What is the difference between Ixi and Eco? What is the difference between eco and ixi. How is it different from IVF?

In this section you will learn:

Perhaps every married couple has a desire to become happy parents. However, unfortunately, not every couple has the opportunity to realize this dream in a natural way. In cases where a woman fails to get pregnant within a year in the presence of a constant sexual life, most likely she will hear such a diagnosis as infertility. Or this diagnosis will be made to her partner.

Fortunately, the possibilities of modern medicine, if not unlimited, are very wide. A procedure such as IVF, or its varieties - ICSI / IMSI, can help a woman become pregnant.

What is it and how does IVF differ with ICSI / IMSI: what is the difference between the procedures and how is each of them done?

IVF is in vitro fertilization. Literally, this term can be deciphered as fertilization outside the (extra) body (corpus) of a woman. The essence of the technique is that a suspension of prepared, actively motile spermatozoa is added to the resulting egg. Then the natural process of fertilization begins - the strongest of the spermatozoa penetrates the egg, as a result of which an embryo is formed. After successful fertilization and the beginning of the development of the embryo, it is placed in the woman's uterus and the pregnancy is expected.

What if natural fertilization does not occur? In such cases, embryologists are involved in the work and microsurgical fertilization methods are used - ICSI or IMSI.

First, let's look at the reasons for the lack of natural fertilization.

They may be as follows:

• Reduced sperm count in semen
• In semen, spermatozoa have reduced motility;
• Many spermatozoa have pathology;
• Semen contains antisperm antibodies (ASAT).

Now back to the essence of the ICSI technique. So, ICSI is intracytoplasmic sperm injection. The specialist-embryologist selects one with the best morphological characteristics from the set of received spermatozoa. For this, a microscope is used, which allows you to achieve a 400-fold increase in the image. Then, with the help of a special microneedle, this spermatozoon moves into the cavity of the egg. Within a day after this manipulation, fertilization should occur. Further actions when using the ICSI conception method are the same as with conventional IVF: culturing the embryo, transferring it to the uterine cavity and waiting for the onset of pregnancy. With poor performance of the female biomaterial, ICSI can be performed and fertilization can be done with a donor egg.

With reduced spermogram parameters (low sperm motility, increased sperm DNA fragmentation, pathological sperm morphology), a complicated ICSI method, namely IMSI, is used to obtain an embryo. To do this, it is necessary to use a special optoelectronic device that will allow you to study the resulting material (sperm) with an image magnification of 6000-6600 times. Such an increase allows you to see the smallest changes in the structure of spermatozoa and exclude from selection those whose morphological characteristics even slightly differ from ideal ones.

Infertility treatment and fertilization by IVF, ICSI / IMSI in St. Petersburg: an experiment or a reliable way to deal with infertility?

No matter what myths IVF has overgrown, it is this method that has already given life to more than 5 million people. Of course, they do not resort to it when it is possible to conceive a child in a natural way. No one is trying to prove that test tube babies are better, stronger, smarter and healthier than those who were born without the intervention of modern medical technology. However, if for a number of reasons a woman cannot become pregnant on her own, IVF is a real chance for her to become a mother.

The IVF procedure (as well as the additional manipulations carried out as part of this procedure - ICSI / IMSI) will be the most effective and safe if:

• Before the procedure, all necessary studies and analyzes will be carried out. Specialists study the biological material of a woman and a man, assess the predisposition to various diseases (including genetic ones), study the causes of miscarriages, termination of pregnancy, if this has already happened in a woman's life. There is a sufficient amount of research at the preparation stage - future parents need to be patient and follow all the instructions of the doctors.
• Before the procedure, all possible contraindications will be taken into account. By the way, there are quite a few of them, but not all of them are absolute. Postponing, temporarily rescheduling the IVF procedure can be caused by such diseases as hepatitis, tuberculosis, infectious, inflammatory processes. In such cases, it is first necessary to carry out therapy aimed at eliminating precisely these pathologies, and then to deal with the problem of infertility. Absolute contraindications to IVF are serious blood diseases, mental disorders, severe pathologies of the liver and kidneys.
• The procedure will take place in a modern center staffed by experienced reproductive specialists, gynecologists, embryologists, and so on. The technological equipment of the center is also important (for example, for the IMSI procedure, as mentioned above, special equipment is required, which is not available in every clinic).

Successful fertilization, embryo transfer and even its proper attachment and implantation in the uterine cavity is only the first step on the way to happy parenthood. Pregnancy resulting from IVF should be monitored in the same way (perhaps even more carefully) as the one that occurred naturally - to perform periodic screening examinations, ultrasound, CTG, and so on.

How to prepare a woman and a man for the IVF-ICSI procedure?

Before starting the IVF-ICSI program, the reproductive specialist, after talking with the patients (male and female) and studying their medical history, will assign both a series of examinations for preparation. The list of examinations is regulated by the order of the Ministry of Health of the Russian Federation No. 107n "On the procedure for using assisted reproductive technologies, contraindications and restrictions on their use."

Tests for a man

Analyzes with a shelf life of 12 months:

• microscopic examination of a smear from the urethra;
• PCR diagnostics for chlamydia, mycoplasma, ureaplasma, herpes, cytomegalovirus (sexually transmitted diseases - STDs);
• blood for antibodies to herpes simplex virus type 2.

• Spermogram, MAR test.

Before these examinations, sexual rest is required for 3-5 days, as well as abstinence from alcohol, sauna baths for 1 week.

Analysis for a woman

Analyzes with a shelf life of 12 months (or are given once in a lifetime, such as, for example, on the Rh factor):

• blood group and Rh factor;
• blood for antibodies to herpes simplex virus type 2;
• fluorography;
• Ultrasound of the heart (ECHO);
• Ultrasound of the thyroid gland followed by a consultation with an endocrinologist;
• Ultrasound of the breast on the 5-11th day of the monthly cycle for women under 35 years old, women over 35 need to undergo a mammogram followed by a consultation with a mammologist;
• blood for rubella, cytomegalovirus, toxoplasmosis.

Analyzes with a shelf life of 6 months:

• cytological examination of a smear from the cervix, cervical canal;
• PCR diagnostics for chlamydia, mycoplasma, ureaplasma, herpes, cytomegalovirus, HPV 16.18 type.

Analyzes with a shelf life of 3 months:

• Blood test for antibodies to syphilis, HIV 1.2 (IgG and IgM), hepatitis B, C.

After undergoing the above procedures, a woman needs to receive a conclusion from the therapist about her general state of health and the possibility of infertility treatment, as well as further pregnancy. It is obligatory that the conclusion should contain an entry: “The use of assisted reproductive technologies and surgical interventions, carrying a pregnancy are not contraindicated.” The validity period of such a conclusion is 6 months.

All of these examinations and analyzes can be done at our center. Additionally, other studies may be prescribed based on the individual health picture.

How is the egg fertilization procedure carried out with the IVF-ICSI method and how long does it take?

ICSI is a microsurgical manipulation within IVF, which becomes necessary when natural fertilization (conception) is impossible even under artificially created ideal conditions. ICSI is used if the spermogram of a man has poor performance - low sperm count, their small number and pathology of the morphological structure. Also, the use of the ICSI method is justified in cases where IVF has already been performed, but fertilization did not occur or occurred, but the embryo turned out to be not viable.

Consider the stages of IVF-ICSI fertilization.

1. For IVF (including using ICSI), one egg is not enough - 5-10 eggs are needed. In this case, the chances of getting a healthy embryo increase significantly. In this regard, IVF begins with the stimulation of superovulation. In order for the maturation of eggs in the follicles to occur, at the end of stimulation, the patient is prescribed hCG preparations, which trigger the processes of egg maturation. As a result, instead of one egg in the body of a woman, several mature. In some cases, the ICSI-IVF procedure is carried out in a natural cycle, that is, without ovarian stimulation. This option is suitable for women who do not have impaired physiological processes in the ovaries. In other words, they have regular periods with normal ovulation, confirmed by research results, or women with a reduced ovarian reserve, when stimulation is contraindicated, and the use of donor oocytes is premature or the woman is not mentally ready for this. The duration of the menstrual cycle should not go beyond the average values ​​- 26-32 days.
2. After the eggs have matured, the next manipulation is performed - transvaginal puncture. For this, a special needle is used, which is used to puncture through the posterior and lateral fornix of the vagina. By vacuum aspiration under ultrasound control, mature eggs are removed from the follicles and placed in test tubes.
3. The resulting eggs are sent to the laboratory. Embryologists examine them under a microscope and evaluate the general external parameters: size, structure, and so on. Then the eggs suitable for fertilization are transferred to a nutrient medium, in which they must be kept for several hours in a special CO2 incubator. We can say that this is how the eggs “rest” and adapt, because they were removed from their familiar environment.
4. While the egg is adapting to new conditions, embryologists work with male germ cells - spermatozoa. The biomaterial is placed on the microscope stage, and its study begins. From the total mass of spermatozoa, the embryologist must select the most viable, having normal morphological characteristics. The sperm must have a well-shaped head and tail. A disproportionately large head may mean that there are chromosomal abnormalities - such an instance of a male cell is not suitable for fertilization. In addition, the sperm must move in a straight line, at a speed of at least 25 microns / sec. After the embryologist has selected the best spermatozoon, he draws it into the cavity of a special glass needle.
5. The next stage is directly artificial insemination. A cup with an egg is placed on the microscope stage. With the help of a special microscopic suction cup, the egg is fixed. Then, a needle containing the prepared spermatozoon is used to pierce the outer layer of the egg. The sperm is then injected into the cavity of the egg. The needle is removed, the egg is dropped from the suction cup. This completes the fertilization process.
6. A fertilized egg is placed in a CO2 incubator for 3-5 days. On each of these days, specialists monitor the development of embryos and can already preliminarily assess which of them will be viable and which will not. Viable embryos, if indicated, are subjected to an additional examination - preimplantation genetic diagnosis PGD - it is necessary to determine whether there are cell mutations. The probability of a child developing with a chromosomal pathology or other genetic abnormalities is revealed.
7. On the 3-5th day of development, the highest quality of the embryos is transferred to the uterine cavity. This is a critical period, because after it the membrane covering the embryo breaks, and it must attach to the wall of the uterus. Naturally, this should happen already in the body of a woman.

How is embryo transfer done in the IVF-ICSI program, where does the procedure take place and how long does it take?

Our experts are inclined to believe that it is more correct to plant only one, because this is what is inherent in nature, and therefore more natural, moreover, multiple pregnancy, which can develop when transferring more embryos, is fraught with negative consequences and is a complication during IVF.

Embryo transfer must be carried out in a strictly defined period of the cycle. There is such a thing for the uterus as the "window of receptivity". At this time, the endometrium lining the inner cavity of the uterus is ready to receive the embryo inside. The difficulty lies in the fact that the period of receptivity does not last long - about 2 days.

The replanting procedure itself is painless for a woman, it is technically simple and takes no more than 15-20 minutes in duration. Replanting is carried out under sterile conditions of the operating unit under ultrasound control on a gynecological chair. Previously, a woman is given a sedative, which will help to endure some discomfort from medical manipulations with ease and without worries.

It is possible to determine the result of embryo replanting, that is, to find out if pregnancy has occurred, after about 12-14 days. To do this, a woman can do a regular pregnancy test. Also, to confirm the result, blood is taken for analysis for hCG.

What can affect the effectiveness of IVF-ICSI?

1. The first factor affecting the effectiveness of in vitro fertilization is the woman's age. It is the health of the expectant mother and her reproductive age that are decisive, since she will not only have to pass the biomaterial, but also undergo the replanting procedure and, if the outcome is successful, endure the pregnancy. Women under the age of 38 are more likely to get pregnant with IVF.

2. The second factor is the genetic features of future parents. More chances for successful IVF are for those couples who do not have serious health problems - there are no hereditary pathologies, hormonal imbalances.

3. The third factor is the readiness of the female body to accept an artificially obtained embryo. It often happens that until the moment of replanting, everything goes fine: there are many eggs, many healthy, mobile spermatozoa, fertilization occurs quickly and even a few healthy embryos are obtained. However, after replanting, the long-awaited pregnancy does not occur.

This can happen for the following reasons:

• too thin or thick endometrium in the uterus;
• inflammatory diseases of the female reproductive system;
• the presence of scars on the uterus or polyps in its cavity.

It is possible to avoid such difficulties during implantation only by carrying out thorough preparation and preliminary examinations before IVF-ICSI. Perhaps, if any problems of an inflammatory nature or other are identified, the in vitro fertilization procedure will have to be postponed. The patient will need to undergo a course of treatment, eliminate the disease, and only then begin to solve the problem of infertility. In such cases, it is very important to be patient, which can be quite difficult, especially for those couples who have been dreaming of a child for a long time.

4. Another factor affecting the success of in vitro fertilization by intracytoplasmic sperm injection (ICSI) is the right time for infusion. Here it is important to correlate the most successful period of embryo cultivation with the most successful period in the woman's cycle, when the endometrium is maximally ready for embryo implantation. Let's analyze this issue in more detail. Cultivation is the process of artificially growing an embryo. Its maximum duration is 5-6 days, but replanting can be carried out already on the second or third day of cultivation. Everything is very individual here and it is rather difficult to name specific dates for replanting - the decision is made jointly by reproductologists and embryologists, who mainly rely on practical experience.

Now about the readiness of the endometrium. Unfortunately, the implantation window, the period when the endometrium is maximally ready to accept the embryo, is very narrow - on average it is only two days. What happens in these two days:

• The endometrium thickens and loosens. Due to this, the embryo seems to sink in its villi, securely fixing itself on the wall of the uterus.
• Endometrial cells store nutrients that the embryo really needs.
• In the endometrium, the number of blood vessels increases, which ensures enhanced nutrition with oxygen and useful substances.

So, the task of reproductologists and embryologists is to correlate the most successful period of endometrial maturity with the most successful period of embryo development and it is during this period to carry out replanting.

5. Of course, the qualifications and experience of embryologists have a great influence on the success of the IVF-ICSI procedure, because it is they who should choose the best sperm for fertilization. Often, embryologists cannot even explain why they choose one or another sperm - just experience tells them which of them can correctly and in full transfer the DNA to the female egg. It is also important how skillfully the embryologist captures the sperm with a microscopic instrument and then implants it into the egg. You can't even call this work jewelry - it is much more difficult and responsible. And the specialists of the Genesis reproduction center successfully cope with it.

IVF or ICSI / IMSI: where are the chances of success and the likelihood of pregnancy after the first attempt?

Perhaps the step-by-step description of the IVF-ICSI process seems very complicated and the question arises of how often the effectiveness of this procedure is achieved. The statistics of conventional IVF protocols indicate that the proportion of successful procedures is approximately 30-38%. We are talking about those cases when not only cultivation is successful, but also replanting, and then pregnancy and childbirth.

As for ICSI specifically, after it the probability of embryo survival and egg fertilization the first time (if done with good sperm) varies from 60 to 100 percent of cases (what specific% depends on many other factors). These are very high indicators that prove the effectiveness of this technique. Such performance indicators are primarily due to the fact that the program selects spermatozoa with the best morphological characteristics. In other words, what nature was supposed to do (natural selection of spermatozoa, their delivery to the egg, and so on) is done by the hands of specialists and with the help of equipment.

These statistics do not unambiguously indicate that ICSI (or its complicated version IMSI) is better and more effective than IVF, although the first procedure has a higher probability of a positive result. Statistics indicate the chances of pregnancy, and which of the methods of fertilization is suitable in each case, experts must determine. If male germ cells are able to fertilize an egg on their own, why interfere with this process using ICSI? If they are not able to do this, why try to repeat a simple IVF, knowing in advance that it will not end with a pregnancy?

How much does IVF cost using the ICSI / IMSI method in St. Petersburg: factors affecting the price

The cost of the in vitro fertilization procedure will depend on the specifics of the infertility problem that exists in a particular couple.

To understand how much the in vitro fertilization procedure will cost at the Genesis Reproduction Center, you need to sign up and come for an initial consultation with our specialists and learn more about our capabilities and special offers. The specialists of the clinic will tell you what specific procedures may be needed in your individual case. They will study your medical history, analyze the infertility diagnoses, and then draw certain conclusions.

What does the cost depend on?

When it comes to the cost of IVF using the ICSI or IMSI method, it should immediately be noted that this procedure requires significant financial investments. Many specialists are involved in the process of artificial insemination, expensive equipment, specific medicines are used, and this, of course, requires appropriate payment. Also, all future parents who are looking for a clinic where they will undergo IVF should remember that this is not a procedure that is worth saving on. First of all, you need to look for highly qualified specialists, and not super-cheap offers.

However, not everything is so sad. Today, various social programs are being developed for couples, and it is possible to undergo IVF-ICSI / IMSI at the expense of the state (if there is a CHI policy). By contacting the Genesis reproduction center, you can take advantage of this chance.

Our prices for in vitro fertilization are affordable for many categories of the population. They are lower than the average European ones, and the total cost of the complex of procedures does not exceed the insurance limit, if we are talking about the possibilities of a medical policy.

We are always focused on results and make every effort to bring the joy of motherhood and fatherhood to as many couples as possible.

To date, reproductive medicine has developed to the point that almost any married couple can become pregnant in one way or another.

Let's talk about IVF-ICSI procedures: what is it, cost, comparison and other issues related to these assisted reproductive technologies. Be sure to discuss the differences between ICSI and IVF.

So, the couple decided, together with their reproductologist, to resort to assisted reproductive technologies to conceive a child. It remains only to choose the procedure: ICSI or IVF. Both methods are highly efficient. Each has its own advantages and disadvantages.

These assisted reproductive technologies are very similar. After a thorough examination, ovulation is stimulated using drugs, after which ovarian puncture is performed and embryos are transferred into the woman's body. But still, there are certain differences.

The essence of the procedures

in vitro fertilization- this is the artificial insemination of the egg with its subsequent transfer to the uterus. Initially, a woman receives drugs to stimulate superovulation. In her ovaries, several follicles with eggs mature. After that, the doctor pierces these follicles during a special procedure. Oocytes are extracted from them. They are fertilized with the husband's or donor's sperm, cultured for 3 to 5 days under special conditions, and then transferred to the uterus. If successful, pregnancy occurs.

intracytoplasmic sperm injection is a procedure performed as part of in vitro fertilization. Instead of mixing sperm and eggs, relying on the spontaneous fusion of male and female gametes, the embryologist literally "takes everything into his own hands." With the help of special microtools, under the magnification of a microscope, he takes a spermatozoon and injects it into the oocyte.

This is almost a 100% guarantee of fertilization. The spermatozoon is selected based on its morphological characteristics.

What is the difference between IVF and ICSI

The main difference between IVF and ICSI is the actual conception procedure.

During IVF, the egg, obtained as a result of follicle puncture, is fertilized by sperm, although not in the body, but still in a natural way. That is, the spermatozoa dissolve the zona pellucida on their own, and one of them, the most “worthy”, enters the cytoplasm. But sperm is not always of sufficient quality to count on a high percentage of fertilized eggs. And there may not be so many oocytes themselves that the embryologist can take risks. It is in such cases that intracytoplasmic sperm injection comes to the rescue.

After all, this procedure ends with successful fertilization in more than 90% of cases.

The main difference is that during ICSI, a specially selected sperm of the highest quality is artificially introduced into the egg.

Read also

What is the difference between ICSI and IVF

This happens if:

• there are very few sperm in the ejaculate;
• they are inactive;
• most spermatozoa have poor morphology or are damaged by antisperm antibodies.

ICSI is preferred for unsuccessful previous IVF attempts, for infertility of unknown origin.

Thus, the choice of the ICSI IVF program depends on the cause of infertility. If the problem is a violation of reproductive functions on the part of a woman (immunological, tubal infertility, etc.), then the possibility of IVF can be considered. In the event that it is necessary to isolate one of the most viable spermatozoa for conception, then ICSI can be called a more effective option.

It should be noted that there is no single answer to the question “what is better - IVF or IVF ICSI”.

First of all, in order to make a choice in favor of a certain method, patients of the AltraVita reproduction clinic are invited to undergo an examination. In addition, one cannot exclude the possibility that both partners have problems with reproductive function.

Therefore, in order for the treatment to give a long-awaited result, sometimes reproductologists offer to undergo both procedures. Note that IVF with ICSI should be used primarily in case of poor sperm quality in the spouse.

The main indications are:

• low number of full-fledged, suitable for fertilization of spermatozoa in the ejaculate of a man;
• poor sperm motility(a low percentage of fertilized eggs is predicted);
• complete absence of sperm in the ejaculate(for fertilization, sex cells obtained from testicular tissue are used);
• immunological infertility in a man;
• a small number of eggs obtained as a result of the follicle puncture procedure;
• low egg fertilization efficiency from the previous procedure.

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ECO ICSI - price

Despite its effectiveness, for many patients, the cost of IVF ICSI treatment may seem too high. But without these procedures, it is often impossible to get pregnant. They are used only as the last, most effective methods of achieving pregnancy, when other methods of treatment have exhausted themselves. ICSI is usually paid separately. This procedure is not always necessary. This additional reproductive technology is carried out according to indications.

It should be noted that prices for procedures at the AltraVita Center for Reproductive Technologies may vary. With some methods, more labor-intensive preparation is needed, and for the procedure itself, additional manipulations are necessary.

The price may also depend on the need for, for example, pre-implantation diagnosis, the use of donor material, cryopreservation, etc. In addition, the Center has developed various programs that differ in the range of services.

Now you know what is the difference between ICSI and IVF. These procedures are successfully used in our clinic. Based on the high performance of IVF ICSI programs, AltraVita clinic offers options that provide for multiple cycles for a fixed amount, without worrying about possible additional costs.

ICSI or Introcytoplasmic Sperm Injection is a modern method of assisted reproductive technologies, which is part of the IVF cycle and consists in injecting the sperm directly into the egg.

ICSI is mainly used for severe forms of male infertility associated with a small number, low motility or poor quality of spermatozoa. Also, this procedure can be recommended for couples who have already undergone conventional IVF, but have not been successful.

Advantages of ICSI.

ICSI allows men who do not produce sperm, have few, slow or immature spermatozoa, to still become fathers. Only one sperm is needed to fertilize one egg.

Even in the case of a complete absence of sperm in the ejaculate, for example, due to damage to the vas deferens, spermatozoa can be surgically removed from the testicle. Since in this case there are usually few spermatozoa and they are not mature enough to fertilize the egg on their own, ICSI is performed.

ICSI is also considered effective when using frozen eggs, as after cryopreservation, the natural penetration of spermatozoa into the egg is impaired.

The choice of one or more spermatozoa, as occurs in ICSI, reduces the likelihood of transmission of HIV and hepatitis.

How IVF with ICSI is done.

After examining the couple and making a decision on IVF with ICSI, hormonal stimulation of the woman is carried out for the maturation of several eggs. Then, under anesthesia, the eggs are taken from the woman’s ovary, and the man donates sperm, or he also undergoes an operation to extract sperm.

This is followed by direct intracytoplasmic injection of the spermatozoon into the egg. ICSI is a complex procedure that must be performed under a microscope by highly trained personnel.

The egg is held with a special pipette, and the spermatozoon is taken with a thin, hollow, sharp needle. The needle then pierces the egg cell membrane and the spermatozoon is injected into its cytoplasm. Several eggs and, accordingly, several spermatozoa can be used.

One or two embryos are usually transferred into the uterus, the rest can be frozen and used later if necessary. After 16-20 hours, fertilization is assessed.

After 3-5 days, if fertilization was successful, it is possible to transfer the embryo (embryos) into the uterus. This is done through the cervix using a thin catheter. The procedure is virtually painless and does not require anesthesia.

After two weeks, you can do a pregnancy test or a blood test for hCG (pregnancy hormone).

ICSI: cons and risks.

The ICSI method is not a guarantee of successful fertilization, even after the introduction of the sperm into the egg, the embryo may not form or the embryo will stop dividing. Rarely, the egg may be damaged during the procedure.

There is evidence of an increased risk of malformations, which is most likely due to infertility and not to the intervention, but it does not exceed that with conventional IVF. However, if the father has genetically determined problems with sperm, then they can be passed on to the male child.

In addition, ICSI has the same risks as conventional IVF, for example, an increased likelihood of multiple pregnancy (if two or more embryos were transferred), the possibility of ovarian hyperstimulation, as well as a greater psychological burden on expectant parents.

The ICSI method is expensive, requires frequent visits to the clinic and takes a lot of time.

What is the difference between ICSI and IVF?

In principle, ICSI is not an independent method, but a part of in vitro or artificial insemination (IVF).

IVF with ICSI is very similar to conventional IVF and consists of the same steps. The usual IVF cycle differs from IVF with ICSI only in the method of fertilization.

In conventional IVF, the egg and sperm are placed in a test tube and fertilization occurs "naturally", that is, one of the sperm enters the egg and fertilizes it.

In the ICSI method, one spermatozoon is injected with instruments into one egg. Then the fertilized eggs grow, divide within 3-5 days and are transferred to the uterus.

Success rates for ICSI are about the same as IVF success rates, ie about 25% on average after one attempt. The effectiveness of the procedure largely depends on the age of the woman, for example, before the age of 34, the probability of pregnancy after ICSI is approximately 40%, and after 40 - about 11%.

With the help of ICSI, more than two million children have already been born in the world. Despite some criticizing this method from an evolutionary point of view, ICSI often gives positive results and is currently an effective way to overcome male infertility.

But with other factors of infertility, the advantage of ICSI over conventional IVF has not been proven.

The inability to conceive a child naturally - for most couples who are faced with such a problem - is a real tragedy. Today, medicine can offer a solution to this problem. Assisted reproductive technologies come to the rescue when all methods of conservative treatment have exhausted themselves. Artificial insemination is an effective method of conception in vitro, which allows you to form a stable pregnancy, with the lowest risk of developing fetal pathologies.

Today, there are two methods of artificial insemination that can be used both separately and as complementary ones. We are talking about the method of in vitro fertilization and intracytoplasmic sperm injection. In order to figure out which procedure is more effective and what is their difference, it is necessary to consider in detail the protocols for their implementation.

ECO

The IVF protocol is a scheme for carrying out the in vitro fertilization procedure, selected individually for each patient based on a carefully conducted study, recommendations from a reproductologist and a phased preparatory period.

At the stage of protocol formation, the IVF preparation procedure consists of several stages:

• study schedule;
• drug stimulation of ovarian growth;
• activation of maturation of healthy eggs.

After obtaining satisfactory results of the preparatory stage, the oocytes are collected by ovarian puncture. Then fertilization takes place in a test tube.

The procedure for "replanting" the embryo into the mother's uterus is not the final stage of the protocol. The transfer of the fertilized embryo to the mother's body is followed by hormonal support. Once pregnancy is confirmed, the protocol is considered completed.

Depending on the state of health of both parents and the individual characteristics of the body of the expectant mother, it depends on how long the eco protocol will last. There are long, short, and natural cycling protocols. For medical reasons, a reproductive specialist can offer an ultra-short, super-long, modified or cryoprotocol.

ICSI

The method of intracytoplasmic sperm injection implies an identical IVF stage of preparing a woman for artificial insemination. Examination, history taking, hormonal stimulation takes place taking into account whether the IVF protocol preceded the ICSI procedure. But the fundamental difference from the extracorporeal method, the ICSI method involves a thorough study of the male biomaterial, since the selection of high-quality sperm and fertilization is done manually. To do this, the father's sperm is examined for pathological disorders in sperm morphology.

Indications for the ICSI protocol are:

• low sperm count and immobility;
• ACAT content in semen;
• the woman's age is over 35;
• received single eggs;
• biomaterial after cryopreservation;
• IVF attempts that did not result in pregnancy.

When performing the ICSI protocol, the embryologist manually, using a microscopic needle, injects the selected and immobilized spermatozoon into the woman's egg. As in IVF, fertilization occurs in a test tube, in a nutrient medium. The embryo is observed for 2-5 days, after which it is transplanted into the uterus. Further hormonal maintenance therapy provides a sufficient content of progesterone in the mother's body, which is necessary to strengthen the fetus and further the full development of pregnancy.

This method of artificial insemination is suitable for couples with a high male infertility factor.

Distinctive features of ICSI from IVF (manual procedure, the ability to select one high-quality spermatozoon) makes it possible to subject the selected but not used biomaterial to cryofreezing, in case the couple in the future wants to have another child and go through the ICSI protocol again.

None of these methods gives a 100% guarantee of the desired pregnancy. But in case of unsuccessful IVF attempts, the inclusion of an auxiliary ICSI protocol increases the chance of a successful outcome of the procedure.

Many families are faced with such a serious diagnosis as infertility. According to statistics, about 20% of couples cannot conceive a child naturally. Today, medicine offers many variations of artificial conception, thanks to which a man and a woman have a great opportunity to give birth to their long-awaited baby.

IVF - what is this procedure?

ECO(in vitro fertilization) is one of the types of assisted reproductive technology used in infertility, based on the extraction of the egg from the female body and its fertilization in the external environment, followed by the return of the embryo to the uterus. In medicine, this technique is also called "in vitro", which means "in vitro" in Latin.

IVF technology is carried out in a specialized medical facility on an outpatient basis. The essence of the procedure lies in the fact that the meeting of the female (ovum) and male (sperm) germ cells occurs in the laboratory. With successful fertilization on the 2-5th day, the embryo is transferred into the uterine cavity for subsequent "engraftment" and the development of pregnancy. Carrying out in vitro fertilization requires high professionalism and good practice from the doctor.

According to statistics, in 60-70% of cases, external fertilization is successful. Usually, as a result of hyperstimulation of ovulation, many eggs are produced (in some cases more than 20), so the chance of getting at least one embryo increases proportionally. However, "survival" directly in the uterine cavity averages about 30% (depending on age). That is why fortune gives some women a successful pregnancy on the first try, while others have to spend a lot of energy and health in order to finally know maternal happiness.

What is ICSI?

IVF is the foundation that no modern artificial insemination procedure can do without. It can be carried out in two ways:

1) in vitro insemination (conventional IVF) - a manipulation in which a suspension of spermatozoa is added to the eggs in a nutrient medium, starting at the rate of 75,000-200 thousand male gametes per female oocyte. After some time (up to several hours), the spermatozoon approaches the egg so close that their membranes merge. As a result of the most complex biological reactions, their chromosomes are combined with the subsequent formation of a zygote - the germ of a future person.

2)ICSI(Intracytoplasmic Sperm Injection) is an assisted in vitro fertilization method for male factor infertility, part of IVF. The procedure consists in the selection of a viable spermatozoon. Then, with the help of a special needle, it is injected into the egg, as if “forcing” it to be fertilized. With poor sperm counts, this is the only way for the meeting and fusion of the male and female reproductive cells.

IVF is the main method that can be performed in the classical way (the spermatozoa are simply connected to the eggs) or using ICSI, when the spermatozoon is injected directly into the egg with a needle. The second method is necessary when the causes of infertility lie in the quality of the sperm.

When is ICSI needed?

Considering that not quite healthy couples (in terms of reproduction) turn to the doctor, the IVF procedure in certain cases may require the use of an auxiliary method - ICSI. It is needed in most cases when it is present - simply put, it will be difficult for the sperm to “find” the egg, regardless of whether it is in a woman or taken into a test tube. Also, the reason may be the peculiarity of the egg, which does not allow the sperm to penetrate into it.

Table. Deviation in sperm counts that may require ICSI

Modern medicine, thanks to the rapid development of science, microscopic nanotechnology and molecular discoveries, introduces new and successful options for the in vitro fertilization procedure.

Many reproductologists say with confidence that real male infertility is the absence of organs responsible for the production of germ cells. With any violations of spermogram indicators, pregnancy can occur, if, of course, modern programs of "external" conception are used.

What are the other components of IVF?

In addition to ICSI, there are several additional methods that increase the chances of conception.

IMSI. This is an improved INSI technique, when the choice of sperm takes into account its morphological features. For a detailed examination of the male germ cell, a strong microscope with a 6000x magnification is used (during ICSI - 400x). The main criteria that a sperm must have are the presence of an oval head with a prominent acrosome, a tail and a neck.

PICSI. Spermatozoa are selected by ICSI, sometimes IMSI. Before fertilization, the male germ cell is tested for maturity by immersion in a test tube with hyaluronic acid. It is believed that those spermatozoa that have reacted to the component have fewer DNA disorders and are morphologically mature. Male gametes selected in this way are considered optimal for conception.

PID(pre-implantation check). This is an examination of an already fertilized egg that has begun to divide. The method is based on the splitting off of a part of the zygote with subsequent genetic analysis. PID testing is recommended for couples who have a high chance of having a baby with a chromosomal abnormality.

In azoospermia, sperm is removed from the testicular tissue by biopsy. This is carried out only in the case when it is known for sure that male germ cells are produced, but for some reason do not enter the vas deferens and, therefore, are absent in the ejaculate. We offer for consideration a table that briefly describes the methods of biopsy.

Children born with the help of IVF, as well as auxiliary methods of this procedure, are no different from those babies who were conceived in a natural way. The risk of chromosomal mutations and developmental anomalies in all cases occurs with the same frequency.

Some experts even note that IVF children are less likely to have deviations due to more careful pregnancy management by the woman (timely ultrasound diagnostics and screening, testing, a full examination of both spouses when planning a baby, etc.). Parents' feedback on in vitro fertilization is positive, because without this procedure they might never have had their own baby. Also, many women note that after the first IVF procedure, conception does not always occur and for its implementation it is necessary to make about two or three attempts, and sometimes more.

Prices for IVF, ICSI and other ancillary procedures

Spouses, before agreeing to in vitro fertilization, are interested in information, how much will it cost? Although this will not be cheap, it must be said here that there are special government offers that cover part of the cost of the procedure. In Russia, the federal program is carried out free of charge under the compulsory medical insurance policy, for this a married couple needs to get on the waiting list and collect all the necessary documents. In Ukraine, one should apply to family planning centers, but today things are worse there - the state does not help everyone and covers only part of the costs (although the Order of the Ministry of Health does not mention this).

If there is no time to wait for state assistance (which can take up to a year), and there is a financial opportunity to carry out an expensive procedure on your own, then you should contact any public or private IVF clinic and take the first steps towards pregnancy in the next cycle.

Table of approximate prices for IVF

The final cost of IVF depends on many factors. In some cases, you have to use donor material to conceive a baby, which increases the price. If a woman cannot bear a baby, surrogate motherhood is offered.