How does the eco puncture work? On what day of the cycle is follicle puncture done during IVF? Features of the procedure

Follicle puncture is one of the stages of IVF. The degree of success of the result depends on the preparation for this procedure. If both parents prepare correctly, it will significantly increase the chances of conception.

In vitro fertilization is a method of combating infertility that allows the process of conception to occur. It is carried out outside the body of the expectant mother. A favorable environment is prepared for sperm and eggs in which their fusion occurs.

Eggs implanted in the uterus do not always take root. Sometimes the fetus dies and a miscarriage occurs.

If the procedure goes well and the woman becomes pregnant as a result, she needs constant monitoring. The expectant mother needs to periodically undergo tests, undergo examinations, and consult with a doctor.

Interesting! In vitro fertilization is an expensive procedure, starting from $20,000. Not every family can afford this, but the state annually allocates quotas for the poor so that they also have a chance to have children.

IVF is carried out if a couple is unable to conceive a child naturally.

There are various reasons for this:

1. The woman has no fallopian tubes or their patency is impaired.
2. The expectant mother suffers from endometriosis.
3. A man has poorly motile sperm or their number is limited.
4. There are complications after an abortion, miscarriage or ectopic pregnancy.

Less commonly, infertility is caused by diseases of the endocrine system and genital tract infections.

Stages of implementation

The process of in vitro fertilization is divided into the following stages:

1. Preparing men and women for it.
2. Examination, consultation with a doctor.
3. Hormonal stimulation of the ovaries.
4. Follicle puncture.
5. Obtaining sperm from a man, removing sperm from it.
6. Placing the egg and sperm in a special environment until they fuse.
7. Growing an embryo until it transforms into a blastocyst.
8. Implanting it into the uterus of the expectant mother.

If necessary, auxiliary manipulations are carried out - selection of the most active sperm, genetic analysis of the fertilized egg. When the implanted embryo does not take root, all stages are repeated again.

How to prepare properly?

The initial stage of IVF - preparing a man and a woman for this procedure involves following certain recommendations. Wherein you need to start not the day before the puncture, but 2-3 months before, because any rare changes in lifestyle are stressful for the body.

He also experiences additional stress when doing so, so you shouldn’t expose yourself to double stress. This may interfere with conception.

As part of the preparation, the expectant mother needs to:

1. Follow a special diet and drink more fluids.
2. Normalize your weight if possible. Excessive fatness can cause problems during fetal development.
3. Take vitamin complexes in consultation with a specialist.
4. Treat existing diseases. If you have chronic diseases, notify your doctor about this.
5. Make sure you have all your vaccinations, especially against jaundice.

A man needs:

1. Get tested.
2. Stop wearing tight clothes that squeeze your groin. This reduces the chances of conception.
3. Do not contact with paints and varnishes.
4. Refrain from masturbation.

Attention! Married couples who smoke and drink alcohol spend 2-3 times longer on fertilization than those who lead a healthy lifestyle.

It is advisable to reduce coffee consumption and not have sex 3-4 days before IVF to improve sperm quality. Moderate physical activity will be beneficial. Men and women should not visit the sauna or soak in a hot bath during this period.

Diet before the procedure

The emphasis is on a balanced menu rich in proteins. 2/3 of the daily amount of food should consist of animal proteins.

1. Chicken eggs, whole milk.
2. Fresh fruits.
3. Green tea, natural juices.
4. Seafood, sea fish.
5. Poultry, rabbit, pork, veal.

Important! It is advisable to eat homemade meat. In industrial conditions, chickens or pigs are raised with the help of hormones that stimulate active growth. Eating their meat can interfere with the process of conception.

You can’t eat a lot of salt - up to 5 g per day, fried and smoked foods.

On what day of the cycle is it done?

There are certain deadlines for follicle puncture. The date depends on the nature of the in vitro fertilization protocol.

The procedure is carried out on certain days:

• Days 12-22 – for a long protocol.
• Days 14-40 – for a short protocol.
• 10-14 days – for the ultra-short protocol.

At this time, the man donates sperm while mature eggs are removed from the woman under anesthesia. Sometimes frozen sperm are used.

What size should follicles be?

The size of the dominant follicle grows by several mm every day. When ovulation occurs, it normally reaches 18-24 mm in diameter. The follicles must be of this size in order to puncture them.

But if they are smaller, this is not a reason to worry. Follicles sometimes range in size from 10-22 mm. Their diameter does not indicate the presence of an egg in them. It may be the other way around - the small ones will contain eggs, but the large ones will not.

How many should there be in an ovary?

A healthy lifestyle is a guarantee of successful conception after puncture of the follicles and implantation of the embryo into the uterus. Sports activities in normal quantities are definitely needed.

Don't overload yourself intensely. The doctor can select special gymnastics to perform several times a week for 30-40 minutes.

Walking in the fresh air will be useful. It is better to walk away from the roadway - in the park, outside the city in a forest or meadow. The duration of stay on the street should be at least 1.5-2 hours a day.

Preparing for follicle puncture is a responsible undertaking. The success of fertilization depends on this. If a man and woman carefully prepare for the procedure, the chances of conceiving a child will increase significantly.

Puncture of mature follicles during IVF is an important stage of the protocol, on which further treatment of infertility depends. We will tell you in this article how this procedure goes and how to properly prepare for it.

What it is?

Every month in a woman of reproductive age, a follicle (sometimes two) matures in one of the ovaries. After menstruation ends, the process of maturation of this vesicle on the gonad begins. Under the influence of hormones, several follicles grow, but only one (rarely two) is destined to become dominant. It is from it that on the day of ovulation the egg will come out mature and ready to meet the sperm.

With in vitro fertilization, one egg is not enough, because the probability of conception and successful development of the embryo, and then the probability of implantation, is higher, the more eggs managed to be obtained at the stage of preparation of the gonads. A woman who is going to become a mother through IVF takes hormonal medications. Follicle-stimulating hormones in the first phase of the menstrual cycle make it possible to expect that more than one or two follicles will grow in the ovaries. Their growth is constantly monitored using ultrasound, and once at least three follicles reach a size of 16 to 22 mm according to ultrasound scanning, hCG is administered.

The injection of this hormone acts quickly and decisively. In 32-36 hours it causes rapid maturation of eggs. After this, the oocytes must be removed from the female body in order to proceed to the most important stage - laboratory fertilization. It is possible to obtain oocytes in only one way - by puncturing the follicles.

This procedure has the status of a minimally invasive surgical intervention; it requires preliminary preparation and proper implementation by medical personnel.

How is it carried out?

The manipulation takes place in a small operating room. On the appointed day (exactly 34-36 hours after the introduction of the ovulation trigger), the woman arrives at the clinic, but this should be done in advance, at least half an hour to forty minutes before the appointed time. The doctor will do another ultrasound to make a final count of mature follicles. Before puncture, they must be of sufficient size (about 18-22 mm).

The woman is also asked to resolve an important issue - what to do with the remaining eggs if she plans to receive a lot of them. In this case, she can agree to cryopreservation of her own germ cells, so that later, if she wants, she can use them for IVF; she can also give them to the cryobank as donors (subject to meeting the requirements for a donor based on health, age and other parameters ).

Among other things, a woman can refuse them in favor of science, then scientists will receive the biomaterial to conduct various studies and tests.

Before the puncture, the woman’s blood pressure and pulse are measured and she is escorted to the operating room. All manipulations are carried out on Rakhmanov’s bed. One day, if IVF is successful, you may have to give birth to your baby using exactly the same procedure. The woman changes into sterile clothes and shoe covers.

The anesthesiologist begins working with the patient first. Follicle puncture is a painful procedure, and therefore in Russia it is not customary to do it without anesthesia. In some European countries, they try to carry out manipulation without administering strong anesthetics, since a number of doctors believe that such drugs have a negative impact on the woman’s condition and complicate pregnancy and gestation in the future.

Russian gynecologists and reproductive specialists are more humane, they do not want to cause severe pain, in addition, they will be much calmer if the woman lies motionless during a subtle and delicate manipulation, which cannot be guaranteed unless she is given anesthesia.

The choice may be general anesthesia with the use of a face mask or intravenous administration of drugs that will induce deep medicated sleep with the absence of any sensitivity.

Some women who have read on the Internet about the “miracles of IVF in the USA or Israel” ask not to be given anesthesia. In this case, they are warned about pain. There is no local anesthesia for ovarian puncture. If the patient is determined to refuse anesthesia, she will be given a painkiller tablet or given an intramuscular injection half an hour before the procedure. An important condition is that the follicles must be easily accessible (this is determined by ultrasound) and their number must be small.

If there are many follicles and access to them is difficult, the absence of anesthesia is out of the question. Those who especially insist on its absence may be denied a puncture. This is required by medical ethics.

After the woman falls asleep, the most important thing begins. The most common method of obtaining oocytes from stimulated ovaries is transvaginal. With it, a puncture is made in the vaginal vault and access to the ovaries is gained through it. There is a second way to take eggs for fertilization - laparoscopic. It is used only when a woman's ovaries are located abnormally.

A special long puncture needle is used to collect eggs transvaginally. It is inserted into the vaginal vault, into its back wall, and then the doctor carefully moves it towards the follicles. Each of them is pierced sequentially, in turn, and its contents are aspirated (sucked out) through a needle into a special container. The follicular fluid along with the eggs is sent in a polymer vessel to the laboratory, where embryologists are already waiting for it.

These specialists will have to conduct an initial examination of the oocytes, wash them from follicular fluid and other impurities and provide the eggs with a “warm welcome” with the sperm of the husband or donor in a Petri dish or by the ICSI method, in which a separate selected sperm is injected into the cytoplasmic fluid of the oocyte directly under the membrane.

Puncture needles, which are used to collect oocytes, have a special coating that should prevent trauma to the female ovaries, and the internal coating of the needles does not allow “maiming” the eggs themselves as they pass through the system as part of the follicular fluid. Doctors observe all the details of what is happening in real time on the monitor of the ultrasound machine. At the end of the puncture needle there is a small air bubble, which serves as a “beacon” that is “detected” by the ultrasound sensor.

Often, after obtaining follicular fluid, doctors carry out preventive manipulations that should prevent hyperstimulation syndrome, which can occur as a consequence of aggressive hormonal therapy (especially often after the drugs Decapeptyl and Clomiphene). To do this, the same needle, without removing it, is advanced along all the follicles that have grown, but are not sufficient for fertilization. The doctor uses a needle to remove them as unnecessary.

Approximately 60% of doctors do not consider such prophylaxis useful because it increases the likelihood of infection or injury. They are limited to only puncture to obtain oocytes, without affecting other follicles.

In any case, they try to pierce the vaginal vault only once, and all subsequent manipulations are performed through one puncture, changing the angle and depth of penetration of the puncture needle. It is not always possible to obtain eggs; the reason for the lack of opportunity may be the inaccessibility of a particular follicle for puncture. If access may be dangerous from the point of view of developing injury to the woman’s gonad with a puncture needle, such follicles are not punctured. The entire described process lasts no more than 15-20 minutes.

The woman is transferred to a ward, where she gradually wakes up, “comes off” from the anesthesia and gains clarity of thinking. She is monitored by the attending physician. It is customary to stay in the ward from 2 to 4 hours - this depends on the individual reaction of the fair sex to anesthesia. As soon as the doctor considers that the woman’s condition is quite stable, he will give her recommendations on how to adhere to the further regimen and send her home for a few days, until the time comes to transfer the embryos into the uterine cavity.

Preparation for puncture

Preparation begins long before the IVF protocol. In order to obtain better quality eggs during treatment and increase the chances of maturation of several full-fledged oocytes, a woman is recommended to have a protein diet, a sufficient amount of vitamins, as well as the mandatory availability of sufficient and high-calorie nutrition. Excessive, exhausting physical activity should be excluded, be it physical labor in the country or going to the gym.

A woman is not recommended to steam in a sauna or take hot baths, limiting herself to a warm shower. You should also not take any medications unless permitted and prescribed by a doctor - medications can negatively affect the quality of reproductive cells. You should quit smoking in advance; drinking alcohol is prohibited.

Since most surgical procedures are usually scheduled for the morning or lunchtime, a woman should not eat since the evening of the previous day. There is no need to drink liquids in the morning. If the procedure is performed on an empty stomach, the chances of normal tolerance to anesthesia are higher. Sleep on the eve of the operation should be complete, at least 8-9 hours, stress and anxiety should be excluded.

A woman needs to take with her to the clinic only her passport and the appointment sheet that was created when joining the protocol. Do not wear contact lenses, earrings, rings, chains, or bracelets. Hair should be collected carefully. Makeup will be clearly unnecessary.

How you feel after the procedure

After follicular puncture, a woman may feel slightly dizzy and drowsy. Light pinkish discharge from the genital tract is considered acceptable. They are associated with mechanical damage to the vaginal vault during a puncture and pass quite quickly - within a day the condition usually normalizes and the discharge stops.

A slight increase in temperature to subfebrile levels (37.0 - 37.8 degrees) is also considered quite natural. After the puncture, the woman is given a single large dose of a broad-spectrum antibiotic, which should prevent possible inflammatory processes after the intervention.

Also, usually from the first day after the puncture (that is, on the day of the procedure), progesterone medications are started. Usually, Duphaston or Utrozhestan is prescribed in individual dosages.

A woman is strongly recommended to behave as carefully as possible after a puncture - avoid exertion, stress, and sexual relations. On the first day, it is better to lie down and rest, sleep, read a book or watch a movie. On the second day you can do household chores, but without fanaticism. A high-calorie protein diet is recommended. It is necessary to reduce the amount of salt consumed, and also avoid foods that can lead to more intense formation of gases in the intestines (peas, beans, black bread, kvass, yeast baked goods, baked goods, cabbage, oranges).

If your lower abdomen hurts after a puncture, this is quite normal. The intensity of the pain syndrome depends on the number of punctured follicles and on the method of obtaining oocytes. With transvaginal manipulation, pain most often subsides the next day. If the sampling was performed by laparoscopy, pain may be present for up to 3-4 days, and there is often a feeling that the abdomen is “bloated” and constipation may occur.

When asked what medications can be taken after a puncture, the attending physician will best answer. Usually, No-Spa is recommended for abdominal pain, and it is also recommended to take it for headaches. For constipation, you can use Bisacodyl rectal suppositories or microenemas. Low-grade fever after a puncture does not require medication to reduce it. It is important not to forget to take hormonal medications prescribed by the doctor on time; the preparation of the endometrium of the uterus for the upcoming implantation of embryos depends on this.

The recovery period after puncture usually lasts 2-3 days. Within a day after the puncture, a woman can find out how many embryos were produced, and another day later she can be told how many of them are developing and growing normally. Usually two-day, three-day or five-day embryos are transplanted into the uterine cavity. The attending physician will decide this.

Possibility of complications

With the current level of development of medicine, complications after oocyte retrieval occur extremely rarely. But every woman who is undergoing such a procedure needs to know about them. First of all, this is necessary in order to notice the symptoms of complications in time and promptly seek medical help. Negative consequences can be caused by a completely human factor - an insufficiently experienced doctor can injure a blood vessel, in which blood may leak into the abdominal cavity. Also theoretically possible are ovarian injuries, development of turbo-ovarian space, ovarian abscess, and ovarian torsion.

No matter how scary all this may sound, the statistics are quite optimistic - such complications occur no more often than in 0.5-1% of all cases of follicle puncture.

The most common complication is the development of ovarian hyperstimulation syndrome. But this is most likely a consequence of their previous hormonal stimulation, and not the process of puncturing the follicles itself. With hyperstimulation, the ovaries increase in size, this is accompanied by quite severe pain in the abdomen and lower back. This complication, according to statistics, occurs in 2.5-3% of cases.

The true origin of the syndrome has not been established, but there is an assumption that it is triggered by an injection of hCG, and so far it seems the most likely. Due to a shift in the balance of hormones in a woman’s body, the permeability of the vascular walls increases, which can result in not only an increase in the size of the ovaries, but also an accumulation of blood in the abdominal cavity.

Women under the age of 35, underweight, with polycystic ovary syndrome, as well as women with allergies and women with high levels of estradiol in the blood are most often susceptible to this consequence. A mild degree of hyperstimulation syndrome is observed in everyone who undergoes hormonal preparation for oocyte collection in the IVF protocol, but in most cases everything goes away by itself and does not need correction. Moderate and severe forms of the syndrome are considered dangerous to the health and life of women.

Thus, the appearance of slight swelling, weight gain, bloating and nagging pain in the lower abdomen indicate a mild form. In more serious situations, vomiting, nausea, diarrhea, increasing bloating and thickening of the abdominal wall appear. The amount of urine excreted by the kidneys decreases, “spots before the eyes” may appear, and the hands and external genitalia become very swollen.

A woman should be more attentive to her well-being. If the temperature rises above 38.0 degrees, with increased pain, severe swelling and vomiting, you should call an ambulance. The woman must be taken to a hospital, where she will receive the necessary medical care.

In this case, embryo transfer can be postponed until a more appropriate moment. The embryos will be cryopreserved until the next protocol.

The transfer can also be canceled if, after the puncture, the woman’s chronic diseases worsened, signs of a viral infection (ARVI, influenza, etc.) appeared, signs of infection appeared, or the temperature increased.

Menstruation after follicle puncture without transfer usually comes within 3-5 days after stopping progesterone medications. If there is no transfer, the woman is immediately advised to stop taking Utrozhestan or Duphaston. The period itself may be more painful than usual.

It is hardly possible to imagine a full-fledged family without children. As they say, “people meet, people fall in love, get married,” but, unfortunately, not everyone succeeds with offspring. Modern medicine successfully solves this issue. One method is in vitro fertilization. Follicle puncture during IVF in this case is a mandatory procedure.

What is IVF?

IVF (in vitro fertilization) is the artificial conception of a baby, as a result of which eggs extracted from the ovary are mixed in a test tube filled with a nutrient medium with male sperm. A few days after artificial insemination, the egg is placed in the uterus, where it implants. Women are recommended to take the hormone progesterone, which prepares the womb for bearing a child.

In most cases, the embryo engrafts successfully. Often, to increase the chances of pregnancy, two or even three embryos are implanted. A pregnancy test after individual fertilization is taken seven to ten days.

If after the procedure there are “extra” embryos left, they are frozen to be used in the future (when the first time or when the couple wants a second child).

Eggs, like sperm, can be used from your own or from a donor. The in vitro fertilization method is indicated for those couples who suffer from infertility, women with and also men with incapacitated (slow) sperm.

On average, one IVF procedure takes from three to six weeks and costs 120-150 thousand rubles. Trying to get pregnant using artificial insemination should be stopped if IVF has failed three times.

Stages of IVF

Before IVF, you need to undergo a full examination and consult with your doctor about possible risks and complications. The specialist must examine the patient in a chair, perform an ultrasound and prescribe all the necessary tests (blood for hormones, cytological examinations of smears, smears for STDs, and so on).

For successful artificial insemination, a woman and a man need:

• Be healthy, free from acute and chronic inflammatory processes.
• Lead a healthy lifestyle, give up bad habits, including coffee.
• Limit physical activity.
• Follow a diet and take vitamins daily.
• Do not take any medications unless prescribed by a doctor.

In vitro fertilization is carried out in several stages and can take from three to six weeks.

First stage- Preparation. Includes a full examination of both partners.

Second phase- stimulation of ovulation. In all normal, healthy women, one egg matures during one menstrual cycle. To successfully perform IVF, doctors need to obtain two or more eggs. Therefore, ovulation is stimulated with the help of various hormonal drugs (“Megonin”, “Diferelin”, “Orgalutran”, “Menopur”, etc.). Only a doctor can prescribe such medications. The tablets are taken under the strict supervision of specialists. An ultrasound may be performed from time to time to determine the growth of the follicles.

When the follicles reach 16-20 mm, begin third stage. This is a puncture of follicles during IVF - the extraction of mature eggs using a special needle. The procedure takes from 15 to 30 minutes and is performed under local anesthesia with the participation of ultrasound. Simultaneously with the puncture, the partner must donate sperm.

The egg and sperm are sent to the laboratory for further examination and fertilization.

Fourth stage- fertilization. Mature eggs are placed in a laboratory test tube with a nutrient medium. Then sperm are injected there. The container is placed in an incubator for one or two days (rarely - five), where conception occurs. When a cell begins to rapidly divide, it is already called an embryo, which is ready for implantation.

Fifth stage- movement of embryos into the uterine cavity. The process takes a few minutes and is absolutely painless. The embryo is inserted into the uterine cavity using a special catheter. "Extra" embryos are cryopreserved for future use.

The first two weeks the embryo takes root in the uterus. Pregnancy can be diagnosed 10-14 days after the procedure. There are cases when pregnancy does not occur the first time. Don't despair. After some time, you can try again. After three unsuccessful attempts, IVF is no longer prescribed.

One of the in vitro fertilization programs is surrogacy. It is used in cases where a woman cannot bear a child on her own. Surrogacy is officially permitted in Russia, Ukraine, Kazakhstan and several US states. In other countries it is either prohibited or not regulated in any way by law.

Follicle puncture during IVF

Follicular puncture is the extraction of mature eggs for further fertilization in vitro. The procedure is performed transvaginally (through the vagina) under In rare cases, egg retrieval can be done, which is monitored by ultrasound. Time 10-15 minutes.

Before follicle puncture, it is important to comply with the following requirements:

• Two to three days before the procedure you should abstain from sexual intercourse.
• Follow a special protein diet. Avoid foods that cause fermentation for a while.
• The manipulation must be carried out in the morning on an empty stomach.
• A day and a half before the puncture, you need to give an injection of the hCG drug, which will accelerate the maturation of the follicles.

After the procedure, the patient may feel slightly dizzy and have pain in the lower abdomen. The ovaries enlarge after puncture of the follicles, sometimes up to 12 cm in diameter. Bloody discharge may also appear. This condition is considered normal.

The appearance of nausea and vomiting, acute pain and heavy bleeding should be alarming. You should immediately notify your doctor about the symptoms, as this can be dangerous not only for IVF, but also for the health of the patient herself.

The main component of artificial insemination is follicle puncture during IVF. Reviews about the procedure vary widely, but without it, conceiving a baby is impossible.

How to behave after IVF?

A married couple who has decided on IVF undoubtedly really wants to have a child. After a successful embryo transfer, a woman needs increased love and care. It is better for her to spend the first days after the procedure at home in bed.

Successful implantation of the embryo is already the beginning of pregnancy. However, such a pregnancy has its own “whims”. Very often, at first, a woman’s body, in particular the uterus, behaves aggressively towards the implanted embryo and rejects the new life. Therefore, after IVF, miscarriages occur much more often.

It is worth saying goodbye to all bad habits that often cause miscarriages.

A healthy lifestyle, proper nutrition and vitamins are all that is necessary to maintain pregnancy. It is important to remember a positive attitude and good emotions. After all, thoughts materialize!

A pregnancy test, as well as blood for hCG, must be taken at least two weeks after IVF. At five to six weeks of pregnancy, it is necessary to undergo an ultrasound examination, which will confirm the final growth and successful attachment of the embryo to the uterus.

Ovarian hyperstimulation syndrome

It should be noted that puncture of follicles during IVF (reviews about the procedure vary) is one of the most important stages of fertilization. However, for its implementation you need as many healthy mature eggs as possible. To do this, ovulation is stimulated using special hormonal drugs. A side effect of the drugs is hyperstimulation syndrome, which leads to the formation of cysts on them, rupture of these cysts and the accumulation of fluid in the abdominal cavity.

You can avoid unpleasant consequences with the help of thorough examinations that are carried out before fertilization. A hormone test is necessary. Thanks to it, you can calculate the exact dosages of drugs and avoid hyperstimulation.

If the patient experiences the following symptoms - pain and distension in the lower abdomen, rapid weight gain, increased waist circumference - she should immediately consult a doctor. This may be the beginning of hyperstimulation syndrome, moderate and severe degrees of which require hospital treatment.

Complications after IVF

Any procedure that is performed without training or by an inexperienced specialist can have negative consequences. This also applies to IVF. Thus, stimulation of ovulation sometimes leads to hyperstimulation. As a result, ascites may develop - a collection of

Complications sometimes arise after such a simple procedure as follicle puncture. Reviews from some patients are frightening - terrible pain, heavy bleeding. This is because during the puncture of the follicle, other pelvic organs may also be affected.

An equally common consequence of artificial insemination is infection. The main reason is medical negligence and unsterile conditions.

Therefore, you need to choose a clinic for IVF very carefully. And if such a manipulation as follicle puncture has negative reviews from patients, then the hospital that performs it should be avoided.

Contraindications to IVF

IVF is a medical procedure that gives infertile families a chance to become parents. However, this procedure has its contraindications. This:

• heart, blood vessels, respiratory system, liver, kidneys, digestive system, hereditary genetic diseases and others).
• Mental illnesses.
• Congenital defects, abnormal structures of the uterus.
• Benign and malignant formations in the uterus, when puncture of follicles during IVF becomes impossible (consequences - death of the patient).
• Acute inflammatory processes.

After treatment of the listed diseases, you can begin the IVF program. If the treatment of diseases does not bring results, the only way out is to use the surrogacy service.

Conclusion

Thanks to new medical technologies, IVF gives many couples hope for the birth of a baby. Thousands of families have already taken advantage of this opportunity and successfully became parents.

Puncture of follicles during IVF is a mandatory component, without which conceiving a new life is impossible. An egg for fertilization can be given either by a woman who is going to become a mother or by a donor woman.

This article provides recommendations that should be followed in the IVF protocol at each of its stages. You will be able to find out what regime should be followed, what can and cannot be done at the stage of superovulation stimulation, after puncture and after embryo transfer.

The IVF procedure can be divided into four important stages:

1. Induction of follicular growth
2. Puncture of stimulated follicles
3. Embryo transfer
4. Post-transfer period

This stage takes on average 8-12 days and includes injections of drugs to stimulate follicle growth. Gonadotropin drugs are used (Menopur, Puregon, Gonal-f, Elonva, etc.), as well as drugs to suppress the pituitary gland - gonadotropin-releasing hormone agonists and antagonists (diferelin, decapeptyl, cetrotide, orgalutran).

At this stage, follicle growth is monitored and, if necessary, the dose of prescribed medications is adjusted. Next, when the follicles reach a diameter of 18-20 mm, an ovulation trigger (hCG drug or gonadotropin agonist) and a puncture date are assigned.

While stimulating follicle growth, it is recommended to lead a measured, healthy lifestyle, spend more time in the fresh air, and eliminate physical activity. It is also advisable not to be sexually active. It is important to understand that by prescribing stimulation, we achieve the growth of all existing antral follicles, so sometimes more than 10 of them can grow. The ovaries increase in volume, which can lead to a feeling of heaviness and discomfort in the lower abdomen.

You cannot take laxatives or do a cleansing enema before a puncture without a doctor’s permission.

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Follicle puncture is performed under general anesthesia and takes no more than 20 minutes. After egg retrieval, the woman remains under observation in the ward for 2 hours, then is discharged home with doctor’s recommendations.

Driving after the procedure is prohibited.

On this day, luteal phase support and preparation for embryo transfer are prescribed.

For this purpose, progesterone preparations are prescribed (progesterone, utrozhestan, kraynon, iprozhin), duphaston, in some cases estrogens (divigel, proginova, estogel), and hCG preparations.

On the first day after puncture, a woman may experience moderate pain in the lower abdomen. This is normal, since during puncture the ovarian tissue is injured by the needle, which can cause pain in the future. But if pain occurs, you should not take painkillers, since their therapeutic effect can smooth out the picture of a possible complication, and help may be provided with a delay. If you experience intense abdominal pain, as well as weakness, dizziness, or bleeding, you should contact your doctor.

After the puncture, sexual rest is required for two weeks. At this time, you should also not take a hot bath, visit the sauna, solarium, swimming pool, or gym.

The next day after the puncture, until the moment the blood is tested for hCG, it is recommended to drink a large amount of still water or fruit drink without sugar (up to 3 liters). Food should contain a lot of protein and a minimum of coarse fiber (raw vegetables, fruits, legumes, brown bread excluded). It is also necessary to limit coffee, strong tea, cola, and alcoholic beverages are not allowed.

After puncture of a large number of follicles, sometimes from 2-3 days, complaints characteristic of ovarian hyperstimulation syndrome may appear: a feeling of fullness and bloating, nausea, vomiting, diarrhea, shortness of breath, rapid heartbeat (tachycardia), dry cough. If such signs appear, you should immediately consult your doctor.

The embryo transfer procedure is usually performed in the afternoon and in a standard situation does not require special preparation.

After embryo transfer, you can rest in the room for an hour.

This period lasts 14 days, after which a blood test for hCG is taken to diagnose pregnancy. These days, we recommend issuing a certificate of incapacity for work so that the woman can follow all the necessary recommendations. During this period it is necessary:

• Continue to follow the drinking regime and diet;
• Avoid physical activity, do not engage in fitness, but also do not lie down all day; short walks in the fresh air with a total duration of at least an hour are suitable;
• Do not stay in a forced position for a long time (for example, sitting) - this contributes to stagnation of blood in the pelvis;
• Try to feel only positive emotions and confidence in success.

In some cases, after embryo transfer, spotting and spotting may appear, which does not exclude pregnancy. In this case, you cannot cancel drug support and try to contact your doctor as quickly as possible.

If your blood test is positive for hCG, you must contact your doctor to receive further recommendations on treatment and when to discontinue some medications. In addition, the doctor introduces the woman to the monitoring plan for pregnant women after the IVF program.

In the case of a negative test for hCG (that is, in the absence of pregnancy), support medications are usually discontinued; an appointment with the attending physician is recommended after the next menstruation . After an IVF cycle with stimulation, the ovaries can return to normal within 1-2 months. In some cases, a doctor prescribes combined estrogen-gestagen drugs for therapeutic purposes.

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Questions for specialists

Eco Elena, 09/18/2019

Good afternoon Please tell me, there was a laparoscopy with removal of the tube. How much recovery time is needed to start an IVF protocol? And another question: can a husband donate sperm in advance and use frozen sperm for transfer in the protocol? Since there will be no way to come to the transfer

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Empty follicles Irina, 09/18/2019

Good afternoon. 1 protocol-amg 1.67; 32 years; stimulation gonal 187.5 trigger diferelin 0.2: 7 oocytes were obtained, on day 5 1 embryo. 2 protocol-amg 1.26;34 years; stimulation pergoveris 150+gonal 75; trigger ovitrel 250: not a single oocyte. Stimulation didn't work or? Cause? How to stimulate further?

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Medical services of inadequate quality Nadezhda, 09/16/2019

Hello, in another clinic they did a cryotransfer, the doctor did not look at any of the latest tests done specifically for this transfer, only with 2 hormones, can this be regarded as negligence, did the doctor have the right to prescribe medication in support, without even knowing the results of the analysis blood, urine, etc. I plan to apply for a refund for a service rendered of inadequate quality.

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Uterine fibroids in combination with adenomyosis Irina, 09/12/2019

Dear Maxim Stanislavovich! I want to contact you with my problem. Now I am 30 years old, I have one 3-year-old child. For 10 years I have been seeing a gynecologist due to the presence of multiple fibroids in combination with adenomyosis. The nodes do not stand still; there is growth dynamics. I have been seeing one gynecologist for a long time, but I go for additional consultations with others. All the doctors, while doing ultrasounds, ooh and ahh about what’s wrong with my uterus at such a fairly young age. No one prescribed any treatment. We couldn’t get pregnant for a little over a year; we wanted to stimulate the ovaries and send her for IVF, but we managed to get pregnant on our own and carry her to term without any problems. After going to the doctor, who has been observing me and my organ for a long time, she said that everything is bad, everything is growing, she is afraid of degeneration into sarcoma and said that the uterus must be removed, the ovaries remain, everything is fine with them. But she sent me for a definitive consultation with a doctor who does surgeries, she looked at the last ultrasound, looked at it on the chair, and said, everything is huge, it needs to be removed, but since I am quite young, and removal is always possible, and this is the last thing that can be done, She said, let’s try 3 injections of Luprid Depot, there are cases where everything decreases significantly and you can postpone the operation for some period. Now there are no plans for a second child with her husband, if only later, but she said there are no deadlines, either now after the injections, or never. In general, I was offered 2 options - inject myself and see what happens next, or lie down and remove the uterus and cervix. The last ultrasound was on August 22, 2019, on the 7th day of menstruation, uterine dimensions: length 120 mm, anterior-posterior. 119, width 120, uneven contours, non-uniform structure, inter.subser along the front wall. m/u 36×30, in the day 52×30mm, this is what can be measured with a device, so the entire uterus is dotted with small nodes, like grape bunches, endometrium 7 mm-1 phase, left ovary 34×15, unchanged, right 35 ×18, no changes. Conclusion: multiple uterine fibroids in combination with adenomyosis. Before that, the previous ultrasound was done on April 6, 2019, uterine dimensions: length 98, anterior-posterior. 110, width 115, uneven contours, heterogeneous structure, differential, along the front wall inter. subser. m/y 38×32, nearby 35×31mm, endometrium 12 mm, ovaries without changes. So from April to August the uterus has enlarged and now corresponds to 14 weeks of pregnancy, my doctor considers the only solution to be removal. She also considers the only way out to be injections, but then to cancel it, put on the Mirena spiral for 5 years and not touch the uterus. Other nynecologists don’t even know what to do with me and say directly, we can’t help, you need specialists of a completely different level, I’m unlikely to find them in Gomel. An aspirate was taken from the uterine cavity on June 6, 2019, according to the results everything was normal, the diagnosis was fibroids combined with adenomyosis, endometrial pathology. Termination: endometrium in the secretion phase, middle stage. I donated blood for tumor markers CA 125 -33, 11, HE 4 -81.53, ROMA premenopausal -21.31, ROMA postmenopausal - 27.87, PEA/CEA - 0.919. Hemoglobin 147, serum iron 21.7, ferritin 38.2. In addition to this, my gynecologist sent me to treat a cyst on the cervix, there was always an inflammatory type of smear, the cytology was normal, she said go treat it, suppositories won’t help, nothing will help, go treat it, you’ll come back like a new penny with a good cervix. I went for an additional paid colposcopy, the doctor said it was a purulent cyst, it needed to be treated, it was like a pimple on the face with contents and it would not disappear anywhere. On April 8, for a fee, a professor performed radio wave ablation of my cervix, two months later I came to see this professor, did a colposcopy, said everything has healed, live as you lived before and sent me home. I went again to another specialist for a colposcopy, she looked and said the wound had not yet healed at all, let it heal for another 2 months and not go in there. And the last doctor I saw, who was operating and said to try injections for now, when examined on the chair, she said that the cervix was in poor condition, that there were foci of endometriosis on it and this was most likely after ablation. She even took a photo and showed how inflamed it was, red-burgundy in color, that’s why she said that if the uterus is removed, I won’t leave you with such a cervix, it’s in bad condition. And if you give injections, then within 3 months, while I’m getting the injections, I’ll have my neck treated again, but not by the professor who did the ablation. They took an aspirate because after this ablation I bleed on the 16th day of my period and before the start of the next one, and so on from month to month, although this had never happened before with all my problems. My gynecologist said that this is not related to the ablation, it just coincided, your endometriosis is making itself felt, so to rule out the worst, they took an aspirate for me. And this doctor who performed the operation said that it was the cervix with endometriotic lesions that was bleeding. They say about EMA that I can’t do it, since my whole uterus is covered with bunches of grapes, this is not my option. This is the situation. Sorry for such a long text. What is possible in my situation, please tell me. Or there are no options, only removal of the uterus and cervix. But 30 years, somehow completely cruel... Our doctors have this opinion: it’s bleeding, the cervix is ​​bad, the uterus is all covered with nodes, everything is growing, endometriosis can only be removed using abdominal surgery. To be honest, I don’t see the point in taking Luprid depot injections. What will happen to me after they are canceled... I think about it. And is there a need to remove the uterus and cervix in my situation? Thank you in advance!

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

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

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

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

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

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

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

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

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

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

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

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

Preparatory stage

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

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

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

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

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

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

Preparation for women

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

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

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

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

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

Before egg puncture, a woman must:

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

Training for men

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

A man must also observe the following:

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

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

Follicular puncture surgery

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

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

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

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

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

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

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

Egg puncture during eco - sequence of actions

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

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

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

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

How to behave after a puncture

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

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

Complications after puncture

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

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

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

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