Pregnancy with IVF: if a woman is soon 40

What is IVF?

So, in vitro fertilization is a technique that is based on the fertilization of an egg by a sperm outside the woman’s body. Germ cells are collected from future parents and placed in a special environment where fertilization occurs, after which the embryo is placed in the uterine cavity to carry the pregnancy.

The IVF method is used in case of infertility in a couple, when the egg and sperm cannot meet in the natural environment, that is, as a result of sexual intercourse. As an example, in case of obstruction of the fallopian tubes or their absence.

Stages of IVF

The procedure includes 5 main steps:

• Removal of eggs from a woman.
• Removal of sperm from a man.
• Fertilization in artificial conditions.
• Growing an embryo.
• Transfer of an embryo into the uterine cavity of the expectant mother.

How to find out that pregnancy has occurred

Often the first signs of your pregnancy after IVF begin to appear already in the third week, as in a normal pregnancy. So, in just two weeks you can take a pregnancy test. The choice of test should be taken seriously; read more about the types of pregnancy tests here . Of course, despite our recommendations for choosing a test, the most reliable result of confirming pregnancy will be provided by laboratory tests. Therefore, for women undergoing IVF, the doctor prescribes tests after two weeks to check the level of hCG in the blood. If the level of hCG hormone has increased, which indicates pregnancy, the doctor will prescribe your first ultrasound on day 21, to fully confirm your pregnancy and to obtain the first data on the condition and development of the fetus, and will also exclude ectopic pregnancy and determine the “fetal eggs”, Simply put, you will know exactly how many babies you have to give birth to. The pregnancy period after IVF is counted in the same way as during normal pregnancy, namely from the first day of the last menstrual cycle.

Reasons for unsuccessful IVF attempts

Unfortunately, not all IVF attempts lead to such a desired pregnancy; the percentage of unsuccessful attempts is very high and varies according to different sources.

Quite often, the reasons for IVF failure are associated with the non-viability of embryos and their reduced ability to divide.

In addition to this, there are other reasons, which include:

1. Stopping the development of the embryo after successful fertilization.
2. Pathological changes in the endometrium (chronic inflammatory diseases of the endometrium, endometrial polyps, hyperplasia, oncopathology).
3. Diseases associated with the fallopian tubes.
4. Infectious and inflammatory diseases of the reproductive system.
5. Genetic pathology in future parents, as well as genetic abnormalities of the embryo.
6. Individual incompatibility of spouses.
7. Pathology of the immune system (antibodies in a woman’s body that prevent pregnancy).
8. Endocrine pathology (hormonal imbalances).
9. Metabolic disorders (obesity).
10. Bad habits (smoking, alcohol, drugs).
11. The woman does not comply with the instructions of the fertility specialist and violates the treatment regimen.
12. Disadvantages of diagnosing concomitant pathology.
13. Eggs that are not suitable for fertilization.
14. Spermatozoa of reduced quality.
15. Chronic concomitant pathology (liver, kidneys, gastrointestinal tract, respiratory system, genital organs).
16. Medical errors.

Other factors that could lead to the death of the embryo cannot be excluded. A very important aspect in this matter is the state of health and physiological reserves of the expectant mother’s body, the ability of her body to implant an embryo and carry a pregnancy. How is IVF pregnancy different from regular pregnancy? Apart from the method of getting the embryo into the uterine cavity, strictly speaking, nothing.

Failure after IVF is not a death sentence, and it often takes several attempts to achieve the desired pregnancy. For many couples, maintaining hope and emotional stability after an unsuccessful attempt at in vitro fertilization is quite a difficult task, so this issue is also worth considering.

Detection of birth defects

In IVF pregnancy, the risk of congenital birth defects is slightly higher than in normal pregnancy. For this purpose, pre-implantation diagnostics are carried out to detect various abnormalities and chromosomal disorders, as well as to identify gene diseases. After the IVF procedure, at 10-12 weeks a special screening ultrasound for TVP is performed. And already at 18-20 weeks of pregnancy, a hormonal study is necessary, along with a DHEAS study to exclude pathologies such as Down's disease and CAH. Pregnancy itself through IVF is complicated by hormonal stress, so during the period of IVF artificial superovulation is carried out, which puts quite a strong strain on the functioning of the woman’s entire body.

Video on the topic “Features of pregnancy management after IVF”

Preparing for IVF

How should you behave during the break between attempts? There are several fundamental recommendations, these include:

1. Before an attempt and during the break between them, it is better for the couple to rest, including mentally. Go on a trip, learn a new hobby, read an interesting book.
2. Engage in light physical exercise, especially those that improve blood flow in the pelvic area, swimming, and aerobics.
3. Contact a therapist and undergo a full examination of all systems and organs; this is necessary in order to minimize the risks of a repeated unsuccessful attempt.
4. Add as many foods rich in vitamins and minerals to your diet as possible.
5. Have a sex life. During this time, give up the very idea of ​​getting pregnant, have sex at will, and not according to a schedule or prescription.
6. Work on stabilizing your psychological state, as stress reduces your chances of pregnancy.

There are many reasons why in vitro fertilization fails, but many of them can be easily corrected and their impact can be minimized. It is also important to remember that the IVF process should be handled by a qualified gynecologist-reproductologist who will help you easily get pregnant and carry such a desired baby.

What determines the probability of success?

The success of an IVF procedure depends on many factors, and not all of them can be controlled. However, a number of good decisions made by you and your doctor will increase the chances of a successful pregnancy.

Choosing a clinic

This is a major factor that can be controlled by the patients themselves. Everything else depends not so much on them, but on the doctors.

In different clinics, IVF success rates differ quite significantly. In leading centers in Moscow, the pregnancy rate per transfer reaches 50-55% (in women under 35 years of age with tubal factor infertility). While the world average is only 25-30% of pregnancies per transfer. Obviously, there are many clinics that drag down these statistics. The probability of pregnancy in them is only 20-25%, and in some categories of patients (age after 35 years, uterine factor infertility) it is significantly less

There are several reasons why pregnancy is common in one clinic and rare in others:

Qualification of doctors. More reputable institutions can attract the best specialists who come here in search of professional growth and decent compensation for their work. It depends on the doctor whether the stimulation program will be chosen correctly and the procedures performed (follicle puncture, embryo transfer). He prepares the endometrium and decides whether to transfer the embryos or postpone this procedure until the next cycle. The qualifications of a reproductologist are the most important factor in the success of the IVF procedure.

Equipment. A well-equipped embryology laboratory, the use of the latest media, high-quality consumables - all this increases the cost of the clinic’s services, but increases the effectiveness of IVF.

New approaches. Good clinics regularly send their doctors to European and American conferences and symposia. They travel to the leading reproductive centers of the world to exchange experiences. Therefore, new technologies and techniques are coming from the West to increase the effectiveness of IVF and the safety of this procedure.

Full diagnostics. Unsuccessful IVF or miscarriage may be the reason for underexamination of the patient. Incomplete diagnosis of hormonal profile, blood coagulation system, endometrial condition, infectious diseases, etc. leads to a procedure with obviously low chances of a successful outcome.

Choosing a good clinic is the best thing a patient can do to prevent IVF failure. You need to choose not by price, not by proximity to home or convenient metro station. It is better to contact a reputable clinic with good statistical indicators. Statistics are often published on the website of the medical institution. If it is not there, it is highly likely that the clinic has nothing to brag about - no one wants to advertise bad statistics. Statistical data may be provided to you upon request.

Lifestyle

Another factor controlled by patients is their lifestyle. What you need to do with infertility treatment:

• quit smoking;
• normalize body weight if it is excessive;
• increase the amount of vegetables and fruits in the diet, reduce the consumption of fatty foods of animal origin;
• do not drink alcohol in excessive quantities, more than 3 times a week;
• exclude any drugs and psychoactive substances;
• lead an active lifestyle, practice physical activity at least 45 minutes a day;
• exclude any extramarital sexual contacts to prevent infection with sexually transmitted infections.

All this will help normalize the immune response, blood clotting, blood supply to the genitals, and the removal of toxic substances from the body.

Detection and treatment of diseases

In most cases, a woman begins to be thoroughly examined to determine the cause of unsuccessful infertility treatment only after 2 unsuccessful IVF attempts, or 2 spontaneous abortions in a row. Until this time, miscarriage or lack of pregnancy after embryo transfer is considered an element of chance.

But many clinics conduct a full examination of the patient even before entering into the first IVF protocol. This increases the success rate. Indeed, if pathological conditions are detected (infectious diseases of the urogenital tract, chronic endometritis, disorders in the hemostasis system), treatment is required before a woman can become pregnant and bear a child.

Of course, additional diagnostics require additional time and money. However, they are not comparable to the expenditure of the same resources that a married couple spends on repeated and unsuccessful attempts to get pregnant and carry a pregnancy to term. Therefore, you should not be outraged that you are prescribed too many tests. It is better to initially exclude all possible causes of unsuccessful IVF.

What to do if 2 or more unsuccessful attempts?

Recommended actions in case of two or more unsuccessful attempts:

1. Consider changing medical institutions. Perhaps you chose the cheapest clinic, not the best.
2. If you trust your clinic and doctor, it’s worth going for a third, and possibly a fourth try. But it is important to analyze the reasons for failure. For this purpose, an examination is carried out.
3. Additional procedures are used that increase the effectiveness of IVF. Which ones exactly depend on the diagnostic results.

1-2 unsuccessful attempts is a common occurrence that can happen even without any reason. It’s just that not all women are lucky enough to get pregnant right away. Not every embryo transfer into the uterus results in pregnancy, even in the best clinics in the world.

The maximum chances of pregnancy are observed in women under 35 years of age, with endocrine or uterine factor infertility. In a good clinic, the success rate reaches, and sometimes slightly exceeds, 50%. However, even in this case, every second woman will not get pregnant after the first IVF attempt, and every fourth woman will not get pregnant after two attempts. But IVF is not a lottery. It’s just that the method of treating infertility should not initially be considered as a one-time procedure. Be prepared for several attempts, because if you take general statistics for all categories of patients, then after the first time only one woman out of three becomes pregnant. Most require 2-3 attempts, and sometimes more.

However, any treatment failure requires analysis. After two, and sometimes after one attempt, the reproductive specialist and embryologist evaluate how the procedure went. They look at what can be improved to further increase the chances of a successful outcome.

Additional assisted reproductive technologies

IVF is not a standard procedure that is carried out in all clinics and for all patients according to a single algorithm. The general principle is the same. But IVF uses different stimulation schemes, different approaches to fertilization and embryo transfer. A large number of additional assisted reproductive technologies are used, which increase the likelihood of pregnancy.

What can fertility specialists do to increase the likelihood of pregnancy in the next cycle and reduce the risk of spontaneous abortion:

PIXIE. A technique for better sperm selection compared to ICSI, where the embryologist selects the male reproductive cell solely based on morphological characteristics (that is, by eye). During PIXI, the degree of interaction of sperm with hyaluronic acid is assessed. As a result, a male reproductive cell is selected, which with a high probability carries normal genetic material. After fertilization of an egg with such sperm, the embryo develops normally and is highly likely not to be rejected by the female body soon after transfer.

Assisted hatching. The procedure is performed mainly on older women. Laser incisions are made on the shell of the egg. They can also be made using other technologies. Incisions in the membrane make it easier for the embryo to “hatch”, therefore slightly increasing the chances of implantation and pregnancy.

PGD. Preimplantation genetic diagnosis allows embryos to be tested for genetic mutations and chromosomal aberrations before transfer. As a result of such research, some embryos are discarded. Only those in which no genetic abnormalities are detected are transferred. Thus, the transfer of many non-viable embryos that would not take root in the uterus at all, or if pregnancy occurs, would be interrupted in the first weeks or months of development, is initially excluded.

Features of pregnancy management after IVF

Every woman during the period of bearing a baby often visits the doctor and undergoes many tests. After IVF, studies will have to be done a little more often, since after this type of fertilization, special attention to the development of the fetus is required. The expectant mother must undergo the following examinations throughout her pregnancy:

Study of the hemostasis system. It can be prescribed either 3 weeks after the start of fetal development or throughout the entire pregnancy.

At the end of the first trimester, a woman should undergo an examination to detect spontaneous dilatation of the cervix, if present. Like all pregnant women, at this stage it is necessary to undergo an ultrasound scan to exclude various pathologies in the fetus.

From 16 to 20 weeks, the doctor will give a referral to determine the level of male hormones. For this purpose, the 17-KS study is being conducted. If their number is high, drug support is necessary to prevent termination of pregnancy. At this time, an additional ultrasound is performed to ensure the normal development of the baby.

The next ultrasound is performed at 20-22 weeks, it allows you to examine in detail the structural features of the child and identify pathologies. The expectant mother can now be told the sex of the baby.

At the beginning of the third trimester, the last planned ultrasound is performed, which determines the motor activity of the fetus.

After IVF, pregnancy is not always easy, so the gynecologist may prescribe additional tests and ultrasound to notice changes in a timely manner. At 37 weeks, the expectant mother is recommended to go to the hospital. Often in such a situation, a woman carries 2 fetuses at once, so it is better to be under the supervision of specialists, since labor can begin unexpectedly.

You can read about nutrition during pregnancy here. You can learn about the benefits of gymnastics during this period in this article.