Assisted reproductive technologies

• in the natural cycle – without the use of drugs to stimulate ovulation;
• in a stimulated cycle.

In the world of VMI, donor sperm is usually offered in forced infertility:

• in azoospermia (absence of sperm) in a man’s ejaculate;
• for discordant couples where a man has been diagnosed with HIV;
• for single women.

VMI male semen is offered at:

• ejaculatory dysfunction;
• negative compatibility test (in case sperm die passing through the cervical canal).
• unexplained (idiopathic) infertility.

As a rule, no more than 2-3 inseminations are carried out. In the absence of positive results, in vitro fertilization is proposed.

• • Controlled stimulation of superovulation
    In order to obtain the optimal number of eggs, medical stimulation of the ovaries is performed. Under the action of stimulants in the ovaries, many follicles with eggs are formed. Several types of drugs and different methods of their administration are used in the treatment process.
    In order to monitor the dynamics of follicle and endometrial growth, ultrasound of the pelvic organs will be performed several times throughout the stimulation. The choice of treatment protocol is determined individually for each patient depending on such factors as age, the results of hormonal studies, data from previous treatment cycles and so on. The woman receives detailed appointments for each day on the stimulus list.
  • Puncture of follicles with aspiration of ova
    Follicle puncture and ovulation are performed transvaginally under ultrasound control and under intravenous anesthesia. The patient comes to the puncture on an empty stomach. On average, this procedure lasts up to 30 minutes. After the puncture, the woman stays in the clinic for another 1-2 hours.
    On the day of the puncture, the man must pass the semen. If for some reason the man is not able to come to the clinic, it is necessary to notify the doctor. In such cases, you can pre-cryopreserve (store in liquid nitrogen) semen in order to use it on the day of the puncture. We get the best quality sperm samples after 2-3 days of abstinence from ejaculation, which we warn our patients.
  • Fertilization of ova
    After collection, the eggs are placed in a special nutrient medium (incubator) to ensure proper conditions and temperature. Fertilization of eggs occurs 3 – 8 hours after puncture.
    Normal fertilization requires at least 10 million sperm throughout the ejaculate after special sperm treatment. The minimum amount of treated sperm is added to the culture plate with eggs for fertilization and placed in an incubator for cultivation.
    In case of deviations in the indicators of the spermogram, insufficient number of obtained eggs, negative results of previous cycles of ART, fertilization by ICSI (intracytoplasmic sperm injection) is recommended.
  • Cultivation of embryos
  • Embryo transfer

Embryos are transferred from the 2nd to the 5th day of their development. The choice of transfer day depends on many factors. However, there are no convincing data on the benefits of a particular day of embryo development for transfer to the uterine cavity. Embryos of good and excellent quality that will not be transferred to the uterus should be cryopreserved for use in subsequent treatment cycles.

Embryo transfer procedure is completely safe, painless and does not require anesthesia. The embryologist places the embryos in a thin, soft catheter, through which the doctor inserts them through the vagina and cervix into the uterine cavity. The embryos are introduced into a drop of nutrient medium, the catheter is removed and examined under a microscope to ensure that the embryos are successfully transferred. This process takes about 15 minutes. After embryo transfer, the hormone progesterone is given in injectable or other forms to prepare the endometrium for embryo implantation. It is important not to stop taking progesterone for a single day without a doctor’s recommendation!

• Lutein phase support
• Diagnosis of pregnancy
  Pregnancy test is performed 14 to 16 days after embryo transfer by determining the level of human chorionic gonadotropin (HCG) in the blood. Sometimes it is necessary to repeat this test in 2-3 days. The reliability of urine tests in early pregnancy is less than 100%. The test results show whether the embryo was implanted in the uterus or not. If the pregnancy test is positive, it is necessary to undergo ultrasound of the pelvic organs in 28 – 30 days after embryo transfer. It is necessary to make sure that there is a fertilized egg, embryo and heartbeat, which confirms the development of pregnancy.

• lack of eggs in follicular fluid during puncture;
• inferiority or non-viability of ova obtained during the puncture;
• non-fertilization for unknown reasons (1-3%);
• stopping the division of an already fertilized egg before transferring the embryos to the uterine cavity.

During ART possible: trauma, loss, death of eggs, sperm and embryos due to equipment failure, natural disasters, employee errors, actions of anti-social elements, etc. (the clinic has backup power supply systems, but not all circumstances can be controlled), embryo transfer may be technically difficult or impossible. [/ su_expand]

Risks and complications associated with the use of drugs to stimulate superovulation, analgesia, etc.

Controlled ovarian stimulation can lead to the development of ovarian hyperstimulation syndrome (OHSS), mild form of which occurs in 8-23%, moderate – in 1-7% of stimulated cycles.

Manifested by nausea, abdominal discomfort, a feeling of distension. Severe GVHD occurs in 0.5-1% of initiated cycles of ART and may be accompanied by vomiting, accumulation of fluid in the abdominal and pleural cavities, thrombosis (Golan et al., 1989; Navot et al., 1992). Treatment is usually outpatient. One of the most effective ways to prevent hyperstimulation is to delay the transfer of embryos into the uterine cavity.

Sometimes this condition requires inpatient treatment. Within one to two weeks, the symptoms of GVHD disappear.

Many studies have shown that in vitro fertilization as well as applicationsІКСІ does not increase the frequency of chromosomal abnormalities in children (Johnson et al., 2006).
The use of ART does not increase the risk of malformations (Rizk et al., 1991; FIVNAT, 1995; Bonduelle et al., 1996, 1999).

The use of ICSI does not increase the risk of malformations in fetuses compared to standard in vitro fertilization (Lie et al., 2007). [/ su_expand] </ span>

Rest assured – at each of these stages, our specialists will take care of your physical and emotional comfort.
We understand all the fears and experiences that are often present during treatment. And this is not surprising. After all, this type of fertilization has grown a lot of stereotypes.

We will try to calm your anxiety by refuting the most common myths about IVF.

Myth 1: Few couples choose artificial insemination

Fact: The IVF method was first tested in 1978. Since then, about 10 million children have been born this way.

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Myth №2: IVF makes it impossible to give birth naturally

Fact: Fertilization in this way does not mean that a woman will not be able to give birth naturally. However, IVF is often performed by women over 35, who have had unsuccessful pregnancies, and these factors may be indications for cesarean delivery.

Myth №3: Pregnancy by IVF is not possible on the first try

Fact: Although in vitro fertilization does not guarantee pregnancy, the effectiveness of this method is from 30 to 70%, depending on the individual performance of each woman.

Myth №4: With IVF, children are born unhealthy

Fact: The probability of developing pathologies in children after IVF is the same as after natural conception. After all, the key factor that affects the health of the baby – the health of his parents. In addition, before transferring embryos to the uterus, doctors can make a genetic diagnosis and implant only healthy embryos.

Myth №5: IVF harms women’s health

Fact: Women are often frightened by hormonal therapy to stimulate the ovaries, which is carried out before IVF. However, drugs and dosages are selected individually for each patient based on her examinations, which eliminates the risk of complications.

Myth №6: IVF guarantees multiple pregnancies

Fact: Most often 2 healthy embryos are transferred to the uterus in order to increase the efficiency of the transfer itself. Therefore, the probability of having several children is, in fact, higher. But more often (75% or more) only one embryo is implanted.

ICSI is performed on the day of follicle puncture. Manipulation is performed only on mature eggs in the presence of the first polar body.
With the help of microinstruments under the microscope, a good quality sperm is selected. It is placed in a microneedle, which is used to pierce the shiny shell of the egg. The sperm is then injected into the cytoplasm of the egg. In this way, all the eggs obtained by puncture are fertilized.

ICSI results

The incidence of pregnancy after ICSI does not differ from the usual in vitro program and is 40-45%.
Fertilization rates in ICS can range from 30 to 80%. There is no guarantee that each of the eggs will be fertilized after the procedure. The inability of the egg to fertilize and divide may be due to damage to the egg during manipulation, as well as the quality of the gametes. For example, when choosing sperm for ICSI externally, they may be of good quality (motility and structure), but contain chromosomal abnormalities. Oocyte quality also affects ICSI results and the entire in vitro fertilization program.

Some genetic disorders in men lead to impaired spermatogenesis – the process of sperm production and infertility. Such couples are shown in vitro treatment with ICSI. During micromanipulation, sperm with genetic abnormalities are theoretically capable of fertilizing eggs. To minimize the risk of transmitting a genetic disease, a comprehensive examination of the couple, especially the husband, including genetic counseling, is performed before starting treatment.

Why has the cryocycle become so important and highly effective today?

A little history

The cryoprotective properties of glycerin were first discovered in the 1950s, and the first pregnancy with thawed embryos occurred in 1983. However, at that time, the so-called slow freezing was used to preserve embryos, which was based on the displacement of fluid from the embryo or cell and its replacement by special substances – cryoprotectants. Unfortunately, this method was completely imperfect, and the probability of pregnancy after thawing of such embryos did not exceed 30%.

Another “revolution” in cryobiology occurred in the late twentieth century with the advent of a new method of freezing – vitrification – “quick freezing”. In 1990, the first child was born after the vitrification of a crushed embryo. In 1999, children were born from vitrified oocytes, and in 2004 the first report on cryopreservation of oocytes to preserve fertility in cancer patients was published. Vitrification (“glazing”) has firmly entered the lives of all reproductive clinics and has enabled us to reach a completely different level of assistance to our patients in overcoming infertility. </ span >

What is vitrification and what are its benefits?

The essence of vitrification is the use of high concentrations of cryoprotectant, thus avoiding the formation of ice crystals – the main cause of intracellular damage, which was accompanied by “slow freezing”. That is, the liquid inside the frozen object immediately becomes “glass” and not “ice crystal”.

Regardless of the method of cryopreservation, all frozen elements are stored in liquid nitrogen at a temperature of -196ᵒC. This makes it possible to stop all biological processes in them for a very long time. In this way, you can freeze embryos at the stage of fragmentation (1-4 days), blastocysts (embryos on the 5th day of development), eggs, sperm, testicular tissue at biopsy.

After thawing, the survival of biomaterial is very high (at least 90%).

Frozen material is stored in special cryotopes – specially designed for vitrification media that allow the safest possible storage of embryos, eggs, sperm or tissue.

Is vitrification dangerous for the health of future offspring?

The world has accumulated vast experience in working with vitrified material. It has been proven that there are no differences in the frequency of birth defects in children born as a result of spontaneous pregnancies and children who developed from thawed embryos. By the way, the same applies to children born in “fresh” IVF programs. Louise Brown had two healthy children.

Who is shown the cryocycle?

The clinic’s reproductive therapist may recommend a cryocycle in the following cases:

• after an unsuccessful IVF attempt. The use of a cryocycle in this case avoids the stimulation of ovulation that precedes embryo transfer and thus achieves the desired pregnancy;
• if the couple, planning the first IVF, already has plans for the second and third child;
• preservation of eggs / sperm / embryos is also shown to those men and women who have been diagnosed with cancer, the treatment of which may affect the subsequent ability to have children;
• preservation of sperm by cryopreservation is indicated for a man if he has diabetes (or some other disease) and there is a risk of complete loss of sperm fertility. Very small amounts of sperm in the ejaculate, as well as periodically diagnosed azoospermia – complete absence of sperm, are also indications for cryocycle.

What are the benefits of a cryocycle?

Using a cryocycle has a number of benefits for the patient. These are:

• significant reduction in the risk of severe complications of IVF – ovarian hyperstimulation syndrome. Stimulation of ovulation usually results in a large number of fertilized eggs, and the resulting embryos are frozen (freezeall). This makes it possible after 1-2 cycles to conduct a cryocycle with an efficiency equal to the transfer in the “fresh” cycle;
• reducing the financial costs of patients in cases where the first IVF attempt was unsuccessful. Cryocycle makes it possible to avoid ovulation stimulation
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  Why “as much as possible”? Because not every egg means the birth of a healthy baby. Reliable data show the following:
  Predicted probability of giving birth to at least one, two and three children according to the number of mature eggs, taking into account the woman’s age and the number of eggs obtained https://pubmed.ncbi.nlm.nih.gov/26604065/The number of mature eggs needed to give birth to a baby correlates with a woman’s age, and this should be kept in mind. So the first step is to get the eggs. How does this happen?The woman is prescribed appropriate drug therapy (stimulation), which stimulates the growth of multiple follicles in the ovaries, which mix potential eggs. The stimulation program is selected individually. In most cases, it lasts from 8 to 12 days. During stimulation, the required number of examinations in the clinic is 1-2 times (if this is not possible – ultrasound screening can be performed at the place of residence).
  The next step is to collect eggs.
  It occurs in a clinic, equipped with an operating room, under intravenous anesthesia through vaginal access. After the procedure of collection – puncture of follicles – eggs are stored in a special nutrient medium for 2 to 5 hours. The woman should remain under the supervision of staff to monitor the health of the clinic for 2 hours after ovulation.
  And the final stage of the program is denudation and freezing by vitrification of all mature eggs. Denudation is the release of an egg from the area of ​​the radiant crown, which allows us to assess the maturity of the egg and ensure its storage. They are stored in 2-3 cells on special cryotopes in liquid nitrogen.
  If there is an opportunity and time, it would be worthwhile before the first stage of the program “Fertility Preservation” to establish a work-rest regime, give up all bad habits, and most importantly – to undergo comprehensive vitamin training to improve reproductive function.
  Before starting stimulation, it is necessary to undergo a regular gynecological examination, which includes ultrasound of the pelvis, colposcopy, smears on the flora, PAP test and ultrasound of the mammary glands. You can get this examination from your gynecologist or our clinic.
  Given the preparation for the program “Preservation of Fertility”, you also need:
  • cervical PCR analysis for sexually transmitted infections;
  • blood test for TORCH infection;
  • hormonal “mirror” of a woman – blood test for 2-3 days of the menstrual cycle: FSH, LH, free testosterone index, prolactin, AMG, thyroid hormones bets – TSH, T3, T4.

  All of the above tests can be taken at the place of residence.

• individual donors (patients themselves choose a candidate that meets their requirements, when the donor is a relative or acquaintance of the patient, a friend);
• anonymous donors selected and examined by the Clinic.

In each case, the donor undergoes a comprehensive examination. Specialists of ICRC “Damia” carefully examine the donor (according to the Order of the Ministry of Health of Ukraine №787 of 09.09.2013), assess his general health, check for hepatitis B and C, syphilis, HIV, sexually transmitted infections , conduct a study of hormonal background, research on cystic fibrosis, also determine the karyotype.

Donor requirements:

• physical and mental health;
• age from 20 to 32 years, having a healthy child;
• satisfactory somatic health;
• no hereditary diseases;
• no bad habits.

Donor selection is a very serious and responsible stage. It is carried out taking into account the wishes of the spouses: blood type, rhesus factor, phenotypic features (eye color and incision, hair color, height, physique), education, etc.
According to the legislation of Ukraine, the donor waives the parental rights to children born with the help of its cells in advance. Information about the identity of the anonymous donor is confidential. The donor also does not receive information about the patients for whom the donation is made.
Our clinic uses only the eggs of women who consciously give them to help couples who want to have a child. This ensures complete anonymity for both the donor and the prospective parents.
We guarantee that no one will know any information about the donor egg program and pregnancy features except you, your reproductive therapist and the embryologist. All information about IVF is confidential.

Effectiveness of donor programs
Because oocyte donors are young healthy women under the age of 35, IVF programs with donor oocytes are much more effective than conventional IVF. In some cases, an oocyte donation program is the only way to conceive a long-awaited baby. The donor egg is more “capable”. Although sometimes patients’ decisions to use an IVF program with donor oocytes are not easy to make, the feeling of life that has arisen under the heart outweighs all the excitement.