In vitro for many couples unsuccessfully trying for a child is the only chance to have children. What is IVF? How much does IVF cost and is it reimbursed? What is the preparation for IVF and the course of IVF treatment like, when can we expect the results?

In vitrois a well-known method of artificial insemination. The first "test tube baby", Louise Brown, was born in 1978. Since then, more than 100,000 babies have been born as a result ofin vitrofertilization. In Poland, the first girl was born in 1987 at the Institute of Obstetrics and Women's Diseases at the Medical University of Bialystok.

Artificial insemination in vitro methodis the most effective method of infertility treatment, next to intrauterine insemination. It consists in fertilizing the egg in laboratory conditions (in vitro, literally "in the glass"), i.e. outside the woman's body. They are carried out when the couple has already exhausted other optionsinfertility treatment .

What is infertility diagnosis?

According to the World He alth Organization, infertility occurs when, after 12 months of regular intercourse without contraception, pregnancy does not occur (this problem affects approx. 16% of couples who want to have children). So, if a couple is trying to conceive and have not conceived naturally for a year, see a gynecologist who specializes in infertility treatment.

Shorter waiting time to start fertility tests is recommended for women who have a disturbed menstrual cycle, diagnosed endometriosis, abnormalities in the structure of the uterus or fallopian tubes, and more than 35 years old. The problem of infertility may concern both partners, therefore the diagnostics covers both a woman and a man.

Tests that help determine the cause of female infertility are:

  • determination of progesterone concentration in the second phase of the cycle, ultrasound of the reproductive organ
  • HSG test, which assesses the correct structure of the uterus and the patency of the fallopian tubes.

To assess a man's fertility, a basic semen collection after 2-7 days is usually sufficientsexual abstinence. In order to determine infertility, at least two semen analyzes, 4 weeks apart, are required.

Infertility treatment - when in vitro

Doctors recommend IVF to couples with infertility caused by:

  • bilateral obstruction of the fallopian tubes or their absence abnormal sperm parameters (reduced sperm motility, reduced sperm quantity or absence in semen) - this concerns nearly 40% couples treated
  • endometriosis
  • idiopathic infertility, that is, unexplained infertility.

This method is also recommended for couples who have made 3-6 unsuccessful attempts at intrauterine insemination (i.e. introducing the partner's or donor's sperm into the woman's body), as well as after several years of infertility treatment. Sometimes IVF attempts are made after shorter treatment, due to the age of the woman. The older she is, the lower her fertility is and the less chance she has of having a baby, so it is better to attempt in vitro fertilization earlier. The effectiveness of the in vitro procedure ranges from 25 to 40 percent. And it depends on a woman's age, body weight, whether she smokes or treats other diseases, and how her body responds to hormonal stimulation.

In vitro contraindications

Contraindication to IVF is very poor general he alth, lack of ovarian function, some cancers. Research shows that the risk of complications and he alth problems in children after in vitro fertilization is only slightly higher than in children with natural pregnancies .

And they usually occur in multiple pregnancies (e.g. due to the more difficult course of pregnancy and childbirth). The most common complications in test-tube babies are: low birth weight (less than 2500 g) and preterm delivery (before 37 weeks).

In vitro - how it's done

Because in the in vitro method, fertilization, i.e. the connection of an egg with a sperm, takes place outside the female body, first male and female sex cells must be obtained. The woman undergoes hormonal stimulation, which aims to collect a few to a dozen or so eggs and prepare the uterus for embryos.

During ovulation stimulation, several (3-5) visits are necessary, during which the doctor uses ultrasound to assess the number and size of follicles and the concentration of estradiol in the blood serum. When the follicles are mature enough, the woman gets an intramuscular injection of hCG (Chorionic Gonadotropin) to trigger ovulation.

32-36 hours after giving the injection with a special needle and underultrasound control, transvaginal puncture of the ovaries is performed to collect the ova (the procedure is performed under short-term anesthesia). The collected follicular fluid is collected in test tubes, then it is examined and the ova are searched for.

Then they are placed on culture plates or tubes, where they mature for 3-6 hours in an incubator at 37 ° C. After this time, the in vitro fertilization procedure is carried out, i.e. sperm cells are added to the eggs - the so-called joint incubation lasts up to 19 hours.

The fertilization of eggs can also be done by microsurgery (ICSI). One sperm is then injected into the ovum using a special device (micromanipulator) with a needle.

This method is used when the cause of infertility is the male factor, i.e. a very small amount of sperm or no sperm in the semen. Then, 16-20 hours after insemination, it is assessed whether the ova have been fertilized.

On the second, third and sometimes fifth day after fertilization, the embryos are transferred to the uterine cavity using a special catheter. In special cases (high risk of genetic diseases) and only in a few specialized centers, preimplantation diagnostics is performed: one or two cells are taken from in vitro developing embryos, and then genetic analysis of chromosomes or DNA is carried out. This allows only he althy embryos to be transferred to the uterine cavity.

If the woman is under 35, the doctor will introduce two embryos into the uterus, if she is older - three. It happens that all the embryos accept each other and then twins are born (18%); triplets are rare today. The remaining embryos are frozen in liquid nitrogen at -196 ° C for future use. If the first cycle is not successful, it is used in the next one.

After IVF - impatient waiting

About two weeks after the embryos have been transferred to the uterus, the woman should do a pregnancy test or have her blood levels checked for hCG. However, a positive result does not always indicate the success of the procedure, sometimes biochemical analyzes say that the woman is pregnant and the menstruation is on.

For about 2 weeks after the procedure, doctors recommend a calm lifestyle, avoiding hot baths and drinking more fluids. Women who undergo in vitro fertilization usually have babies ahead of schedule. This is especially true in the case of multiple pregnancies.

In vitro - risk of complications

In vitro treatment, performed in a specially prepared center,It carries a low risk of complications, especially in relation to its high effectiveness and the chance of having children. But as with any procedure, complications can occur after IVF.

  • The so-called overstimulation (hyperstimulation) of the ovaries. Its effects include accumulation of fluids in the abdominal cavity and pleura, disorders of blood coagulation, liver function disorders.
  • During the ovarian puncture procedure, the intestines or the vessels in the smaller pelvis may be damaged.
  • In women after IVF, the risk of ectopic pregnancy is at least twice as high. There may also be an ectopic pregnancy that accompanies a normal pregnancy. Then it is sometimes necessary to remove the fallopian tube in which it is developing to preserve the intrauterine pregnancy.

How much does IVF cost

The costs of IVF are high. You have to take into account the expenses of 5-6 thousand. PLN for the procedure itself, plus the cost of additional tests (e.g. testing one hormone costs PLN 30-50) and medications (about PLN 2-3 thousand). The procedure is not reimbursed by the National He alth Fund, but many cities organize their own assistance programs for people who want to use IVF.

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