Contraindications to IVF in women are therapeutic. How and when to do eco? Complications and consequences of in vitro fertilization

In vitro fertilization (IVF) is a reproductive technology. With its help, an egg is removed from the body of a woman, which is fertilized by artificial means. Then the embryo develops in a special incubator for several days and is placed in the uterus.

Indications for IVF in women are the absence of pregnancy for 12 months or the presence of diseases in which conception naturally impossible. So, in what cases is IVF done?

Endocrine

Hormonal imbalance can lead to the following pathologies:

Insufficiency of the luteal phase (production not enough progesterone).
Lack of ovulation (lack of follicle-stimulating or luteinizing hormone in the body).
Polycystic ovaries (disorder functional work ovaries and an increase in the level of male hormones in a woman's body).

If, despite treatment with hormonal drugs for 6 months, pregnancy does not occur, this is an indication for IVF.

Tubal-peritoneal

In 50% of women with impaired reproductive function infertility results from irregular structure or work fallopian tubes. The consequence of the pathology is that the fertilized egg cannot reach the uterine cavity in time, so pregnancy does not occur.

The cause of tubal-peritoneal infertility is hormonal disorders or inflammatory processes in the pelvic area. It can also cause pathology surgery resulting in the formation of adhesions.

When is IVF done? If medical treatment does not give the desired results or if the fallopian tubes are lost as a result of outside uterine pregnancy.

Immunological

This type of infertility is characterized by the production of antisperm bodies that attach to spermatozoa and prevent them from entering the egg. They can appear in the body, both in men and in women.

The cause of this pathology has not been fully elucidated. But in the event that the problem is eliminated with the help of hormonal and antihistamines fails, resort to extratemporal fertilization.

Age

Women with fading reproductive function are stimulated to ovulate with hormonal drugs and use the oocytes of the patient herself. Also, if necessary, you can use donor material.

Eggs can be frozen in liquid nitrogen and store long time. This method is resorted to if there is a threat to the health of a woman or her reproductive function.

no indication

Many women have a question, is it possible to do IVF without indications? Yes, it is possible, but there are several factors to consider:

Hormonal drugs that are used to stimulate ovulation can adversely affect a woman's body.
Some malformations in babies conceived by extratemporal fertilization appear more often than in other children.

Contraindications

Contraindications for IVF in women are as follows:

Mental illness in which the patient becomes incapacitated and unable to care for the child.
Congenital malformations of the uterus.
Deformation of the uterus, in which it is impossible to plant an embryo or bear a fetus.
Neoplasms in the uterine cavity or ovarian region requiring surgical intervention.
Inflammatory diseases in an exacerbated form.
Malignant diseases.

Order of the Ministry of Health No. 107n (Video)

IVF - in vitro (i.e., performed outside the body) fertilization - is a method of infertility treatment, in which conception, i.e. the fusion of a female cell (ovum) and a spermatozoon does not occur in the female body, but in a test tube. Subsequently, the embryo is transferred into the uterine cavity.

Indications for IVF

Indications for IVF are cases when fertilization in a natural way is impossible with:

The so-called tubal factor of infertility, ie. in the absence of fallopian tubes (for example, after an ectopic pregnancy) or obstruction of the tubes in cases where surgical treatment is futile. For example, this situation may arise after operations or inflammatory diseases abdominal cavity.
Endocrine infertility (occurs with hormonal disorders in the body) when it is impossible to conceive against the background of hormone therapy within 1 year.
Infertility with endometriosis of the pelvic organs and with unsuccessful treatment for more than 2 years. (Endometriosis is the growth of the inner layer of the uterus - the endometrium - into the muscles of the uterus, as well as outside the uterus.)
With immunological infertility, when specific proteins are produced in the woman's body that destroy the partner's spermatozoa.
With male infertility, not amenable to treatment. IVF with the husband's sperm is carried out with a decrease in the number of viable spermatozoa, high content in the sperm of pathological male germ cells, for example, with defects in the structure of the head or tail.
infertility of unknown origin. This is a variant of infertility when, after a long examination using all methods, the reason for the lack of pregnancy in married couple.
Hereditary diseases - for example, cystic fibrosis, hemophilia, when future parents and doctors want to avoid hereditary diseases in offspring. In these cases, the embryo is examined for the presence of this disease before it is transferred, or donor material (eggs or sperm from donors) is used.

Contraindications for IVF

Contraindications to IVF are serious diseases in which doctors categorically do not recommend pregnancy and childbirth - for example, uncompensated diabetes, the presence of a woman (including in the past) malignant tumors of various organs.

For IVF, of course, it is necessary that there are no acute or exacerbations at the time of the start of treatment. chronic diseases various organs and systems. Next, you should consult with a reproductive specialist who will answer all your questions, prescribe the scope of the examination, choose the treatment protocol and the time of its implementation.

Preparation for IVF

Survey. A number of examinations are mandatory, regulated by the order of the Ministry of Health of the Russian Federation No. 67. This allows you to prevent and reduce the risk of complications. In addition, depending on clinical situation a specialist may recommend additional tests that allow you to clarify the factors of infertility, develop individual approach, optimize the IVF program and, ultimately, increase the likelihood of pregnancy.

The determination of antibodies to rubella in the blood of a woman is carried out. Since rubella infection during pregnancy leads to serious fetal malformations, in the absence of immunity to this disease All patients are shown the introduction of the rubella vaccine. After vaccination, after 2 menstrual cycles, it is allowed to carry out.
Determination of the blood group and Rh factor, blood tests for HIV, hepatitis B and C, syphilis, clinical analysis blood, hemostasiogram - a blood coagulation test, a smear on the flora from the vagina, general analysis urine, biochemical blood test, ECG, conclusion of the therapist about the possibility of treatment for infertility and pregnancy. For a man, blood tests for HIV, hepatitis B and C, syphilis, a blood test for the group and Rh factor, a semen analysis, which is given after 3-4 days of sexual abstinence, against the background of the absence of alcohol, saunas and baths for 1 month, are required, the MAR test is a study aimed at identifying specific proteins (antisperm antibodies) on spermatozoa that can prevent conception.

Most women, after consulting a gynecologist-reproductologist, but before the above tests are performed, are prescribed additional examination which includes:

Blood test for sex hormones and hormones thyroid gland to exclude hormonal disorders or their timely correction, as well as to assess the so-called ovarian reserve - the supply of eggs in a woman's ovaries.
Hysterosalpingography, ultrasonohysteroscopy is an x-ray or ultrasound examination of the patency of the fallopian tubes.
An endometrial biopsy is an examination of a small area of the inner layer of the uterus. It is necessary in order to assess the quality of the endometrium and its ability to "accept" the fetal egg.
Laparoscopy, hysteroscopy - examination of the walls of the uterus and abdominal cavity, uterus and ovaries using special equipment. These surgical procedures can be prescribed for endometriosis or the presence of fluid in the fallopian tubes, if you suspect the presence of pathological changes in the uterine cavity.
Smear for sexually transmitted infections.
Bacteriological culture on flora from cervical canal and vagina.

Blood test for CMV ( cytomegalovirus infection), herpes, toxoplasma. All of these studies are required to reduce the risk inflammatory complications during IVF and subsequent pregnancy.
A blood test for antiphospholipid antibodies is special group blood proteins, the study of which is prescribed for expectant mothers who have had two or more spontaneous abortions in the past, as well as women with thrombosis of various vessels. Phospholipids are complex fats that are part of the membranes of all body cells. In some cases the immune system produces a large number of antibodies to some of its own phospholipids and proteins that bind these lipids. They are called antiphospholipid antibodies and, when interacting with the cells of the body, cause their damage and activation of the blood coagulation system, which leads to thrombosis. Antiphospholipid Syndrome is the most common cause thrombotic complications during pregnancy.
Consultation with a mammologist to exclude diseases of the mammary glands, in which ovulation stimulation is contraindicated (for example, tumors).
Consultation with an endocrinologist to assess the function of the thyroid gland important role in support of the hormonal status of the body.
Cytogenetic study, karyotype - determination of the complete set of spouses' chromosomes for exclusion genetic disorders preventing pregnancy.
Pap smear from the cervix - a smear on the cells that cover the cervix from the outside and line its canal from the inside. This analysis is necessary to rule out oncological processes on the cervix, since the use of auxiliary reproductive technologies and pregnancy itself can worsen the course of these diseases.
Genetic consultation - if the spouses are over 35 years old or if there is a sick child in the family, to assess the risk of chromosomal or genetic pathology.
Mutations of thrombophilia genes are a blood test for a hereditary tendency to thrombosis (formation blood clots V various vessels). This study it is mandatory to be prescribed if the family history has indications of thrombosis and thromboembolism in relatives (under the age of 40), thromboembolic and other complications during pregnancy.
Full examination will identify problems that need to be corrected before starting the IVF program.

Lifestyle of parents before IVF. Before IVF, it is necessary to conduct healthy lifestyle life, to exclude the use of alcohol and smoking, since these factors have a pronounced negative effect on the quality of maturing germ cells in both men and women.

IVF procedure

Stimulation of superovulation, i.e. artificial cultivation a large number follicles, instead of one, in a woman's ovaries in one menstrual cycle.
Obtaining eggs from the ovaries by ovarian puncture.
Fertilization of eggs by spermatozoa in vitro.
Cultivation of embryos from 2 to 6 days in artificial conditions.
Transfer of embryos into the uterine cavity.
Hormonal developmental support gestational sac on early dates pregnancy.

Stimulation of ovulation. This is the first stage of in vitro fertilization. In a normal menstrual cycle, one, maximum two follicles mature in the ovaries of a woman, in which the egg is located. In the IVF program, doctors strive to get large quantity eggs (about 15-20) in one cycle. For this, the patient is prescribed various hormonal drugs. In the process of growth of follicles, they are necessarily controlled by ultrasound. Getting a large number of eggs is necessary to increase the effectiveness of the IVF program, because not all eggs will be in good condition and will be able to be fertilized by sperm. In addition, several embryos are usually transferred into the uterus, which increases the pregnancy rate.

Stimulation of superovulation is carried out with special hormonal preparations. The doctor chooses the drugs and the regimen for their use individually for each patient. There are 2 different protocols for inducing superovulation. They differ in the duration of the use of hormonal drugs.

The first is a short protocol. It starts on the 3-5th day of that menstrual cycle when IVF is planned. Stimulation takes 12-14 days. special hormonal means the ovaries are stimulated, forcing them to “grow” several eggs at once. The quality of the eggs is not always the best, they are often of different sizes, but this protocol is much easier for patients to tolerate.

The long protocol begins in the cycle preceding the IVF cycle, and begins with hormonal drugs blocking the ovaries' own function and stimulating brain impulses. This allows you to get eggs of better quality and reduce the risk of complications (overstimulation of the ovaries - overstimulation). The protocol lasts an average of 3-4 weeks. The dose of hormones in this case is greater than in short protocol. With the help of blood tests, the doctor fully controls hormonal background patient and chooses the moment to start stimulation. Oocytes at long protocol are obtained best quality, the same size. But the load on the woman's body with hormonal drugs is higher and the protocol is more difficult to tolerate.

In situations where hormonal stimulation is contraindicated for the patient, IVF is performed in natural cycle. That is, stimulation of ovulation with hormonal drugs is not used. In this case, only one egg matures, and the chance of getting it is much less. Only one embryo is transferred to the uterus, and the chance of pregnancy is much lower.

Receiving eggs. Puncture of follicles in the ovaries to obtain eggs is the next stage of IVF. The procedure is carried out under general anesthesia and lasts an average of 15-20 minutes. With a special needle through the vagina under ultrasound control, the doctor carefully pierces the largest follicles and collects the follicular fluid, and with it the mature eggs, into a special sterile container that enters the embryological laboratory. At the end of the procedure, the patient is under observation for 1.5-2 hours, and then can go home.

Getting sperm. After a successful puncture of the follicles, the patient's husband donates sperm, which is also sent to the embryological laboratory. IN rare cases, in the absence of spermatozoa in the seminal fluid, a testicular puncture is performed (i.e., spermatozoa are obtained directly from the testicular tissue through a special needle).

Fertilization. In vitro fertilization itself, i.e. the connection of an egg with a spermatozoon is carried out by embryologists. After the eggs "live" for 4-6 hours in an incubator, in special cups with a nutrient medium, the resulting male and female germ cells are combined. To do this, prepared spermatozoa are planted to the eggs (moreover, there are from 50,000 to 100,000 spermatozoa per egg). Spermatozoa stick around the egg and secrete an enzyme that helps them get inside. As soon as one of the spermatozoa is inside, the egg acquires a dense shell that prevents the penetration of the remaining spermatozoa. The infiltrated sperm cell and the nucleus of the egg merge, and the cell begins to divide, forming an embryo.

Cultivation of embryos. The embryo is cultivated in a special incubator that simulates the conditions of the uterine cavity in terms of such indicators as temperature, humidity, concentration carbon dioxide. Embryos develop into laboratory conditions within 2-5 days, depending on the cultivation method, after which they can be transferred to the uterus.

ICSI

At male factor Infertility often resort to the procedure of fertilization of the egg with a single sperm - ICSI (intracytoplasmic sperm injection). This technique applied in cases where it is not possible to obtain enough complete spermatozoa. For example, with a significant decrease in the number of spermatozoa, with a large number of pathological forms, with the detection of antisperm antibodies (proteins that kill spermatozoa) in the semen, as well as with a low fertilization index in previous IVF attempts (less than 20% of total number received eggs).

With ICSI, the embryologist selects an outwardly normal spermatozoon, then, using a special hollow needle, pierces the egg cell membrane and injects it into the cytoplasm of the egg cell.

Transfer of embryos to the uterus. This is the next stage of the IVF procedure. It is carried out 48-72 or 96 hours after the puncture. The procedure is usually completely painless. The doctor through a special catheter (thin silicone tube) introduces into the uterine cavity nutrient medium containing one or more embryos. Usually 2-3 embryos are transferred. The rest are subjected to cryopreservation, i.e. frozen in liquid nitrogen. Frozen embryos can be stored for a long time and, in the event of an unsuccessful IVF attempt, will be used for transfer. That is, a woman can go through the embryo transfer procedure again without undergoing ovulation stimulation and ovarian puncture.

In some cases, according to indications, pre-implantation diagnostics is performed. Such a study is usually done for patients over 35 years old, with a history of the birth of children with hereditary or congenital genetic pathology, in the case of carriage by one of the spouses of chromosomal abnormalities.

Pre-implantation diagnostics of embryos is carried out on the 3rd-5th day, when the embryo consists of 5-6 cells. If one cell is taken for analysis at the same time, this does not cause damage developing child. Embryo transfer is last step in the IVF cycle. After it, the doctor prescribes maintenance drugs that increase the likelihood of pregnancy.

After this procedure, you should not be subjected to physical and emotional stress, take hot baths, should refrain from sexual intercourse. A sick leave may be issued for the period following the embryo transfer.

The onset of pregnancy is determined 10-14 days after the embryo transfer according to the level hCG hormone in blood.

Possible complications of IVF

A serious complication of ovulation stimulation in the IVF program is ovarian hyperstimulation syndrome. This condition results from hard work ovaries, they secrete a large amount of female sex hormones - estrogens. One of the main links in the development of hyperstimulation syndrome is an increase in the permeability of the walls blood vessels, due to which the liquid part of the blood penetrates the walls of the vessels and accumulates in the abdominal cavity, in pleural cavities(around the lungs) or pericardial cavities (cavities around the heart). This is manifested by pain in the abdomen, bloating, nausea, difficulty breathing. In addition, the release of fluid from the bloodstream leads to thickening of the blood, increases the risk of thrombotic complications.
With hyperstimulation syndrome mild degree special therapy not required. Patients are prescribed painkillers, limit physical activity. With moderate hyperstimulation syndrome and severe course illness requires hospitalization.

Follicle puncture in the IVF program can be complicated by bleeding, which happens infrequently. Same rare complications are ovarian torsion and bleeding from enlarged ovarian cysts. Both of these conditions often require surgical treatment, but the probability of their occurrence is minimal.

Pregnancy and childbirth after IVF

After determining the onset of pregnancy (by the level of the hCG hormone in the woman's blood), an ultrasound confirmation of the uterine pregnancy is mandatory. IVF significantly increases the risk of ectopic pregnancy, i.e. attachment of the fetal egg not in the uterine cavity, but outside it, most often in the fallopian tubes. This is due to violation contractile activity uterus and fallopian tubes, while the fetal egg is "pushed out" from the uterus into the tube. Up to 16-18 weeks of pregnancy is mandatory hormonal support developing ovum and embryo.

Pregnancy that occurred in the IVF protocol is classified as a high-risk group for miscarriage, i.e. premature termination of pregnancy. The frequency of spontaneous abortions after IVF is from 18 to 44.4?%, and the frequency premature birth ranges from 19.5 to 37.6?%, so patients after IVF require more careful monitoring.

Often, as a result of the use of assisted reproductive technologies, multiple pregnancy, to which doctors are very wary, although many women consider twins to be a very good outcome of treatment. Multiple pregnancy, especially if the number of fetuses is more than two, is associated with a high risk of complications during pregnancy and childbirth and reduces the likelihood of a successful pregnancy.

Embryo reduction. Reduction of embryos (reduction in their number) is performed if pregnancy has occurred with three or more fetuses. The procedure is carried out at the gestation period from 7 to 11 weeks under mandatory ultrasound control. Contraindications for it are the threat of abortion, inflammatory diseases.

Embryo reduction methods

transcervical- penetration into the uterine cavity through the cervical canal. This method is used for a period of 5-6 weeks of pregnancy. Through a thin catheter with the help of vacuum aspiration (sucking out the contents using a special apparatus), excess fetal eggs are removed.

transvaginal- reduction is carried out using a special needle, which is inserted into the uterus through the vagina under control ultrasound. This method is considered the least traumatic and is used for a period of 7-8 weeks. This intervention is performed under general anesthesia.

transabdominal- insertion of a needle through the anterior abdominal wall. It is performed under local anesthesia, most often for a period of more than 8 weeks of pregnancy.

childbirth. Childbirth in patients after IVF can be carried out both through natural birth canal and by caesarean section.

Test tube babies. The state of health, physical and psycho-emotional development of children born as a result of in vitro fertilization does not differ at all from the corresponding indicators in babies conceived in a natural way.

Help from a specialist

Feel free to ask your questions and our full-time specialist will help you figure it out!

The method of in vitro fertilization (IVF) allows childless couples to conceive and give birth to a genetically own child without endangering the health of the mother. This method of conception is not effective for all couples. There are contraindications that make the use of the method impossible.

The decision on the possibility of extrauterine fertilization is made by the doctor after considering all the pros and cons of the procedure and taking all measures to treat diseases that prevent pregnancy.

The main indication for participation in the IVF program is the inability to cure the infertility of one of the spouses. The indications for the procedure are:

obstruction of the fallopian tubes;
violation of ovulation;
endometriosis;
anatomical features of the uterus that prevent conception.

For men, indications for IVF are sperm pathologies or impaired excretion of seminal fluid.

When spouses can be denied participation in the program

The procedure is not prescribed if a woman is unable to endure pregnancy for health reasons. There are absolute and temporary (relative) contraindications.

Temporary obstacles to artificial insemination

Temporary contraindications are correctable, and after appropriate treatment, a woman will be able to become pregnant and give birth to a baby. The procedure of artificial insemination is postponed in case of:

expressed adhesive process in the small pelvis;
accumulation of fluid in the fallopian tubes, preventing the implantation of the embryo;
chronic disease of the appendages, aggravated in the current year;
benign tumor in the uterus, ovaries.

After treatment, the doctor may authorize participation in the program. An obstacle to IVF is some congenital or acquired diseases of a woman, such as heart defects, bone fragility, and the absence of one kidney.

Intrauterine fertilization is not always possible due to genetic diseases women. Such diseases include hemophilia, Duchenne myodystrophy. In this case, pre-implantation genetic diagnosis is performed before the artificial insemination procedure.

Conditions that increase the chance of pregnancy

One of the conditions for the effectiveness of IVF is the body weight of a woman. It is desirable that the weight of a woman be more than 50 kg, but not exceed 100 kg.

Being underweight can lead to difficulty getting a fertilized egg into the uterus. Excess weight can lead to premature birth, adversely affect the health of the baby.

Smoking is considered a relative contraindication for participation in the artificial insemination program. The frequency of pregnancy in smoking women below. There is another contraindication that affects the effectiveness of the method, this is age. Although the procedure is carried out after the age of 45, the chance of conceiving and bearing a child decreases with age.

In what cases IVF is not performed

In vitro fertilization is contraindicated for women whose health condition does not allow them to carry a child without risk to their own health.

Absolute contraindications:

tuberculosis, HIV, hepatitis, syphilis;
malignant tumors of any localization;
blood diseases;
diabetes;
diseases of the heart, blood vessels;
hypertension that is not controlled by drugs;
mental illness.

They do not resort to artificial insemination for congenital malformations of the uterus, deformities that can prevent the implantation of the embryo into the uterine wall, and childbirth. The use of the method of in vitro fertilization is not indicated for chronic somatic diseases that are not amenable to treatment, such as intestinal fistula, kidney failure.

IVF is contraindicated for benign tumors in the genitals. Taking hormonal drugs during the program can provoke the transition of a benign neoplasm into a malignant tumor.

The decision to conduct IVF for the treatment of infertility of a married couple is made by the doctor after a comprehensive examination of the spouses. IVF is used when other methods of infertility treatment are not possible.

Video from a specialist

As for every procedure in medical practice, the use of assisted reproductive technologies, namely in vitro fertilization, has its own indications and contraindications.

There are regulated indications for IVF and the same contraindications for IVF.

IVF: indications and contraindications

It is very important to know the indications and contraindications for the protocol.

There are some diagnoses that have not only indications for IVF, but this method is the last chance for married couple to find the happiness of becoming a mom and dad.

Eco: indications for the protocol:

Installed tubal infertility or removal of the fallopian tubes on both sides.

Tubal infertility is a diagnosis that is made on the basis of a set of diagnostic measures, as a result of which complete obstruction of the fallopian tubes was established. This diagnosis is confirmed by the presence in the anamnesis of the absence of pregnancies in the absence of the use of contraceptives, given by metrosalpingography. This method consists in introducing into the uterus contrast medium and run a series x-rays in order to trace the movement of this contrast through the fallopian tubes and its exit into abdominal cavity. If only the contours of the uterus are visualized in the images, and the substance does not enter the tubes, then we can conclude that the fallopian tubes are obstructed. Also, with the advent of optical minimally invasive methods of surgery, tubal infertility can be established by conducting diagnostic laparoscopy in conjunction with diagnostic hysteroscopy. With the help of a hysteroscope, blue is introduced into the uterine cavity, and with the help of a video laparoscope, penetration of this substance into the abdominal cavity is observed. If this does not happen, then there is an obstruction of the fallopian tubes and pipe factor infertility is confirmed.

Indications for eco-causes of obstruction of the fallopian tubes

The causes of obstruction of the fallopian tubes are:

Infectious and inflammatory diseases of the pelvic organs;
A history of sexually transmitted infections, especially such as gonorrhea, which leaves behind a diffuse adhesive process;
Any kind surgical interventions carried out on the uterus and fallopian tubes, as they entail the formation of an adhesive process;
Congenital anomalies in the development of the fallopian tubes;
If there is no pregnancy, the woman's age is over 30 years old, there is a history of more than 5 years of treatment with the use of conservative therapy for obstruction of the fallopian tubes, an already existing attempt at surgical correction of patency - plastic surgery of the fallopian tubes, carried out more than 1 year ago, in a woman is an indication for eco-indication.

Myoma after eco-myth or reality?

For conservative therapy of obstruction of the fallopian tubes, apply:

Antibacterial therapy to eliminate the infectious agent that caused such changes;
Anti-inflammatory therapy mainly using non-steroidal anti-inflammatory drugs.
Hormonal therapy - the use of drugs with a hormonal component to correct hormonal imbalances.

Used in conjunction with this treatment

Balneotherapy;
Ultrasound treatment;
Medicinal electrophoresis;
Electrical stimulation of the uterus and appendages;
Gynecological massage;

If medication, or rather, conservative therapy does not work, then proceed to surgical methods treatments, the essence of which is plastic surgery pipes. These methods include:

Salpingo-ovariolysis - removal of the adhesive process from the tubes and ovaries;
Fimbrioplasty - removal of the adhesive process in the fimbriae of the fallopian tube;
Salpingostomy - removal of an obstructed area fallopian tube and matching ends;
Tubal-uterine implantation - transplantation of sections of the fallopian tubes into the uterus;

Idiopathic infertility situation. In which all diagnostic methods were performed, but not one gave results on what is the cause of infertility in a particular woman;

Immunological infertility- a factor that cannot be written off when diagnosing the etiopathogenetic cause of such a condition. The essence of this type of infertility is the formation of antisperm antibodies in a woman - antibodies that damage male germ cells. Interfering with fertilization. The female body perceives male germ cells as an antigen and directs all its forces to fight them.

Pathological conditions of spermatozoa in a man and, as a result, the impossibility of fertilizing an egg.

Azoospermia is a pathological condition. In which there are simply no spermatozoa in the ejaculate;

Akinospermia is a condition in which there are a sufficient number of male germ cells in the ejaculate, but they are motionless;

Asthenozoospermia is a process in which spermatozoa are not as mobile as necessary to reach the egg.

Hemospermia - the presence of a hemorrhagic component in the semen;

Hypospermia - a decrease in the amount of sperm;

Necrospermia - the presence in the seminal fluid of non-viable germ cells;

Normozoospermia - indicators are normal, but there are minor problems, for example, increased

Pyospermia is the presence of inflammatory elements, or simply speaking, pus in the semen;

Teratozoospermia - a large percentage the content of pathologically altered spermatozoa.

The diagnosis of endometriosis, which, when using all types of medication and surgical correction did not respond to treatment.

The age factor of infertility, which is associated with the deterioration of the reproductive material.
Anovulatory infertility is a condition that is associated with a persistent lack of ovulation despite its medical and surgical stimulation and attempts to get pregnant naturally.

The success of the in vitro fertilization protocol implementation depends on many factors, therefore, to predict exact result manipulation is impossible. The result depends on:

The age indicator of a man and a woman, as well as compensatory opportunities female body, since when applying the in vitro fertilization protocol, rather rigid ovulation stimulation schemes are used, which may be accompanied by the occurrence of complications.
The woman's lifestyle, history, the presence or absence of influence on the body of bad habits;
The duration of the period during which attempts were made to become pregnant and the use of which methods of treatment were used.
The hormonal background of a woman's body and its ability to respond to drug therapy.
Somatic pathological conditions, the degree of their compensation.

After revealing the indications for the in vitro fertilization protocol, a full range of diagnostic measures is performed. If any deviations from the norm are detected, some pathological conditions that are not compatible with the protocol, then the couple is sent for treatment, and only after correcting these deviations, it is possible to re-diagnose and admit to IVF.

The process of conducting an in vitro fertilization protocol is a complex multi-stage manipulation with the use of powerful hormonal therapy, as well as carrying a pregnancy itself is a burden on the body. Therefore, in this area, both there are indications and contraindications for this manipulation. decisions need to be made on the basis of full complex examinations to rule out misdiagnosis.

Contraindications for eco

All contraindications to in vitro fertilization can be divided into contraindications for men and women. And they are also divided into absolute and relative.

Absolute contraindications for in vitro fertilization are indications when under no circumstances can a woman perform IVF.

Severe extragenital pathology that threatens the health and life of a woman. These are such pathological conditions as congenital and acquired heart defects leading to decompensation, kidney and liver failure, Crohn's disease and many others. If a woman is diagnosed with a disease, she must be consulted specialized specialist to make a conclusion about the possibility of such manipulations as IVF.
Congenital anomalies in the development of the genital organs, not amenable to surgical correction, which make it impossible to endure pregnancy.
Oncological diseases, regardless of their location, stage of the process.
Severe diabetes mellitus, stages of subcompensation and decompensation. Pregnancy is physiological, spontaneously occurring - this is a huge burden on the body with such a pathology, and the in vitro fertilization protocol is an unacceptable manipulation in these cases.
Psychiatric pathology in the form mental illness so is

Absolute contraindications for the IVF procedure are also contraindications for natural pregnancy and bearing.

Relative contraindications for IVF:

Any infectious and inflammatory diseases are indications for the transfer of the protocol. After the onset of the convalescence period, the procedure is possible. Including diseases such as tuberculosis, viral hepatitis in acute stage, or chronic pathologies in the acute stage.
Pathological, which is very important, benign neoplasms reproductive organs women who require surgical treatment. After the course of treatment, rehabilitation, the protocol is possible.
Somatic pathology of a chronic course in the acute stage. After the medical measures protocol is possible.
Recent surgery, traumatic lesions.

After correcting the state of application of the in vitro fertilization protocol, it is possible in the absence of other contraindications.

For IVF, contraindications may be on the part of a man, since not only women should undergo a set of examinations. But also men. For males, IVF is more accessible method, so the presence of contraindications can be corrected thanks to the possibilities of modern medical techniques and to obtain high-quality biological material for the fertilization of the egg.

Contraindications for IVF for men and ways to solve them

Main men's problems and methods for solving them:

A man may have high risks of genetic pathologies that may lead to the formation birth defects fetal development, pathology of pregnancy. This problem is easily solved by performing PGD at the blastocyst stage. This makes it possible to identify pathological conditions and transfer 100% of genetically healthy embryos to the uterus.
During diagnostic measures sexually transmitted infections may be detected. After the course drug therapy and receiving negative results it is possible to take material for the implementation of the in vitro fertilization protocol.
Pathological conditions of spermatozoa can cause the refusal of the duct. In this case, the use of ICSI, PICSI techniques will help.
A problem such as the absence of spermatozoa in the ejaculate may be identified. Correction given state can be done using the TESA or microTESE testicular biopsy technique.
If a man is found oncological disease, which involves chemotherapy treatment, then the sperm must be taken before starting chemotherapy.

If a man is found complete absence the production of male germ cells, then reproductologists can suggest the use of donor spermatozoa to fertilize the wife's egg.

Summing up, if a woman has a diagnosis of infertility, indications for in vitro fertilization and, of course, no contraindications, you can apply to the site and use federal program free IVF procedure under the CHI program, which brings Russian families closer to their cherished dream.

In vitro fertilization (IVF) or just artificial insemination, unfortunately, can not be applied to every infertile couple. Its use may be limited by some specific factors, and health problems in which pregnancy itself is contraindicated.

With careful IVF planning, women approach treatment fully informed of all the risks to themselves and to the fetus. In the presence of any pathology, doctors should tell patients about possible impact planned IVF and pregnancy on health and quality of life.

IVF Restrictions

To begin with, consider the limitations associated with the peculiarities of the IVF methodology. These are not contraindications in the strict sense of the word, but conditions in which the usual IVF protocol may not be sufficient to achieve pregnancy. In such cases, additional measures may be required.

Decreased ovarian reserve (OR). OR - the ability of the ovaries to produce eggs capable of fertilization, followed by successful pregnancy. Usually this condition is associated with physiological aging. However, a decrease in OR can also occur in relatively young age due to diseases radiotherapy or chemotherapy. Methods for assessing this indicator are described in our article on pre-IVF studies. This problem can be circumvented with drug treatment(often this different kinds hormone therapy) and the use of donor eggs.
There are a number of conditions when the usual IVF protocol cannot be effective and the use of additional methods is obviously required, such as the use of donor germ cells (eggs or sperm), embryos, or recourse to surrogate motherhood. Such conditions include, for example, the absence of a uterus or ovaries (congenital or after surgery), a T-shaped uterus, uterine hypoplasia, recurrent miscarriage, and the absence of live sperm from a partner.
The presence in women of hereditary diseases associated with sex, such as hemophilia or muscular dystrophy Duchenne. In this case, after consultation with a geneticist, it is possible to carry out IVF with subsequent genetic diagnosis of the embryo before its implantation in the uterus.

The list of contraindications for IVF, presented in the current order of the Ministry of Health of August 30, 2012 N 107n "On the procedure for the use of assisted reproductive technologies, contraindications and restrictions on their use", is quite large, it can be found online. We will focus on a number of important points.

Conditions that can be either relative or absolute contraindications

Relative are called contraindications, in which IVF and pregnancy are possible under certain conditions and under the close supervision of a doctor.

Human immunodeficiency virus (HIV) disease

This problem should not be the reason for refusing IVF. In couples where one partner is infected, artificial insemination is performed to reduce the risk of infection of the second partner when trying to conceive. There are some limitations here - not all stages of the disease are suitable for IVF. In addition, it is desirable that the virus is not detected in the blood after antiretroviral therapy, in his presence, the issue of the possibility of infertility treatment is decided by a council of doctors.

Other infections

Syphilis. The disease is extremely dangerous for the fetus, pregnancy and IVF are possible only after a complete cure 1.
Tuberculosis. Active Forms tuberculosis are a contraindication for IVF, as they pose a threat to the mother and fetus. Moreover, many drugs for the treatment of tuberculosis cannot be used during pregnancy.
Viral hepatitis. At chronic course hepatitis B and C IVF and pregnancy are not contraindicated, the woman should be informed about potential dangers(for example, the risk of infection of the child during childbirth). However, each case requires a separate decision by the doctor. Sharp forms hepatitis are a contraindication, since in this case the likelihood of infection of the fetus increases, there is a risk of premature birth, the diseases themselves are more severe, antiviral drugs contraindicated.

Diabetes

If the woman's blood sugar level is well controlled and diabetes has not given complications, the disease is not a contraindication for IVF. At the same time, IVF and pregnancy are completely contraindicated in diabetic retinopathy (damage to the retina), coronary disease heart and severe kidney failure against the backdrop of diabetes. The risk of retinopathy progression doubles with pregnancy. In addition, you should be aware that diabetes in an uncontrolled course is a risk factor for fetal death. The possibility of congenital anomalies increases several times with poor disease control.

Cirrhosis of the liver

Cirrhosis of the liver is a very serious pathology. According to the current order of the Ministry of Health, IVF is contraindicated at the stage when the disease is complicated by bleeding from the veins of the esophagus and liver failure. On early stages disease, without complications, IVF is possible in case of the woman's urgent desire and the consent of the doctors. The course of cirrhosis during pregnancy is rarely activated. The frequency of spontaneous abortions (termination of pregnancy) with cirrhosis can reach 15-20%.

Chronic renal failure (CRF)

This disease was recently absolute contraindication for pregnancy due to high risk for mother and fetus. Currently, pregnancy and IVF are allowed at the earliest stages of the disease.

Epilepsy

Epilepsy is a risk factor for the development of anomalies nervous system newborn. In addition, it increases the risk of developing epilepsy in a child. In general, it is not a contraindication for IVF and pregnancy. The disease must be well controlled frequent seizures do not pose a critical risk to the fetus. Contraindications for pregnancy and IVF: epileptic personality changes, too frequent seizures, occurrence status epilepticus(continuous succession of seizures).

Arterial hypertension

This disease is a contraindication for IVF only if poorly controlled blood pressure when target organ damage begins (stages above IIB). Uncontrolled hypertension during pregnancy threatens the development of preeclampsia and eclampsia (an increase in blood pressure by later dates pregnancy), the development of complications (stroke, renal failure), pregnancy fading, placental abruption, fetal growth retardation.

cystic fibrosis

A few decades ago, women with cystic fibrosis were more likely to die reproductive age. Now the situation has changed due to a significant improvement medical care with illness. IVF and pregnancy are possible, but absolute contraindications are pulmonary hypertension and corresponding changes in the heart, as well as high performance hypoxia (low blood oxygen saturation), which are dangerous to the health of the fetus.

Presence of prosthetic heart valves

Some medicines required if available artificial valves, contraindicated in pregnancy, increases the risk of strokes. Therefore, in most cases, the doctor must decide on the possibility of IVF and pregnancy individually. The current order lists multiple prosthetic valves as an absolute contraindication.

Marfan syndrome

This hereditary disease dangerous, first of all, the possibility of rupture of the aorta during pregnancy. An objective contraindication for IVF in this pathology is aortic expansion of more than 45 mm.

uterine fibroids

After surgical treatment conservative myomectomy), which is carried out if necessary, fibroids are usually not an obstacle to IVF and pregnancy.

Absolute contraindications

Absolute contraindications include serious diseases, the course of which worsens during pregnancy and / or threatens with serious consequences for the mother and fetus.

Pulmonary hypertension

Pulmonary hypertension is a condition in which pressure in the pulmonary artery rises. Two large systemic analyzes have shown that maternal mortality from heart failure or pulmonary thrombi in this pathology is 26-37%. This condition is rare in young girls, but is an absolute contraindication for pregnancy or medical indication for an abortion.

aplastic anemia

Maternal mortality in this pathology is 45%, this is an absolute contraindication for IVF and pregnancy.

Hyperparathyroidism

Excessive hormone production parathyroid gland is an absolute contraindication for pregnancy. The latter dramatically increases the risk of crises in this disease, which in 60% end in death. The fetus is also harmed, for example, elevated level calcium in the mother's blood inhibits the development of his parathyroid glands.

Malignant tumors

IVF is not performed malignant tumors any localization. If you know about cancer in the past, then the oncologist must decide on the possibility of IVF individually.

Also, IVF is not carried out with severe liver failure, severe heart defects.