In-vitro fertilization (IVF)

Extracorporal fertilization (derived from Latin “extra” – outside and Latin “corpus” — body, that is fertilization “outside the body”) is an attendant reproductive method applied to infertility treatment cases. Synonyms: “in-vitro fertilization”, “artificial fertilization”.
The IVF process involves extraction of a mature oocyte from female body and its artificial fertilization under “in-vitro” conditions. The resulting embryo is placed in a special incubator to let it cultivated during 2-5 days and be further transferred into a uterine cavity where it continues growing.
Order of the Health Ministry of Ukraine “Approval of Order of Application of Attendant Reproductive Processes” No. 787, dated September 09, 2013, approves the list of medical indications and methods applied to cases of in-vitro fertilization treatment.


Medical indications to apply IVF methods

In case of female infertility:
  • no uterine tubes;
  • obstruction of uterine tubes;
  • apparent commissural processes in small pelvis organs;
  • disturbance of follicular growth in ovaries and ovulation;
  • ovarian luteinization syndrome;
  • endometriosis;
  • recurrent failed intrauterine insemination attempts;
  • recurrent failed superovulation stimulation attempts;
  • infertility cases related to age and early exhaustion of ovaries;
  • uncertain genesis infertility;
  • diseases calling for preimplantation genetic diagnosis (PGD) to avoid birth of children having inherited genetic pathologies.
In case of male infertility:
  • uncertain genesis infertility;
  • diseases calling for preimplantation genetic diagnosis (PGD) to avoid birth of children having inherited genetic pathologies;
  • obstructive azoospermia;
  • asthenozoospermia;
  • oligospermia;
  • oligoasthenoteratozoospermia;
  • erectile dysfunction (impotence);
  • anejaculation;
  • retrograde ejaculation;
  • anatomic defects in male genital organs (hypospadias, epispadia);
  • immunological factors (autoantibodies and sperm agglutination).


Contraindications to IVF

  • bodily and psychological diseases serving as contraindication to pregnancy and birth;
  • uterus body length is less than 35 mm;
  • acute inflammatory processes of a varied localization before ARP treatment is applied;
  • inborn maldevelopment or evoked uterus malformation, which make it impossible to implant an embryo and carry pregnancy;
  • benign uterine tumors that deform the uterine fundus or require surgical interference;
  • malignant new growth of varied localization.
Should it be proved impossible for a female patient to donate her own genetic matter (oocytes) for in-vitro fertilization purposes, or carry and give birth to a child, her doctor could recommend that such extra ARP procedures as donation of oocytes and surrogacy services be made use of.

IVF program fulfillment stages
  • examination of patients;
  • control over stimulation of superovulation of ovaries;
  • monitoring of follicle and endometrium growth rate;
  • transvaginal aspiration of follicles in ovaries;
  • preparation of patient’s sperm for fertilization;
  • insemination (fertilization) of oocytes and in-vitro cultivation of embryos;
  • transfer of embryos into uterine cavity;
  • maintenance of lutein phase of stimulated menstrual cycle;
  • pregnancy diagnostics.


Controllable stimulation of ovaries

The process of controlled ovarian stimulation can only involve the use of medicines legally registered in the territory of Ukraine. The pattern of stimulation, drugs and dosage are to be chosen by the doctor-in-charge with the consideration of drug application instructions, specifics of patients, clinical and ultrasonic examination results.


Transvaginal aspiration of follicles – puncture of oocytes

The procedure is applied 35-36 hours after injecting the ovulation trigger – a hormonal medicine to be used in the final phase of follicular growth stimulation.

Mature follicles are extracted in the outpatient setting, under general anesthesia conditions, with the use of special puncture needles and under US control. This procedure lasts 20 minutes or less.

If puncture of follicles is proved impossible due to atypical location of ovaries, oocytes can be collected by laparoscopic means.


Sperm preparation

To fertilize punctured oocytes, patient’s or donor’s sperm should be specially cleaned and prepared.

If patient’s sperm is to be used for in-vitro fertilization purposes, the patient is recommended to abstain from sexual intercourse for 3-5 days. 


Insemination (fertilization) of oocytes and in-vitro cultivation of embryos 

Follicular fluid collected by puncturing follicles is tested for presence of oocytes, which are sampled to be transferred in special vivifying fluid. They are fertilized with spermatozoa 2-6 hours following their extraction from ovaries.

Fertilized oocytes are placed in a special incubator to be developed further.


Transfer of embryos

The embryos can be transferred into the uterine cavity (of a patient or surrogate mother) at different stages of embryo development, beginning from the stage of division of a fertilized oocyte and ending by the stage of blastocyte, which gets formed on day 5 or 6 of the day of its fertilization with a spermatozoon.

It is not recommended to transfer more than 2 embryos into the uterine cavity. Should the predicted likeliness of implantation of embryos be too low, 3 embryos could be transferred. The rest of the embryos can be subject with the consent of the patients to cryopreservation for the purpose of their subsequent use.

The embryos are transferred into the uterine cavity under US control with the help of a special thin elastic catheter. The procedure is painless, does not require surgical interference or application of different anesthetics.


Maintenance of lutein phase of stimulated menstrual cycle

Lutein phases of stimulated menstrual cycles are maintained by the doctor by prescribing progesterone-containing drugs to a patient (surrogate mother).
 

Pregnancy diagnostics

The pregnancy diagnostics procedure is applied 10-16 days after embryo transfer and involves testing the blood for the level of beta – chorionic human hormone and testing the urine for pregnancy condition.

Ultrasonic pregnancy diagnostics is applied at least 21 days after the day of embryo transfer.