There are a lot of protocols in the in vitro fertilization program. Each of them has its own advantages, so it is impossible to choose the best. The appointment of a protocol occurs taking into account the individual characteristics of the patient’s health. The doctor’s task is to identify all possible contraindications and achieve a positive result, that is, a successful pregnancy. Currently, two IVF protocols are most common: short and long. Each of them has its own characteristics. But at the same time they consist of exactly the same stages. Below are discussed in detail the short IVF protocol by day, as well as the long one.
General principles
The in vitro fertilization program consists of several stages. Moreover, their number does not depend on the protocol. It often happens that women, inspired by the information presented on the forums, put pressure on the doctor, imposing a successful scheme, in their opinion. It is important to understand that a protocol suitable for one patient may fail for another.
IVF programs are designed to block the synthesis of FSH and LH hormones. It can be either complete or partial. Against the background of blockade, medications are introduced, the active components of which contribute to the maturation of the desired number of follicles.
There are uniform rules for all protocols. All prescribed drugs are administered either intramuscularly or subcutaneously (in this case, in the stomach). Injections need to be done daily strictly at the same time. Patients are forbidden to cancel or replace the drug, adjust the dosage, and also skip the introduction of the drug. Only a doctor is entitled to make changes to the scheme on the basis of ultrasound.
Features of the short protocol
Its duration is only 4 weeks. In other words, it is fully consistent with the physiological cycle.
Short IVF protocol by days (in detail):
- On the first day of the cycle, an ultrasound examination is prescribed. Based on its results, the doctor selects medications.
- On the 2nd or 3rd day, the beginning of the introduction of stimulating and regulatory drugs. This stage takes 10 days.
- On the 12th or 13th day, triggers are assigned. These are drugs whose active components modulate the conditions under which the oocyte detaches from the follicle.
- After 35 hours, a puncture is performed.
Often a short protocol is prescribed after a long one has been unsuccessfully. It is well tolerated by most patients, due to low dosages of hormonal drugs. In addition, he usually does not have ovarian hyperstimulation syndrome.
Indications
In most cases, a short protocol is prescribed for healthy women. The main indications for this scheme:
- Regular menstrual cycle.
- Failed IVF attempts in the past using other protocols.
- Good stock of eggs.
In addition, this scheme can be assigned to women for financial reasons. It is considered the cheapest.
Features of the long protocol
As a rule, it is prescribed with a low quality of previously obtained eggs. With this scheme, the development of follicles occurs synchronously, they have the same size. In addition, the number of immature eggs is significantly reduced.
Long IVF protocol by days (in detail):
- In the first 20 days of the cycle, no activities are carried out.
- On the 21st or 22nd day, the introduction of regulatory drugs begins. After this, you must wait for the onset of menstruation.
- On the 2nd or 3rd day from the onset of bleeding, the introduction of stimulant drugs begins. Injections are carried out from 10 to 12 days (in isolated cases it takes a longer period of time).
- When the eggs mature, a puncture is performed.
For all this time, the patient must undergo an ultrasound examination 4 times.
A long protocol is characterized by a high risk of ovarian hyperstimulation syndrome.
Indications
This treatment regimen is often prescribed for the first time, and after others have not led to a positive result. Indications for the long protocol:
- Regular menstrual cycle.
- A small supply of eggs in middle-aged women.
- Endometriosis
- Uterine fibroids.
- Hyperplastic phenomena in the endometrium.
- Unsuccessful attempts to conceive using other protocols.
A long treatment regimen is very expensive.
The first step is to enter the program
About 10 days before the onset of menstrual bleeding, you must sign up to your doctor and undergo an ultrasound. During the study, the reproductologist evaluates the condition of the pelvic organs and the thickness of the uterine mucosa. In the absence of cysts on the ovaries and endometrial pathologies, the doctor and the patient sign all the necessary documents (contract, agreement, etc.).
After that, the specialist draws up a list of appointments for the woman. With him, she should come at every appointment. The doctor talks about the principles of in vitro fertilization, and also provides information on the selected IVF protocol in detail every day.
During treatment, both partners must strictly comply with the recommendations of a specialist and come to the reception at a strictly scheduled time. Implementation of measures can be terminated at any stage if the doctor is confident in the failure of the result. In this case, the patient will be refunded for unfulfilled actions.
The second stage - stimulation of ovulation
The reproductologist talks about the drugs in detail, the IVF protocol by day is also being discussed again. This is due to the fact that short and long stimulation schemes exist.
The following drugs are prescribed to the patient:
- Gonadoliberin agonists. Examples of funds: "Diferelin", "Dekeptil".
- Gonadoliberin antagonists. These include: Tsetrotid, Orgalutran.
- ChMG preparations. Most often, Menopur is prescribed.
- FSH preparations. Examples of funds: Gonal-F, Puregon.
- HCG drugs. As a rule, experts recommend “Rotted”.
These medications can be prescribed both jointly and sequentially. The doctor without fail talks about the dosing regimen by day and in detail. IVF protocol at the stage of ovulation stimulation is strictly forbidden to violate.
In all cases, the introduction of "Decapeptil" or "Diferelin" is first carried out. These are drugs that prepare the ovaries for their stimulation process.
Speaking by the day, the long IVF protocol implies their introduction on the 2nd or 3rd day, from the moment of the beginning of menstrual bleeding. Short - in the same period of the cycle.
The third stage is monitoring
The patient needs to undergo an ultrasound several times and donate blood to the hormone estradiol. The number of studies depends on the individual health characteristics and the selected IVF protocol. In detail and by day, the doctor analyzes the changes during treatment. As a rule, the first monitoring is carried out on the 5th day after the start of stimulation. During an ultrasound, the doctor evaluates the dynamics of follicular growth and the thickness of the uterine mucosa. Based on the results of the study, adjustments can be made to the dosage regimen of drugs.
As a rule, ultrasound is performed 1 time in 5 days. After the start of active follicular growth, the study should be carried out every 2-3 days. Blood sampling for analysis is carried out with the same frequency, or slightly less.
At each monitoring, the doctor evaluates the size of the follicles and the thickness of the endometrium. As soon as the reproductologist decides that the patient is ready for the puncture, he prescribes the introduction of the hCG drug. As a rule, the injection is carried out after 35 hours. This time is necessary for the final maturation of follicles.
The fourth stage - puncture
According to any IVF protocol by day, it is carried out when ovulation occurs. The main task at this stage is to obtain eggs from the follicles by piercing the latter with a hollow needle. This intervention is carried out under sterile conditions and under the supervision of an ultrasound machine. Previously, the patient is immersed in a state of anesthesia.
The duration of the procedure is no more than 20 minutes. At the same time, the partner must donate sperm for examination and subsequent processing.
The obtained follicular fluid containing eggs in sterile disposable containers is sent to the embryological laboratory.
After the intervention, the patient is under medical supervision for about 2 hours. As soon as the anesthetist makes sure that there are no complications after anesthesia, he will refer the woman and her husband to the attending reproductologist. According to reviews, the IVF protocol (detailed daily by the scheme described above) at this stage is well tolerated by most patients. After the procedure, minor pain and scanty spotting may disturb.
Medical support of the function of the corpus luteum after a puncture is another point of the IVF protocol. In detail, the doctor writes the dosing regimen daily. Strict adherence to recommendations leads to an improvement in the condition of the endometrium, which significantly increases the chances of successful implantation. As a rule, doctors prescribe Utrozhestan vaginal capsules and Dufaston or Proginova tablets.
Fifth Stage - Ovum Fertilization
In the laboratory, the embryologist examines the resulting follicular fluid. He selects the most viable eggs and places them in an incubator. Regardless of whether a woman chose a long or short IVF protocol (by day both schemes are described above), the fertilization process is carried out a maximum of 6 hours after receiving the biomaterial.
Initial assessment is carried out after 18 hours. At this time, the first signs of successful fertilization are already visible in the eggs. Re-evaluation is carried out after another 8 hours. Then the specialist monitors the condition of the embryos daily, recording all clinically relevant parameters. Only those that are of good quality are subject to transfer.
As a rule, the operation is prescribed for 4-5 days of cultivation, when the doctor will make sure that the embryos develop well.
Sixth stage - transfer
On the appointed day, the patient should see a doctor about half an hour before the start of the procedure. Extra time is needed to resolve the issue of how many embryos need to be transferred. Then the patient goes to the operating room.
The algorithm of the procedure:
- A woman is placed on a gynecological chair.
- The doctor transfers the embryos into a special catheter.
- The specialist with the help of mirrors exposes the cervix.
- The doctor inserts a catheter directly into the cavity of the organ. Through a thin tube, embryos enter the uterus.
The procedure does not take much time. Typically, one lasts no more than 10 minutes. The transfer is not associated with the onset of pain, in some cases, patients experience only slight discomfort. Immediately after the transfer, the woman should be in a horizontal position for about an hour.
After this, the patient and her spouse go to the attending physician, who gives them an extract and talks about what lifestyle to lead in order to significantly increase the chances of a successful outcome of in vitro fertilization.
Finally
There are many treatments for infertile couples. According to reviews, a short IVF protocol (it was described in detail by days above) in a shorter time period can lead to the onset of a long-awaited pregnancy. Its duration is fully consistent with the physiological cycle of women. It has a large number of good reviews and a long IVF protocol. In detail, the doctor writes the treatment of patients by days, focusing on the fact that it is unacceptable to make adjustments to the scheme. It is important to understand that the first attempts may be unsuccessful. In such cases, the doctor may prescribe a different protocol.