Indications for IVF: a list of diseases, infertility, the right to IVF under the policy, preparation, features and contraindications

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

Modern technologies and the development of science make it possible, if not to cure infertility, then to have a child with such a diagnosis. There are many reasons for not being able to conceive naturally. Increasingly, in vitro fertilization is used, which is quite expensive. Not every couple can afford such a procedure, and it is not carried out in all cities. To this end, the Ministry of He alth has created a program for free IVF under CHI. In this article, we will consider the indications for IVF. It will also talk about the process of its implementation and the features of preparation.

The most common indications for IVF in women

The cause of a couple's infertility can lie both in the male body and in the female. That's whyit would be logical to break all the causes into de groups. First of all, we will consider the indications for IVF in women. These include the following:

1. Endocrine infertility. This is a violation in the process of ovulation, which is the most relevant reason for the inability to become pregnant. Endocrine infertility is accompanied by anovulation, that is, a violation in the menstrual cycle, which leads to the impossibility of maturation of the egg and its release from the follicle. At the same time, the duration of the cycle does not differ from a he althy one. As a result of deviations, the production of the hormone progesterone is disrupted, which leads to the inability to become pregnant or miscarriages. The cure for endocrine infertility is to take hormonal drugs that stimulate ovulation. If within 6 months the result is not achieved, then anovulation becomes an indication for IVF. After the procedure, most women with this diagnosis were able to become pregnant and give birth to a child. It's all about drugs that stimulate superovulation.
2. Tubal-peritoneal infertility is the second most common indication for IVF. As a result of the development of such a disease, adhesions appear in the pelvic organs, which leads to the inability of the fallopian tubes to function properly. A fertilized egg cannot pass through them. The same category of indications includes weak contractions of the tubes, due to which the cell does not reach the uterus. This pathology can occur as a result of infectious diseases in the abdomen, ectopic pregnancy, inflammation of the fallopian tubes and ovaries, postoperative complications or surgical interventions. FROMIVF solves this problem.
3. Severe endometriosis is an equally common indication for IVF, during which the inner layer of the uterus grows very actively and begins to go beyond it. The danger of the disease lies in the fact that it is painless and may not even be felt by a woman. Treatment of the disease is carried out either with the help of therapy (with the use of hormones), or in an operable way. If the previous options have not brought results, resort to IVF.

Other testimony concerning women

In medicine, there are a number of factors that affect a woman's ability to become pregnant, but rarely occur in practice. It is them that we will now consider.

1. Polycystic ovary syndrome is an indication for IVF. It doesn't occur very often. The disease leads to disruption of the ovaries. Often, the level of male hormones increases significantly. This leads to such visible signs as baldness, acne, lack of menstruation, obesity. Treatment begins primarily with therapy that stimulates ovulation. If it did not bring results, IVF is carried out.
2. Unclear genesis has recently become an official indication for IVF. Accompanied by the well-being of both spouses and the possibility of getting pregnant, but despite this, all attempts are unsuccessful. There are no more than 5% of such cases, since modern technologies make it possible to determine the cause of infertility.
3. Immunological infertility is very rare and is accompanied bythe emergence and development of antisperm bodies. They can appear in both men and women. They strike at the spermatozoa, attaching to their tail and preventing them from entering the egg. The reasons for such infertility are little known, therefore, first of all, the woman is again invited to undergo a course of therapy with hormones. The second stage is IVF.
4. The age factor is an indication for IVF, which is increasingly common in recent years. The older a woman gets, the slower the processes in her body proceed, and this applies not only to ovulation. As a result, there may be problems with conceiving a child. Many women use the "delayed motherhood program", which involves the removal of a few mature cells into girls at the age of about 20 years. They keep frozen for many years. At any time convenient for the patient, she can carry out the IVF procedure with her own cells.

Sperm pathologies as indications for IVF

Problems with conceiving a child can occur in any couple, in which case both partners need to be examined. After all, there are a number of indications for IVF in men. Let us consider in detail the pathologies of sperm, what they are:

1. Oligozoospermia, which means a decrease in the number of spermatozoa in semen.
2. Teratozoospermia, when there are a large number of deformed cells with a short tail in the sperm, disorders in the head, structure. There may be spermatozoa with two heads, they are not capable offertilize the woman's cell.
3. Asthenozoospermia is very common and consists in a reduced speed of spermatozoa. Its severe stage is called akinospermia, when the cells have completely lost the ability to move. Such pathologies are often formed as a result of excessive use of alcohol, tobacco.
4. Hypospermia is the secretion of a small amount of sperm as a result of sexual intercourse. If the amount of material does not exceed 2 ml, this indicates a disease.
5. There is even necrospermia, in which there are more dead spermatozoa in semen than live ones.
6. Polyspermy means a significant increase in the amount of sperm and male cells in it. In this case, there are many cells, but they cannot fertilize the egg - their penetrating ability is significantly reduced.
7. Pyospermia is a form of pathology in which there is pus in the semen. This is usually the result of various diseases.
8. Azoospermia is a disease in which there are no spermatozoa in semen.
9. Aspermia is a condition in which there is no sperm at all.

All these pathological conditions are indications for IVF.

Other indications for men

There are two more reasons that lead to male infertility. Consider them in more detail:

1. Varicocele, which means varicose veins of the testicle or seminal canal. This cause occurs in 40% of male infertility cases. Expansion of the veins leads to an increase in temperature and the creation of unfavorable conditions for the developmentspermatozoa. In most cases, this is treated with surgery. If it did not bring positive results, the disease becomes an indication for IVF.
2. Immunological infertility duplicates the type of the same name concerning female infertility. In the body of a man, antisperm bodies are formed. They can occur as a result of trauma, varicose veins, hereditary predisposition.

Indications for both spouses

Any genetic diseases and anomalies are indications for IVF protocols. In addition, pre-implantation diagnostics is carried out, which allows to identify anomalies and diseases. Indications are not only the classic causes of infertility described above, but also the following situations:

1. Genetic disorders.
2. The couple are over 35 years old.
3. Chronic diseases leading to infertility.
4. Missed pregnancy in a woman's clinical history.
5. Inability to bear a child.

Pre-implantation diagnosis allows you to generate results and data on the he alth of a woman and a man, which will help increase the chances of a successful IVF.

Free IVF

On the territory of Russia, there is Order of the Ministry of He alth No. 107n, which regulates the procedure and grounds for free IVF. The law says that a woman and a man, both married and unmarried, can exercise the right to a freein vitro fertilization. A woman who is single can also exercise this right.

What indications for IVF does the law establish?

1. Infertility that has not been successfully treated. No matter what the reason and form of the inability to have a child.
2. Diseases in which pregnancy cannot occur on its own, IVF is necessary.

Selection of patients

First of all, the cause of infertility and indications for IVF according to compulsory medical insurance are determined. As part of this stage, the endocrine state of patients is assessed, as well as the ovulatory status of the woman. The patency of the tubes and the ability of the pelvic organs to function properly are assessed. The endometrium is examined, its thickness, dimensions and boundaries. A man's sperm is examined to identify pathologies. Also, both spouses (cohabitants) are examined for infections. Thus, the reason why the couple cannot have children is calculated, and a conclusion is made about the indications for IVF according to compulsory medical insurance. The duration of this stage varies from 3 to 6 months. After that, the following actions are carried out:

1. At the second stage, the doctor identifies the possibility of curing the problem, various types of therapy are applied, and various kinds of assistance are provided. In this case, the duration of the stage may be delayed up to 12 months.
2. Immediately before the procedure, a complete examination of a man and a woman is carried out. Blood is tested for antibodies to the human immunodeficiency virus, herpes, molecular testing for cytomegalovirus, chlamydia, mycoplasma,ureaplasma, treponema.
3. Women take additional tests - complete blood count, biochemical analysis, urinalysis, x-rays, ECG, vaginal swabs. It also requires the determination of antibodies to rubella, cytology of the cervix, consultation with a therapist.
4. Women over the age of 35 are prescribed mammography, and up to 35 years of age, an ultrasound of the mammary glands is performed.
5. Men undergo semen testing.
6. If there are diseases of the pelvic organs, then they are treated.
7. In the presence of certain types of pathologies, consultations are scheduled with specialists in different areas.

Conducting a basic IVF program

The law regulates in detail not only the indications for IVF under the policy, but also the procedure for the procedure, which is no different from a paid procedure. Work steps:

1. Superovulation stimulation is the first stage of work, which involves taking drugs from the group of menotropins and gonadotropins by a woman. They are able to significantly increase the efficiency of the ovaries and produce many instead of one egg. The amount depends on the individual indications and the type of protocol. All this is discussed with the doctor at the preparation stage. The dosage and response of the woman's body is monitored in tabular form, depending on which the order of the procedure is adjusted.
2. Puncture of eggs from the body of the patient. With the help of the transvaginal technique, all the eggs that have matured are taken from the ovary. At this stage, useanesthesia, so the presence of an anesthesiologist is mandatory during the procedure.
3. Under artificial conditions close to natural, the fusion of female and male cells is ensured, resulting in in vitro fertilization.
4. Embryo culturing involves the process of selection by an expert embryologist of the strongest fertilized cells. They are grown in artificial conditions.
5. The last step is the implantation of fertilized cells into the uterine cavity. It is not recommended to transplant more than 2 embryos in one procedure. If the patient wants to implant 3 embryos, then she gives her written consent.
6. After 12-14 days, the fact of pregnancy is checked.

Restrictions on the use of IVF

IVF for medical reasons, like any other procedure, has its limitations and contraindications. IVF restrictions are:

1. Decrease in ovarian reserve, which is detected at the stage of preparation for the procedure using ultrasound or blood results for anti-Müllerian hormones. Ovarian reserve is an indicator of the reserve of eggs in the ovary laid down before birth in a woman.
2. Patient conditions where other programs would be more effective, eg fertilization with donor cells, preserved cells, surrogacy.
3. Gender related diseases. In women, this is hemophilia, muscular dystrophy and more. In this case, beforeIVF refers patients to a specialist geneticist.

Contraindications for IVF

The law establishes a whole range of IVF indications and contraindications. If we analyzed the first in detail earlier, then we list the contraindications now:

1. Infectious or parasitic diseases. These include various forms of tuberculosis, viral hepatitis in all forms of manifestation. Also a disease that is caused by human immunodeficiency, syphilis in a man or woman. Such a contraindication is relevant until the moment of cure.
2. Neoplasms. This includes malignant neoplasms anywhere. Benign tumors that affect the uterus or ovaries are also a contraindication for IVF.
3. Diseases of the blood and hematopoietic organs. This includes acute forms of leukemia, aplastic anemia, acute forms of hemolytic anemia, chronic myeloid leukemia, high-risk lymphomas, and more. You can see the full list of diseases in Appendix No. 2 to the Order.
4. Diseases of the endocrine system and metabolic disorders. This includes diabetes mellitus with renal insufficiency, or a condition after a kidney transplant, or progressive retinopathy. In addition to these forms of diabetes, hyperparathyroidism is contraindicated.
5. Mental disorders are serious contraindications. These are psychosis, dementia, hereditary degenerative disorders, affective disorders and diseases caused by the use of psychoactive substances.
6. Diseases of the nervous system associated withpronounced mental and motor disorders.
7. Diseases of the circulatory system, various types of heart defects, cardiomyopathy, Aerz's disease, consequences of pulmonary hypertension, various vascular diseases, hypertension.
8. Respiratory diseases.
9. Digestive disorders.
10. Diseases of the genitourinary system.
11. Congenital developmental disorders.
12. Pathologies in bone, muscle and connective tissue.
13. Complications in previous pregnancy and childbirth.
14. Poisoning and injury from external causes.

All of these contraindications are diagnosed by the doctor during the preparation phase, resulting in other programs suitable for each specific case.