The child “from a test tube“
you will surprise nobody with the words “children from a test tube“ or “artificial insemination“ Now. What possibilities of auxiliary reproductive technologies? And in what cases they can use?to
to Whom will be helped by EKO?
In July, 2008 executed 30 years by Luise Braun - to the first child conceived in the artificial way by means of so-called extracorporal fertilization (EKO). Then this sensation had effect of the become torn bomb. Today the branch of medicine which is engaged in an auxiliary reproduction develops with great strides, giving the chance to test happiness of motherhood to thousands of women to whom couple of decades ago the medicine was powerless to help.infertility the impossibility of merge of a spermatozoon to an ovum which can be connected with violations both in female, and in man`s organisms is the cornerstone of
: or quality of sperm is reduced, or function of one of bodies of women`s reproductive system is broken.the EKO Method was developed by
for women with a so-called “pipe“ factor of infertility at which uterine tubes either are impassable, or are absent at all. The principle of a method is simple: to replace function of the injured uterine tubes with the process which is taking place in vitro as close as possible on all indicators to natural. In other words, “meeting“ of spermatozoa and an ovum happens not in the woman`s organism, and in “test tube“, to the subsequent transfer of embryos in mother`s uterus.
Today carrying out EKO practices at any form of infertility when approach of pregnancy by means of an auxiliary reproduction most likely, otherwise, at unsuccessful treatment of various forms of infertility during 1,5 - 2 is recommended EKO as the most effective way of achievement of pregnancy (on average 30 - 40% from the first attempt).the EKO program Course Preparation for carrying out the EKO program occupies
on average 1 - 2 month. Preparation includes, as a rule, infectious and hormonal inspection, in some cases - consultations of the endocrinologist, the mammologist, the andrologist and other experts if it is necessary. All program is carried out on an outpatient basis, quality of life of the woman at the same time does not suffer, Analyses and inspections for each couple are determined by results of reception.
Carrying out the program consists of several stages:
- of the Stage first - stimulation of an ovulation which is carried out by means of special preparations under ultrasonography control. By means of ultrasonography the doctor - reproduktolog monitors growth and maturing of follicles in ovaries, defines dosages of preparations and duration of stimulation. Most often it begins on 2 - 3 - y days of a menstrual cycle of the woman and 9 - 11 days proceed. Do to the woman of 1 times a day an injection of the preparation stimulating growth of follicles, the patient does not feel at the same time any subjective feelings.
- the Stage second - a puncture of follicles transvaginal access (through a vagina wall) which is carried out under control of ultrasonography with use of short-term intravenous anesthesia. To the woman give an intravenous injection, she falls asleep, take away several ova which ripened after stimulation from her. All received ova are impregnated by the husband`s sperm (or the donor, depending on a clinical situation). Sperm is prepared in a special way, selecting for fertilization the healthiest spermatozoa which carefully are located in special cups with ova). At the same time, if the reason of infertility was the man`s factor at which natural penetration of spermatozoa into an ovum is impossible, the IKSI procedure - an intratsitoplazmatichesky injection of a spermatozoon in an ovum when the spermatozoon is located in ovum cytoplasm manually - by means of the special device similar to the syringe (the special micromanipulator), under an electronic microscope is carried out. It is important to note that it is only the way of hit of a spermatozoon in an ovum which is not influencing fertilization process.
- the Stage third - embryological, it proceeds 2 - 5 days. Development of embryos, their quantity and quality is monitored, optimum day for transfer of embryos in a uterus cavity is defined. Every day the embryologist investigates embryos under a microscope, estimating whether correctly they share, whether there is no delay in development, whether there is no fragmentation - inclusions which normal should not be.
- the Stage fourth - transfer of embryos. It is painless procedure which is carried out under control of ultrasonography by means of a special catheter for transfer of embryos. It is spent most often on 3 - y or 5 - e days of development of embrin.
Digression to physiologyas a result of cyclic hormonal changes in the woman`s ovaries ripens every month 1 or 2 follicles (liquid “sacks“ in which the ovum - a female gamete contains). In the middle of a cycle (approximately on 14 - y day) there is a rupture of a follicle, and the ovum gets into a uterine tube where meets spermatozoa. In spite of the fact that for fertilization it is enough of only one, men eyakulit has to contain tens of millions of spermatozoa which “lay a way“ to this one, being attached to a cover of an ovum and emitting the special enzyme splitting it. The impregnated ovum gradually moves ahead on a uterine tube to a uterus, turning by division into an embryo which approximately on 5 - e after fertilization gets days into a uterus cavity where it is implanted (takes root) into a mucous membrane of a uterus and at favorable combination of circumstances gives rise to pregnancy.
Now around the world can transfer no more than 2 embryos to a uterus cavity in order to avoid polycarpous pregnancy. 3 embryos can be in exceptional cases transferred - for example, at several EKO inefficient programs in the past, after the undergone uterus operations, to women 40 years when chances of successful implantation of embryos in mucous of a uterus are considerably reduced are more senior.by
After transfer of embryos reproduktolog appoints to the woman special preparations for support of potential pregnancy to 12 - 14 days, the result of the carried-out program will not be known yet. In 2 weeks after transfer of embryos the woman makes blood test on pregnancy, at positive result in a week ultrasonography is carried out to define presence of one or two (sometimes three) fetal eggs in a uterus cavity. Twins at the same time are stated in 10 - 15% of cases, triplets - in 3 - 7%. Polycarpous pregnancy is peculiar “complication“ of the EKO programs, reproduktolog of the whole world are puzzled with searches of possible solutions of this problem. Some clinics of EKO in Europe and America were passed to transfer of 1 embryo at a stage by blastotsist, that is 5 - a day embryo (selective transfer) and in spite of the fact that pregnancy approach frequency decreased a little, consider this measure effective as the number of the complications connected with incubation of polycarpous pregnancy and the subsequent childbirth sharply decreased.
Development of the EKO technologyfor receiving an ovum was necessary to resort Earlier to a laparoscopy (the operation performed through an opening in a forward belly wall) therefore the woman was forced to be several days in a hospital. Besides, EKO was carried out in a natural cycle (without use of medicines) therefore in most cases it was possible to receive one ovum. Respectively, and efficiency of the program was low - no more than 12%. Over time the EKO technology was improved, the special preparations for stimulation of an ovulation allowing to receive the bigger number of ova were developed environments for cultivation of embryos, catheters for transfer of embryos in a uterus improved. And with the advent of the vaginal ultrasonic sensor receiving ova through a vagina wall became possible that considerably simplified procedure and allowed to carry out it in polyclinic conditions, without hospitalization.
Donorship in EKO
the Important milestone in development of an auxiliary reproduction became creation of bank of gametes - spermatozoa and oocytes (ova). And if we got used to the phrase “bank of sperm“, then “bank of donor oocytes“ for a long time - concept for most of Russians rather new, and very few clinics have own bank of donor oocytes.
Presently demand for donor oocytes considerably exceeds the offer. Perhaps, it is connected with the fact that the woman first of all seeks to realize herself in study, then in career and only then thinks of a child-bearing. And even more often it occurs closer by forty years when ovaries work much worse or do not work absolutely, and own oocytes cannot already be used. In such situations the only exit - to use donor ova. In a case when to the woman on any medical indications delete ovaries (and sometimes - at young age), donor ova also come to the rescue. Donors of ova are the women till 30 years having at least one healthy child 1 years are more senior. The clinic carries out by each of them full clinical, genetic and ultrasonic inspection, they are advised without fail by the psychiatrist. By results of inspection the decision on a possibility of use of this woman as the donor of oocytes, and her data (age, growth, weight, color of eyes, a blood type, etc.) is made take place in the database of clinic at special code number as donorship of gametes is anonymous. Sometimes the relative or the acquaintance of a retsipiyentka acts as the donor of ova if it approaches according to all established standards.
are eyakulit Sometimes by men does not contain spermatozoa at all or it is impossible to use spermatozoa owing to the genetic disorders incompatible with the birth of normal posterity. Unfortunately, the drugs capable to help with similar cases, do not exist yet, and use of donor sperm can be an exit.Man`s infertility the Percent of man`s infertility steadily grows presently at
. If in 1997 the ratio of female and man`s infertility was 60:40, then now these figures look “exactly the opposite“. The man`s factor is the main reason for infertility more than in 6o % of cases. Reproduktolog sound alarm: sharply quality of sperm and its ability to conception worsens. More and more fruitless couples are forced to resort to services of an auxiliary reproduction in this reason. One of the last innovations - donorship of embryos. In this case donor oocytes are impregnated by donor spermatozoa and in the frozen look are stored in cryobank. By means of this type of donorship the chance to have children appeared at lonely women of advanced age. Such practice is yet not so widely introduced, but becomes more and more popular.
the Highest achievement of the last years, certainly, can consider by
emergence of a possibility of genetic inspection of future child even to his transfer in a uterus. The so-called predymplantatsionny genetic diagnostics (PGD) is for this purpose carried out. However it is impossible without carrying out EKO as research is conducted on 3 - day embryos which are under natural conditions simply inaccessible. by
by means of a biopsy of one blastomer (one of “cages“ of which the embryo consists is pinched off, and is exposed to genetic research) investigates a set of chromosomes of each embryo and if necessary its sex (is defined at probability of the hereditary disease linked to a floor, for example hemophilias when the birth of boys is undesirable because the illness at men is shown). Then 1 - 2 healthy an embryo of the necessary floor (in a case with hemophilia are girls) without chromosomal violations on 5 - e days of development are transferred to a uterus cavity. It gives chance to people with hereditary chromosomal diseases to have healthy children that was absolutely impossible several years ago, Now there is an opportunity to diagnose by means of violation PGD in 5 chromosomes, the most known of them - a Down syndrome (a trisomiya on 21 - y to a chromosome). Other chromosomes are still inaccessible for research, however in this direction continuous developments are conducted, and there are a wish to believe that in the near future the medicine will have all necessary for full genetic inspection.
One more minus of PGD is its high cost, comparable with EKO cost today.with
Financing of EKO
Since 2006 in Russia the program of federal financing of high technologies including EKO, in this regard at much bigger number of fruitless couples will appear an opportunity to carry out EKO free of charge began to work. At first couple addresses the local gynecologist, receives the list of necessary documents, having collected which has interview in the Ministry of Health and Social Development where the special commission passes the decision on a possibility of carrying out free EKO. If such decision is made, then couple is sent to concrete clinic which carries out these programs.
Several clinics of a reproduction in Russia had an opportunity to carry out the EKO free programs. According to the order of the Ministry of Health and Social Development of the Moscow region from 29. 08. 2007, service is provided to couples which are consisting among themselves in the registered marriage and not having the general children because of female infertility provided that the woman is no more than 38 years old. Within this Government of the Moscow Region program finances to inhabitants of the region carrying out 2 attempts of EKO. At the positive solution of steam there passes inspection across the place of residence and goes to the recommended clinic of EKO.