Happy New Year
How to become parents in the coming year
Alexander Lapshikhin, reproductologist at the REMEDI clinic
Making a wish for the New Year is a wonderful tradition and magic that works. However, it's not that Santa Claus hears us and sends a wizard in a blue helicopter loaded with happiness and luck. Everything is much simpler and more complicated. Choosing for ourselves the most important and cherished desire, we must make one more choice – to start moving towards the dream. Then help will definitely come, and the most ordinary people will be in the role of wizards. For those who dream of having a child and cannot get pregnant in any way, such magicians can be reproductive doctors, specialists in in vitro fertilization.
IVF is the most effective method of infertility treatment today, surrounded, unfortunately, by millions of myths and legends. For years, trying to have a child in the "usual" way, many couples do not even consider the option of in vitro fertilization, because in the public consciousness it is difficult, expensive and long.
All these myths are the result of insufficient awareness. And you need to fight the unknown with knowledge. Let's analyze the main misconceptions and try to figure out whether they have a basis.
Unnatural?
Not really. What is fertilization?: this is the penetration of the sperm into the egg. When trying to conceive naturally, the success of fertilization is always in question. In a number of situations, such uncertainty does not suit future parents. It is possible to fully reproduce and control the fertilization process in vitro. Performing IVF, reproductive doctors and embryologists monitor it at all stages, correct and support it if necessary to ensure the success of fertilization.
Expensive?
Since 2013, IVF has been available in Russia as part of the compulsory health insurance system. Couples with a confirmed diagnosis of infertility have the right to IVF treatment, and the number of procedures is not limited.
How long?
Yes, it will take some time. It will be necessary to confirm the diagnosis of "infertility" – a condition that is defined as the inability to get pregnant after 12 months of regular sexual activity without the use of contraception (and for couples where a woman has already turned 35, this period is reduced to six months). Then, after receiving the referral, it will be necessary to undergo a full examination in order to choose the optimal plan of preparation for the procedure. And finally, the IVF procedure itself, which is carried out according to an individual scheme, taking into account the characteristics of each couple. Thus, ECO is a multi–stage project. Therefore, for couples who have been trying to become parents for a long time, this will be time spent usefully, because with the right approach, a positive result is extremely likely.
Difficult?
Unpopular statistics: at the reproductive age, the probability of getting pregnant naturally is on average 20% per year, and after 40 years it decreases to 10% and then only falls. This is due to the fact that even in a healthy young woman, about half of the eggs have physiological defects, and another part, being fertilized, cannot be fixed in the uterine cavity or is not carried. If we also take into account the quality of male germ cells, which decreases with age and under the influence of external factors, then the onset of natural pregnancy becomes even less likely.
At the same time, the probability of success with IVF is on average 35%. This happens precisely because at every stage, when something could go wrong, doctors control the situation: they select only healthy, mature eggs and full-fledged seed material, if necessary, carry out genetic diagnostics of the resulting embryo, and then accompany pregnancy taking into account the needs of a particular patient.
35% is the average. There are situations when the probability of conception is 50-55% for one attempt. A lot depends on the age and health of a woman.
Thus, in vitro fertilization is an effective method of infertility treatment, which can help even in many seemingly hopeless cases.
How do you know that he will help you?
There are quite a lot of reasons for IVF now: it can be, for example, a violation of the patency of the fallopian tubes in a woman – the so–called tubal factor, or problems with the spermogram - that is, the male factor. With the modern development of IVF technology, you can help almost everyone. Another thing is that not everyone decides to use this method because of their fears.
Couples where a woman is over 35 years old should think especially seriously about this method; if habitual miscarriage is noted, or couples with hereditary diseases (the reason for this may be genetic failures). In this case, before implantation of the fetus, it is necessary to carry out a genetic diagnosis. Yes, unlike other procedures, it is not included in the CHI, but it is quite accessible for a seriously minded couple. Geneticists will analyze each embryo and select only the successful ones for transfer.
The chance not just to give birth to a child, but to give birth to a healthy child – isn't that a reason to use IVF?
So, you have decided – what to do?
Confirm the diagnosis of infertility
First of all, you need to be examined to find out if you really have infertility. Then undergo the prescribed treatment in any state or officially registered private clinic. If therapy does not help, infertility will be confirmed.
What could possibly go wrong? Therapy can help, and then the "quest" will be completed earlier, and the couple will receive the long-awaited baby.
Send the documents to the special commission
The decision on the appointment of IVF procedure is made by a special commission consisting of obstetricians and gynecologists, chief physicians of specialized hospitals and other representatives of the healthcare sector. The task of the commission is to thoroughly study the results of the tests and the medical history and decide whether the in vitro fertilization procedure will help the patient.
What could possibly go wrong? The Commission may conclude that even with the help of IVF, the probability of giving birth to a healthy baby is very small. But even in this case, you can go to a private clinic or consult with specialists and find out what your chances are. The decision whether to try it is up to you.
Get examined
A difficult, but necessary stage. In Russia, unlike many other countries where IVF is carried out exclusively on a commercial basis, before the in vitro fertilization procedure, the patient must undergo a serious examination. It includes not only tests for infectious diseases, but also a full-fledged diagnosis of the whole organism. Doctors need to make sure that there are no contraindications to the procedure, and after its successful completion, the patient will be able to carry a child.
What could possibly go wrong? Sometimes during this examination, diseases that are included in the list of contraindications to IVF are identified.
Undergo ovarian stimulation
Stimulation of egg production, preceding their collection, raises especially many questions. The fear of hormone therapy has been ingrained in us for a long time, since the days when such procedures were not perfected, and the doses of hormones used are really high. However, modern hormonal stimulation is carried out according to new methods. It simulates the same events that occur in the body of a woman of reproductive age on a monthly basis, and is no more harmful than normal ovulation – of course, if innovative therapy with proven high efficiency is used, which increases the chances of success of the procedure.
Stimulation is necessary to obtain a sufficient number of healthy eggs for subsequent fertilization and transplantation and to minimize possible risks.
There are a lot of risks when receiving only one egg: it may be immature, contain genetic defects, may be damaged during its collection, it may not be fertilized, the embryo may develop incorrectly, and so on, so the more eggs – in reasonable quantities – the fewer these cumulative risks.
What could possibly go wrong? With modern therapy – practically nothing. Ovarian hyperstimulation syndrome is extremely rare now, its probability is only 0.01%. There are no other complications from the procedure, and it does not affect the further functioning of the ovaries in any way.
Puncture of oocytes
The procedure of puncture of mature follicles is carried out under short–term general anesthesia and takes one and a half to two minutes. An hour and a half after the procedure, you can already go home.
What could possibly go wrong? A specific reaction to anesthesia, possible absolutely with any other operation. To avoid it, be honest with your anesthesiologist – he asks questions for a reason.
Fertilization
There are two methods of in vitro fertilization. Either the embryologist will put the egg into a nutrient solution with a pre-prepared medium, or specially selected, the healthiest sperm cells are injected into the mother cell "manually" using microsurgical instruments. The latter method allows you to overcome male infertility and is used mainly for problems with a spermogram – this is a fairly common case.
What could possibly go wrong? In modern clinics with highly qualified staff – practically nothing. However, the presence of only one egg for IVF increases the risk of an unfavorable set of circumstances and imposes enormous responsibility on the embryologist. That is why you need to get several eggs for fertilization at once.
Genetic diagnosis
Despite the fact that genetic diagnosis is not paid for under the compulsory health insurance system, there are many indications for it: the age of parents, habitual miscarriage, possible genetic diseases in the family. But it will not be possible to "order" the sex of the child, this is prohibited by law in Russia – of course, except in cases when the inherited disease is directly related to gender (for example, hemophilia in boys).
At the time of diagnosis, the future embryo is a cluster of 150-200 cells. From three to five cells are selected for analysis, this allows you to determine whether the correct set of chromosomes is contained in the embryo, and at the same time not to harm it.
However, even if genetic diagnosis is not performed, specialists monitor the process of embryo development, and only the most successful ones are selected for transfer. If there are many of them, then they are transferred to storage at the request of the couple for possible use in the future. They can be stored in liquid nitrogen indefinitely.
What could possibly go wrong? Genetic diagnostics, unfortunately, can reveal the presence of defects in all embryos. In this case, the chances of the birth of a healthy child will be explained in detail to the couple and the decision on the transfer will be made in accordance with the desire / willingness of the parents.
Embryo transfer
Multiple pregnancy is another difficulty associated with IVF. For a long time, in order to increase the effectiveness of the procedure, doctors placed several embryos in the uterus at once. This often led to multiple pregnancies, and although couples who had been trying to become parents for a long time were happy with their children, it is not so easy to carry and raise several babies at once.
However, modern technologies make it possible not to be reinsured: now in most cases only one embryo is transferred, which is safe for mom and baby. Only in the rarest cases, doctors decide to transfer two (and extremely rarely more than two) embryos, and this is always due to the individual characteristics of the patient.
The transfer procedure is completely painless, passes quickly and practically does not require any preliminary preparation.
What could possibly go wrong? The transfer procedure is technically very simple, so it practically does not involve risks. However, pregnancy may still not occur.
Expectation
On average, expectant parents need 10-14 days to make sure that pregnancy has occurred. This is a difficult period for the couple: now there is nothing to do, just wait.
What could possibly go wrong? Pregnancy may not occur: the embryo may not take root. However, it is worth remembering that in case of failure, you should understand its possible cause and after that the procedure can be repeated, and in case of success…
Pregnancy support
Pregnancy resulting from IVF is no different from pregnancy that occurred in the usual way. The only difference is that the parents initially had health characteristics that forced them to resort to the procedure. This is a minus. And the plus is that doctors know about these features – in every detail.
The work of a reproductologist does not end with determining the onset of pregnancy, in any case, we control both the appointments and the situation as a whole. As a rule, women with certain gynecological problems come to IVF, so they need special attention from specialists.
What could possibly go wrong? A lot can happen during the nine months of pregnancy, but women who have approached its planning consciously and have undergone the IVF procedure, on average, are more responsible about their health at this stage.
The birth of a child and its further development
Further events are no different from the events that are coming to couples whose child was conceived in the usual way. A child is born by natural childbirth or by Caesarean section, develops according to age and sooner or later becomes an adult, fully – it should be especially noted – capable of natural reproduction.
In the 40 years since the first successful IVF, more than 6.5 million children have been born in the world using this technology. Their health was monitored especially carefully, and none of the national registers of observation of such children shows any difference between IVF children and children conceived by the usual method.
These are just children whose parents wanted their birth very much.
Portal "Eternal youth" http://vechnayamolodost.ru