Today we will talk about the most exciting aspects of the IVF program and, based on scientific research in recent years, we will answer possible questions.
What is the danger of ovulation stimulation? Modern features
In the past years of the revival and the beginning of the use of controlled superovulation in the implementation of IVF programs, reproductologists used high doses of gonadotropins during stimulation, sought to get as many oocytes as possible, since it was believed that this increases the chances of fertilization and obtaining embryos. As they tried to get more cells, they also tried to transfer “more” embryos.
Now the approaches have changed categorically. Currently, it has been proven that the use of high doses of gonadotropins during controlled supervovulation does not increase the chances of fertilization, leads to rapid depletion of the ovaries, has a greater number of side effects. The ovarian response to stimulation after puncture is evaluated as follows: 0 oocytes – no response, 1-2 oocytes-poor response, 3-6 oocytes-a satisfactory response, more than 7 oocytes – a good response.
It is proved that the level of ovarian response does not affect the quality of embryos in the presence of mature oocytes. However, with a satisfactory and good response, it is possible to cryopreservate a larger number of embryos without forcing a woman to undergo the ovulation stimulation procedure several times.
With a poor answer, the scheme of “accumulation” of embryos is currently used: several ovulation stimulations are performed with minimal doses of gonadotropins and 1-2 embryos are obtained from each such program, after which the “best” embryos are cryopreserved and only then the endometrium is prepared for embryo transfer. This scheme is beneficial for its gentle effect on the ovaries of a woman, it also contributes to the production of the most mature eggs and is used mainly in women with extremely low ovarian reserve (AMH level<1 ng/ml).
Ovarian hyperstimulation syndrome, what is it and how to avoid it?
Most women suffering from infertility have heard about ovarian hyperstimulation syndrome, the fear of this complication of IVF often pushes women away from the program. Ovarian hyperstimulation syndrome (OHSS) is a condition based on the reaction of the ovaries in response to the introduction of hormonal drugs (ovulation inducers), the doses of which exceed physiological values. This condition was first described in 1930 when using the serum of foaled mares.
Ovarian hyperstimulation syndrome is characterized by a fairly wide range of clinical manifestations: from minor changes in laboratory parameters to quite serious conditions requiring hospitalization.
The main reasons for its occurrence are high doses of hormonal drugs that are used to stimulate ovulation, and with a high level of activity of the hormone estradiol, which is produced in growing follicles, high levels of the hormone hCG. The main risk group for the formation of this syndrome are girls with a diagnosis of “Polycystic ovary syndrome”, since this group has a high follicular reserve and a large number of follicles “begins to grow” during induction.
Ovarian hyperstimulation syndrome is currently a well-studied syndrome, for this reason, reproductologists around the world are trying to stimulate the ovaries using minimal hormonal load, pursuing the main goal: to get the maximum number of mature and high-quality oocytes, to avoid ovarian hyperstimulation syndrome. All patients who are preparing for the IVF program undergo a thorough examination (according to order 107n of the Russian Federation), a reproductive doctor assesses all possible risks, preventive measures are taken in the presence of risk factors for OHSS.
Women with a high risk of the syndrome are recommended to carry out an IVF protocol followed by embryo cryopreservation and embryo transfer in another cycle.
IVF program” freezing ” of embryos
The cryopreservation method allows you to save embryos for a long time, so if the IVF attempt is unsuccessful, the “saved” embryos can be used in the future. In cases where the IVF program has been successful and the pregnancy has occurred, the remaining frozen embryos can be used in the future, when the couple decides to give birth to another child. An additional advantage of the method is to reduce the number of repeated ovarian stimulation and follicle puncture, which significantly reduces the drug load on the female body.