Preparations before eco for a woman. Preparing for eco

The list of drugs that help to carry out in vitro fertilization is quite wide. We list only the main ones.

Note:

The medicines listed below, which are used for IVF programs, can only be used as prescribed by a doctor. Be sure to carefully read the instructions for each drug. The information provided here is for informational purposes only. That is why the dosage of drugs is not indicated.

I. Blockers

1. Agonists (analogues) of gonadotropin-releasing hormone

Gonadotropin-releasing hormone (GnRH) is produced by the hypothalamus. It has a distinct specificity. GnRH creates rather strong complexes, interacting most often only with the corresponding receptors, which are located in the anterior pituitary gland, and with some proteins. After the first phase of pituitary activation passes (usually after 7-10 days), the sensitivity of GnRH to stimuli begins to decrease.

Then there is a decrease in the level of LH, FSH, ovarian stimulation stops. The amount of estrogen decreases, its level drops below 100 pmol / l. Similar characteristics are seen in postmenopausal women. The amount of production of tostesterone, progesterone, produced by the ovaries also decreases.

Gonadotropin-releasing hormone agonists increase the likelihood of fertilization through IVF programs.

The use of gonadotropin agonists has side effects. As a rule, unpleasant symptoms appear due to a lack of estrogen, a hypoestrogenic state develops, accompanied by headache, sweating, hot flashes, a feeling of dryness in the vagina, mood swings, and depression.

The most dangerous effect of agonists on bone tissue, the density of which may decrease due to prolonged use of these drugs. There is evidence that some recovery of bone tissue is observed for a year after agonist treatment is completed.

Manufacturers list:

(Ferring Arzeimittel, Germany)

(Beaufour Ipsen International, France)

(Astra Zeneca, UK)

Preparations:

Diferelin

Artificial decapeptide, is an analogue of natural GnRH

Decapeptyl

Sterile set for depot injections, as well as for daily appointments, which is completely ready for use. It consists of: 1) a syringe containing a suspension preparation 2) a conventional syringe 3) microcapsules containing triporelin 4) injection needles, a connecting element.

Triptorelin, which forms the active basis of the drug, is an artificial analogue of GnRH. Has a longer half-life. Used during artificial insemination.

The concentration of the drug in the blood is reduced to a minimum when intramuscular injection for 44 days, subcutaneous - 64 days.

Lucrin depot - leuprorelin

It has antiestrogenic, antiandrogenic effects, the field of application is the treatment of endometriosis, hormone-dependent tumors, which include prostate cancer, uterine fibromyoma. Lucrin-depot helps to reduce the concentration of estradiol in women, testosterone in men, in addition, inhibition of FSH and LH incretion by the pituitary gland.

When injected intramuscularly, a depot is created that is able to maintain an effective concentration of the substance for 30 days. The bioavailability index is approximately 90%.

After treatment with the drug is stopped, the physiological secretion of hormones is gradually restored.

Goserelin, Sinarel, Buserelin

These drugs are nasal sprays.

Zoladex

The drug is a synthetic analogue of the natural releasing factor luteinizing hormone (LH). Often used in artificial insemination. Taking the drug helps to reduce the concentration of estradiol in the blood serum, is the result of suppression of LH secretion of the anterior pituitary gland. It is a capsule that, once inside, slowly dissolves, so that the substance inside is released evenly. The concentration is maintained for four weeks.

New generation:

2. Gonadotropin-releasing hormone antagonists

These drugs more effectively suppress the secretion of LH, and the activity of the pituitary gland is restored after the cessation of the intake of the drug inside much faster. Often used in the treatment of infertility.

Pharmacodynamics: after the drug enters the body, the level of blood gonadotropins decreases significantly, and LH, other than FSH, is more susceptible to the process. For example, if a single injection of 0.25 mg of the drug, the concentration of FSH will decrease by 32%, LH - 74%. The duration of suppression is then 4 to 16 hours. If the drug was administered repeatedly, the concentration will remain unchanged for 2-3 days.

So, its pharmacokinetics is distinguished by the blocking action of gonadotroph receptors directly, good bioavailability, the drug begins to act very quickly. The level of gonadotropins recovers very quickly after discontinuation of the drug. Due to the fact that the substance is rapidly excreted, the effect on the receptors is immediately reversible.

The main pharmacokinetic, pharmacodynamic features of the drug:

The half-life of the drug is 13 hours;

The after-effect period is maximum 3 days;

Pharmacokinetics is commensurate with the dose of the drug required to suppress the function of the pituitary gland;

The functions of the pituitary gland are quickly restored after the cessation of treatment.

The main differences from GnRH analogues (clinical studies were conducted by leading clinical centers for in vitro fertilization):

The duration of stimulation is reduced by 1-2 days;

The first days after stimulation with recombinant FSH - the size of the follicle increases much faster;

To stimulate ovulation, a smaller dose of gonadotropins is needed;

The final number of follicles is smaller, however, the production of estradiol is also slightly reduced, the number of eggs is reduced by 1-2 pieces;

Number of embryos undergoing artificial insemination High Quality, fertilization frequency demonstrate high results;

A good clinical result, which consists of the quality, number of oocytes, embryos, frequency of implantation, fertilization, pregnancy, as well as its progression.

Another important difference inherent in the stimulation of GnRH - support for the function of the corpus luteum after artificial insemination is optional.

The most commonly used drugs - Orgalutran, Citroride (Cetrorelix), differ from each other only by the manufacturer (Organon, Serono). Both drugs are well tolerated, have high safety, and have a low likelihood of adverse reactions.

II. Direct ovulation stimulants

These drugs are used in such operations as drugs that can replace natural gonadotropins, acting on the ovaries, causing growth, maturation of the follicles, subsequent ovulation.

Medicinal substances are represented by two groups: urinary gonadotropins, recombinant gonadotropins. Several companies produce: Ferring Arzeimittel (Germany), Aeras-Serono (Switzerland), Organon (Netherlands).

Several analogues of medicines are produced for operations similar in composition, method of exposure.

1. Urinary gonadotropins

These include Menogon, Pergonal, Humegon.

Pergonal

The drug contains the active ingredient - menotropin, which contains human menopausal gonadotropin. The content of LH, FSH of the hormonal substance has a ratio of 1:1.

Pergonal is used during artificial insemination, stimulates growth, maturation of the follicles, increases the concentration of estrogen in the blood, and also causes endometrial proliferation. The drug must be administered intramuscularly.

Pergonal has contraindications. Pronounced sensitivity to menotropins, abnormal development of the genital organs, gynecological bleeding of unknown etiology, persistent ovarian enlargement, ovarian cyst not due to a polycystic ovary, uterine fibroids, primary ovarian failure.

Treatment with gonadotropins can cause multiple pregnancy, miscarriage.

Menogon (Menogon)

The drug is used to stimulate superovulation during IVF. Menogon contains an active ingredient - menotropin, produced from the urine of postmenopausal women. Contains FSH, LH, 3:1 ratio. Gonadotropic pharmacological action. Helps stimulate the maturation of the follicles.

Metrodin (Metrodin)

The drug is used in the treatment of infertility in in vitro fertilization programs. It is a follicle-stimulating hormone that is produced from the urine of postmenopausal women. The drug helps to stimulate the growth and maturation of follicles, as well as increase the level of estrogen in the blood and endometrial proliferation. Lutenizing action is not observed.

Humegon (Humegon)

The preparation of gonadotropic hormones of the pituitary gland, helps to activate the maturation of the follicles, the egg (before the onset of the preovulatory period), making up for the lack of FSH, LH. The production of steroid hormones by the sex glands is significantly increased due to the effect of the drug. Doctors often prescribe it to treat infertility.

2. Recombinant gonadotropins

(Puregon, Gonal-F)

Puregon (Puregon) - follitropin beta

The drug is a pure follicle-stimulating hormone, the result of genetic engineering. To stimulate the follicles in IVF, smaller doses are used compared to urinary preparations, since Puregon is more powerful. One significant difference is the absence of the effect of ovarian hyperstimulation.

3. Indirect ovulation stimulants

(frequent use - stimulation of ovulation in egg donors)

Klostilbegit (Egis, Hungary)

An antiestrogen drug containing an active ingredient - clomiphene, which is an antiestrogen of a non-steroidal structure. The drug is able to selectively block the binding of estradiol to ovarian and pituitary receptors.

The effectiveness of the drug depends on the content of estrogen hormones inside the body. Due to the low concentration, a moderate estrogenic effect may be observed. A high concentration of estrogen contributes to the antiestrogenic effect. Small doses of the drug can increase the secretion of gonadotropins (FSH, LH, prolactin).

Clostilbegit stimulates ovulation, the use of large doses of the drug causes inhibition of the secretion of gonadotropins. Androgenic, progestogenic activity is absent.

The drug is used to stimulate ovulation in patients with anovulatory ovarian dysfunction, which is the cause of infertility. Indications for use are also dysfunctional uterine bleeding, other pathologies caused by diseases of the endocrine system. The drug is well absorbed by the gastrointestinal tract.

Clostilbegit has contraindications, should not be used in pregnant women, patients with renal, hepatic insufficiency, neoplasms of the genital organs, metrorrhagia of unknown etiology, endometriosis, tumors, pituitary insufficiency, ovarian insufficiency occurring against the background of hyperprolactinemia, hypersensitivity to the drug. The use of Clostilbegit is often accompanied by multiple pregnancies.

The highest efficiency of the drug is observed when the level of endogenous estrogens is high - a low level helps to reduce the effectiveness of the drug. A low level of gonadotropic hormones reduces the effect of the drug to zero.

III. Ovulation triggers

Ovulation triggers are medications that mimic or stimulate the release of LH. Thanks to their influence, the egg matures, ovulation occurs. Indications for use - treatment of infertility (some of its forms).

Manufacturers: Ferring, Aeras-Serono, Arzeimittel, Organon

Preparations:

In vitro fertilization is carried out using the following preparations containing human chorionic gonadotropin: Horagon, Profazi, Pregnil.

There are also drugs that have not received practical application, well described by theory:

Recombinant hCG (ovidrel);

Recombinant FSH;

Recombinant LH (LHadi);

GnHRH, GnHRH agonists;

GnHRH antagonists.

Profazi

Contains the active substance - chorionic gonadotropin, produced from the urine of pregnant women. Promotes stimulation of gonadal steroidogenesis, production of estrogen, progesterone - post-ovulation period. Assign when artificial insemination is carried out.

Caution should be exercised when prescribing Profazi to women with kidney disease, heart failure, hypertension, migraine, epilepsy.

Sometimes the use of the drug can provoke the development of ovarian hyperstimulation syndrome. Then the drug should be stopped. Treatment with gonadotropins often develops multiple pregnancies, and the risk of miscarriage also increases.

Horagon (Horagon)

The drug helps to stimulate the production of progesterone, estrogen in women in the postovulation period, testosterone in men. In addition, Choragon provokes an increase in gonadal steroidogenesis. Recommended as an ovulation stimulator in IVF.

There are side effects: simultaneous use with clomiphene citrate, menogon, the drug can provoke the appearance of hyperstimulated ovary syndrome. This is fraught with their break.

IV. Support for corpus luteum function (second phase)

Utrogestan (Utrogestan)

Producer: Laboratories Besins-Iscovesco Lab., France

The active substance is the corpus luteum hormone, natural micronized progesterone.

The drug is used as a stimulant for the formation of the secretory endometrium of patients who need in vitro fertilization. Due to its effect, a sufficient amount of secretory endometrium is formed, which contributes to the normal implantation of the egg. The mucous membrane of the uterus after taking the drug passes into the secretory phase. After artificial insemination occurs, the mucosa assumes the state necessary for the fertilized egg to develop normally. The drug blocks ovulation without having androgenic activity.

Possible side effects: allergic reactions, slight drowsiness, sometimes dizziness appears, usually stopping 2-3 hours after taking the medicine.

Vaginal use of the drug is practiced.

Duphaston

Manufacturer: Solvay Pharmaceuticals B.V. , Holland

The active ingredient is dydrogesterone.

The drug selectively acts on the uterine mucosa, contributing to the onset of the secretory phase of the endometrium.

Indications for use: lack of own endogenous progesterones. The drug is prescribed to support the luteal phase after embryo transfer.

Progesterone

It looks like an oil solution. Injections (1%, 2.5%).

Manufacturer: Russia.

The drug is used for intramuscular injection.

Progesterone injections are very painful, and long-term treatment may contribute to the appearance of bumps.

Horagon (Horagon)

Horagon injections - 3,6,9 days of the postovulation period. The corpus luteum is stimulated.

Additional drugs that can be prescribed to the patient before, during, after in vitro fertilization

Diprivan (DIPRIVAN) PROPOFOL ZENECA

It has the appearance of an emulsion. Intravenous administration. It is used to provide short-term anesthesia in order to puncture oocytes.

1 ml of the substance contains 10 mg of propofol.

Pharmachologic effect:

Propofol is a substance used for general anesthesia. The result of the application - sleep comes pretty quickly - 30 seconds, does not last long.

Pharmacokinetics:

Propofol has the ability to be rapidly excreted from the body, metabolism occurs most often in the liver.

Indications:

Used for induction, maintenance of general anesthesia, to achieve a sedative effect in adult patients, performing intensive care, or mechanical ventilation. Diprivan is also used in some diagnostic, surgical procedures, when the patient is conscious.

Side effects:

Induction anesthesia using Diprivan is carried out smoothly, the signs of arousal of the patient are minimal. Sometimes there is a temporary apnea, a decrease in blood pressure. Other side effects are extremely rare.

Very rarely, epileptiform movements were noted - opisthotonus, convulsions. There is information about the occurrence of pulmonary edema. After waking up, a minimum number of patients report headache, nausea, and vomiting. After prolonged use, the color of urine may change. Postoperative fever is extremely rare. Phlebitis, thrombosis are also noted only occasionally.

Contraindications:

The presence of an allergic reaction, the active substance of Diprivan is propofol.

Special instructions:

Often Diprivan is used in conjunction with analgesics. Not recommended for children under 3 years of age.

Caution should be given to Diprivan in severely debilitated patients, as well as in patients with a history of respiratory and cardiovascular diseases, epilepsy, oligemia, liver and kidney dysfunction.

Patients suffering from lipid metabolism disorders require special attention. If the patient is at risk of excessive accumulation of fats, it is recommended to monitor the level of blood lipids when prescribing Diprivan. If fats are not sufficiently excreted from the body, the dose of Diprivan should be adjusted.

Patients who have been prescribed Diprivan should exercise caution while driving, as well as in other situations where increased attention is required.

It is undesirable to prescribe the drug to pregnant women, it is able to overcome the placental barrier, causing neonatal depression. It is allowed to use Diprivan when pregnancy is terminated if the period is less than 12 weeks. Regarding lactating women, there is no information about the safety of the drug for the child. Therapeutic doses of Diprivan do not suppress the synthesis of adrenal hormones.

It is forbidden to use Diprivan as an anesthetic for medical workers who do not have the appropriate training - conducting intensive care. A doctor performing a surgical, diagnostic procedure is not authorized to administer an anesthetic, this must be done by a separate specialist.

The use of the drug should be accompanied by monitoring the patient's condition. Be sure to have special equipment with which you can carry out resuscitation.

Diprivan should be stored at a temperature of +2 - +25 degrees. It is strictly forbidden to freeze the medicine. Shake before use. The remains of the medicine inside the syringe and ampoule must be destroyed immediately.

Overdose:

An overdose of the drug can cause respiratory depression, cardiac activity. In the first case, it is recommended to carry out mechanical ventilation using oxygen, in the second case, it is necessary to administer a vasopressor drug, a plasma substitute, to the patient.

Drug interaction:

There is a good combination of Diprivan with drugs for epidural, spinal anesthesia, as well as drugs that are used for premedication, analgesics, muscle relaxants.

In practice, there were no cases of pharmacological incompatibility of Diprivan.

Estrofem (estradiol) 2 mg

Manufacturer: NOVO NORDISK A/S Denmark

The drug contains the active ingredient estradiol.

Estrofem is a hormonal drug that helps compensate for the lack of endogenous estrogens, which may appear after artificial insemination, the appearance of proliferative changes in the endometrium. It is used as a stimulant for the development of the uterus. Estrofem helps to increase libido, maintain normal bone structure.

Side effects:

There may be tenderness of the mammary glands, headache, nausea, edema, uterine bleeding, exacerbation of cholelithiasis. All side effects, as a rule, are temporary, after a while they pass on their own. If the discomfort continues for a long period, you should consult a doctor.

Proginova (Proginova) - estradiol valeriate.

Manufacturer: Shering-Germany

The drug contributes to replenishing the deficiency of endogenous estrogens, the appearance of proliferative changes in the endometrium, and maintaining the normal structure of bone tissue. Assign after the implementation of artificial insemination.

Side effects:

When prescribing the drug, headaches, nausea are sometimes observed, very rarely there is a change in weight, engorgement of the mammary glands, uterine bleeding.

Metipred (methylprednisolone)

Manufacturer: ORION CORPORATION, Finland.

It is a hormonal drug used as a substance that suppresses the immune system, preventing the rejection of the transplanted embryo.

General indications for use:

Rejection reactions after transplantation of tissues, organs, which include artificial insemination, some disorders of the liver, kidneys, allergic diseases, ulcerative colitis.

Side effects:

From the endocrine system: weight gain, suppression of the hypothalamic-pituitary-adrenal function, hirsutism, decreased resistance to carbohydrates.

From the immune system: hypersensitivity, decreased resistance to infectious diseases, immunosuppression.

From the neuropsychic sphere: insomnia, depression.

On the part of the organs of vision: cataracts, exacerbation of fungal, viral eye diseases, increased intraocular pressure.

In addition, after application, nausea, changes in appetite, and a tendency to thromboembolism may occur.

Dexamethasone

Manufacturer: Weimer Pharma-Germany.

The drug is a powerful glucocorticoid drug, has an immunosuppressive, anti-inflammatory, anti-shock, anti-allergic, anti-toxic effect.

When prescribing glucocorticoids, the following fact should be taken into account: the level of cortisol reaches its maximum level early in the morning. If used to suppress androgen levels (when adrenal cortex dysfunction), it is recommended to take it in the evening; for autoimmune disorders, glucocorticoids are best taken in the morning, then the risk of side effects is minimal.

The use of any drugs must be agreed with the attending physician!

IVF procedure algorithm by day

In vitro fertilization is the latest assisted reproductive technology. This medical manipulation allows to achieve the birth of a child in the most difficult and seemingly completely hopeless cases of infertility. The procedure is based on the fertilization of a woman's own egg with the sperm of a donor or husband. The scheme of conduct and preparation for the procedure by day is signed in.

The contact of the egg with the sperm takes place in an artificially created favorable environment, in sterile laboratory conditions. After successful fertilization, it returns to the mother's body, but after cultivation in a special environment in the form of an embryo.

The need for superovulation

Unfortunately, not every "meeting" of sperm and egg in the laboratory ends effectively. To increase the chances of success, in clinical practice, superovulation stimulation is used.

Normal in female body one, sometimes two eggs (in rare cases) mature in one cycle. For successful fertilization during IVF, one female germ cell may not be enough. In the body of a woman, with the help of hormonal agents and drugs, conditions are created under which, in the process of ovulation, instead of one or two eggs, four or more mature.

To obtain the required number of oocytes during the IVF procedure, it is necessary to take hormonal preparations strictly on the days specified in the protocol. Signed for each patient individual scheme reception. Next, we will take a closer look at how such ovulation is stimulated, what protocols and drugs exist to achieve the goal.

The main stages of the IVF cycle

Consider the IVF cycle in more detail, it consists of four main stages:

• stimulation of the superovulatory cycle;
• extract received ;
• fertilization of extracted eggs;
• into the body of the potential mother.

The last three stages of the procedure are quite standard, and do not differ depending on the individual and specific characteristics of the woman. However, how many days IVF lasts largely depends on which protocol will be used. There are two main options - a short and a long protocol, then we will consider them in more detail.

Features of the short protocol

The main feature of the protocol is that the start of IVF by the day coincides with the start of the natural cycle. The protocol begins with the impact on the stimulating phase of ovulation. This period starts from the second to the fifth day of the menstrual cycle. The process can be started in two ways.

Way one

Effects on the body of gonadotropin preparations. The main active ingredient in them is a hormone that stimulates the development and growth of follicles. The appointment of gonadotropin is carried out in combination with drugs that stimulate the action of gonadoliberin (a hormone, without which the secretion of one's own follicle-stimulating hormone is impossible). This combination of drugs allows you to achieve maximum concentrations of hormones and super-strong stimulation of the ovaries.

The advantage of such a regimen is that it is easily tolerated by patients. The disadvantage is the risk of getting low-quality eggs during ovulation.

On the 3rd day of the cycle, the synthesis of pituitary hormones is blocked. At the same time, ovulation begins to be stimulated by gonadotropins and lasts from twelve to seventeen days.

Approximately two weeks later is carried out . Their maturation is monitored by ultrasound. 36 hours before the puncture, the patient is prescribed human chorionic gonadotropin. After 5-6 days, the fertilized egg is returned to the uterine cavity, and agents containing progesterone, a hormone responsible for gestation and on the uterine mucosa, are prescribed.

Way two

This is a similar IVF cycle, which uses drugs that weaken the action of GnRH, in combination with gonadotropins. The advantages of such a scheme are the minimal risk of defective eggs, comfort for patients, but the chances are somewhat reduced due to the “unpreparedness” of the endometrium - the uterine mucosa.

On the third day of the cycle, the woman is prescribed GnRH antagonists in combination with gonadotropins, these drugs continue to be taken for two weeks. On the 14-20th day, the follicles are punctured to remove the eggs. For 36 hours, human chorionic gonadotropin is also prescribed. The egg is placed in the uterine cavity and the patient receives progesterone support.

Long protocol

Seven days before menstruation, the patient is prescribed significant doses of GnRH agonists (substances that increase the sensitivity of GnRH receptors), as a result of which the synthesis of the ovarian and pituitary hormones stops. The duration of this blockade is about fourteen days. After that, the patient on the third day of the next cycle begins to receive gonadotropins for two weeks.

Quite often, the expected pregnancy does not occur. There is infertility of unknown origin. There are many reasons for this state of affairs. Modern medicine successfully fights this disease. IVF preparations aimed at stimulating ovulation allow increasing the chances of fertility. Before using them, you need to undergo a medical examination to determine which ones will help increase ovarian function.

Indications

Modern medicine considers many reasons for prescribing stimulation. It is used when there is no dominant follicle. Its formation is associated with the level of FSH. The fertile stage is not able to occur if the luteinizing substance is at a low or normal level.

The next problem is the transition of the dominant into a cystic formation. It is an overgrown follicle, the size of which reaches 4 centimeters. The danger of this phenomenon lies in the violation of the progesterone phase, the lack of fertility. The corpus luteum does not form when there is no mature germ cell. Progesterone is not produced. The cycle drags on.

Another factor is the presence of pathology in a woman at the genetic level. A normal pregnancy cannot occur when the genetic code is broken.

When the problem is diagnosed:

1. fading pregnancy;
2. miscarriage;
3. death is still inside the uterus.

The repeated manifestation of pathologies is controlled by the doctor, ovulation is stimulated before IVF.

On what day do stimulation begin with IVF? For 3 or 5 menstrual cycles. It is also possible to conduct IVF without ovarian stimulation. Upon receipt of the embryo on the 5th day, it is possible to perform a biopsy of the trophectoderm, to conduct PGD.

Contraindications

When there is a dense capsule on the surface of the ovary, the follicle cannot develop to the desired size. For this reason, drugs are not suitable for every woman.

Stimulant drugs before IVF cause the growth of several dominants. The dense shell prevents their exit, the ovaries are depleted, which prevents the procedure.

Preparations for ovarian stimulation with IVF are not prescribed if:

• there are chronic pathologies of the hormonal system. Due to its instability, it disrupts the course of stimulation;
• when there is an adhesive process. It blocks the cell's access to the uterus. In some cases, laparoscopy will be required;
• with erosion. This lesion consists of atypical cells. The vagina loses its functions. If stimulation is done, there will be a threat of infection with all kinds of diseases;
• inside the body there are inflammatory processes, a cold;
• with viral infection. There is an increased risk of bacterial infection in the ovaries. To make eco possible, the doctor prescribes concomitant treatment;
• neoplasms appeared. They do not always have an oncological characteristic. If stimulated, the nature of the formations may change. Also, hormones will provoke the active growth of tumors.

Drugs are prohibited when there is a danger of increased stimulation. With hyperstimulation, many dominants appear simultaneously. The ovary during ovulation is able to burst, unable to withstand such a load. Loss of it reduces the chances of natural fertilization.

In preparation for in vitro fertilization, the doctor conducts a complete examination of the patient in order to determine which method of stimulation to choose. Each protocol has its own characteristics. For example, with Shanghai, double stimulation is carried out with eco in one cycle of menstruation.

Used drugs

Clomiphene preparations are used up to 4 times throughout life. An overdose is fraught with depletion of the ovaries. The use of this drug should be under the strict supervision of a doctor. Small doses of gonadotropin accelerate the growth of follicles. Progesterone is used to increase the chances of a fertilized egg fixing.

Before IVF, superovulation is first performed to increase the chance of conception. When the nuances are observed correctly, the dose of hormones is not exceeded, the process can proceed further.

The procedure is carried out with the support of medicines. What hormones inject during IVF:

1. progesterones;
2. chorionic gonadotropin;
3. clomiphene.

The list of medicines for IVF is quite large. The choice is made individually for each woman. In some cases, endometrial support will be needed. With insufficient thickness, the pregnancy will fail.

How many days are stimulated with eco? The amount of time depends on the rate of cell growth. It usually takes up to 13 days. Stimulation schemes for IVF, the type of drugs is selected by the doctor. The whole procedure takes place under his strict supervision. The list of medicines is quite wide. They should be taken on the recommendation of a doctor, after carefully reading the instructions. The cost of drugs to stimulate ovulation with IVF is low.

Stimulation and its consequences

For some female representatives, negative sensations during IV stimulation persist for some period after the end of the procedure. Pain occurs due to the use of hormonal drugs.

The consequences of hormonal therapy for IVF are:

• stool problems;
• bad feeling;
• cyst formation;
• fluid collection.

Problems are often observed with multiple formation of cysts. They are able to pass on their own, but it is possible that surgery will be needed. Another side effect is an ectopic pregnancy. If there is intolerance to any components of the drug, an allergic reaction occurs.

To exclude undesirable phenomena, it is necessary to follow the recommendations of the doctor. Often women have the question of whether it is possible to take immunomodulators during pregnancy. Their effect on the fetus is little studied.

For stimulation

Orgalutran is a drug made on the basis of ganirelix. It is used to treat infertility in women. The drug is prescribed for stimulation of superovulation for a short time.

Cetrotide is a drug that is used to prevent premature ovulation and then obtain eggs for IVF. This drug is quite expensive, on average 10,300 rubles.

What is better orgalutran or cetrotide for IVF? Both drugs block the release, as a result of which premature ovulation is prevented. The doctor prescribes the medicine, based on the presence of an allergic reaction to the constituent components. If you are allergic to Orgalutran, Cetrotide is prescribed or vice versa. In addition, it must be taken into account that Orgalutran will cost a woman less than Cetrotide.

Loperamide is an antidiarrheal drug. Pregnant women often experience diarrhea. Loperamide should not be used during early pregnancy. It is prescribed with caution only in the later stages, and then with urgent need.

Medicine Spermin and Ovodorin- This is Buddy. The first is used to treat male infertility, it improves sperm quality. And the second is prescribed for gynecological abnormalities, but pregnancy is included in the list of contraindications.

Cetrotide injection

The first injection of Cetrotide is performed in the presence of a doctor. The drug is injected subcutaneously, into the abdomen near the lower part of the navel.

How to inject cetrotide yourself:

1. open the container, wipe the cork with the ring with an alcohol swab;
2. a needle with a yellow tip is placed in a container with a lyophilisate, the liquid is slowly drained, shaking the vial;
3. completely draw the drug into the syringe;
4. change this needle to a needle with a gray tip;
5. release air from the syringe, it is forbidden to shake;
6. wipe the injection site with an alcohol swab and gently squeeze it with one hand;
7. the needle is inserted completely at an angle of 30-450 under the skin;
8. let go of the skin;
9. pull the plunger of the syringe back, if blood appears in the contents, then the injection cannot be given;
10. if there is no blood, the contents of the syringe are slowly injected;
11. the needle is removed, the puncture site is treated with an alcohol swab.

Often doctors prescribe cetrotide and gonal at the same time. Detailed instructions about the drug are attached with the purchase.

Gonal-f

Gonal-f and Puregon are stimulant drugs that have the same effect and are also interchangeable. They are created with the help of genetic engineering, they contain only a separate section of the FSH molecule. This area is responsible for the growth of the follicle.

Stimulation by Gonal with PCOS promotes the growth of follicles and starts the process of ovulation. Insemination is also used on Gonal. At the same time, Gonal in a long protocol can provoke. Therefore, a short protocol with the correct dosage of the drug and careful monitoring of the condition of the woman gives good results.

Gonal-f is quite expensive. Its price depends on the dosage, volume and configuration. The price range is from 1200 to 16 thousand rubles.

Gonal-f injection

How to inject gonal-f video can be viewed here. After viewing, you need to read the injection execution algorithm.

How to stab gonal f in the stomach:

• spread out in a clean place: two alcohol swabs, a syringe in which there is a solvent, a bottle of medicine and a syringe for injection;
• inject a syringe with a solvent into the medicine vial through the rubber cap. Slowly inject the liquid into the vial. After remove and discard the syringe;
• fill the syringe for injection with air up to a certain mark. Insert the needle into the vial, release the air and draw up the drug;
• remove air from the medicine. To do this, take the syringe with the needle up and knock on the body, the bubble will rise to the base of the needle. Gently press the piston and squeeze out the air;
• an injection is made in the abdomen or thigh, injected slowly. At the end, treat the puncture site with an alcohol swab;
• discard the syringe.

It must be remembered that the packaging of the medicine is designed for only one patient. The prepared solution is injected immediately. The next injection is made the next day at exactly the same time.

Drugs during pregnancy

Thrombo Ass is not used in IVF at the initial stage. Since it does not guarantee the onset of pregnancy. But ThromboAss is prescribed after embryo transfer, 1 tablet a day, in order to exclude negative consequences for the child. As a prophylaxis for IVF thrombosis, reproductologists prescribe Thrombo Ass and Clexane. The antibiotic Ceftriaxone is a powerful drug.

Before using any drug before the IVF procedure or during it, you need to consult with a reproductologist. Otherwise, it is possible to harm both the woman herself and her unborn baby.

Before in vitro fertilization, both partners need to undergo a thorough examination in order for the implantation of the embryo to be successful.

Full preparation for IVF significantly increases the chances of success, and also allows parents to properly tune in before the event.

Why is it important to prepare well for IVF?

Preparation for IVF includes mandatory tests and examinations by doctors, as well as diet, medication, lifestyle correction and therapeutic measures for those diseases that are identified during the examination. Such a set of measures is largely responsible for the success of artificial insemination.

It is possible to allocate a federal quota, as well as to conduct an in vitro fertilization program under compulsory health insurance. If the couple wants not to waste time, the woman has the right to go to the procedure for a fee.

What reduces the chances of successful IVF

There are certain factors that increase the risk of failure. Let's take a closer look at exactly what causes doctors consider the most dangerous.

Inflammatory diseases of the pelvic organs

With the development of an infectious process in the appendages of the uterus, large intestine or bladder, adhesions form, which impede the physiological movements of the organs of the female reproductive system. The acidity of the environment changes, which disrupts the structure of the appendages and uterus. Doctors believe that the implanted embryo will have difficulty implanting and may not attach to the endometrium.

Abortions or curettage of the uterine cavity

Any surgical procedures that imply a violation of the structure of the inner lining of the uterus are dangerous when performing subsequent in vitro fertilization. During an abortion, the function of the hypothalamus is impaired. Because of it, the gland is not able to give the correct commands, which negatively affects the preservation of pregnancy, which is obtained using technology.

Violation of sperm formation partner

If the quality of the seminal fluid deteriorates, the success of the procedure is reduced.

Doctors call the main reasons why this happens:

1. Harmful effects on the body of medicinal, industrial, toxic substances, cigarette tar and alcoholic beverages.
2. Low testosterone.
3. Hypovitaminosis of vitamins A, C, E and group B, affecting the production of male germ cells.
4. Impact of sexually transmitted infections.

Low follicular reserve

Egg laying occurs while the girl is in the womb. When born, the number of oocytes decreases. The sex cells of a woman, maturing in each menstrual cycle, should normally be gradually consumed. With the appearance of inflammatory diseases of the ovaries or the influence of various toxic substances, the consumption of eggs occurs much faster.

Over time, a woman has fewer and fewer follicles that will turn into full-fledged germ cells. Upon reaching the age of 40, the success of IVF may decrease, which is why it is necessary to use a donor oocyte.

Chronic diseases of a woman

Various diseases of the digestive, cardiovascular, nervous and respiratory systems can have a harmful effect on the ovaries and impair their blood supply. If the appendages are severely damaged, it is difficult to take a healthy egg for IVF.

In addition, endometriosis of the ovaries or uterus complicates the puncture of the female germ cell and the implantation of the embryo into the endometrium.

How to prepare for IVF

The procedure is quite expensive and time-consuming, which is why a preparatory period is carried out before in vitro fertilization. A man and a woman gradually correct their lifestyle and undergo an examination. The sequence of events is determined by the attending physician.

woman

Preparation for IVF should begin with a complete examination. The representative of the weaker sex will have to pass a large list of studies in order for the embryo transfer attempt to be successful.

Such a list includes:

1. Clinical blood test (content of blood cells, hemoglobin and ESR).
2. General urine analysis.
3. Blood chemistry.
4. Hemostasiogram.
5. Hormone analysis (plasma progesterone and estrogen, AMH, FSH).
6. Smear on flora.
7. PCR diagnostics.
8. Serological testing of antibodies to TORCH infection, HIV, hepatitis B, C.
9. Blood test for RW.
10. A smear for oncocytology.
11. Fluorography of the lungs.
12. Ultrasound of the pelvic organs performed transvaginally.
13. Mammography.
14. Colposcopy.
15. Hysterosalpingography (to visualize the patency of the fallopian tubes).

During preparation for the procedure, women suffering from general diseases should consult with specialized specialists. If a married couple has multiple miscarriages or missed pregnancies, children with developmental anomalies or hereditary abnormalities, a genetics examination is prescribed. The doctor recommends taking an analysis for karyotyping - a study of the quality and number of chromosomes of both partners.

Some doctors advise undergoing a plasmolifting procedure, arguing that the method increases the success of embryo attachment during IVF and the onset of pregnancy.

man

To prepare for in vitro fertilization, the stronger sex will have to take the following tests:

1. Spermogram: please note that before the test, abstinence from sex is 2-7 days.
2. Blood test for detection of antibodies to HIV, hepatitis B, C.
3. A smear from the urethra for the presence of a sexual infection.
4. Blood test for RW.
5. Cytological analysis of a smear from the urethra for the presence of atypical and tuberculous cells.
6. Ultrasound examination of the scrotum, prostate.
7. Analysis of sperm DNA fragmentation.

In the presence of diseases of the genitourinary system, a man goes for a consultation with a urologist and andrologist.

How long does preparation take

The duration of preparation for in vitro fertilization is determined by the doctor individually and takes as much time as necessary to be fully prepared for the event.

The specialist assesses the condition of the woman and identifies temporary contraindications to reproductive technology. If everything is normal, the preparation does not last long: it takes about 3-6 months.

Lifestyle modification before IVF

Before in vitro fertilization, not only tests with the advice of doctors are required, but also a change in lifestyle.

Both spouses must complete the following training:

1. Refrain from drinking alcohol and smoking.
2. Drink no more than 1 cup of coffee per day.
3. Try to avoid temperature fluctuations (visiting baths, saunas).
4. Carry out therapy for diseases that have become chronic.
5. Normalize sleep patterns: you need to sleep at least 8-9 hours a day.
6. Psychological preparation for IVF: create a comfortable environment for yourself. Doctors do not recommend spending a lot of time on the Internet, trying to find information about in vitro fertilization.

Diet

Preparation before IVF includes the normalization of nutrition for both men and women. To do this, you will have to give up fried, fatty foods, as well as spicy and sweet foods. Remove food containing preservatives or chemical additives from the diet.

Try to eat small meals 5-6 times a day. If you have a violation of weight, no matter its increase or decrease, it is necessary to normalize body weight. It depends on the hormonal background. In order for the diet to be correct and suitable for you, try to consult with a nutritionist: the doctor will select the diet.

Drink

In preparation for in vitro fertilization, you will have to consume about 2-3 liters of water per day, provided that there is no pathology of the kidneys and heart. This volume of fluid cleanses the body of toxins, and during hormonal therapy during IVF, it helps to prevent severe and dangerous complication- ovarian hyperstimulation syndrome.

You should drink water, compotes, fruit drinks, green tea, but the use of strong tea and carbonated drinks will have to be abandoned.

Medications

During the preparation before in vitro fertilization, the doctor prescribes medications that stimulate the technology and ensure a successful outcome of the procedure.

For the treatment of many diseases associated with male or female infertility, a medicinal herb is used - upland uterus. To make it easier for a woman to become pregnant with in vitro fertilization, doctors prescribe Pregnoton, as it improves the function of the reproductive system before the IVF protocol.

For normalization hormonal background, also with the immaturity of the endometrium, a woman takes Femoston. Indication for the use of Regulon is the correction of the menstrual cycle, which will help prepare for the procedure. Patients over the age of 40 are recommended to take DHEA, which improves egg quality.

Before preparing for an embryo transfer during IVF, it is necessary to protect the body from bacterial inflammation. For this, Terzhinan is used. If a couple suffers from genital herpes or cytomegalovirus infection, Panavir will be required, which promotes the production of interferon. To reduce the adhesive process and increase immunity, Wobenzym, Longidase is used.

The appointment of Actovegin is advisable when the patient has a history of miscarriage and hypoxia. To regulate metabolism and improve reproductive function Omega-3 is prescribed. If a woman complains of increased nervousness in connection with the upcoming procedure, the doctor prescribes sedatives (Valerian, Motherwort).

Sport

If a woman takes up swimming or walking, they will help her strengthen her body before in vitro fertilization. It is believed that oriental dances are very effective at the stage of preparation for the procedure. The fact is that with active movements of the abdomen and small pelvis, which are inherent in oriental dances, the blood supply to the organs of the reproductive system improves, which increases the chances of favorable outcome embryo implantation and subsequent gestation of the crumbs.

Vaccination

To protect yourself and your unborn baby from serious and dangerous diseases doctors recommend that a woman be vaccinated against hepatitis B, polio, rubella, tetanus, influenza and diphtheria. Vaccination is carried out no later than 2-3 months before in vitro fertilization.

How to prepare for IVF - an algorithm of actions in video format:

Preparing for the second try

It often happens that the first IVF is unsuccessful. Don't despair and look forward to your next try. Despite the fact that many women are ready to go through a second procedure immediately after in vitro fertilization, experts allow embryo implantation to begin 2-3 months after finding out the cause of the failure. The couple will again have to go through some tests and re-examination by doctors.

After preparing for the next procedure, the expectant mother must be in good physical shape and in a favorable psychological mood, otherwise the failure may repeat. If a partner in the analysis reveals a poor quality of sperm, freezing of the seminal fluid is carried out before in vitro fertilization, thus increasing its shelf life.

Conclusion

Modern medical technologies allow a married couple to become parents, despite the presence of certain reasons that prevent them from conceiving a child on their own.

Does IVF always end successfully? Unfortunately no. To increase the chances of a favorable outcome, both partners should properly prepare for the procedure, following all the doctor's recommendations.

^ It is important to remember that each patient has her own individual response to medications received during treatment, and that each subsequent treatment cycle is different from the previous one. This means that in reality your response will be different from the response of other patients to the same drugs, but for each subsequent cycle of IVF treatment, your body may respond differently, i.e., not the same as in the previous cycle ECO. In this regard, your examination, treatment and, accordingly, its results may differ from those of other patients. You cannot compare the results of your examination and treatment, as well as the treatment planned in the future, with the results of examination and treatment obtained from other patients. Although there is much in common with them, it must be remembered that IVF and ICSI treatment is a personal matter and that most patients experience inconvenience and embarrassment when publicly discussing their personal problems.

^ If you are planning IVF treatment, it is recommended to consult a doctor about 1-2 months before the start of the cycle you have chosen for IVF to resolve all your questions. At the appointment, the results of the preliminary examination are re-evaluated, including: examination on the armchair, ultrasound, hormonal studies, identification of pathogens of sexually transmitted infections, i.e. standard examination for patients before IVF treatment. According to the indications, additional examination methods are carried out. For review and subsequent registration, the patient is issued an agreement for IVF treatment (including ICSI methods, assisted hatching, fragmentation removal). All forms of agreement between the parties for each procedure must be signed before the start of the treatment cycle. One of the main requirements for starting IVF treatment is prevention of pregnancy in the cycle in which treatment begins using non-hormonal, but barrier methods of contraception (condom).

^ Interventions that increase the chances of success in a given treatment cycle

^ For women:

Avoid, if possible, taking any medication other than regular aspirin. If you are prescribed any medications by another doctor, you must notify your doctor before starting treatment. - Eliminate smoking and drinking alcohol. - Limit coffee and caffeinated drinks as much as possible (no more than 2 cups a day). - Avoid dietary changes and weight loss diets during an IVF cycle. - Refrain from sexual intercourse for 3-4 days before follicle puncture, and subsequently and after embryo transfer until the day of the pregnancy test (detailed recommendations will be given to you in the statement on the day of embryo transfer). Normal physical activity, as well as physical exercises, is not contraindicated until the ovaries enlarged as a result of treatment create some discomfort. - Avoid hot baths, baths and saunas. - Try to avoid contact with patients with acute respiratory viral infections (ARVI), avoid hypothermia. In case of an increase in body temperature, the appearance of symptoms of a cold, inform your doctor.

^ For men:

An increase in body temperature above 38 ° C 1-2 months before the IVF / ICSI procedure can adversely affect the quality of sperm; if you are ill, please take your temperature and report any increase in temperature (any illness or ailment accompanied by an increase in body temperature). It is not recommended to visit baths and saunas, as high temperatures can adversely affect the quality of sperm; please refrain from visiting them for at least 3 months before the expected start of treatment. Medications, alcohol and cigarette smoking should be avoided prior to IVF/ICSI treatment. Do not start any new sports activities or activities that involve heavy physical activity within 3 months prior to the start of IVF/ICSI. If you are a runner, please try to switch to walking without overload. Refrain from wearing tight underwear. Abstain from sexual intercourse for at least 3 days, but no more than 7 days before semen collection (on the day of follicle puncture).

^ For both spouses:

If you have a genital herpes infection, you must report the onset of symptoms preceding the disease (general malaise, general weakness, unmotivated fatigue), acute manifestations of the disease or healing rashes. Regardless of whether a man or woman suffers from genital herpes, any of the indicated stages of a herpes infection will require the immediate cessation of IVF / ICSI treatment.

^ Beginning of the IVF program (introduction to the program)

^ On the eve of the start of the IVF program, 7-10 days before your period, you need to make an appointment with your doctor for an ultrasound of the pelvic organs and an assessment of the condition of the ovaries and the thickness of the endometrium (uterine lining). After the doctor ascertains the normal condition of the ovaries (absence of ovarian cysts) and endometrium, in the presence of the necessary official documents (contract for the provision of medical services, agreement on this method treatment signed by both partners) and the results of the necessary examinations, the doctor introduces the patient to the program (IVF treatment cycle). The patient is given an individual prescription sheet, the rules for administering drugs and the “lifestyle” throughout the IVF treatment cycle are explained in detail. For each subsequent appointment, the patient should come with an appointment sheet. The list of prescriptions indicates the name of the patient, her age, the number of the outpatient card, and the entire treatment regimen is signed in detail: the name of the drugs, daily doses, frequency, ways and sequence of their administration and the date of each subsequent visit to the doctor. During the treatment cycle, both spouses must strictly comply with all the appointments and recommendations of the attending physician and appear for examination at the appointed time. The patient is issued referrals (vouchers) to pay for each stage of IVF treatment. Before the beginning of each stage of treatment, it must be paid in advance. Treatment may be terminated at any stage if, in the opinion of the doctor, the chances of its successful completion and obtaining good results are extremely low. In this case, the patient will be refunded for the unfulfilled stages of treatment. The first stage is the stimulation of superovulation. Its goal is to increase the chances of pregnancy. To do this, a woman is prescribed hormonal drugs that cause the simultaneous maturation of several follicles in her ovaries. In each of the follicles, one egg matures, which are taken during the puncture. After their fertilization, several embryos are obtained. The more embryos were received, the greater the chances for the successful development of pregnancy after their transfer to the patient's uterus.

^ Drugs to stimulate superovulation:

^ Gonadoliberin agonists (a-HRH) - " Diferelin" or " Decapeptyl»; Antagonists of gonadoliberin (ant-GRH) - " Orgalutran », « Cetrotide»; Preparations of human menopausal gonadotropins (HMG) - " Menopur»; FSH preparations - " Puregon », « Gonal-F»; Preparations of human chorionic gonadotropin (hCG) - " Pregnil ". All these drugs are prescribed according to the developed treatment regimens or “superovulation stimulation protocols”. At present, several such “stimulation protocols” have been developed and successfully used throughout the world, providing for the joint or sequential use of drugs of these groups to achieve the main goal of ovarian stimulation in IVF cycles - the growth of several follicles. Before starting stimulation, the doctor discusses with you the most suitable stimulation protocol for you. As a rule, a GnRH agonist, Diferelin or Decapeptyl, is first prescribed for 10-14 days from the middle of the second phase of the previous cycle (day 21 of the menstrual cycle) to suppress spontaneous ovarian activity. This is not the stimulation itself, but only the preparation of the ovaries for its implementation with hMG or FSH preparations. It is very important, because increases the effectiveness of subsequent stimulation and reduces the dose of prescribed HMG (FSH) preparations and, accordingly, the cost of treatment. This is an important argument, since all stimulation protocols used in IVF are carried out exclusively with expensive hormonal preparations. The beginning of the administration of a-GRH usually falls on the 21st day with a 28-day cycle or the 23rd with a 30-day cycle and lasts, on average, 10 -14 days, but possibly longer if needed. This superovulation stimulation scheme is the most traditional, most common and effective of all proposed today. It is called the “long” stimulation protocol. There are other stimulation schemes (“short” and “ultra-short” protocols), but they are used much less frequently and, mainly, when the standard “long” modes are ineffective. For 10 - 14 days of ovarian preparation the patient needs to visit the doctor only twice: before the start of the introduction of a-GHG (1st appointment, that is, directly entering the IVF program) and after this period (2nd appointment). Of course, if there are no unforeseen reasons for an additional visit to the doctor. After the necessary degree of ovarian suppression is achieved under the action of a-HRH (as judged by the doctor at the 2nd appointment by reducing the concentration of estradiol in the blood and a characteristic ultrasound picture ), the doctor makes additional appointments for the patient. The dose of a-HRH is halved and a new drug is prescribed directly to stimulate the “suppressed” ovaries - gonadotropic hormone preparations - Menopur or Puregon (Gonal-F) in addition to a-HRH for 12-14 days. The scheme described above - the a-HRH + HMG (FSH) complex allows you to significantly increase the number of follicles in the ovaries. This, in turn, improves the quantity and quality of the embryos obtained and allows planning the treatment cycle taking into account the wishes and needs of the patient: “bring closer” or, conversely, “move back” for several days the puncture of the follicles to obtain mature eggs in them without fear that this will worsen the results of treatment. This stimulation continues up to a single appointment in the middle of the cycle of the hCG drug, which causes the maturation of the eggs in the follicles, which allows them to be prepared for puncture at the second stage of treatment (the stage of puncture of the obtained follicles). Gonadotropins are usually used to stimulate ovulation three types: HMG - "Menopur" and FSH - "Puregon" or "Gonal-F". The first day of the introduction of gonadotropins is considered the first day of the cycle, and the countdown is continued from this day. In this IVF treatment cycles differ from other stimulated cycles used in assisted reproduction (intrauterine insemination or insemination with donor sperm), in which stimulation begins on the 3rd - 5th day of the menstrual cycle and without prior administration of a-GHG. The drugs act on the ovaries and stimulate follicular maturation. The dose of the administered drug to stimulate the growth of follicles is selected individually, taking into account the woman's age, her weight and the initial state of the ovaries (their functional reserve) and depends on the response of the ovaries to IVF treatment. This reaction is periodically assessed by the level of sex hormones in the blood serum (estradiol) and the ultrasound picture (the number and size of follicles in each of the ovaries, as well as the thickness of the endometrium). Ultrasound and determining the concentration of estradiol during treatment with hormonal drugs are called “Ultrasound - and hormonal monitoring.

^ Ultrasound and hormonal monitoring

^ Organizational moments

^ Ultrasound monitoring is carried out by the attending physician at the reception, and a blood test for estradiol is given in the direction of the doctor in the diagnostic laboratory. Monitoring is not paid separately, because its cost is included in the cost of this stage of treatment. The frequency of monitoring is set by the doctor depending on the results obtained (ultrasound picture and estradiol concentration). The date and time of each subsequent visit to the doctor for monitoring is entered in the appointment sheet, which is in the hands of the patient. As a rule, the number of visits does not exceed 4 or 5. The time is chosen necessarily taking into account the wishes of the patient, because most of them continue to work.Usually, ultrasound is performed with a vaginal sensor (abdominal ultrasound), which is much more informative than conventional ultrasound through the abdominal wall. Before performing an abdominal ultrasound, you need to empty bladder to improve the quality of the resulting image. The nurse invites you to the monitoring room. You will be asked to undress as for a gynecological examination, after which you lie down on a prepared gynecological chair and your attending physician is invited. The sensor is inserted by the doctor into the patient's vagina, after which a sterile condom is put on it, which is discarded after use. The ultrasound procedure is completely painless and safe. Some patients may experience a feeling of discomfort or embarrassment, there may be a slight discharge from the vagina after the end of the ultrasound procedure, mainly associated with the use of a special gel to improve the quality of the image obtained. What is evaluated on monitoring? The first ultrasound monitoring is usually performed on the 5th or 6th day of gonadotropin stimulation to assess the ovarian response (follicle growth dynamics) and endometrial thickness in order to select the most optimal dose of the drug and determine the date of the next visit. Before the beginning active growth follicles (until they reach sizes of 10 mm and above), ultrasound is performed 1 time in 4-5 days, then the ovaries are examined more often - 1 time in 2-3 days. Blood tests for estradiol are taken either at the same frequency or somewhat less frequently (depending on the specific situation). Depending on the dynamics of follicle growth and hormonal levels, the attending physician determines the frequency of attendance for monitoring individually for each patient and selects the exact dose of drugs. At each monitoring the doctor determines the number of follicles in each ovary, measures the diameter of each follicle, evaluates the thickness of the uterine mucosa. Finally, when your doctor decides that you are ready for follicle puncture (more precisely, the follicles are ripe enough for puncture in order to collect oocytes), you will be prescribed hCG injection. As a rule, this drug is prescribed 35-36 hours before the puncture itself for the final maturation of the eggs. If the puncture is not carried out, ovulation occurs 42-48 hours after the time of injection. The main and mandatory conditions for the appointment of hCG are some degree follicular development by ultrasound (at least 3 mature follicles). A potentially mature follicle against the background of stimulation is a follicle measuring 18-20 millimeters.

^ Second stage - puncture of follicles

^ The purpose of this stage is to obtain eggs from the stimulated ovarian follicles by puncturing them with a hollow needle (puncture). This intervention is carried out under ultrasound control, under sterile conditions (operating room) and under intravenous anesthesia. The date and time of the proposed puncture are recorded in the patient's appointment sheet. The contents of the follicle (follicular fluid with eggs) are transported to the embryological laboratory in special sterile disposable plastic containers made of non-toxic polymer. The entire follicle puncture procedure lasts, on average, 15-20 minutes.

^ Memo for patients before follicle puncture

^ In order to avoid vomiting during and after anesthesia, it is necessary: ​​In the evening, on the eve of the puncture, refrain from eating after 18:00 and from taking any liquids after 24:00. On the day of the procedure, refrain from eating and any liquids before the procedure. An urgent request is to come to the puncture without makeup, contact lenses, manicure and jewelry. You don't have to take off your wedding ring. By the time the puncture is completed, the spouse or donor must donate sperm for its subsequent analysis, special processing and fertilization of the resulting eggs. Then the patient is invited to a special dressing room: her body temperature, blood pressure are measured, her general well-being is ascertained, and she is asked to completely empty her bladder. She is escorted to the operating room, where she is prepared for the puncture: they help her lie down in the gynecological chair, treat the external genital organs. An anesthesiologist and the attending physician are invited to the operating room. After the introduction of drugs for anesthesia (that is, when you fall asleep), the procedure itself is carried out. After the puncture, you are under the supervision of the hospital's medical staff for 1.5-2 hours. After the anesthesiologist has made sure that you are in a satisfactory condition and feel well, you will be allowed to stand up. The IVF laboratory nurse accompanies you and your husband to the attending physician.

^ Memo for patients after follicle puncture

^ The doctor informs you about the results of the puncture, makes new appointments, sets the date and time of embryo transfer. After the puncture, you can eat and drink as you see fit, according to your well-being. In order to prevent the occurrence of an infectious process after the puncture, you will be advised to take antibiotics (a single loading dose of a broad-spectrum antibiotic - for example, 1 capsule of doxycycline).

After the procedure, you may experience some pain in the pelvic area, a feeling of fatigue or even drowsiness (the latter is associated with the use of anesthesia). There may also be minor bloody issues from the genital tract after puncture associated with a puncture of the vaginal wall during puncture. As a rule, they are scarce and vary in color from red to dark brown.

^ Please tell your doctor if you experience any of the following symptoms after the puncture:

High temperature (over 37 degrees C).

Severe bleeding from the vagina.

Unusual or severe pain in the pelvic area.

Difficulty urinating or stool problems.

Nausea, vomiting or diarrhea.

Sharp or shooting pain.

Pain or cutting when urinating.

Unusual back pain.

An increase in the circumference of the abdomen.

^ Support for corpus luteum function

^ In place of punctured follicles, yellow bodies are formed. Normally, a corpus luteum is also formed in a woman of reproductive age at the site of a mature follicle that “bursted” during ovulation, main function which is the production of the hormone progesterone, which "prepares" the uterine mucosa for the attachment of the embryo. However, in IVF cycles, α-GH drugs are used to stimulate ovulation, which reduce the function of the corpus luteum. Moreover, levels of the hormone estradiol in stimulated cycles are disproportionately elevated compared to progesterone. Therefore, medical support for the function of the corpus luteum and normalization of the ratio of estrogen and progesterone is necessary, starting from the day of follicle puncture. This improves the condition of the uterine mucosa - the endometrium and thereby increases the chances of successful implantation (attachment) of the embryos. In most cases, a natural hormone is prescribed progesterone in the form of a pharmaceutical Utrozhestan"or synthetic progesterone" Duphaston". "Utrozhestan" is available in the form of capsules for oral administration (through the mouth) or into the vagina. The vaginal route of administration of the drug is preferable, since in this case it immediately enters the uterus, bypassing the systemic (general) bloodstream. "Dufaston" is available in tablet form and is taken only orally. In some cases, after the puncture of the follicles, up to the day of the pregnancy test, such drugs are prescribed as, for example, " Proginova" or " Estrophem". Both drugs contain another female hormone, estradiol, which also takes part in the preparation of the uterine lining for implantation. The drugs are available in the form of tablets, but Proginova is taken orally, and Estrofem is injected into the vagina. The choice of the type and dosage of the drug is carried out individually. All appointments are recorded by your attending physician in the list of prescriptions immediately after the puncture, and then after the embryo transfer, the dose of the drugs is adjusted.

^ The third stage - fertilization of eggs and cultivation of embryos

^ After the follicular fluid enters the laboratory, the embryologist conducts a “search” for eggs, which are then placed in an incubator. Fertilization is carried out with concentrated sperm 4-6 hours after receiving the eggs. For conventional fertilization, approximately 50 thousand spermatozoa are used for each egg. If the sperm parameters do not meet the requirements of standard IVF or previous IVF attempts were unsuccessful, the issue of further treatment tactics is discussed (possibly ICSI or IVF using donor sperm). The ICSI technique is used to fertilize mature eggs in case of sperm abnormalities in the spouse (“ICSI”). If it is difficult to obtain sperm on the day of puncture or there are no spermatozoa in the ejaculate, a special procedure is provided - testicular biopsy. The day of puncture is considered zero day of embryo cultivation; the first day of cultivation is the day following the puncture. It is on this day that most eggs show the first signs of fertilization. They are already noticeable 16 - 18 hours after the connection of eggs with spermatozoa (insemination). Reassessment of fertilization is carried out 24-26 hours after insemination. Fertilization control is carried out by the embryologist when looking at dishes with cultured cells under a microscope. One of the reasons for IVF failure is the lack of egg fertilization. Often it is not possible to establish the reason for this, despite the wide knowledge of scientists in this field. No one is immune from this, and such an outcome is often difficult to predict, but it must be remembered. If your couple did not have egg fertilization with the standard IVF method, you and your husband need to visit a doctor to decide on the further tactics of managing your couple. Possible options: re-sperm donation and ICSI procedure, or ICSI with sperm already obtained on the day of puncture (if it is good quality). It is advisable from the very beginning, even before the puncture, to discuss the possibility of switching to ICSI in case of failure of the standard IVF procedure.

^ Stages of embryonic development

^ A fertilized egg is called a zygote - it is a single-celled embryo that already contains a double set of chromosomes, that is, from the paternal and maternal organism. However, the presence of zygotes is not yet sufficient to resolve the issue of the possibility of transferring embryos into the uterine cavity. First you need to make sure the normal crushing and development of embryos. This can only be judged on the basis of the quantity and quality of the dividing cells of the embryo and not earlier than a day after fertilization, when the first signs of crushing appear. They appear most clearly only on the second day of cultivation. Every day, the embryologist evaluates the embryos with the fixation of all parameters: the number and quality of embryonic cells (blastomeres), the rate of cleavage, the presence of deviations, etc. Only good quality embryos are subject to transfer. Embryo transfer is carried out on the 2nd - 5th day of cultivation - depending on the rate of their development and the quality of the embryos. Until recently, embryos were cultured for three days and then transferred to the uterus and / or frozen. At present, the so-called extended culture of embryos for five or six days until they reach the blastocyst stage is widespread. Blastocysts have a higher implantation success rate, allowing fewer embryos to be transferred and reducing the risk of multiple pregnancies while increasing pregnancy rates.

^ Fourth Stage - Embryo Transfer

^ As mentioned above, embryo transfer is carried out on the 2nd - 5th day of cultivation, depending on the stage of their development. On the day of the embryo transfer, you must arrive 30 minutes before the scheduled time. The presence of the husband is possible, but not required. On the day of the transfer, we allow patients a light breakfast, but fluid intake should be limited. This will reduce the discomfort associated with a full bladder. Immediately prior to embryo transfer, the doctor, embryologist and couple decide on the number of embryos to be transferred. The embryologist demonstrates the embryos selected for transfer in the photograph, answers the questions of interest to the married couple. After receiving information about the doctor’s readiness for the embryo transfer procedure, the embryologist carries out a set of embryos in a transfer catheter, which is a thin plastic tube with an attached syringe, and passes it to the doctor, the person who carries out the transfer. The embryo transfer procedure is easy to technical terms. The patient lies on a gynecological chair. The doctor exposes the cervix in the mirrors, after which he inserts a catheter through the cervical canal into the uterine cavity. The catheter contains embryos that enter the uterine cavity. Then the doctor passes the catheter to the embryologist, who examines its contents under a microscope for the remaining embryos in the catheter. Embryo transfer usually does not take much time (5-10 minutes). The procedure is painless, although sometimes the patient may experience slight discomfort. In the event that, after the embryo transfer, the couple has "extra" good quality embryos, the couple is invited to freeze them for further storage and subsequent transfer after thawing in case of no pregnancy after this IVF attempts (“Embryo Cryopreservation”). After embryo transfer, you are in a horizontal position for 40 - 45 minutes, after which you get dressed and invited to your doctor to discuss further treatment options and lifestyle.

^ How to behave after embryo transfer?

^ Your attending physician gives a detailed extract in 2 copies (to you and your attending physician at the place of residence) on the IVF treatment performed. The extract indicates: lifestyle recommendations, the timing of the pregnancy test and ultrasound, dosage and duration of medication. In addition, if necessary (working patients) a disability certificate (sick leave) is issued. Patients from other cities are issued an open sick leave, which they can extend at their place of residence. After embryo transfer, the dose of progesterone preparations (Utrozhestan or Duphaston) is usually doubled, and their intake can continue up to 12-14 weeks pregnancy, when the placenta (baby place) is formed and releases “its own” progesterone in sufficient concentration. After the transfer, some patients note slight liquid spotting or air bubbles from the genital tract. Please don't worry about this. This does not mean that at this time your embryos are expelled from the uterine cavity. Immediately after the embryo transfer, it is very useful to lie down and try to relax when you come home. From the moment of transfer until the pregnancy test, you can safely return to most of your daily activities and duties with the exception of excessive physical activity. It is considered absolutely normal that with a negative pregnancy test result, you will blame yourself for doing something or , on the contrary, did not do during this period of time - the waiting time. In this regard, try not to do anything for which you will reproach yourself if pregnancy does not occur, and follow the recommendations below: - Do not take a bath and do not swim in first day after transfer. - Do not shower or splash water. - Do not use tampons. - Do not be sexually active until you receive your first pregnancy test. - Do not engage in running, aerobics, tennis, skiing, mountaineering and other similar species sports. - Do not start other sports or physical education. - Don't lift heavy things. You can return to "work" after 24 hours in bed and one or two days of moderate physical activity. Try to do something to take your mind off waiting for pregnancy test results, which will help you get through those 12 to 14 days. You may have slight spotting from your vagina before taking a pregnancy test. Approximately 50% of our IVF pregnant patients had similar discharge before the test and even after receiving it. positive result! Do not lose optimism! You should definitely donate blood for analysis, even if you think that these discharges are menstruation and pregnancy has not occurred. A quantitative pregnancy test should be done - determination of hCG in the blood. Diagnosis of pregnancy Quantitative hCG - a pregnancy test should be done 14 days after the embryo transfer. If this time falls on a "Sunday" day off, the test can be done on Monday. Patients from other cities are advised to do an hCG test at their place of residence and inform us by phone about its results. A blood test for hCG determines the hormone (chorionic gonadotropin) secreted by the embryo in case of its attachment in the uterine cavity. As a rule, the concentration of this hormone is comparable to the result of IVF treatment: the presence of pregnancy, the number of embryos in the uterine cavity, etc. Most pregnancy tests give either positive or negative results. However, sometimes there are “weakly positive” results - a low concentration of hCG in the blood. If you were given just such a result, it may indicate the following: - Late, but normal embryo implantation. - Interrupted pregnancy. - Ectopic pregnancy. - Laboratory error. Further monitoring of hCG is extremely important in each of the above situations. After 2-3 days after a weakly positive result, you need to repeat this study. A second blood test for hCG will give us the opportunity to determine if your pregnancy is progressing and developing normally. The first ultrasound is recommended one week after the day of the pregnancy test (or 3 weeks after the embryo transfer). This is an ultrasound early term extremely important in terms of the possibility of abortion (miscarriage), ectopic pregnancy and multiple pregnancy. Ectopic tubal pregnancy may occur in 2-3% of pregnancies after IVF. Timely, early diagnosis ectopic pregnancy and laparoscopic surgery avoids serious complications that threaten the woman's life. The second ultrasound examination is performed 10 days after the first one in order to confirm the normal development of the pregnancy - to determine the fetal heartbeat. As soon as the doctor detects the fetal heartbeat, he recommends that you contact your obstetrician-gynecologist for early registration for a dispensary pregnancy. Approximate gestational age this moment will be 6-7 weeks. With a negative pregnancy test, you stop taking progesterone. It will be 3 or 5 days before the menstruation comes, if it has not come before. Your menstrual flow may be different from your normal periods (heavier, thinner, shorter or longer). If menstruation does not come within the next week, inform your doctor and repeat the blood test for hCG.Gonadotropin preparations Operating start such drugs are the two main gonadotropic hormones of the pituitary gland, necessary for the normal functioning of the woman's ovaries. FSH - follicle-stimulating hormone is responsible for the growth and development of the follicle in the ovary, and LH - luteinizing hormone ensures the final maturation of the egg and ovulation in the middle of the cycle (rupture of the leading follicle and release of the mature egg into the abdominal cavity). There are two types of gonadotropic hormone drugs: hMG drugs - contain both hormones - FSH and LH; FSH preparations - contain only the hormone FSH. In our clinic, the most commonly used HMG preparations are Menopur (Ferring, Germany), and FSH preparations are Puregon (Organon, Holland) and Gonal-F (Serono, Italy) . These drugs differ not only in composition, but also in the technology of their production. "Menopur" is obtained from the urine of women in menopause, using a special technology of high purification. Preparations "Puregon" and "Gonal-F" are created by genetic engineering - the composition of the preparations includes only a certain part of the FSH molecule, which directly ensures the growth of the follicle. The use of all drugs is safe in terms of the risk of developing an immune reaction against "foreign" hormones. Side effects These drugs occur infrequently and include abdominal discomfort, flatulence (bloating), mood swings, fatigue or restlessness, which in most cases subside or disappear completely after follicular puncture. One of possible complications therapy with gonadotropic hormones is multiple growth of follicles and the development of ovarian hyperstimulation (“ovarian hyperstimulation syndrome”). The drugs are available in the form of a dry substance (powder) and an attached solvent (in ampoules) and are administered once a day intramuscularly. At the same time, 2-4 ampoules of dry matter are diluted with the contents of one ampoule of the solvent. Usually, patients inject themselves, sometimes they involve their relatives or friends who can make intramuscular injections. It will be better if the nurse gives the first injection in order to teach the patient or the person who will give her injections how to administer the drug. It is important to administer the drugs at the dose prescribed by the doctor at the same time of day, preferably in the 2nd half of the day. Instructions for IVF patients on the administration of Menopur, Puregon and Gonal-F dry your hands. Prepare in advance: one sterile syringe with a needle for intramuscular injections, 2 cotton balls moistened with 70% alcohol, one ampoule of solvent and 3 or 4 ampoules of the medicinal substance (in accordance with the prescription sheet). With an alcohol ball, treat the index and thumb right hand and quickly (in one motion) uncork the ampoules. Remove the cap from the needle and draw 1 or 2 ml of water (the proposed sterile solvent) into the syringe and dissolve this amount of solvent in turn in each of 2-4 ampoules with dry matter, sequentially transferring the contents of the previous ampoule (already dissolved) into the next ampoule (with not yet dissolved dry matter). The substance dissolves almost instantly; the needle should be inserted as deep as possible into the ampoule. Draw the dissolved contents of all ampoules into the syringe; holding the syringe vertically, lightly press the plunger to remove all air bubbles from the syringe. Take the syringe and the new spirit bulb in your right hand. Choose a site for the injection, it is desirable that it does not coincide with the site of the previous (yesterday's) injection. Gently grasp the skin in this area with your left hand. Take a comfortable position and, leaning on the leg opposite to the one where the injection is to be made, try to relax the muscles of the latter as much as possible. Apply an alcohol ball to the injection site and hold the ball under the thumb of your left hand. Holding the filled syringe like a “throwing spear”, pierce the skin with the needle (the penetration depth should be at least 1/2 the length of the needle) and quickly insert the needle into the muscle. Squeeze out the contents of the syringe by gently pressing the plunger, then quickly remove the needle. Clean the injection site with an alcohol swab. All used material (cotton balls, used syringes, etc.) is thrown away (in regular waste containers - some special equipment not required). Gonadoliberin agonists So that the woman's own pituitary hormones do not interfere with the stimulation of superovulation, their production is blocked by analogues (agonists) of the hormone gonadoliberin (a - GRG). The active principle of the drugs is the compound triptorelin - a synthetic analogue of gonadoliberin. The latter causes the release of gonadotropic hormones in the female body, which, in turn, have a direct effect on the production of female sex hormones, the growth of follicles and the maturation of eggs in the ovaries. Gonadoliberin agonists prepare the ovaries and thereby “unify” the conditions for the subsequent maturation of follicles during stimulation. In addition, these drugs prevent premature ovulation, that is, the rupture of the follicles before the puncture. Of the agonists, Decapeptyl Daily (Ferring, Germany) and Diferelin Daily (Ipsen, France) are most commonly used. The drugs are available in the form of forms for daily injections (daily - from English word"daily" - daily) and deposited forms (the drug is administered once every 4 weeks). In the IVF program, drugs with daily administration are most often used. Most drugs are produced for subcutaneous injections, some drugs are administered intramuscularly. "Dekapeptil-Daily" The drug is available in the form of ready-made syringes of 2 types: "Dekapeptil - Daily 0.5 mg" - and "Decapeptyl - Daily 0.1 mg". Each such syringe looks very much like an insulin syringe, which patients use. diabetes- very thin (no thicker than a hair needle for painless subcutaneous injection of the drug). Usually we prescribe "Decapeptyl - daily 0.1 mg" as daily subcutaneous injections. One package contains 7 or 28 syringes with the drug. The drug is stored in the refrigerator. One syringe is enough for one injection (when administered in the first 10-14 days of treatment); when the doctor reduces the daily dosage (the next 12-14 days of administration of a-HRH - already together with gonadotropin preparations), it is enough to inject not the entire syringe, but only half of its contents per day, and the medicine remaining in the syringe (0.5 ml) is recommended to be stored in refrigerator until the next dose (after putting a cap on the needle). Immediately before the administration of the drug, it is not necessary to heat it up additionally. Instructions for the administration of "Decapeptyl-Daily 0.1 mg" Open the package and take the syringe from the package. Remove the plastic cap from the syringe needle. Take the syringe to left hand and a cotton ball soaked in 95% alcohol in the right hand. Choose the site of the subcutaneous injection (on the shoulder or on the anterior abdominal wall); it is advisable to change injection sites daily. Gently clean the injection site with a cotton ball soaked in alcohol. Holding the syringe in your right hand like a "throwing spear", at an angle to the surface of the skin, quickly insert the syringe needle under the skin. Smoothly, without jerking, squeeze out the entire contents of the syringe, then remove the needle, treat the injection site with a new cotton ball with alcohol and discard the used syringe. When you start the introduction of "Menogon" or "Puregon", the dose of "Decapeptyl-Daily" is reduced exactly by half; the syringe is not thrown away, and the second half of the contents of the syringe remaining after the injection is stored until the next injection in the refrigerator, for which the cap is put on the needle again. ampoules) and administered once a day subcutaneously. At the same time, the contents of the dry matter ampoule are diluted with the contents of one ampoule of the solvent. Instructions for the introduction of "Diferelin-daily 0.1 mg" Wash and dry your hands thoroughly. Prepare in advance: one sterile syringe with a needle for intramuscular injection, 2 cotton balls moistened with 70% alcohol, one ampoule of solvent and a bottle of dry substance. Use an alcohol ball to treat the index and thumb of the right hand and quickly (in one motion) open the ampoule with the solvent. Use an alcohol ball to treat the cap of the bottle and open it. Remove the cap from the needle and draw 1 or 2 ml of water (provided sterile diluent) into the syringe and dissolve this amount of diluent in the dry vial; The substance dissolves almost instantly; the needle should be inserted as deep as possible into the ampoule. Draw the dissolved contents of the vial into the syringe; holding the syringe vertically, lightly press the plunger to remove all air bubbles from the syringe. Take the syringe and the new spirit bulb in your right hand. Choose the site of the subcutaneous injection (on the shoulder or on the anterior abdominal wall); it is advisable to change injection sites daily. Gently clean the injection site with a cotton ball soaked in alcohol. Holding the syringe in your right hand like a "throwing spear", at an angle to the surface of the skin, quickly insert the syringe needle under the skin. Smoothly, without jerking, squeeze out the entire contents of the syringe, then remove the needle, treat the injection site with a new cotton ball with alcohol and discard the used syringe. When you start the introduction of "Menogon" or "Puregon", the dose of "Diferelin-Daily" is reduced exactly by half; the syringe is not thrown away, and the second half of the contents of the syringe remaining after the injection is stored until the next injection in the refrigerator, for which the cap is put on the needle again. Gonadoliberin agonists must be administered at the same time, preferably in the evening. If you change the time of drug administration (the difference is more than an hour), you must inform your doctor about this and discuss the time of the next injection with him. detailed instructions of the manufacturer about the features of the use and storage of this drug, its side effects, which greatly facilitates their administration by the patients themselves. mood, hot flashes, rarely - depression. But all these manifestations are transient and indicate the effectiveness of the drug, paradoxically, because they are associated with a temporary decrease in the level of sex hormones (estradiol) in the body. All of these symptoms associated with a decrease in estrogen saturation disappear after the start of the administration of gonadotropins due to increased estrogen production in the stimulated ovaries of a woman. The drugs do not accumulate in the body, and all side symptoms disappear without a trace. Sometimes there is a little soreness, redness, or, less commonly, itching at the injection site (the injection site). This is a local allergic reaction, which usually does not require the appointment of additional drugs and discontinuation of the drug, but about it, as well as about other possible side effects the drug should be reported to the attending physician in a timely manner. Gonadoliberin antagonists Gonadoliberin antagonists (ant-HRH), like agonists, block the work of the pituitary gland, and thereby provide conditions for stimulating the growth of follicles. Antagonists are prescribed at the final stage of stimulation of follicle growth to prevent premature ovulation (as a rule, from the 6-7th day of stimulation, that is, the use of Menopur or Puregon). In the process of stimulation, as a rule, no more than 4-5 injections are required. Drugs in this group include Orgalutran (Organon, Holland) and Cetrotide (Serono, Italy). Our company uses the drug "Orgalutran". The drug is produced in the form of ready-made syringes "Ogralutran 0.25 mg". Each such syringe looks very similar to insulin, which is used by patients with diabetes mellitus - very thin (no thicker than a hair of a needle for painless subcutaneous injection of the drug). The drugs are prescribed as subcutaneous injections at the same time of the day, which is indicated by your doctor. Instructions for the introduction of the drug "Orgalutran 0.25 mg" Open the package and take the syringe from the package. Remove the plastic cap from the syringe needle. Take the syringe in your left hand and a cotton ball soaked in 95% alcohol in your right hand. Choose a site for subcutaneous injection (upper arm or anterior abdominal wall); it is advisable to change injection sites daily. Gently clean the injection site with a cotton ball soaked in alcohol. Holding the syringe in your right hand like a "throwing spear", at an angle to the surface of the skin, quickly insert the syringe needle under the skin. Squeeze out the contents of the syringe by gently pressing the plunger, then quickly remove the needle. Clean the injection site with an alcohol swab. All used material (cotton balls, used syringes, etc.) is thrown away (in regular trash cans - no special equipment required). which causes ovulation of the leading follicle in the middle of the menstrual cycle. HCG injection is designed to prepare the follicles for puncture and the final maturation of the eggs. Ovulation occurs 42-48 hours after hCG administration. Therefore, follicle puncture must be performed before ovulation, otherwise the follicles will be empty. HCG is prescribed 35 - 36 hours before the puncture. The time of prescribing the drug is recorded in the list of prescriptions and once again specified by your doctor immediately before the puncture. Many patients experience lower abdominal discomfort after an HCG injection due to an increase in the size of the ovaries and believe that they are ovulating. In fact, careful monitoring of patients during treatment and the drugs used (α-GH or antagonists) almost completely eliminate the risk of premature ovulation, i.e., ovulation before follicle puncture. HCG is produced by different companies under different commercial names. The most commonly used drug is Pregnil (Organon, Holland). The drug looks like a white powder. Each ampoule of dry matter is supplied with 1 ampoule of solvent. The drug is administered intramuscularly. HCG injection is carried out only once during the entire treatment cycle, the injection is painless and, as a rule, the patient makes it herself. Until the appointed time of the puncture (recorded in the appointment sheet), an additional visit by the patient to the doctor and blood tests for hormones is not required. Wash and dry your hands thoroughly. Prepare in advance: a disposable syringe with a needle, 2 cotton balls moistened with 70% alcohol, and medicine (an ampoule with a dry substance). Take the dry substance ampoule from the package; remove all plastic protective covers. Spray each ampoule with an alcohol ball. Remove the cap from the needle, insert the needle straight and firmly into the center of the rubber cap of the solvent ampoule. Turn the ampoule upside down. Lower the plunger of the syringe to draw up a sterile solvent (in the amount of 3 ml), then disconnect the empty ampoule. Remove air bubbles from the syringe by lightly flicking it or shaking it with your fingers, then squeezing out the air with the plunger of the syringe. Choose a place for intramuscular injection. Stretch the skin in the chosen place with your left hand. Take the ready-to-use syringe and a cotton ball soaked in alcohol in your right hand. Treat the skin with alcohol and hide the used ball under your left hand. Holding the syringe like a “throwing spear”, insert the needle into the muscle at an angle, then squeeze out the entire contents of the syringe with sharp pressure on the piston, remove the needle, and treat the injection site with a new cotton ball with alcohol. Place used tools and medications in a trash can.0ClosedPage: 1» GOAL - PREGNANCY! » Articles (recommended for reading) » A very detailed article about IVF (in stages) Rating of forums | Create a forum for free © 2007–2016 «QuadroSystems» LLC