, a natural pregnancy occurs after IVF failure. It is related to diagnosis and treatment possible diseases couples, improved hormonal levels, better preparation of the endometrium. In this case, approximately 3-4 weeks after the first menstruation, initial symptoms appear - nausea, poor health, and sometimes lower abdomen pain. If such pain becomes stronger and is accompanied by bleeding from the vagina, you should immediately consult a doctor. Such symptoms may be a sign of early miscarriage. Abdominal pain may occur earlier than the specified period. They also require consultation with a gynecologist or reproductive specialist to rule out ovarian hyperstimulation syndrome.

Physiological pregnancy after unsuccessful IVF develops normally. A woman should be regularly monitored by a doctor. She can give birth naturally.

Medical solutions to the problem

All couples faced with such a situation have a question: what to do next?

Usually the couple is asked to try again. How to prepare for your next IVF procedure:

Repeated diagnosis

Repeat diagnostic studies are carried out if previous results were obtained more than a year ago:

1. The level of antisperm and antiphospholipid antibodies is determined. Antiphospholipid antibodies interfere with normal uterine blood flow and embryo implantation. Positive antisperm antibodies damage the embryo immediately after implantation, when the woman does not even know that she has become pregnant.
2. The level of lupus coagulant and antibodies to hCG are examined, and the contents of the endometrium are inoculated on a nutrient medium to identify possible causative agents of chronic endometritis.
3. Prescribed to prevent fluid accumulation in the pipes (hydrosalpinx). It can enter the uterus and be a toxin for the implanted embryo.
4. An ultrasound of the uterus is performed with filling its cavity with a sterile solution (hydrosonography) to exclude fibroids or polyps.
5. If necessary, Doppler ultrasound of the vessels of the uterus and pelvic organs is prescribed to rule out varicose veins in this area.

Ovarian stimulation

They are convinced of the maximum possible for the patient at her age. Any clinic tries to avoid ovarian hyperstimulation syndrome. With this pathology, the ovaries enlarge and secrete a large amount of fluid into the abdominal cavity, which can be life-threatening.

Although this risk must be taken very seriously, reducing the amount of hormonal drugs below a safe level leads to a decrease in the normal stimulation of egg production in the follicles, a decrease in their number, a deterioration in the quality of the resulting egg and then the embryo, and a decrease in the success rate of repeat IVF. With a decrease in drug stimulation of the ovaries, the number of eggs may not decrease, but each of them receives less hormonal influence, which leads to its underdevelopment.

Finding another clinic

Unsuccessful IVF attempts are a reason to look for another clinic that uses other artificial insemination programs. There are several such protocols, and in each of them medical centers Usually they stick to one. If it does not work, it is necessary to collect more information about other reproductive centers.

Using Helper Methods

To increase the effectiveness of IVF, auxiliary methods can be used:

1. “Assisted hatching” is the creation of a microscopic hole in the wall of the embryo to help it “hatch” before implantation in the uterus.
2. Co-culture, that is, the joint development of the embryo with endometrial cells obtained from the uterine wall.
3. , in which 1 cell is taken from a 3-day embryo and subjected to chromosomal analysis.
4. Preventive removal of the fallopian tube for large hydrosalpinx.
5. Extending the cultivation “in vitro” up to 5 days, until the formation of not a zygote, but a larger formation - a blastocyst.
6. Adding to the hormonal therapy protocol a somatotropic hormone necessary for the complete maturation of the egg, most often in young patients with a large number of eggs received or in women over 38 years of age.

Application of analog technologies

How can I improve my retry success rate? If all possible factors have been taken into account, but pregnancy has not occurred, other technologies can be used:

1. Use taken from another woman.
2. ZIFT is a procedure in which your own eggs are retrieved and fertilized in the same way as in IVF, but after that they are not incubated, but are transferred into the fallopian tube through laparoscopy during the first 2 days.
3. GIFT is a procedure in which eggs are obtained either through transvaginal aspiration or laparoscopy, mixed directly with sperm and immediately placed in the fallopian tube.

ZIFT and GIFT technologies allow the fertilized egg to immediately enter its physiological environment - the fallopian tube. As a result, more harmonious development embryo, the influence on it of beneficial factors contained in the tubes, “independent choice” of the place and time for implantation in the uterus. This increases the chance of pregnancy from 5% to 40%.

The effectiveness of the in vitro fertilization procedure, according to statistics, after the first attempt does not exceed 30%. You should not expect 100% success, even if the procedure is carried out in the best foreign clinics. Unsuccessful IVF after the first attempt is not a death sentence. Several of them can be carried out. Next, we will try to understand the reasons that most often cause unsuccessful IVF.

Unsuccessful IVF: main reasons

• The main reason why IVF failures occur is the low quality of the resulting embryos. In order for the procedure to be successful, it is necessary to place into the woman’s uterine cavity those embryos that consist of 6-8 cells and also have high division rates. Poor-quality embryos can be obtained in situations where the embryologist’s qualifications are insufficient, or there are disturbances in male and female reproductive cells (eggs, sperm).
• Unsuccessful IVF can occur if there is any damage to the inner layer of the uterus (endometrium). Normally, for high-quality and successful attachment of the embryo in the uterine cavity, the presence of endometrium with a thickness of 7-14 millimeters is necessary. Most often, endometrial pathology, which is determined after unsuccessful IVF, is chronic endometritis, polyps, hyperplasia or thinning of the endometrium. All these disorders are quite easily diagnosed using ultrasound (ultrasound).
• Unsuccessful IVF may be a consequence of obstruction of the patient’s fallopian tubes, as well as the accumulation of fluid in them. This is a fairly serious pathology that requires treatment, most often surgically.
• Genetic disorders in one or both spouses can provoke a situation where IVF is unsuccessful.
• The presence of special antibodies in a woman’s body that prevent pregnancy from occurring even through artificial insemination.
• Hormonal imbalance in a woman's body. It has been scientifically proven that the entire process of egg maturation, their release from the ovaries during ovulation, fertilization, attachment (implantation) in the uterus and subsequent pregnancy are regulated by hormones. Which means any hormonal disbalance violates the integrity of this chain and leads to IVF failures.
• The presence of bad habits of both spouses. The harmful effects of alcohol, nicotine, narcotic substances has been proven for a long time and is not subject to any doubt.
• Age factor. The older the woman undergoing IVF is, the higher the risk that the IVF will fail. The same applies to the partner whose sperm is used to fertilize the egg.
• Obesity is a problem that has serious overall impact on the woman's health status. It may be the reason that IVF is unsuccessful.
• Polycystic changes in the ovaries, leading to the fact that the quality of eggs decreases and it is much more difficult for sperm to fertilize them.
• Ovarian depletion, which occurs for some reason and leads to a decrease in follicular reserve. If a patient has such a pathology, it is very difficult to obtain high-quality eggs in the required quantity.
• Infectious diseases such as herpes, mycoplasmosis, chlamydia, cytomegalovirus infection, Epstein-Bar infection, hepatitis B, C and others increase the likelihood that IVF will fail.
• Adhesive processes that exist in a woman’s pelvis also lead to unsuccessful IVF attempts.
• The presence of acquired or congenital anomalies of the uterine structure in a patient (bicornuate or saddle-shaped uterus, uterine fibroids, etc.) can be a serious obstacle to pregnancy.
• Unsuccessful IVF may be a consequence of chronic somatic diseases gastrointestinal tract, cardiovascular system, respiratory system, as well as other organs and systems of the woman’s body.

In the case where even repeated IVF is unsuccessful, you need to more carefully look for the reason that leads to this.

Failed IVF: no periods

Each woman's body reacts differently to the in vitro fertilization program. If IVF has failed and there is no period, there is no need to panic. Most often, the restoration of the menstrual cycle occurs several months after unsuccessful IVF. The reasons for the delay of menstruation after artificial insemination are those medicinal and invasive interventions in the woman’s body that were performed to stimulate superovulation, take eggs from the ovaries and introduce embryos into the uterine cavity. You should know that under no circumstances should you take hormones and other medications on your own if IVF has failed and you are not menstruating.

In addition to the absence of menstruation, heavy discharge is also often observed after artificial insemination. This phenomenon does not indicate serious problems, but is a consequence of taking various hormonal drugs. Sometimes patients after unsuccessful IVF note that menstruation is longer and more painful, which occurs due to the same stimulation of superovulation that is carried out before the IVF procedure.

Most often, the next menstruation will be the same as before IVF. If the restoration of menstruation has not occurred, then it is necessary to see a specialist.

Physiological pregnancy after unsuccessful IVF

There are statistics that show that more than 20% of partners who had an unsuccessful IVF program subsequently conceived a child naturally. This is explained by the fact that the IVF protocol involves taking various medications that seem to trigger a woman’s physiological hormonal cycle. Thus, the natural mechanisms of the woman’s reproductive system are activated.

Repeated IVF after failure

Before repeating IVF after an unsuccessful attempt, both partners must restore their physical and psycho-emotional health. For this you need adhere to special recommendations.

• Rest and rest until the next in vitro fertilization protocol. At this time, “light” sports (swimming, exercise, dancing, yoga, etc.) will help restore the body’s strength. Special attention It is advised to pay attention to those exercises that improve blood flow in the pelvic organs.
• Normal sex life, which should not be carried out according to a special schedule.
• Conducting additional examinations, taking tests, and performing procedures that will help identify the reasons that IVF was unsuccessful.
• Getting out of depression is another important factor, overcoming which, you can carry out repeated IVF. After all, everyone knows that depression and stress significantly reduce the chances of success. During this period, the support of relatives, friends and significant other is extremely important. If this is not enough, then you need to seek help from a specialist (psychologist, psychotherapist).

Repeated IVF: how many attempts are allowed

According to experts, the in vitro fertilization protocol does not have any particular negative impact on the female body. The number of times repeat IVF can be performed must be determined individually and together with the attending physician. Cases have been described where successful IVF occurred only in the ninth procedure.

There is an opinion that after the third or fourth attempt, when IVF is unsuccessful, you need to think about other infertility treatment options. This may be the use of donor germ cells (eggs or sperm), ICSI fertilization or surrogacy.

At the Volgograd IVF Center clinic you can undergo a full examination and infertility treatment, including the use of IVF.

When performing artificial insemination, it is not always possible to get pregnant the first time. If this does not work, a second IVF attempt is made. will be successful, with a scrupulous analysis of the previous failure and additional examination.

Reasons for failure

Despite careful preparation for the procedure, no one gives a complete guarantee of a positive outcome. The first embryo transfer is rarely successful, but the chances of a second IVF attempt increase significantly. Repeated fertilization does not harm the patient’s health and is absolutely safe.

Some future parents are worried about possible abnormalities in children born after a frozen embryo transfer. According to the research results, no pathologies in the child’s development were identified. The percentage of children born with any disorders using cryotransfer is no higher than that of children conceived naturally.

Deadlines

After how long can you do a repeat eco? The timing of a new attempt at artificial insemination mainly depends on the recommendations of the attending physician and the desire of the woman. By coordinating these indicators, after a certain time, you can do IVF, usually 2-3 months. But, taking into account the individual characteristics of the body, only the doctor will determine when a second IVF attempt can be made, after two months or after a longer time.

But no specialist guarantees that second IVF attempts will be successful. Therefore, it is important, after each failure, to correctly determine the reasons that prevent pregnancy. But the inability to get pregnant for the first or second time is not a reason for despair. Many factors can be eliminated, and in half of the cases the woman carries and gives birth to a healthy child.

Only in difficult situations, after three unsuccessful attempts, doctors suggest taking other options. For example, the use of donor embryos, sperm or eggs. Sometimes, only surrogacy is possible. But before making a decision, you should not refuse to make another attempt at fertilization.

Modern medicine uses the latest techniques, and now almost every woman can become a mother. Everything should be considered as a new step towards a successful pregnancy. During the next transplant, the negative factors of previous procedures are minimized.

Remember that IVF with your own eggs or with donor eggs can be diagnostic in itself. Most couples will get pregnant on their first or second IVF attempt, which (obviously) assumes that IVF is all they need.

If embryo implantation does not occur after 2 or 3 IVF cycles or occurs, but pregnancies fail early stages, which means it is necessary to find out the reasons for the failures before going through the protocol again. (we recommend reading the article: “What is good in the IVF program”)

So, let’s discuss the possible reasons step by step:

Make sure you have all the information available: You should know:

What medications did you take, in what dosage and for how long;

What condition were your ovaries (and uterus) in just before you started your IVF cycle: how many antral follicles were on each ovary, what size were the ovaries, what was your endometrium at the beginning of the protocol;

What is your normal hormonal profile (follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, thyroid-stimulating hormone (TSH), Free-T4), what tests were done on days 1-3 of your last cycle; (article: “Hormones – which ones, on which days of the cycle, what the results say”)

How many eggs were retrieved during puncture;

What spermogram indicators were on the day of puncture; (article: “Deciphering spermogram results”)

What is the sperm fertility percentage;

What the embryos looked like on day 2 after puncture (good embryos should have 2-4 cells, should be symmetrical and not fragmented);

What the embryos looked like on day 3 after puncture (good embryos should have 6-8 cells, should be symmetrical and not fragmented);

What the embryos looked like on day 5 after puncture (they should be a blastocyst - ideally: an expanding blastocyst or one that is already beginning hatching);

How did your puncture go (easy or with complications);

Have you had uterine cramps, strong tugging on the day of the puncture or the next 2 days;

Have you had any symptoms of an immune reaction to the implantation (eg, flu-like symptoms, sore throat, joint pain, high fever 8-12 days after the puncture);

Whether there was any implantation at all - for example, a positive pregnancy test that disappeared or an ectopic pregnancy; - whether bleeding was observed before the test;

Find out from your doctor whether there were any favorable signs when you started your last IVF cycle:

Your endometrium should have been thin, say 3mm, when you started stimulation.

If you had troublesome cysts at the beginning of a long protocol, it can be assumed that you would have achieved more success on a different protocol, for example, short. Likewise, if you have a short cycle (or short follicular phase) and you had 1 or 2 follicles that developed ahead of the rest and had to be sacrificed to allow the others to mature (often a bad idea, since the fastest follicles may contain the best quality eggs that will mature), you may have more success with a long protocol than with a short one.

If you had less than 2 antral follicles in each ovary at the start of the protocol, especially if you had a high FSH and/or low AMH, then this could mean that this is not the most suitable cycle for an IVF protocol, especially if the doctor usually sees you have more follicles than at the beginning of this protocol. Or it could mean that your ovarian reserve is poor and you might as well use a natural IVF cycle (without stimulation) as stimulated IVF. (more in the article: "Elevated FSH and IVF") Or you should ask your doctor to check your DHEAS (dehydroisoandrosterone sulfate) level to see if it is low and discuss whether taking extra DHEA for 3 months will help. You may need to ask your doctor to prescribe an estrogen-directed protocol.

If you have previously been diagnosed with endometriosis, you should know that some women remain quite fertile, but others have significantly reduced fertility due to inflammation associated with endometriosis. If implantation does not occur, then your doctor should prescribe a course of treatment to reduce inflammation. (details in the article: “Successful IVF program for endometriosis”)

Know and understand the response of your ovaries. Your clinic should aim for a good ovarian response to stimulation, such as a response of 8-15 eggs, but no more.

If you have:

Very high ovarian response and/or hyperstimulation

Or a huge number of follicles, but not many eggs removed,

And yet, with all this, if you have more than 10 antral follicles on each side, there is high AMH and low egg quality.

All of this assumes that you have been overstimulated.

Options to reduce the risk of overstimulation on a subsequent attempt include:

If necessary, reduce your general index weights up to 20-25;

Talk to your doctor about using a protocol with birth control pills (you take the pill for 1-3 months before your period to calm your ovaries)

Ask your doctor about using a short agonist protocol or the so-called conversin protocol, instead of a short antagonist protocol or the usual long protocol (please note the article: “Protocols in IVF”)

Reduce the amount of LH hormone in the protocol, but keep in mind that a certain amount of LH is needed especially on a long protocol or on an antagonist protocol after starting to take the antagonist drug.

Reducing the total dose of the stimulant or using alternative daily dosing, such as 150 and 75 every other day

Using the long drift method - taking fairly low doses of stimulant drugs (eg 150 IU), and stopping once at least 2 follicles have reached an average diameter of 18-22mm (by ultrasound) and 50% of the remaining follicles have reached 14-16mm, and a subsequent wait (drift) of up to 5 days until the level of Estradiol in the blood drops below 2500 pg/ml before giving the hCG trigger before puncture.

Use of cabergoline tablets (a drug that has been shown to reduce the severity of overstimulation without compromising egg quality/pregnancy rates) to reduce the likelihood of overstimulation - although this generally does not reduce the number of eggs or improve their quality.

Freezing the embryos and cryopreserving the next month does not reduce the number of eggs or improve their quality, but may help avoid dangerous overstimulation.

If you have a poor response - less than 4 eggs retrieved with a typical dose of stimulation (eg 10 days of 300 IU), then there are methods to try to optimize your chances in this case too. The goal is to improve the ovarian response to produce more eggs, but not at the expense of their quality. Some methods can reduce the quality of eggs, so they are not suitable for all patients. Other methods may not increase the number, but may help the quality of the eggs. Some clinics are reluctant to tailor their protocols to individual patients, so if your clinic is not willing to discuss and change the structure of your unsuccessful protocol due to a poor response, I advise you to seek a second opinion at a more specialized clinic.

Here are my tips for you to discuss in your clinic.

1) changing the protocol type. The number of eggs punctured is usually higher in the long protocol for patients with a normal ovarian response. But some women have very sensitive ovaries that do not return to “normal” after a blockade (Differin injection, etc.) in a long protocol - so for them a short protocol that begins with the onset of menstruation is more suitable. In addition, some people obtain better quality eggs using the short protocol. Therefore, if you had a long protocol fail, then you should probably think about switching to a short protocol, and vice versa. Some women experience improved egg quality if their ovaries rest for a month or more on birth control pills before entering the IVF protocol. But there are also other cases when a woman's ovaries do not return to normal quickly enough after taking birth control pills. In this case, they are better off trying a protocol where its onset coincides with the onset of menstruation in the natural cycle, or trying the Convershin protocol with an agonist/antagonist combination with a preliminary blockade contraception. Some may have a better response to a burst protocol: a short protocol in which the agonist is started around the same time as the stimulants. True, sometimes this leads to a deterioration in the quality of the eggs - so again, you may have to try it to find out if this protocol suits your body. Some clinics do not use the flash protocol at all due to its reputation for decreasing egg quality (particularly in older patients) because the level of FSH that a woman's body will produce on the flash protocol is unpredictable. Clinics that customize your FSH and LH levels through very careful monitoring with blood tests and related individual dosage stimulation to get FSH and LH closer to desired levels are less likely to use the burst protocol due to its unpredictability, but those clinics that are trying to reduce the number of stimulation drugs use the burst protocol for some patients, especially those with normal ovarian response. so that with the help of FSH produced by the body, the number of stimulant ampoules can be reduced.

Some fertility doctors believe that for the group of those who have a weak ovarian response, but at the same time ovulation occurs regularly in natural cycles, and for the group of older patients with a weak response, the chances of becoming pregnant with IVF will not increase due to the use of high doses of stimulating drugs , and carrying out IVF in a natural cycle has the same, and maybe even better, success rate than in conventional IVF. This approach consists of attempting 2 or 3 IVF cycles in natural cycle without stimulants. During this natural protocol, regular monitoring of follicular development by ultrasound is carried out (often starting 4 days before predicted ovulation, usually ovulation occurs 14 days before the start of the next cycle). A trigger injection of hCG is done 3 days before ovulation and a puncture 3 days after the injection to collect only 1 or 2 eggs, and embryo transfer usually occurs on the 2nd day after the puncture. The goal of this natural protocol is that it is gentle, maintains natural hormone levels in the body, and focuses on achieving the best egg quality rather than quantity.

2) try changing stimulant medications. Stimulants may be pure FSH (eg, Gonal-F, puregon, Follistim) or mixed FSH and LH (merional, Menopur, pergoveris) and may be natural (derived from human urine, eg Menopur, merional) or synthetic (eg, gonal F, pergoveris). Most doctors agree that PH is necessary for good growth follicles, but some believe that too much LH can be detrimental to egg quality. So if you already had a poor response on a long protocol using pure FSH, you may be able to improve your ovarian response by switching to a short protocol (in which your natural LH remains in your system) or staying on a long protocol but supplementing with LH (e.g. partial use of Merional/Menopur). Some doctors prefer natural preparations stimulation because they have a reputation for being more intense (and often cost less), but others prefer synthetic materials, which have a reputation for being more "intense" - but until research shows that natural is superior to synthetic and vice versa, then the answer to the question is - which one is better? - probably the one to which your body reacts better.

3) Taking DHEA pre-protocol. Older patients, as a rule, have more low level DHEA and the resulting weak ovarian response. Some studies show that if DHEA levels in the blood are low, taking DHEA can improve or even restore levels back to the normal range, which in some cases results in improved ovarian health. This improvement is usually seen after about 3-6 months. Therefore, if you had one protocol with a weak response, we advise you to take the following blood tests (on days 1-3 of the menstrual cycle): DHEAS, free testosterone, estrodial, SHBG, FSH, LH and prolactin. If DHEAS is low and testosterone and LH have not yet risen and your SHBG has not yet fallen, then you can try taking DHEA (eg. 25 mg micronized DHEA from famous brand 3 times a day for 3 months before the IVF protocol). After the first month, you should repeat the blood test to check if your levels are outside the normal ranges, as too high DHEA, testosterone, LH or too low SHBG reduces egg quality.

4) taking Estrogen. A good response is usually associated with relatively low FSH levels, so some clinics require you to wait until the month your FSH is at its lowest level on days 1-3 of your menstrual cycle before allowing you to enter the protocol. Estrogen tends to suppress FSH, so some doctors believe that taking estrogen for 1 week before stimulation may help those with a weak ovarian response.

5) Increasing the dose of FSH. Increasing the dose of FSH often helps increase the number of follicles and thus reduce the risk of a poor response - but some studies show that high doses also reduce egg quality. Accordingly, not all doctors want to prescribe high doses of stimulation to patients. If necessary (doses greater than 300 IU), doctors use a so-called “step down” approach - where the patient begins the protocol with a high dose and gradually reduces it. If in your last protocol you took particularly low doses of FSH for your age group(for example, 225IU or 150IU for 35 years), and the answer was weak, then of course it would be reasonable if your clinic offers you higher doses, for example, 450IU turning after 4 days into 300 IU, but you should be wary of those doctors , the only solution to which is huge doses of FSH (for example, 600 IU). An exception here may be cases when patients are still quite young and have had a poor response to the previous protocol; they have high quality eggs and high doses can be tried to increase the number of follicles.

6) Lifestyle/vitamins/supplements. Some supplements should help those who have a weak response. For example, estrogen/estrogen-like supplements can help lower FSH, which in turn helps improve your response (eg, wheatgrass, spirulina). Other supplements or lifestyle changes may only have an indirect effect on your body - eg royal jelly, extra protein. Great importance It has good food and rest.

7) thyroid problems. Undiagnosed thyroid abnormalities increase the risk of a poor response. Get tested for TSH, T4 and antithyroid antibodies. Often, doctors evaluate results using recognized normal ranges, but not the ranges that are optimal for those trying to conceive. If antithyroid antibodies are detected, this means that there is big chance development of thyroid disease, even if hormone levels are now normal. Some studies show that if you have antithyroid antibodies, your chances of getting pregnant can be increased by taking thyroxine, blood thinners and steroids.

8) Immune issues: If you are relatively young and without other obvious known causes have received a weak ovarian response in the IVF protocol, then this indicates a decrease in ovarian reserve and it is possible that your ovaries are suffering from an attack of anti-ovarian antibodies. This is associated with premature ovarian failure and accordingly leads to a poor response to IVF. Some studies suggest that taking immune medications such as steroids may help reduce anti-ovarian antibodies and increase the chance of pregnancy.

9) You may not be ready now and have not even considered the possibility of using a donor egg, but know that this possibility exists. Even if this is something that you don’t even allow yourself to think about until all the paths with your own eggs have been explored, at least know that this path also exists and is easily accessible until the age of 50. So even if your own eggs do not work for you, with a donor egg there is a good chance of having a child (for example, 70% after 2 cycles) for most women under 50 years old. (more details in the article: “ Gaze for oocyte donor")

What does the total number of eggs indicate? As practice shows, the chances of success increase when, out of the total number of punctured eggs, at least 1 or 2 are immature. Where there were no immature eggs, this could be a sign that the stimulation went on for too long and the eggs became overripe. In some cases, immature eggs can be fertilized through conventional IVF rather than ICSI. Therefore, if the sperm parameters are satisfactory, for immature eggs it is worth asking the embryologist to try to fertilize them through conventional IVF, and for mature eggs, as planned, through ICSI.

The embryologist can give you some information about the apparent (external) quality of the eggs even before fertilization, and should note, for example, whether the eggs are spotty or have thickened (hard) membranes. These may be signs of reduced egg quality. (more details in the article: “Quality of obtained embryos”)

If the number of eggs retrieved is low compared to the number of follicles counted (predicted) before puncture, this may indicate the following:

1) the doctor was unable to “get” to one of the ovaries, for example, due to adhesions / scars that made the ovary inaccessible, or due to the fact that the patient is overweight.

2) premature ovulation may have occurred before the puncture - this can be confirmed by taking a blood test on the day of the puncture. A protocol with antagonists (or) or (a very cheap drug that slows down some of the processes necessary for the follicle to rupture, such as the body's production of prostaglandin) - may help prevent premature ovulation.

3) The hCG injection for egg maturation may have been given too early (less than 34-36 hours before puncture) or in an insufficient dose for the patient, so that the eggs cannot be completely released from the follicle.

There are cases when patients forget (!!!) to inject hCG.

Oocyte fertilization percentage and sperm factors affecting fertilization. If 75% of your eggs are fertilized, most embryologists consider this a good indicator. Fertilization rates are often lower with ICSI, such as 60%, partly because sperm quality is typically reduced, but also because not all eggs can survive the ICSI process; some may not be mature enough for ICSI. Fertilization percentage - 50% is marginally acceptable, below 50% is generally considered a poor level.

If your IVF protocol included low rate fertilization, a good embryologist should be able to give an explanation of why this happened:

Visible/external (visible to the eye) poor quality of the egg, for example, a thickened membrane, spots on the surface of the egg; eggs that disintegrated after ICSI injection are all parameters that indicate that the poor quality of the eggs themselves may be the reason for the unsuccessful protocol. (we bring to your attention the article: “Is defective eggs a cause of infertility?”)

The eggs were mostly immature (stimulation may not have been carried out long enough or the hCG injection was in an insufficient dose); or the eggs were overripe - stimulation was carried out for too long

During conventional IVF (not ICSI), sperm fail to fertilize eggs, most likely due to the presence of antisperm antibodies or defects in the sperm - ICSI should be tried in the next protocol. But before that, it is advisable to do a test for antisperm antibodies (if the sperm has a high viscosity, or does not change from a liquefied consistency to a liquid consistency, this already indicates a high probability of the presence of antisperm antibodies), and also do a test for the presence of sperm DNA fragmentation. (more details in the article: “Anti-sperm antibodies”)

The embryologist may suspect other reasons that indicate a decrease in sperm quality - for example, he had difficulty finding enough normal-looking sperm for ICSI.

Bacterial contamination may be suspected - sperm and embryonic environment can sometimes be tested for this.

In a cycle with DU, (if it is proven that this donor had good results in previous cycles), if fertilization (or embryo development) is poor, this may also indicate significant problems with the sperm.

Many doctors focus only on the quality of the eggs and ignore the quality of the sperm. If you have had more than 3 unsuccessful IVFs, even if the quality of the eggs is suspect, it makes sense not to ignore the quality of the sperm. In any case, if the sperm parameters are far from ideal (there is agglutination (gluing), lack of transition from a liquefied consistency to a liquid consistency), it is worth testing your partner for infections (for example, chlamydia / mycoplasma / ureaplasma), but in some clinics only the woman is tested because they consider it more reliable.

It is better to determine whether there are specific bacteria that can be cured with appropriate antibiotics (analysis + antibioticogram). But even if you don't do an antibiogram, some clinics will offer a 30-day course of doxycycline 100 mg twice a day + along with a course of high doses of antioxidants (for example, vitamin E and vitamin C), and then retest the spermogram (and DNA fragmentation) after 60 days. If there is a significant improvement, such as 200%, then it is generally assumed that infection is contributing to the sperm quality problems.

In some cases, the man has a history of medical conditions viral infection, for example, herpes, which can contribute to inflammation and decreased sperm quality. Where this is suspected, some doctors suggest a course of antiviral drugs (eg, valaciclovir 500 mg twice daily for 21 days).

To improve egg quality:

It is possible to undertake antioxidant preparation: for example, taking resveratrol and/or pycnogenol and/or pre-treated lycopene, antioxidant diets with plenty of red/orange/green vegetables, wheat germ, beet powder (you may be interested in the article: “In 2-3 months before the protocol (advice)")

3 months DHEA (Dehydroepiandrosterone) pre-treatment, but only if blood DHEA is low, unless LH:FSH ratio is high, or low SHBG (sex hormone binding globulin), high testosterone, PCOS

Assisted hatching if the shell is thickened;

High Protein Diet/Low Glycemic Index Diet

During stimulation, limit LH levels (using only/mainly pure FSH until day 4 of stimulation, and then only limited doses of LH per day, for example, using mainly or Follistim and adding or Luveris, which contain LH); and using a long or short protocol with a half dose of antagonist, which begins on the 1st day of stimulation.

Reducing stimulation days without sacrificing the dominant (and likely best quality) follicle just so the others can catch up in size will reduce the number of eggs retrieved but improve their quality.

Anti-inflammatory diets/supplements, e.g. omega-3, turmeric, nettle, resveratrol, pycnogenol, cordyceps.

It is worth considering natural cycle IVF or very low dose stimulation to maximize egg quality, but if sperm quality is compromised, this adds challenges because not all eggs can survive the ICSI process.

Understanding the process of embryo development. Good quality embryos are usually divided according to standard timing. The day after egg puncture, they should demonstrate obvious signs fertilization. On the 2nd day they should have 2-4 cells, be symmetrical, without fragmentation. On the 3rd day they should have 6-8 cells, be symmetrical, without fragmentation. By day 4 they should be a morula (a clump of cells, like a mulberry) and by day 5 they should be blastocysts, ideally exposed or even beginning to hatch. Embryos that deviate from normal development by dividing too quickly or too slowly, showing asymmetries on days 2-3, or that have a lot of fragmentation are less likely to produce a healthy pregnancy.

But, keep in mind that just because the embryo looks great, it does not mean that it will necessarily develop into a healthy baby. For example, if the eggs are of excellent quality, but the DNA of the sperm is very poor, the egg at its own expense will be able to compensate for the defects of the sperm, allowing the embryo to reach the blastocyst stage and even implant, but, unfortunately, it will not be possible to get a healthy pregnancy.

If the embryos are of poor quality (dividing slowly / dividing too quickly), then you need to think about the quality of the sperm or eggs, and it is worth asking for a DNA test for sperm fragmentation. Although the embryologist himself should have some idea about the quality of the eggs from his observations.

Was the endometrium good? Good endometrium is three-layered, even in to a greater extent darker on the ultrasound monitor rather than pale, and about 9mm-14mm. Some doctors claim that a thinner endometrium is not a problem and point out that they have seen pregnancies with 6mm endometrium, but studies have consistently shown that the likelihood of pregnancy is higher with a 9mm endometrium than with a 6mm endometrium. But it is likely that in those patients who did become pregnant with an endometrium 6mm thick, other aspects were stronger (for example, very good embryo quality), which compensated for the weak endometrium. If the endometrium is less than 9 mm, your doctor should try to solve this problem next time, and not dismiss this point, which supposedly is not a problem. (we recommend the article: “The weak link is the endometrium during IVF”)

Thin endometrium may be due to:

Hormonal problems (for example, too little estrogen - which can be corrected with hormonal correction: oral or vaginal, or body patches).

Poor blood flow – which may be detected directly by Doppler ultrasound to examine the uterine artery, or may be suspected after a blood clotting test, or when increased immune activity, such as increased NK (natural killer cell) activity, may increase the likelihood of having microscopic coagulation in the uterus in endometrial tissue. Reduced blood flow can be improved with Clexane and possibly vasodilators such as terbutaline, or vaginal. Vitamin E, L-arginine and selenium are also indicated for endometrial growth.

Endometritis (inflammation of the mucous membrane) - usually associated with infection, for example, chlamydia, mycoplasma, ureaplasma. It is visible on hysteroscopy as red, spotted, strawberry-like. It is usually easy to treat with antibiotics, although if the bacteria can be successfully identified it will be easier to select the appropriate antibiotic.

Irreversible damage to the endometrium after STDs (sexually transmitted diseases), inflammatory diseases women's genital organs or pregnancy-related infections (endometritis after abortion or after childbirth) or damage caused by scars from operations. These scars, where scar tissue attaches to the surface of the uterus in the form of adhesions, are usually visible on hysteroscopy, but not always. Scar tissue can often be cut away during surgical hysteroscopy, but some women are prone to recurrence of scar tissue after surgery. Some surgeons temporarily leave "balls" or coils in the uterus after surgery to try to stop the adhesions from reforming. Most doctors prescribe estradiol treatment after uterine surgery to reduce the likelihood of adhesions forming.

Options for solving the problem of thin endometrium

New treatments such as PBMC (peripheral blood mononuclear cells), GCSF (granulocyte colony stimulating factor) or hCG uterine irrigation may help with endometrial problems.

Treatment, such as salt rinses or micro-scratches of the endometrium. Most likely, this will not affect the increase in endometrial thickness, but implantation in general may help.

Sometimes hysteroscopy with gentle curettage can help give a new boost to the endometrial tissue so that next time it grows more evenly, but not necessarily thicker. Thick endometrium can sometimes be seen with PCOS or adenomyosis (experienced doctors should be able to identify adenomyosis on ultrasound), and sometimes due to the presence of cysts that produce hormones, preventing the normal drop in hormone levels. The old, thick, patchy endometrium must be shed (pro-menstruated) and grown back to increase the chance of embryo implantation. Studies have shown that if donor egg recipients were on estrogen for more than 5 weeks before the transfer (that is, they had old, stale endometrium), this resulted in a significant reduction in pregnancy rates.

How did the embryo transfer take place and were there any cramps after the transfer? According to studies, it has been proven that if the transfer occurred easily, then the chance of pregnancy is higher than if the state of health during the transfer was poor. Therefore, during the next transfer, you need to think about how to make the transfer easier: expand the uterus or use a different catheter. Other studies show that patients who have experienced uterine cramps and post-transplant pain are less likely to become pregnant and need to calm their uterus after the catheter is inserted (allow it to adjust) but before embryo transfer, or achieve this with medication.

The concept of implantation. If you do not have spotting during the anovulatory cycle and have spotting during the ovulatory cycle, this means that you have implantation, but nothing more.

It is very difficult to identify the reasons for implantation failure, they may be:

Egg quality problem;

Problems with sperm, such as DNA fragmentation;

Male or female karyotype defect;

Infection, such as mycoplasma/chlamydia/ureoplasma, prevents the uterus from accepting the embryo;

Poor endometrial quality/anatomical problems with the uterus, such as poor blood flow, scarring, adhesions, polyps, fibroids;

Increased number of killer cells;

Endometriosis or other inflammation;

Thrombophilias, which reduce blood flow to the endometrium (we also recommend the article: “Lack of implantation”)

Hormonal problems such as hypo- or hyperthyroidism, poorly controlled diabetes or progesterone problems, thyroid antibodies or other hormonal antibodies lead to problems with egg quality and/or implantation. Women who suffer from an immune reaction to implantation may experience the following symptoms: flu-like symptoms, joint pain, fever, skin rash, sore throat approximately 6-10 days after the puncture. These may be signs of increased inflammatory cytokines and NK activity. However, it happens that immunity is the cause of implantation failure and no symptoms are observed. In cases where the cause of failure of implantation/pregnancy is immunity, your doctor should offer you the following diagnosis:

1. Thyroid gland (TSH, free T4 and antithyroid antibodies), for immunity (ANA, rheumatoid arthritis/ lupus screening), vitamin D deficiency, coagulation (including antiphospholipid antibodies).

2. Tests that are done only in special laboratories: killer cell analysis, TH1: TH2 cytokines, LAD / anti-paternal genetic antibodies, HLA-DQA ratio, genetic thrombophilia (MTHFR, factor II prothrombin, factor V Leiden, PAI-1)

Heavy bleeding (not spotting) before the pregnancy test day while on progesterone support may be due to improper absorption of progesterone or abnormal metabolism of progesterone by the body. This often occurs in patients with high level a class of cells called CD19+ 5+, which are often associated with anti-hormonal activity. For unknown reasons, but possibly related to stimulation, low progesterone levels are typical in patients diagnosed with chlamydia. Most easy way The treatment for such a problem is the use of a high dose of progesterone starting 6-7 days after the puncture.

What else to do when everything seemed to go perfectly. When it comes to unexplained repeated failure of implantation, the first step is to check whether some trivial research/diagnosis may have been missed:

1. Karyotype for both partners to determine the main chromosomal abnormality - if the karyotype is abnormal, then the next step is to visit a geneticist in order to determine whether there is a chance to give birth to a healthy child and whether PGD technologies can help; (read more in the article “Preimplantation diagnostics”)

2. thyroid(TSH, free T4, thyroid antibodies). TSH levels should be around 0.9-2 and T4 should be within normal limits. If thyroid antibodies are elevated, research suggests there may be an increased chance of IVF success when steroids, thyroxine, and blood thinners are used in the protocol. Vitamin D deficiency (fertility decreases and the immune system fails when there is a lack of vitamin D), ANA (elevated ANA can often be associated with autoimmune infertility, which can be resolved with steroids, blood thinners and sometimes intralipid drips) blood clotting test including antiphospholipid antibodies (elevated APLAs can be corrected with blood thinners and steroids, other blood clotting problems (blood clots) can often be treated with blood thinners).

3. Basic hormonal background: days 1-3 FSH, LH, estradiol, prolactin, SHBG, DHEAS. If FSH and/or estradiol is high, this reduces egg quality and ovarian response, but pregnancy is possible with the right IVF protocol. If prolactin is high, you need to see an endocrinologist to make sure there are no serious reasons, but, nevertheless, your doctor will need to lower prolactin with medications, such as or. Some studies suggest that IVF success will not be greatly affected by untreated elevated prolactinin, but the higher the prolactin, the more will need to be treated. If LH is high and/or SHBG is low, mixed drug stimulation can keep LH levels low. If DHEAS is low, poor egg quality and/or poor ovarian response can be prevented by taking a course of DHEA for 3 months.

4. Sperm analysis for DNA fragmentation. If the % DNA fragmentation is higher than ideal, in this case a lifestyle change (health diet with large quantity vegetables, omega 3, which is found in fish, nuts and seeds (not fried), avoiding smoking, alcohol and taking even prescribed medications such as anti-depressants) can help. However, frequent ejaculation, a course of antibiotics and a high dose of antioxidants before retesting after 60 days can be quite beneficial. Some andrology specialists compare sperm values ​​taken 2 hours after the first ejaculation as this sometimes improves sperm quality (but at the cost of a reduced sperm count). Careful visual diagnosis of the uterus for physical abnormalities - detailed examination by an experienced doctor, 3D examination or hysteroscopy. If a detailed examination reveals the presence of scars, septa, adhesions, polyps or fibroids in this case, some doctors suggest immediate surgical removal. Others may be more conservative and insist that they have had patients with a similar diagnosis and become pregnant. This position may not be useful for patients who have not undergone implantation. And just because a particular patient managed to become pregnant despite such a defect does not mean that a patient with lower fertility will be able to achieve the same result without the intervention of surgery. You need to understand that while a good surgeon will increase your chances of success, a bad surgeon can only worsen your situation.

6. Checking for infections (female diagnosis is usually more accurate) for chlamydia, mycoplasma, ureoplasma, etc. – many doctors may miss this diagnostic, as meaningless, others do only a basic test for chlamydia from urine or a vaginal smear. This is because most doctors work with patients who have transferred from other clinics after failure to conceive and endless treatment with antibiotics. There is a generally accepted concept that antibiotics do not increase the chance of pregnancy during IVF. However, it ignores the fact that most patients manage to get pregnant only after the 3rd attempt.

7. diagnosis: For genetic thrombophilias (PAI-1, prothrombin II, factor V Leiden, MTHFR), which can be easily treated with blood thinners (and sometimes high doses of folic acid, B6 and B12); Killer cells and their ratio - which can be treated with various combinations of Intralipids, steroids, Clexane (enoxyparine), (and possibly Xumira and/or IVIG (Bioven)); TH1:TH2 cytokines - which can be treated with steroids, antioxidants, intralipids and possibly Xumira and/or IVIG (Bioven); HLA DQA - which can be treated with intralipids.

Interventions that your doctors might have neglected The main intervention is a thorough study and a very carefully selected IVF protocol for you: for example, for a normal or high reaction/response for a normal or long cycle, suggest a short protocol or choose a protocol that would reduce LH for those patients who have an elevated level or have polycystic ovary syndrome, or administer LH if it is deficient.

For patients with a short cycle, and in particular with a short follicular phase, a long protocol (to avoid the danger of developing a dominant follicle earlier than necessary) - paying attention to LH, so that it is sufficient so that the follicles can develop normally.

In case of poor reaction/response for a normal or long cycle, do a protocol with the introduction of LH and increase the dose if necessary, or use IVF in a natural cycle with drug stimulation or an estrogen protocol.

Lately everything large quantity women resort to artificial insemination. An egg removed from the body is fertilized outside the body, stays in a special incubator for several days, and then is transferred to the uterus, where it develops, as in a normal pregnancy. Thanks to this reproductive technology, many infertile couples were able to carry and give birth to a child. One of the questions that worries those who plan to sign up for the procedure is whether IVF is done with excess weight and, if so, what parameters are considered normal by doctors.

The legislative framework

The in vitro fertilization service is specified in the relevant regulatory document at the legislative level. If it does not state that excess weight and IVF are interconnected, obesity is a contraindication for this procedure, the doctor does not have the right to refuse a woman it.

So, the main document is the Order of the Russian Ministry of Health. Dated August 30, 2012, listed under number 107n. There is a corrected and expanded edition dated February 1, 2018. The full title is “On the procedure for using assisted reproductive technologies, contraindications and restrictions on their use.”

On the one hand, there are no contraindications for obesity or excess weight. Even if you open more detailed explanations about diseases endocrine system, eating disorders and metabolic disorders, nothing of the kind is mentioned in them. Only diabetes mellitus and hyperparathyroidism are prescribed there. On the other hand, an overweight patient should understand that her problem may be due to one of these factors. And, if doctors make such a diagnosis, by law they have the right to refuse IVF.

What is the problem

To include obesity and excess weight in the list of contraindications for IVF, a substantial evidence base is needed based on laboratory research and research. There is no such thing yet, but experts are already working on it. And in New Zealand, for example, these two points are officially taboo for in vitro fertilization.

Why does the question of whether weight affects IVF remain relevant for several years? Firstly, due to increased interest in the procedure. Secondly, due to the fact that the opinions of doctors on this matter differ. In some clinics, overweight women are allowed to undergo IVF, in others they are strongly recommended to lose weight first, in others they are completely refused.

In addition, cases in practice are as ambiguous and contradictory as the attitude of doctors. There are women who, at the time of fertilization, were not only overweight, but even obese. They were not only allowed to participate in the protocols, but they ended successfully, the responses were positive, the embryo successfully took root in the uterus, and healthy children were born.

But there were also stories when numerous attempts ended in nothing, and doctors blamed it on excess body weight. And not so much her, but the accompanying clinic (disturbed metabolism, eating disorders).

What should the weight be?

Most doctors still believe that IVF and obesity are incompatible. In the case of excess body weight, the chances of obtaining permission for artificial insemination are higher. But the root causes are always found out first. If it's a lifestyle, it can be fixed. If problems with metabolism are hereditary, everything is much more complicated.

What weight is taken for IVF? Most often, the first study begins with the patient’s doctor. Weight divided by height squared. The first indicator is taken in kilograms, the second - in meters. The result obtained is compared with the table:

If the result is normal, no one will be able to refuse the patient the in vitro fertilization service, citing her weight. Some doctors allow those whose excess body weight does not exceed 27. Others advise losing weight if BMI = 25-30. Obese patients, as a rule, are still referred to an endocrinologist and nutritionist.

According to the above-mentioned Law, if IVF is refused on the basis of health problems, a woman has the right to undergo treatment for a year (without losing her quota) and return to the procedure again. It is quite possible to solve the problem of excess weight in a year.

How weight affects IVF

Why do doctors insist that a woman lose excess weight before IVF? The problem is that it has a very direct effect (and far from positive) on the reproductive system:

• the menstrual cycle is disrupted;
• ovulation may be absent;
• hyperplastic processes develop in the endometrium;
• hormonal levels are disrupted;
• egg quality decreases;
• follicle growth stops;
• egg maturation does not occur;
• luteinization of the corpus luteum of the ovary slows down;
• thromboembolic complications are diagnosed.

All these processes contribute to infertility. Moreover, even IVF protocols with all their injections, drug and hormonal therapy cannot always correct such advanced cases. In order for the procedure to be successful and fertilization of the egg to occur, all this biochemistry must be brought back to normal as much as possible. reproductive system. And without weight normalization this is impossible.

Therefore, when going for in vitro fertilization with extra pounds, think about whether it is worth wasting your time and the efforts of doctors, knowing in advance that the protocols may turn out to be useless and nothing will work out. It is much more correct to first bring your BMI to normal and only then plan a pregnancy.

According to statistics. Excess weight reduces the effectiveness of protocols during IVF by 10%, since stimulating drugs do not reach the ovaries, getting stuck in adipose tissue. And during a puncture, the doctor receives much fewer eggs than if the BMI were normal.

If you are overweight, do not rush to the clinic and sign up for the procedure. If age allows, first take care of your figure. To do this, follow simple basics healthy weight loss.

1. Get examined in a regular hospital to find out the possible physiological causes of the pathology.
2. If they are present, undergo treatment.
3. If they are not there, move on to proper nutrition and a healthy lifestyle.
4. Calculate your BMI to be within the normal range.
5. Spread your weight loss over several months so that you lose no more than 1 kg per week.
6. Don't go on diets. They slow down metabolism, and this is one of the main contraindications for IVF at the legislative level.
7. Eat healthy, but limit portion sizes.
8. Play sports, but without fanaticism.
9. Leave bad habits. When planning any pregnancy (not just IVF), alcohol and smoking are prohibited. Read about their effect on excess weight.

Alternative way: go to an appointment with specialists at the clinic where you plan to have IVF. Consult them about your problem. They can refer you to an endocrinologist and nutritionist and give practical advice on nutrition and exercise programs.

If a doctor, without any tests, despite your doubts, says that excess body weight is not an obstacle to fertilization, and he can prescribe the first protocol even for tomorrow, you should think about his qualifications. Just in case, listen to the opinion of one more or even several specialized experts.

Excess weight during IVF and after it

One of the reasons why some doctors refuse to perform artificial insemination in the presence of excess body weight is weight gain during the protocols. This is the name for preparing the body for the upcoming procedure and further pregnancy through medication and hormonal therapy.

For some, the egg turns out to be viable the first time, but this happens quite rarely. In most cases, you have to wait for good news for weeks, during which they give injections, give vitamins, improving the functioning of the reproductive system in every way.

During this time:

• changes occur in hormonal levels;
• appetite increases (partly due to worries).

The result is weight gain. If you consider that even before IVF he was overweight, then it is clear that the kilograms are increasing, and the chances of successful fertilization are less. Moreover, take into account the fact that while undergoing the protocols, a woman is strictly forbidden to lose weight by any means. Therefore, it is better to do this before the procedure.

The second point that expectant mothers should be concerned about is excess weight after IVF. It is simply inevitable due to hormonal therapy, which is first carried out during the period when the egg is fertilized, and then again after a successful embryo transfer to support pregnancy. Under the influence of drugs and injections, unnatural processes occur in the female body:

• the work of the pituitary gland is suppressed;
• ovarian activity is hyperstimulated;
• The level of progesterone, which is most directly related to the formation of fat deposits, artificially increases.

Even if a woman tries to lose weight during the protocols or pregnancy after artificial insemination, she is unlikely to succeed. Where hormones play the first role, nutrition and physical activity fade into the background and no longer work.

So weight gain after IVF is almost inevitable, which will be fraught with pregnancy.

Despite the fact that excess weight is not legally a contraindication for IVF, it is better to get rid of it first. This will reduce the likelihood of refusal of the quota and the procedure as such, increase the chances of successful fertilization and reduce the risk of complications during pregnancy and childbirth. Be smart people - take care of this in advance.

The painful wait for the result is already over. It seems that all the tears have already been cried, but they still flow...

“Well, why am I so unlucky! Others are doing well, but for me...” The sad eyes of a husband who is trying to be brave and console. It's hard...

Unfortunately, many of us have been through this several times already.

It is impossible to get used to grief.

And when except heartache Health problems also begin to bother you, and you feel sick.

So, what is “bad luck” and how to deal with it.

Depression

Many people believe that depression is a constant state of bad mood, tearfulness, etc. Therefore, many people do not consider their condition after unsuccessful IVF to be depression. Rather, we say “apathy,” noting depression, lack of motivation (“I don’t want anything,” “a feeling of emptiness,” “everything is falling out of my hands,” “I come to the kitchen and don’t remember why,” “I don’t want to see anyone,” etc.) .P.). Even after sleeping for 10 hours, you feel sleepy and exhausted. It starts to hurt here and there, but the doctors can’t find anything. All desire to have sex disappears - “Why? Nothing will work out anyway!” So, all these are signs of hidden depression.

What to do?

Unfortunately, at this moment I don’t want to do anything. I want everyone to be left alone. We do not believe in our own strength or in doctors. And time goes by...

The easiest way to advise is to contact a good psychologist. But, as a rule, psychologists have a vague idea about IVF and cannot establish contact. Even doctors at IVF clinics complain about this, who sometimes invite psychologists to consult their patients. Until we have created a psychological support office (and this is in our plans), we will fight this problem with available means.

Here is a sample list of what helps:

1. Talk it out and cry.

2. Draw up a further action plan.

For example,

a. try to find out the reason for the failure,

b. restore poor health

c. think about changing doctor or clinic

d. plan your next attempt

e. go on vacation, etc.

3. Go to Gym And

do fitness, shaping, go to the pool, etc. Physical activity promotes the production of endorphins - “happiness hormones” (And we’ll lose weight at the same time!)

4. Throw yourself into work.

(Definitely with your head! Otherwise we can drag our mortal body to the office, and continue to scroll through ECO-related thoughts in our heads)

5. Do something interesting, but requiring concentration.

6. Buy yourself some good books.

8. Take care of other people's problems.

For example, go to your relatives and find out that your grandmother’s refrigerator is broken, and your mother hasn’t been able to decide to go to the dentist for six months, cousin I quarreled with a friend, and my dad urgently needs to translate an article, but everyone is afraid to disturb you, because... You already have enough problems of your own. (I wouldn't have survived the death of my babies if I had only thought about myself.)

9. And don’t forget that time heals.

(Tested on my already pretty worn skin).

In addition to depression, there are several other psychological problems:

1. Blame doctors for failure, get angry at them and, in the end, work yourself up until you completely lose heart (happens often)

2. Blame yourself for everything, engage in self-flagellation and bring yourself to nervous breakdown(happens often)

3. Blame your husband for everything, regularly quarrel out of nowhere and bring the situation in the family to the boiling point (happens less often)

How to deal with all this?

Tell yourself that neither the doctor nor you and your husband are the Lord God, that IVF is a chance, but not a panacea. Nothing can be changed in the past. But the future partly depends on us. The one who walks will master the road. In such cases, stories about a long-awaited pregnancy after many attempts help me a lot.

Health problems

Unfortunately, after an unsuccessful protocol, health problems quite often begin. Not all doctors invite you for an examination after a failure. Most often they simply say: “Come back in a couple of months for a new protocol.” If your doctor did exactly this, then you will have to take the initiative into your own hands. Be sure to do an ultrasound of the uterus and ovaries and go to a mammologist. It’s better to hear once again that everything is fine than to miss something serious. There were cases of polycystic ovary syndrome, cervical polyposis, neoplasms, etc.

Quite often after stimulation, the menstrual cycle is disrupted. Those. The first menstruation comes 3-5 days after the support is discontinued, but then the cycle begins to fluctuate. Its recovery may take several months, sometimes six months, sometimes a year.

What to do?

Allow the body to recover from hormone therapy, i.e. Don’t start suppressing it with medications. Leeches help some, herbs help others. Check out our collection of recipes

Pay attention to B vitamins and vitamin E.

Quite often stomach problems begin (gastritis, ulcers). On the one hand, not everyone responds well to medications, on the other hand, stress causes an exacerbation of old sores and provokes the emergence of new ones. I’ll share my experience right away - I cured an ulcer with a diet (banal oatmeal) And sea ​​buckthorn oil- no medications. The gastroenterologist could not believe his eyes - the ulcer had healed completely and without a scar.

Problems with the veins in the legs may begin. It's better not to let the situation get worse. In the event of a long-awaited pregnancy, deterioration may occur. Creams help some, special tights help others, and sometimes you have to go to a surgeon...

The kidneys begin to act up and swelling appears. The reason, as a rule, is the load on the kidneys due to taking medications + exacerbation of old problems due to stress. My advice, as an old kidney sufferer (if not a pepper shaker?) is to be careful with diuretics. It's better to just drink lingonberry tea and cranberry juice. You should not severely limit your fluid intake - this is a common misconception. It seems that if you drink less, there will be less swelling. And the body is cunning. If he feels that he is not getting enough food, he will begin to store liquid. In principle, swelling can go away on its own in a couple of months.

The most important thing is to continue to love yourself and take care of yourself. Our future children need healthy mothers!

Weight gain

Almost everyone who has made 2 or more attempts faces this problem. Gain from 2 to 15 kg. On the one hand, metabolism is disrupted due to hormonal imbalance, and on the other hand, we usually console ourselves with sweets.

In principle, you can ignore this, because... a skinny cow is not yet a gazelle. But there is evidence that excess weight, as well as lack of it, can lead to cycle disruption and interfere with conception. So why add problems to yourself?

First, I propose to decide whether the weight gained is excessive. I give a “fork” of normal body weight according to the latest data from the Research Institute of Nutrition of the Russian Academy of Medical Sciences. Height in cm. Weight in kg.

Most likely, everything is not so scary.

Personally, I “ate” 5 kg and did not even reach the upper limit of the norm. Sometimes your reflection in the mirror appears to be the fattest for absolutely no reason. But if excess weight after IVF still becomes a problem, then losing it may be more difficult than ordinary “winter” fat.

What to do?

If you haven't hit the gym yet while battling depression, now is the time to start. If you (like me?) are a sloth animal, then you will have to limit yourself in food.

When Maya Plisetskaya was asked how she manages to maintain such good figure, she replied: “You need to eat less.” Rough, but honest. How much is less?

The Nutrition Research Institute recommends reducing caloric intake depending on the nature of the activity. Your current kcal norm per day is your weight x 32.5 (when doing mental work, which includes regular office work) or your weight x 35.5 (if you consider your work to be light physical). For fun, you can calculate your norm for moderate (x 41.5) and heavy (x 48.5) physical labor. But this is definitely not about you.

The joy of the birth of a long-awaited baby is sometimes accompanied by grief over the kilograms gained during pregnancy. Time passes, and the excess weight refuses to go away. Your optimal weight is different dates during pregnancy you can calculate using a simple pregnancy weight calculator. However, as you know, most of us begin to think about our weight only after childbirth. How to properly lose weight after childbirth, advises Researcher Endocrinological scientific center RAMS in Moscow Larisa Viktorovna SAVELIEVA.

The joy of the birth of a long-awaited baby is sometimes accompanied by grief over the kilograms gained during pregnancy. Time passes, and the excess weight refuses to go away. You can calculate your optimal weight at different stages during pregnancy using a simple pregnancy weight calculator. However, as you know, most of us begin to think about our weight only after childbirth. Larisa Viktorovna SAVELIEVA, a researcher at the Endocrinological Research Center of the Russian Academy of Medical Sciences in Moscow, advises how to lose weight properly after childbirth.

In fact, not everyone gains extra weight while expecting a baby. According to physiological standards, a woman can gain about 8-10 kilograms during pregnancy. She gets rid of them naturally during childbirth and in the postpartum period. But, unfortunately, very often expectant mothers exceed this figure, gaining up to 20 extra pounds while expecting a child.

- Why is this happening?

- There are several reasons. Firstly, it is believed that expectant mother should eat as much as possible - “for two.” Therefore, many women during pregnancy stop monitoring a balanced diet and allow themselves to relax, justifying this with the needs of the unborn baby.

Secondly, a woman in this position moves much less, that is, the energy received from food is not consumed. In addition, pregnancy is always stress, a restructuring of all body systems. A special mechanism to protect the unborn baby is activated, and the fat layer on the abdomen, waist and hips actively develops.

Finally, weight gain during pregnancy can be caused by fluid retention in the body, as well as some obstetric problems.

— How can a healthy woman lose weight after childbirth?

- First of all, analyze your behavior. There are common mistakes that often prevent women from returning to their previous shape after childbirth.

Don't overeat. For some reason, it is believed that the quality of her milk depends on the abundance of a mother’s nutrition. In fact, the lactation process is controlled by the hormone prolactin, the production of which is in no way related to nutrition. Therefore, you have every right to change your diet, making it balanced. Do not finish eating after your baby. Even if the baby has eaten less than half of his sweet porridge, you are not obliged to eat the rest. Remember: all excess food will inevitably be deposited on the waist and hips. Try not to taste when preparing food. This way you can quietly gain hundreds of extra calories, which over time will turn into extra pounds. No matter how busy you are with your baby, eat at least 4 times a day. At the same time, never skip breakfast, and in the evening try to get by with light food. Dinner should end no later than 4 hours before bedtime. You should not follow the categorical rule “Not a crumb after six o’clock in the evening.” If you are used to going to bed at 12, by the evening you will be brutally hungry. And in such a situation, it is very easy to lose control over yourself. If you decide to make your diet less high in calories, do not give up bread. Often, ladies who want to lose weight eat only a piece of cheese or ham instead of a traditional sandwich. It’s better to do the opposite: eat the bread, but “give the sausage or cheese to the enemy.” A nursing mother should forget about any diets and fasting. All these extreme methods of losing weight will inevitably affect both your health and the well-being of the child.

— How to properly organize your diet in order to lose weight, but still get the energy necessary for household chores and worries?

— The calorie content of the diet should be limited to 1500-2000 kcal. If you are short and fragile, stick to the lower limit of this norm. And for stately, naturally large ladies, it is recommended to eat about 2000 kcal per day.

At first, it is better to keep a special food diary to control calorie intake. Write down everything that goes into your mouth, down to the last crumb. Believe me, the process itself will take you no more than 10 minutes a day, and will bring enormous benefits. You will learn to understand how much you eat and become more intelligent in your diet.

Pay attention to the choice of products. Remember: there is no strictly prohibited food, there are only temporary restrictions:

Fats should make up no more than a quarter of the total calorie intake. If you stick to the 1,500 calorie goal, you can get no more than 40 grams of pure fat each day. For reference: in a liter of one percent kefir, as in a tablespoon vegetable oil, contains 10 grams of lipids. A bar of milk chocolate will “give” you as much as 70 grams of pure fat. You can eat meat and meat products only once a day, with breakfast or lunch. But try to include fresh, boiled and stewed vegetables without fat in every meal. You should only eat low-fat and low-fat dairy products. Kefir, yogurt and milk - no more than 1% fat, cottage cheese - no more than 5%, cheese - maximum 30%. Such varieties as Adyghe, Chechil, Camembert, cheese with cumin will suit you. Do not give up grain products: porridge with water or with skim milk, whole bread, brown rice. But it is better to exclude sweets from the diet. If it’s hard for you to completely give up sweets and chocolates, allow yourself a piece of marshmallow or marmalade, a marshmallow, one or two caramels a day. Ban nuts and seeds. Unnoticed by yourself, along with a couple of handfuls of nuts, you will get almost half daily value calories and significantly exceed the fat limit. Instead of juices, choose water or fresh fruit. A liter of orange juice contains as many as 900 kcal, and a kilogram of fresh oranges contains only 400. It is better to avoid carbonated sweet drinks like cola altogether - in addition to sugar and caffeine, they contain many dyes, flavors and preservatives that are completely unnecessary for a young mother. A nursing mother should completely avoid alcohol. If you are not breastfeeding, remember that alcoholic drinks are very high in calories - with a glass of champagne you will get almost 150 kcal. Do not take special medications, weight loss supplements, or “cleansing” herbal teas while you are breastfeeding. Their use may affect the quality of your milk. Don't forget to take vitamin and mineral supplements. But try not to exceed the permissible vitamin intake limits.

— What to do if the baby is allergic or suffers from dysbacteriosis?

“In these cases, it is necessary, first of all, to treat the disease itself. And, of course, a nursing mother should adjust her diet without violating the general principles rational nutrition. If the child has allergies, it is better for the mother to adhere to a hypoallergenic diet with the exclusion of foods that can cause a reaction in the baby. And with dysbacteriosis, foods such as cabbage, legumes, and brown bread are excluded from the diet.

— Successful weight loss is impossible without physical activity. But a nursing mother is not able to devote much time to sports.

— Physical activity after childbirth is vital. Moreover, you need to start moving actively two weeks after the birth of the child. You don’t need to set aside special time for this, just use the hours of walking with your baby. The most important thing is not to give in to the temptation to spend the entire time allotted for a walk in the company of other mothers, discussing the problems of caring for infants.

Your task is to walk quickly for at least an hour. Walk at maximum speed without breaking into a run and avoiding shortness of breath. Such a brisk walk will help burn a lot of calories and will definitely appeal to your baby. I recommend purchasing a pedometer and walking at least 4 thousand steps daily.

About a month after giving birth, you can begin more serious exercise. If you have the opportunity to leave your baby for a while, go to sport Club for yoga, dancing, balance classes. Enter the training regime gradually - do not take on an exorbitant load from the very beginning.

An alternative option could be home exercises. Select a suitable set of movements yourself, from books or magazines, or buy a special video cassette with exercises for young mothers. Start exercising once or twice a week, gradually increasing the number of workouts to three. Daily walks, of course, are not canceled. By the way, if it’s difficult for you to find a whole hour for a full workout, break it up into 15-minute segments and do it throughout the day.

— What to do if the weight still doesn’t come off?

— If you honestly follow all the principles of rational nutrition and give yourself adequate physical activity, you will definitely lose weight. This process should not be very fast - it is optimal to lose 250 - 500 grams per week.

But in the case when the scale needle stands rooted to the spot for several weeks, despite all the conditions being met, it is better to contact an endocrinologist and check the condition of the thyroid gland, as well as the general hormonal status of the body.