Sh.K. Тuleubayeva, Zh. Kussaiyn

Buketov Karaganda State University, Karaganda

The method of in vitro fertilization

In the world of IVF (in vitro fertilization) is regarded as the main method for the treatment of infertility. It is effective in any forms, in addition, IVF is often the only way for families in which the man is sich. The method of vitro fertilization is a relatively new method of treatment of 147 infertility. It was first used in the UK in 1978 year. However, even 200 years ago it was made such attempts.

The essence of the in vitro fertilization: sperm meet the egg in a test tube, and then they are transferred into the womb to the womb of a barren woman, or a surrogate mother. With a favorable outcome of the procedure (pregnancy) are frequent cases where fertilization of the tube results in multiple pregnancies: conceived twin or triplet, because in an attempt to participate in vitro fertilization few ovules. At the request of the woman can be carried reduction (removal of excess embryos), but sometimes it leads to the destruction of the remaining and subsequent miscarriage. IVF success is about 30-35% [1].

IVF is effective in promoting those forms of infertility when to eliminate the cause that prevents conception fails. For example, after the ectopic pregnancy removed when one or both fallopian tubes; after inflammatory diseases, when the permeability of the fallopian tubes is broken and repair it is not possible. When sperm is insufficient or when it contains very little sperm physicians andrologists developed methods of obtaining sperm artificially by puncture or operation. If male factor infertility is not necessarily required to perform conceived with IVF, you simply enter the resulting artificially sperm into the uterus. However, such method of producing sperm complex, in this case the use of IVF gives a greater chance of success [4].

Unfortunately, IVF procedure is used infrequently. There are many reasons: firstly, this method of treatment of roads and it is not available to all patients;

Second, few IVF centers subsidized by the state and can be found only in large cities.

Prior to conceiving via IVF woman appointed special hormones that stimulate the growth and maturation of not one or two (as in the normal cycle), and several follicles. This is necessary, as for IVF must have a supply of embryos. The woman herself makes a daily injections of hormonal drugs. The duration of hormonal treatment averages two weeks. Then, the woman made a puncture of follicles. The procedure is performed on an outpatient basis. Needle through the vagina under ultrasound mature follicles are extracted from the ovaries. Thus, it produced few eggs. This procedure is low-traumatic, and complications from it are unlikely.

If the man is healthy, difficulties in obtaining the required number of sperm is not usually the case. In cases where spermatogenesis is disturbed, a man needs a special treatment. There are situations where sperm is produced, but to get it in a natural way is not possible, in this case the doctor performs a puncture. This manipulation is performed under general anesthesia. There is the possibility of fertilization of the egg by a single sperm [8].

Directly conceived by IVF doctors, embryologists held under the embryology laboratory. With the use of modern equipment is carried out in a special solution compound of sperm and egg. After 2-4 days the embryos are ready for the next stage.

Preimplantation diagnosis is a method of investigation of the embryo resulting from IVF, before his transfer to the uterus. With the help of modern genetic technologies can examine an embryo consisting of only 4-8 cells. With this method of diagnosis revealed grave defects of embryo development and hereditary chromosomal disorders such as Down syndrome, hemophilia and others. In addition, with the help of predimplatational diagnosis can determine the sex of the child.

Embryo transfer into the uterus is the simplest procedure of the whole method. With a special flexible catheter 2-3 fertilized eggs are transferred into the uterus. This does not require anesthesia. After the transfer of eggs a woman can go home or to work. No special mode is required. However, in some centers of IVF are given sick leave papas. Naturally, after the procedure is not recommended for women great physical and emotional stress [2].

Pregnancy with IVF occurs in 30-35% of cases. The 20 pregnancies end in birth averaged of 18. After the introduction of the embryo once in three days, you need to control the level of hormones in the blood. After 12 days a pregnancy test is performed. In the case of multiple pregnancy women can do reduction the removal of "excess" embryos.

Childbirth pregnancy after IVF is no different from usual. In cases where the cause of infertility is a disease of women, childbirth shall take account of the specific disease. By the method of fertilization, it is irrelevant.

According to doctors, the fertilization of the tube does not affect the child's future, and it is no different from other children born naturally. However, it is believed that these children learn better, but more often are ill. Doctors believe that this may be due to excessive care of the desired child.

As it is known, a pregnancy occurs in 30-35% of attempts of artificial insemination. The question arises: what about those 70 out of 100 women who did not become pregnant? How many times can you attempt IVF?

In each case, this problem is solved individually. IVF procedure itself is safe enough and can be repeated many times. Some couples pregnancy occurs from 8-10 attempts. A reasonable limit on the number of procedures is determined by the doctor depending on the specific situation. Repeated attempts may use embryos which are not used in previous times. Unfortunately, nobody can give the guarantee of pregnancy with IVF [3].

When puncture of follicles can be produced by more than necessary number of eggs. In these cases, offer healthy women to become donors. Their egg will be used in cases where the patient does not have its eggs. After removal of the ovaries at menopause, when the ovaries modified, etc. In order to encourage the donation, the woman agreed to give their eggs, less pay for IVF attempt. Naturally, anonymous egg donation, the donor has no rights to children born out of its egg. Donated eggs are fertilized by the sperm of the husband and woman, which are implanted. In this case the hormone preparation for IVF is not required. Most IVF centers excess fertilized and unfertilized embryos are stored in a frozen state, regardless of whether they are used in other women or not. Shelf life is defined in 55 years.

Pregnancy and its successful gestation is possible in almost all cases, when a woman has a uterus. Patients aged 40-50 years may also have children. Usually women of this age are turning to IVF forced if the child died, while later marriages and so on. If pregnancy is not contraindicated in women for health reasons, the IVF method can be used.

During the first trimester of pregnancy is usually accompanied by hormone replacement therapy, it is canceled and the pregnancy is held by yourself.

The main complication faced by doctors is a multiple pregnancy. In addition, sometimes after embryo reduction can occur miscarriage. Complication of hormone replacement therapy, which is done before IVF may be of ovarian hyperstimulation syndrome. It is manifested by abdominal pain, abdominal distention [6]. In its early diagnosis amenable to correction. It is important to experience any discomfort during hormone therapy, if patient has some problem immediately consult a doctor. Ectopic pregnancy with IVF is rare.

The main task of a doctor before starting stimulation and produce biological material (the man is sperm, woman's egg cell) carefully examine patients and to identify the factors that may hinder positive results of treatment.

After a phase of the survey and the preparation of woman held superovulation (MTR) of medication that will get more eggs.

On the day of egg collection, both spouses come to the medical center at the appointed time. His wife held the fence eggs, usually under general anesthesia in the operating room. Man delivers sperm by masturbation. After receiving the biological material the egg and sperm come in laboratory of embriology.

Sperm is purified, concentrated and placed to the eggs. Culturing human gametes occurs in special environments in gas incubators. Embryologist monitors the development of the embryo, not Mace embryos (which have no progressive development) are not subject to transfer. Taken into account the rate of fertilization, fragmentation is carried out visual quality assessment. Embryologist cannot detect genetic abnormalities in appearance embryo. To identify the embryo pathology is necessary to conduct genetic research. If male factor infertility (low sperm count, many deformed sperm) held mikromanipulation ICSI procedure.

The special equipment is fixed sucker egg and sperm is immobilized and placed into micro needle. Then micro needle with the sperm is injected into the cytoplasm of the egg. IMSI is the largest increase in the embryologist chooses the best quality sperm for later introduction of sperm into the egg by ICSI [5].

On the 3rd or 5th day woman carried out the transfer of the embryo into the cavity uterus. Each country has a law regulating how many embryos can be transferred into the uterus. In Sweden - 1 embryo in Russia - two of the embryo, in some states of America to 5 embryos. When repeated unsuccessful attempts of IVF more embryos may be transferred. This issue is negotiated between the doctor and the patient, and written informed consent. good quality embryos to be frozen, in case of failure in this protocol will not have to spend ovulation stimulation.

After the transfer of the embryos into the uterus the doctor prescribes medicines progesterone series, which support the corpus luteum, which in turn keeps the pregnancy. Of course, the implantation mechanism is even more fantastic than the IVF procedure and has not been studied until the end. Besides hormonal important role belongs to the immune system, coagulation system and unknown mechanisms that molecular level can be considered the embryo of the patient and stop its development or make a mistake.

On day 14 after embryo transfer pass the test for HCG, which shows becoming pregnant or not.

IVF is contraindicated those who wish to avoid pregnancy itself, that is, the woman is not only able to get pregnant, but also make a baby she cannot afford it or is a threat to her life: сertain infectious and parasitic diseases; neoplasms; diseases of the blood and blood-forming organs; endocrine, nutritional and metabolic disorders; mental disorders; diseases of the nervous system; diseases of the circulatory system; respiratory diseases; diseases of the digestive system; diseases of the genitourinary system; pregnancy, childbirth and the postpartum period; diseases of the musculoskeletal system and connective tissue; congenital malformations.

Injury, poisoning and certain other external causes: have malformations of the uterus and deformation; have malignant tumors of any organ; have ovarian tumor; there are benign tumors of the uterus, which require surgical treatment; proceed complex inflammatory disease of the body; have a mental illness and disorders.

The effectiveness of the treatment of infertility by IVF is low: about one out of three patients became pregnant after IVF, approximately one out of four patients completing treatment of the birth of the child. According to statistics from the European Society for Reproductive Medicine and Embryology (Eng. ESHRE) in 2010 to 33.2% of patients who have carried out the transfer of the embryos into the uterus after IVF have achieved clinical pregnancy [7]. According to published in 2013. According to the Russian Association of Human Reproduction (RAHR) in 2011, 36.6% of patients became pregnant after IVF, 25.8% of women who had undergone IVF gave birth to a child process.

Pregnancy and birth after IVF in general is not different from the usual. The increased likelihood of complications during pregnancy and childbirth is not associated with artificial insemination, but with the increased average age of women giving birth and multiple pregnancies more common among IVF patients.

Due to the revolutionary development of assisted reproductive technology have a new way of treating infertility, who gave great hope infertile couples. It is a method of in vitro fertilization (IVF), which is the most effective treatment for infertility, helping even in the most hopeless situations.

Literature

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2. Kulakov V.I., Leonov B.V., Kuzmichev L.I. Treatment of female and male infertility. Assisted reproductive technologies / - M .: Medical Information Agency, 2008. - 592 p. - 3000 copies.

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