What to do after two failed ecos. Repeated eco in case of failure

Efficiency of the procedure in vitro fertilization, according to statistics, after the first attempt does not exceed 30%. You should not expect 100% success, even if the procedure is carried out in the best foreign clinics. Unsuccessful IVF after the first attempt is not a death sentence. Several of them can be carried out. Next, we will try to understand the reasons that most often cause unsuccessful IVF.

Unsuccessful IVF: main reasons

• The main reason why IVF failures occur is the low quality of the resulting embryos. In order for the procedure to be successful, it is necessary to place into the woman’s uterine cavity those embryos that consist of 6-8 cells and also have high performance division. Poor-quality embryos can be obtained in situations where the embryologist’s qualifications are insufficient, or there are disturbances in male and female reproductive cells (eggs, sperm).
• Unsuccessful IVF can occur if there is any damage to the inner layer of the uterus (endometrium). Normally, for high-quality and successful attachment of the embryo in the uterine cavity, the presence of endometrium with a thickness of 7-14 millimeters is necessary. Most often, endometrial pathology, which is determined after unsuccessful IVF, is chronic endometritis, polyps, hyperplasia or thinning of the endometrium. All these disorders are quite easily diagnosed using ultrasound examination(ultrasound).
• Unsuccessful IVF may be a consequence of obstruction of the patient’s fallopian tubes, as well as the accumulation of fluid in them. This is enough serious pathology, which requires treatment, and most often surgically.
• Genetic disorders in one or both spouses can provoke a situation where IVF is unsuccessful.
• The presence of special antibodies in a woman’s body that prevent pregnancy from occurring even through artificial insemination.
• Hormonal imbalance in a woman's body. It has been scientifically proven that the entire process of egg maturation, their release from the ovaries during ovulation, fertilization, attachment (implantation) in the uterus and subsequent pregnancy are regulated by hormones. Which means any hormonal disbalance violates the integrity of this chain and leads to IVF failures.
• Availability bad habits both spouses. Malicious influence alcohol, nicotine, narcotic substances has been proven for a long time and is not subject to any doubt.
• Age factor. The older the woman undergoing IVF is, the higher the risk that the IVF will fail. The same applies to the partner whose sperm is used to fertilize the egg.
• Obesity is a problem that has a serious overall impact on a woman's health. It may be the reason that IVF is unsuccessful.
• Polycystic changes in the ovaries, leading to the fact that the quality of eggs decreases and it is much more difficult for sperm to fertilize them.
• Ovarian depletion, which occurs for some reason and leads to a decrease in follicular reserve. If a patient has such a pathology, it is very difficult to obtain high-quality eggs in the required quantity.
• Infectious diseases such as herpes, mycoplasmosis, chlamydia, cytomegalovirus infection, Epstein-Bar infection, hepatitis B, C and others increase the likelihood that IVF will fail.
• Adhesive processes that exist in a woman’s pelvis also lead to unsuccessful IVF attempts.
• The presence of acquired or congenital anomalies of the uterine structure in the patient (bicornuate or saddle uterus, uterine fibroids, etc.) can be a serious obstacle to pregnancy.
• Unsuccessful IVF may be a consequence of chronic somatic diseases of the gastrointestinal tract, of cardio-vascular system, respiratory system, as well as other organs and systems of the woman’s body.

In the case where even repeated IVF is unsuccessful, you need to more carefully look for the reason that leads to this.

Failed IVF: no periods

Each woman's body reacts differently to the in vitro fertilization program. If IVF has failed and there is no period, there is no need to panic. Most often, the restoration of the menstrual cycle occurs several months after unsuccessful IVF. The reasons for the delay of menstruation after artificial insemination are those medicinal and invasive interventions in the woman’s body that were performed to stimulate superovulation, take eggs from the ovaries and introduce embryos into the uterine cavity. You should know that under no circumstances should you take hormones and other medications on your own if IVF has failed and you are not menstruating.

In addition to the absence of menstruation, there are also often copious discharge after artificial insemination. This phenomenon does not indicate serious problems, but is a consequence of taking various hormonal drugs. Sometimes patients after unsuccessful IVF note that menstruation is longer and more painful, which occurs due to the same stimulation of superovulation that is carried out before the IVF procedure.

Most often, the next menstruation will be the same as before IVF. If the restoration of menstruation has not occurred, then it is necessary to see a specialist.

Physiological pregnancy after unsuccessful IVF

There are statistics that show that more than 20% of partners who had an unsuccessful IVF program subsequently conceived a child naturally. This is explained by the fact that the IVF protocol involves taking various medications that seem to trigger physiological hormonal cycle women. Thus, the natural mechanisms of the woman’s reproductive system are activated.

Repeated IVF after failure

Before repeating IVF after an unsuccessful attempt, both partners must restore their physical and psycho-emotional health. For this you need adhere to special recommendations.

• Rest and rest until the next in vitro fertilization protocol. At this time, “light” sports (swimming, exercise, dancing, yoga, etc.) will help restore the body’s strength. It is advised to pay special attention to those exercises that improve blood flow in the pelvic organs.
• Normal sex life, which does not have to be carried out according to a special schedule.
• Carrying out additional examination, taking tests, as well as performing procedures that will help identify the reasons that IVF was unsuccessful.
• Getting out of depression is another important factor, overcoming which, you can carry out repeated IVF. After all, everyone knows that depression and stress significantly reduce the chances of success. During this period, the support of relatives, friends and significant other is extremely important. If this is not enough, then you need to seek help from a specialist (psychologist, psychotherapist).

Repeated IVF: how many attempts are allowed

According to experts, the in vitro fertilization protocol does not have any particular negative impact on the female body. The number of times repeat IVF can be performed must be determined individually and together with the attending physician. Cases have been described where successful IVF occurred only in the ninth procedure.

There is an opinion that after the third or fourth attempt, when IVF is unsuccessful, you need to think about other infertility treatment options. This may be the use of donor germ cells (eggs or sperm), ICSI fertilization or surrogacy.

At the Volgograd IVF Center clinic you can undergo a full examination and infertility treatment, including the use of IVF.

Since in vitro fertilization and planned pregnancy are quite a serious burden for the body, they are mandatory.

If there are any somatic diseases- before attempting, it is necessary to make sure that the process is in stable remission and will not worsen during the procedure, as this may complicate the in vitro fertilization program or even stop stimulation.

If the causes of infertility are obvious and prognostically can be solved with the help of IVF, as a rule, you can count on success on the first attempt.

After unsuccessful IVF, it is necessary to conduct a serious analysis - this makes it possible to significantly increase the chances of achieving pregnancy in the next ART cycle. If necessary, additional examinations should be carried out.

We invite you to watch a video where gynecologist-reproductologist Nova Clinic talks in detail about what to do after unsuccessful IVF and how to prepare for the next attempt.

What do you pay attention to when analyzing unsuccessful IVF?:

• was there ovarian response sufficient and what can be done to change it in the future. If the response differed from what was expected (it was weak or, on the contrary, excessive and led to OHSS), it is worth considering whether it is worth changing the protocol or using other hormonal drugs or changing the dose of hormones.
• fertilization rate And egg quality . If the IVF attempt is unsuccessful, the fertilization rate is low, the next cycle makes sense. If the quality of the eggs is very poor, especially in women over 40 years of age, the use of donor eggs can be recommended. If the woman is young, perhaps the poor quality of the eggs is due to a reaction to the hormonal drugs used, in which case it makes sense to change the protocol or do IVF in a natural cycle.
• which sperm quality was at the time of puncture. Despite the fact that the embryologist has the opportunity to select the most suitable sperm for fertilization during the ICSI procedure, in some cases, with greatly altered indicators, the best of the worst sperm is selected, which is one of the reasons for unsuccessful IVF. If necessary, decide on the indications for using donor sperm.
• grade structure and thickness of the endometrium during stimulation. Is there a suspicion of the occurrence of pathological processes in the endometrium (polyps, endometrial hyperplasia, intrauterine synechiae), was the thickness of the endometrium sufficient at the time of transfer (a thickness of at least 8 mm is desirable). If there are deviations in the structure of the endometrium, it is necessary to decide whether to conduct a Doppler mapping of the uterine vessels before trying again, if the endometrium was thin (to assess the sufficiency of blood supply), conduct (to exclude chronic endometritis), culture from the uterine cavity and, if there are changes, conduct them correction (antibacterial therapy, cyclic hormone therapy, physiotherapeutic treatment).
• changes in the fallopian tubes. In this case, it is very important to promptly identify the presence of hydrosalpinx/s (accumulation of transudate in the fallopian tube, often against the background of chronic inflammatory processes of the pelvic organs). In such a situation, it is recommended to remove the altered tubes during laparoscopy, since hydrosalpinxes reduce the likelihood of pregnancy. If hydrosalpinxes occur during stimulation, it makes sense to decide on the possibility of cryopreservation of the resulting embryos and transferring them in a cryocycle after laparoscopy.

In the presence of a so-called “biochemical pregnancy” or pronounced change tests in the direction of blood thickening (additional examination is often prescribed after embryo transfer, at the stage of waiting for B-hCG) - conduct an examination for miscarriage. It is better to conduct the examination no earlier than a month after an unsuccessful attempt.

• Antibodies to phospholipids IgG and IgM (especially pay attention to the presence of antibodies to cardiolipin and B2-glycoprotein)
• Lupus anticoagulant
• Antibodies to hCG IgG and IgM.
• Homocysteine.
• Mutations of the hemostasis system (Leiden factor, MTHFR, PAI 1).
• with aberrations (together with the spouse).
• HLA typing class 2 (analysis is carried out together with the spouse)

If there are changes in the tests, correct them and, if indicated, consult a hematologist or immunologist.

Thus, it makes sense to proceed with the next IVF attempt after failure only after conducting an additional examination, analyzing the unsuccessful IVF attempt and correcting the changes found that could have a negative impact on the previous result.

Gynecologist-reproductologist Nova Clinic, Ph.D., Kalinina N.G.

Every year the number of childless couples in Russia is growing. Today this figure already exceeds 15% of total number families. But thanks to the clinic’s assisted reproductive technologies New life 50,000 families not only from Russia, but all over the world have already been able to have a child.

Is it possible to repeat IVF?

When you contact our clinic for IVF, the doctor will definitely tell you that the first attempt at in vitro fertilization is sometimes unsuccessful. Having learned this, a married couple dreaming of a child will ask a fair question: is it possible to carry out the procedure several times and is it safe?

Each repeat with medical point vision is as safe as the first one, so it can be carried out repeatedly. Moreover, each repeated attempt increases the chances of success by analyzing and correcting the failures of the first attempt. If a child is your cherished dream, we recommend that you decide on a repeat procedure, and we will be with you until the desired result is achieved, so that together we can share the joy of the birth of a new life!

What are the benefits of repeat IVF?

Repeated IVF with more likely will lead to success. You may ask why the odds are increasing? Because the treatment program will be adjusted based on previous results. The doctor will have more confidence in a successful outcome, and you will worry less, since you will already know what to expect from the procedure.

Our practice shows that most couples going for repeat IVF are less nervous, and this is important, since the psychological state is an important factor contributing to the success of any event.

When can repeat IVF be performed?

We recommend that you wait about two months before starting treatment again. During this time, our specialists will be able to analyze why the failure occurred, and you will be able to mentally prepare for the second procedure.

If the failure was due to poor egg quality, we will advise you to use. In addition, you will need to undergo several tests, which also takes time. Your body also needs a “vacation”, after which it will begin to fight for successful fertilization with renewed vigor!

The myth about the dangers of repeated treatment

Previously there was an opinion that re-treatment has a negative effect on a woman’s body. It was believed that it increases the risk of cardiovascular, cancer and. But by now this myth has been debunked, and we can assure you with one hundred percent confidence that a second attempt at IVF does not pose any danger to your health!

How many times can the procedure be repeated?

IVF can be repeated many times. Of course, there is no generally accepted “maximum”. Everything will depend on you and the decision of your doctor, who, like no one else, will see the whole picture and understand the situation. When deciding on the possibility of conducting another attempt at fertilization, the doctor is guided by the results of past procedures and tests, individual characteristics the patient's body, her psychological state, age and other significant parameters.

Not all patients successfully become pregnant even after several attempts at in vitro fertilization (IVF). This becomes not only a medical, but also a psychological problem. Therefore, before undertaking such a procedure, each married couple should take a realistic approach to its possible results.

Frequency of development of a negative result

It is considered that if the first one is unsuccessful, the chances of success remain the same for the next two attempts. However, on the fourth and subsequent attempts, the probability of pregnancy decreases by 40% and is less than 5%. If the second IVF, and especially the third, are also unsuccessful, it is necessary to change the procedure protocol or take advantage of other possibilities, which are described below (ZIFT and GIFT procedures).

Causes

The main reasons for unsuccessful IVF:

• advanced age of the mother;
• increased levels of follicle-stimulating hormone (FSH);
• negative reaction to medications taken to improve fertility;
• small number of eggs received;
• delay in carrying out fertilization;
• a small number of obtained embryos available for;
• a decrease in the quality of embryos, which can occur for a variety of reasons.

Sometimes even multiple IVF attempts fail for some unknown reason.

Other diseases and conditions:

• chronic endometritis;
• after numerous abortions or curettages;
• hydrosalpinx;
• genetic incompatibility of parents;
• diabetes, pathology thyroid gland and others endocrine organs which could have worsened under the influence of hormonal preparation for the procedure;
• obesity in both mother and father;
• sperm pathology ().

If there is a failure

If IVF fails, close cooperation with your doctor is necessary. Only he can identify the problem and find its solution. The physician should review the procedure cycle in detail and determine if there are any ways to change it to ensure future success. Sometimes it is enough to add 1-2 drugs to achieve pregnancy.

At this time it is necessary to establish trusting relationship with your doctor. Only by understanding what is happening to her can the patient improve her chances of treatment success. To do this, she needs to find a specialist who will answer all her questions.

It should be understood that unsuccessful IVF is a common occurrence. An example is the fact that during normal sexual life of healthy spouses, the probability of pregnancy is no more than 7% per month. This figure is significantly lower than the effectiveness of IVF.

What you need to review first with your doctor:

• type of protocol, types and dosages of medications, results of blood tests and ultrasound;
• characteristics of the rate of fertilization in the laboratory, development of embryos, their cryopreservation;
• selection of new technologies, for example, the use of new drugs or embryo cultivation for up to 5 days;
• exclusion of endometriosis, hydrosalpinx, polyps or uterine fibroids or treatment of these conditions;
• diagnosis of polycystic ovary syndrome and appropriate adjustment of therapy.

You need to understand that most often no one is to blame for failure. However, if there is no trust in the clinic where the first attempt was made, it is better to find another hospital.

Signs of a failed attempt

After IVF, you need to wait for 2 weeks. After this, the patient takes a test to determine the level of hCG. If the indicator has not increased compared to the initial one, then the procedure was unsuccessful.

Signs of unsuccessful IVF before taking hCG:

• there are no unusual symptoms, for example: temperature fluctuates, chills appear, or feeling unwell;
• remains at up to 37.2°;
• there are no manifestations of early toxicosis, primarily nausea.

After an unsuccessful attempt at in vitro fertilization in most patients, to identify missed pathological changes in the uterus, which could cause miscarriage, is prescribed. Sometimes, immediately after the first cycle, they try again, and this can contribute to the onset of the desired pregnancy.

Fertility restoration

Recovery after an unsuccessful procedure takes up to 3 months. In this case, it is necessary to pay attention not only to physical, but also to emotional health.

Factors that help you survive stress and recover faster:

• psychological: conversation with a medical psychologist, auto-training, meditation;
• physiological: acupuncture sessions, massage, regular exercise;
• biochemical: balneological procedures, healing mud, bath procedures, swimming, hardening, moderate tanning;
• physical: taking sedative herbs.

• assistance from a psychologist at the Center for Reproductive Technologies;
• improving relationships with your spouse, since trying to get pregnant should not turn into an end in itself for a woman;
• nutritious food, adequate sleep;
• communication with loved ones.

In some cases, a woman develops severe depression - thoughts of her own worthlessness appear, apathy, tearfulness, a constantly depressed state sets in, and the desire to live, work, and even get out of bed disappears. In this case, the help of a psychiatrist and medication are necessary.

When can I try again?

This depends on the individual condition of the patient. She must again gather her courage, undergo all examinations and tests, and cure existing diseases. Typically, a repeat protocol is prescribed after 3 months. The number of attempts is practically unlimited; some women become pregnant only after the 6th – 8th procedure.

In some cases, cryotransfer after unsuccessful IVF is done after just one menstrual cycle, that is, when the first and second menstruation are completed. At the same time, the time required for the procedure is reduced, since there are already frozen embryos obtained in the first attempt. Therefore, egg retrieval, fertilization and cultivation are not carried out. At the same time, the quality of the embryos does not suffer.

The cryoprotocol can be supplemented with hormonal therapy to support the process in the endometrium, but medications are usually prescribed only for the endocrine form of female infertility.

To take advantage of this opportunity, it is necessary, immediately after the failure of the first IVF, to undergo a full examination, find out and eliminate the cause of the pathology. In this case, there is a chance of pregnancy on the second attempt without unnecessary hormonal load on the body.

Menstrual cycle and pregnancy

Is it possible to get pregnant naturally after an unsuccessful attempt?

Yes it is possible. After it was received negative result hCG studies, the woman stops taking hormonal medications.

When does your period start?

Usually menstruation occurs in the first 10 days after hormone withdrawal. If spotting appears literally in the first days after IVF, you should immediately consult a doctor. This may be a sign of miscarriage or ovarian hyperstimulation syndrome.

A delay in menstruation after unsuccessful IVF may be caused by a developed disease. To find out the reasons, you should consult a doctor and do an ultrasound.

It happens that after an unsuccessful attempt, your chest hurts. This is fine. This is how the body reacts to significant hormonal changes occurring during this period. After cycle recovery similar symptoms must disappear.

The first menstruation can be heavy and long (up to 10 days), sometimes moderate pain occurs. Scanty periods during this period are often a sign of endometrial pathology or hormonal imbalance. Ovulation occurs 12-14 days after the start of menstruation, sometimes later. At this time, natural pregnancy may occur. If this does not happen, subsequent menstrual bleeding should be normal for the patient.

In about a third of cases, after IVF failure, natural pregnancy. It is related to diagnosis and treatment possible diseases couples, improved hormonal levels, better preparation of the endometrium. In this case, approximately 3-4 weeks after the first menstruation, initial signs– nausea, feeling unwell, sometimes lower abdomen hurts. If such pain becomes stronger and is accompanied by bleeding from the vagina, you should immediately consult a doctor. Such symptoms may be a sign of early miscarriage. Abdominal pain may occur earlier than the specified period. They also require consultation with a gynecologist or reproductive specialist to rule out ovarian hyperstimulation syndrome.

Physiological pregnancy after unsuccessful IVF develops normally. A woman should be regularly monitored by a doctor. She can give birth naturally.

Medical solutions to the problem

All couples faced with such a situation have a question: what to do next?

Usually the couple is asked to try again. How to prepare for following procedure ECO:

Repeated diagnosis

Repeat diagnostic studies are carried out if previous results were obtained more than a year ago:

1. The level of antisperm and antiphospholipid antibodies is determined. Antiphospholipid antibodies interfere with normal uterine blood flow and embryo implantation. Positive antisperm antibodies damage the embryo immediately after implantation, when the woman does not even know that she has become pregnant.
2. The level of lupus coagulant and antibodies to hCG are examined, and the contents of the endometrium are inoculated on a nutrient medium to identify possible causative agents of chronic endometritis.
3. Prescribed to prevent fluid accumulation in the pipes (hydrosalpinx). It can enter the uterus and be a toxin for the implanted embryo.
4. An ultrasound of the uterus is performed with filling its cavity with a sterile solution (hydrosonography) to exclude fibroids or polyps.
5. If necessary, Doppler ultrasound of the vessels of the uterus and pelvic organs is prescribed to rule out varicose veins in this area.

Ovarian stimulation

They are convinced of the maximum possible for the patient at her age. Any clinic tries to avoid ovarian hyperstimulation syndrome. With this pathology, the ovaries enlarge and secrete abdominal cavity a large amount of liquid, which can be life-threatening.

Although this risk must be taken very seriously, reducing the amount of hormonal drugs below a safe level leads to a decrease in the normal stimulation of egg production in the follicles, a decrease in their number, a deterioration in the quality of the resulting egg and then the embryo, and a decrease in the success rate of repeat IVF. With a decrease in drug stimulation of the ovaries, the number of eggs may not decrease, but each of them receives less hormonal influence, which leads to its underdevelopment.

Finding another clinic

Unsuccessful IVF attempts are a reason to look for another clinic that uses other artificial insemination programs. There are several such protocols, and in each of them medical centers Usually they stick to one. If it does not work, it is necessary to collect more information about other reproductive centers.

Using Helper Methods

To increase the effectiveness of IVF, auxiliary methods can be used:

1. “Assisted hatching” is the creation of a microscopic hole in the wall of the embryo to help it “hatch” before implantation in the uterus.
2. Co-culture, that is, the joint development of the embryo with endometrial cells obtained from the uterine wall.
3. , in which 1 cell is taken from a 3-day embryo and subjected to chromosomal analysis.
4. Preventive removal of the fallopian tube for large hydrosalpinx.
5. Extending the cultivation “in vitro” up to 5 days, until the formation of not a zygote, but a larger formation - a blastocyst.
6. Adding to the hormonal therapy protocol a somatotropic hormone necessary for the complete maturation of the egg, most often in young patients with a large number of eggs received or in women over 38 years of age.

Application of analog technologies

How can I improve my retry success rate? If all were taken into account possible factors, but pregnancy never occurred, you can use other technologies:

1. Use taken from another woman.
2. ZIFT is a procedure in which one’s own eggs are retrieved and fertilized in the same way as in IVF, but after that they are not incubated, but are transferred to fallopian tube through laparoscopy.
3. GIFT is a procedure in which eggs are obtained either through transvaginal aspiration or laparoscopy, mixed directly with sperm and immediately placed into the fallopian tube.

ZIFT and GIFT technologies allow the fertilized egg to immediately enter its physiological environment - the fallopian tube. As a result, there is a more harmonious development of the embryo, the influence of beneficial factors contained in the tubes on it, and “independent choice” of the place and time for implantation in the uterus. This increases the chance of pregnancy from 5% to 40%.

Remember that IVF with your own eggs or with donor eggs can be diagnostic in itself. Most couples will get pregnant on their first or second IVF attempt, which (obviously) assumes that IVF is all they need.

If embryo implantation does not occur after 2 or 3 IVF cycles or occurs, but pregnancies fail in the early stages, then it is necessary to find out the reasons for the failures before going through the protocol again. (We recommend that you read the article: “What is good about the IVF program”)

So, let’s discuss the possible reasons step by step:

Step 1

Make sure you have all the information available: You should know:

What medications did you take, in what dosage and for how long;

What condition were your ovaries (and uterus) in just before you started your IVF cycle: how many antral follicles were on each ovary, what size were the ovaries, what was your endometrium at the beginning of the protocol;

How many eggs were retrieved during puncture;

What is the sperm fertility percentage;

What the embryos looked like on day 2 after puncture (good embryos should have 2-4 cells, should be symmetrical and not fragmented);

What the embryos looked like on day 3 after puncture (good embryos should have 6-8 cells, should be symmetrical and not fragmented);

What the embryos looked like on day 5 after puncture (they should be a blastocyst - ideally: an expanding blastocyst or one that is already beginning hatching);

How did your puncture go (easy or with complications);

Have you had uterine cramps, strong tugging on the day of the puncture or the next 2 days;

Have you had any symptoms of an immune reaction to the implantation (eg, flu-like symptoms, sore throat, joint pain, high fever 8-12 days after the puncture);

Whether there was any implantation at all - for example, a positive pregnancy test that disappeared or an ectopic pregnancy; - whether bleeding was observed before the test;

Step 2

Find out from your doctor whether there were any favorable signs when you started your last IVF cycle:

Your endometrium should have been thin, say 3mm, when you started stimulation.

If you had troublesome cysts at the beginning of a long protocol, it can be assumed that you would have had better success on a different protocol, such as a short one. Likewise, if you have a short cycle (or short follicular phase) and you had 1 or 2 follicles that developed ahead of the rest and had to be sacrificed to allow the others to mature (often a bad idea, since the fastest follicles may contain the best quality eggs that will mature), you may have more success with a long protocol than with a short one.

If you had less than 2 antral follicles in each ovary at the start of the protocol, especially if you had high analysis FSH and/or low AMH could mean that this is not the most suitable cycle for an IVF protocol, especially if the doctor usually sees more follicles in you than at the beginning of this protocol. Or it could mean that your ovarian reserve is poor and you might as well use a natural IVF cycle (without stimulation) as stimulated IVF. (more details in the article: “Increased levels of FSH and IVF”) Or you should ask your doctor to check your DHEAS (dehydroisoandrosterone sulfate) level to see if it is low and discuss whether taking extra DHEA for 3 months will help. You may need to ask your doctor to prescribe an estrogen-directed protocol.

Step 3

Know and understand the response of your ovaries. Your clinic should aim for a good ovarian response to stimulation, such as a response of 8-15 eggs, but no more.

If you have:

Very high ovarian response and/or hyperstimulation

Or great amount follicles, but not many eggs were recovered,

And yet, with all this, if you have more than 10 antral follicles on each side, there is high AMH and low egg quality.

All of this assumes that you have been overstimulated.

Options to reduce the risk of overstimulation on a subsequent attempt include:

If necessary, reduce your overall weight index to 20-25;

Talk to your doctor about using a protocol with birth control pills (you take the pill for 1-3 months before your period to calm your ovaries)

Reduce the amount of LH hormone in the protocol, but keep in mind that a certain amount of LH is needed especially on a long protocol or on an antagonist protocol after starting to take the antagonist drug.

Reducing the total dose of the stimulant or using alternative daily dosing, such as 150 and 75 every other day

Using the long drift method - taking fairly low doses of stimulant drugs (eg 150 IU), and stopping once at least 2 follicles have reached an average diameter of 18-22mm (by ultrasound) and 50% of the remaining follicles have reached 14-16mm, and a subsequent wait (drift) of up to 5 days until the level of Estradiol in the blood drops below 2500 pg/ml before giving the hCG trigger before puncture.

Use of cabergoline tablets (a drug that has been shown to reduce the severity of overstimulation without compromising egg quality/pregnancy rates) to reduce the likelihood of overstimulation - although this generally does not reduce the number of eggs or improve their quality.

Embryo freezing and cryo protocol in next month, - this does not reduce the number of eggs or improve their quality, but it may help avoid dangerous overstimulation.

If you have a poor response - less than 4 eggs retrieved with a typical dose of stimulation (eg 10 days of 300 IU), then there are methods to try to optimize your chances in this case too. The goal is to improve the ovarian response to produce more eggs, but not at the expense of their quality. Some methods can reduce the quality of eggs, so they are not suitable for all patients. Other methods may not increase the number, but may help the quality of the eggs. Some clinics are reluctant to tailor their protocols to individual patients, so if your clinic is not willing to discuss and change the structure of your unsuccessful protocol due to a poor response, I advise you to seek a second opinion at a more specialized clinic.

Here are my tips for you to discuss in your clinic.

1) changing the protocol type. The number of eggs punctured is usually higher in the long protocol for patients with a normal ovarian response. But some women have very sensitive ovaries that do not return to “normal” after a blockade (Differin injection, etc.) in a long protocol - so for them a short protocol that begins with the onset of menstruation is more suitable. In addition, some people obtain better quality eggs using the short protocol. Therefore, if you had a long protocol fail, then you should probably think about switching to a short protocol, and vice versa. Some women experience improved egg quality if their ovaries rest for a month or more on birth control pills before entering the IVF protocol. But there are also other cases when a woman's ovaries do not return to normal quickly enough after taking birth control pills. In this case, they are better off trying a protocol where its onset coincides with the onset of menstruation in the natural cycle, or trying the Convershin protocol with an agonist/antagonist combination with a preliminary blockade contraception. Some may have a better response to a burst protocol: a short protocol in which the agonist is started around the same time as the stimulants. True, sometimes this leads to a deterioration in the quality of the eggs - so again, you may have to try it to find out if this protocol suits your body. Some clinics do not use the flash protocol at all due to its reputation for decreasing egg quality (particularly in older patients) because the level of FSH that a woman's body will produce on the flash protocol is unpredictable. Clinics that individually adjust your FSH and LH levels through very close monitoring with blood tests and appropriately individualized stimulation dosing to get FSH and LH closer to desired levels are less likely to use the burst protocol due to its unpredictability, but those clinics that try to reduce the number Stimulant drugs use a flash protocol for some patients, especially those with normal ovarian response, so that the number of stimulant vials can be reduced using the FSH produced by the body.

Some fertility doctors believe that for the group of those who have a weak ovarian response, but at the same time ovulation occurs regularly in natural cycles, and for the group of older patients with a weak response, the chances of becoming pregnant with IVF will not increase due to the use of high doses of stimulating drugs , and carrying out IVF in a natural cycle has the same, and maybe even better, success rate than in conventional IVF. This approach involves attempting 2 or 3 cycles of IVF in a natural cycle without stimulant medications. During this natural protocol, regular monitoring of follicular development by ultrasound is carried out (often starting 4 days before predicted ovulation, usually ovulation occurs 14 days before the start of the next cycle). A trigger injection of hCG is done 3 days before ovulation and a puncture 3 days after the injection to collect only 1 or 2 eggs, and embryo transfer usually occurs on the 2nd day after the puncture. The goal of this natural protocol is that it is gentle and supports natural level hormones in the body and relies on achieving best quality eggs, not quantity.

2) try changing stimulant medications. Stimulants may be pure FSH (eg, Gonal-F, puregon, Follistim) or mixed FSH and LH (merional, Menopur, pergoveris) and may be natural (derived from human urine, eg Menopur, merional) or synthetic (eg, gonal F, pergoveris). Most doctors agree that PH is necessary for good growth follicles, but some believe that too much LH can be detrimental to egg quality. So if you already had a poor response on a long protocol using pure FSH, you may be able to improve your ovarian response by switching to a short protocol (in which your natural LH remains in your system) or staying on a long protocol but supplementing with LH (e.g. partial use of Merional/Menopur). Some doctors prefer natural preparations stimulation because they have a reputation for being more intense (and often less expensive), but others prefer synthetic materials, which have a reputation for being more "intense" - but until research shows that natural is superior to synthetic and vice versa, then the answer to the question is - which one is better? - probably the one to which your body reacts better.

3) Taking DHEA pre-protocol. Older patients, as a rule, have more low level DHEA and the resulting weak ovarian response. Some studies show that if DHEA levels in the blood are low, taking DHEA can improve or even restore levels back to the normal range, which in some cases results in improved ovarian health. This improvement is usually seen after about 3-6 months. Therefore, if you had one protocol with a weak answer, we advise you to take the following tests blood (on days 1-3 of the menstrual cycle): DHEAS, free testosterone, estrodial, SHBG, FSH, LH and prolactin. If DHEAS is low and testosterone and LH have not yet risen and your SHBG has not yet fallen, then you can try taking DHEA (eg. 25 mg micronized DHEA from famous brand 3 times a day for 3 months before the IVF protocol). After the first month, you should repeat the blood test to check if your levels are outside the normal ranges, as too high DHEA, testosterone, LH or too low SHBG reduces egg quality.

4) taking Estrogen. A good response is usually associated with relatively low FSH levels, so some clinics require you to wait until the month your FSH is at its lowest level on days 1-3 of your menstrual cycle before allowing you to enter the protocol. Estrogen tends to suppress FSH, so some doctors believe that taking estrogen for 1 week before stimulation may help those with a weak ovarian response.

5) Increasing the dose of FSH. Increasing the dose of FSH often helps increase the number of follicles and thus reduce the risk of a poor response - but some studies show that high doses also reduce egg quality. Accordingly, not all doctors want to prescribe high doses of stimulation to patients. If necessary (doses greater than 300 IU), doctors use a so-called “step down” approach - where the patient begins the protocol with a high dose and gradually reduces it. If in your last protocol you took a particularly low dose of FSH for your age group (e.g. 225IU or 150IU for 35 years old) and the response was poor, then it would of course be reasonable for your clinic to offer you higher doses, e.g. 450IU turning into 300 IU after 4 days, but you should be wary of those doctors whose only solution is huge doses of FSH (for example, 600 IU). An exception here may be cases when patients are still quite young with a weak response in the previous protocol; high quality eggs and you can try high doses to increase the number of follicles.

6) Lifestyle/vitamins/supplements. Some supplements should help those who have a weak response. For example, estrogen/estrogen-like supplements can help lower FSH, which in turn helps improve your response (eg, wheatgrass, spirulina). Other supplements or lifestyle changes may only have an indirect effect on your body - e.g. royal jelly, extra protein. Great importance It has good food and rest.

7) thyroid problems. Undiagnosed thyroid abnormalities increase the risk of a poor response. Get tested for TSH, T4 and antithyroid antibodies. Often, doctors evaluate results using recognized normal ranges, but not the ranges that are optimal for those trying to conceive. If antithyroid antibodies are detected, this means that there is a high chance of developing thyroid disease, even if your hormone levels are now normal. Some studies show that if you have antithyroid antibodies, your chances of getting pregnant can be increased by taking thyroxine, blood thinners and steroids.

8) Immune issues: If you are relatively young and without other obvious known reasons received a weak ovarian response in the IVF protocol, then this indicates a decrease in ovarian reserve and it is possible that your ovaries are suffering from an attack of anti-ovarian antibodies. This is associated with premature ovarian failure and accordingly leads to a poor response to IVF. Some studies suggest that taking immune medications such as steroids may help reduce anti-ovarian antibodies and increase the chance of pregnancy.

Step 4

What does the total number of eggs indicate? As practice shows, the chances of success increase when total number At least 1 or 2 of the punctured eggs are immature. Where there were no immature eggs, this could be a sign that the stimulation went on for too long and the eggs became overripe. In some cases, immature eggs can be fertilized through conventional IVF rather than ICSI. Therefore, if the sperm parameters are satisfactory, for immature eggs it is worth asking the embryologist to try to fertilize them through conventional IVF, and for mature eggs, as planned, through ICSI.

If the number of eggs retrieved is low compared to the number of follicles counted (predicted) before puncture, this may indicate the following:

1) the doctor was unable to “get” to one of the ovaries, for example, due to adhesions / scars that made the ovary inaccessible, or due to the fact that the patient is overweight.

2) may have happened premature ovulation before the puncture - this can be confirmed by taking a blood test for progesterone on the day of the puncture. A protocol with an antagonist (Cetrotide or Orgalutran) or Indomethacin (a very cheap drug that slows down some of the processes necessary for the follicle to rupture, such as the body's production of prostaglandin) may help prevent premature ovulation.

3) The hCG injection for egg maturation may have been given too early (less than 34-36 hours before puncture) or in an insufficient dose for the patient, so that the eggs cannot be completely released from the follicle.

There are cases when patients forget (!!!) to inject hCG.

Step 5

Percentage of egg fertilization and sperm factors influencing fertilization. If 75% of your eggs are fertilized, most embryologists consider this a good indicator. Fertilization rates are often lower with ICSI, such as 60%, partly because sperm quality is typically reduced, but also because not all eggs can survive the ICSI process; some may not be mature enough for ICSI. Fertilization percentage - 50% is marginally acceptable, below 50% is generally considered a poor level.

If your IVF protocol included low rate fertilization, a good embryologist should be able to give an explanation of why this happened:

The eggs were mostly immature (stimulation may not have been carried out long enough or hCG injection was in insufficient dose); or the eggs were overripe - stimulation was carried out for too long

The embryologist may suspect other reasons that indicate a decrease in sperm quality - for example, he had difficulty finding enough normal-looking sperm for ICSI.

Bacterial contamination may be suspected - sperm and embryonic environment can sometimes be tested for this.

In a cycle with DU, (if it is proven that this donor had good results in previous cycles), if fertilization (or embryo development) is poor, this may also indicate significant problems with the sperm.

Many doctors focus only on the quality of the eggs and ignore the quality of the sperm. If you have had more than 3 unsuccessful IVFs, even if the quality of the eggs is suspect, it makes sense not to ignore the quality of the sperm. In any case, if the sperm parameters are far from ideal (there is agglutination (gluing), lack of transition from a liquefied consistency to a liquid consistency), it is worth testing your partner for infections (for example, chlamydia / mycoplasma / ureaplasma), but in some clinics only the woman is tested because they consider it more reliable.

It is better to determine whether there are specific bacteria that can be cured with appropriate antibiotics (analysis + antibioticogram). But even if you don't do an antibiogram, some clinics will offer a 30-day course of doxycycline 100 mg twice a day + along with a course of high doses of antioxidants (for example, vitamin E and vitamin C), and then retest the spermogram (and DNA fragmentation) after 60 days. If there is a significant improvement, such as 200%, then it is generally assumed that infection is contributing to the sperm quality problems.

In some cases, the man has a history of medical conditions viral infection, for example, herpes, which can contribute to inflammation and reduced sperm quality. Where this is suspected, some doctors suggest a course antiviral drugs(eg, 500 mg valacyclovir twice daily for 21 days).

To improve egg quality:

3 months DHEA (Dehydroepiandrosterone) pre-treatment, but only if the blood DHEA is low, unless the LH:FSH ratio is high, or low SHBG (sex hormone binding globulin), high testosterone, PCOS

Assisted hatching if the shell is thickened;

Diet with high content protein/low glycemic index diet

During stimulation, limit LH levels (using only/mostly pure FSH until day 4 of stimulation, and then only limited doses of LH per day, for example using mainly Gonal-F, Puregon or Follistim and adding Menopur or Luveris, which contain LH); and using a long or short protocol with half the dose of antagonist, which begins on the 1st day of stimulation.

Reducing stimulation days without sacrificing the dominant (and likely best quality) follicle just so the others can catch up in size will reduce the number of eggs retrieved but improve their quality.

Anti-inflammatory diets/supplements, eg omega-3 fish oil, turmeric, nettle, resveratrol, pycnogenol, cordyceps.

It is worth considering natural cycle IVF or very low dose stimulation to maximize egg quality, but if sperm quality is compromised, this adds challenges because not all eggs can survive the ICSI process.

Step 6

Understanding the process of embryo development. Good quality embryos are usually divided according to standard timing. The day after the egg is punctured, they should show clear signs of fertilization. On the 2nd day they should have 2-4 cells, be symmetrical, without fragmentation. On the 3rd day they should have 6-8 cells, be symmetrical, without fragmentation. By day 4 they should be a morula (a clump of cells, like a mulberry) and by day 5 they should be blastocysts, ideally exposed or even beginning to hatch. Embryos that deviate from normal development by dividing too quickly or too slowly, showing asymmetries on days 2-3, or that have a lot of fragmentation are less likely to produce a healthy pregnancy.

But, keep in mind that just because an embryo looks great, it doesn't mean it will necessarily turn into one. healthy child. For example, if the eggs are of excellent quality, but the DNA of the sperm is very poor, the egg, at its own expense, will be able to compensate for the defects of the sperm, allowing the embryo to reach the blastocyst stage and even implant, but, unfortunately, receive healthy pregnancy it won't work.

If the embryos are of poor quality (dividing slowly / dividing too quickly), then you need to think about the quality of the sperm or eggs, and it is worth asking for a DNA test for sperm fragmentation. Although the embryologist himself should have some idea about the quality of the eggs from his observations.

Step 7

Thin endometrium may be due to:

Hormonal problems (eg too little estrogen - which can be corrected with hormonal correction: oral or vaginal Proginova, or Estrofem body patches).

Poor blood flow – which may be detected directly by Doppler ultrasound to examine the uterine artery, or may be suspected after a blood clotting test, or when increased immune activity, such as increased NK (natural killer cell) activity, may increase the likelihood of having microscopic coagulation in the uterus in endometrial tissue. Reduced blood flow can be improved with Clexane and possibly vasodilators such as terbutaline, Trental or vaginal Viagra. Vitamin E, L-arginine and selenium are also indicated for endometrial growth.

Endometritis (inflammation of the mucous membrane) - usually associated with infection, for example, chlamydia, mycoplasma, ureaplasma. It is visible on hysteroscopy as red, spotted, strawberry-like. It is usually easy to treat with antibiotics, although if the bacteria can be successfully identified it will be easier to select the appropriate antibiotic.

Irreversible damage to the endometrium after STDs (sexually transmitted diseases), inflammatory diseases women's genital organs or pregnancy-related infections (endometritis after abortion or after childbirth) or damage caused by scars from operations. These scars, where scar tissue attaches to the surface of the uterus in the form of adhesions, are usually visible on hysteroscopy, but not always. Scar tissue can often be cut away during surgical hysteroscopy, but some women are prone to recurrence of scar tissue after surgery. Some surgeons temporarily leave "balls" or coils in the uterus after surgery to try to stop the adhesions from reforming. Most doctors prescribe estradiol treatment after uterine surgery to reduce the likelihood of adhesions forming.

Options for solving the problem of thin endometrium

New treatments such as PBMC (peripheral blood mononuclear cells), GCSF (granulocyte colony stimulating factor) or hCG uterine irrigation may help with endometrial problems.

Treatment, such as salt rinses or micro-scratches of the endometrium. Most likely, this will not affect the increase in endometrial thickness, but implantation in general may help.

Sometimes hysteroscopy with gentle curettage can help give a new boost to the endometrial tissue so that next time it grows more evenly, but not necessarily thicker. Thick endometrium can sometimes be seen with PCOS or adenomyosis (experienced doctors should be able to identify adenomyosis on ultrasound), and sometimes due to the presence of cysts that produce hormones, preventing the normal drop in hormone levels. The old, thick, patchy endometrium must be shed (pro-menstruated) and grown back to increase the chance of embryo implantation. Studies have shown that if donor egg recipients were on estrogen for more than 5 weeks before the transfer (that is, they had old, stale endometrium), this resulted in a significant reduction in pregnancy rates.

Step 8

How did the embryo transfer take place and were there any cramps after the transfer? According to studies, it has been proven that if the transfer occurred easily, then the chance of pregnancy is higher than if the state of health during the transfer was poor. Therefore, during the next transfer, you need to think about how to make the transfer easier: expand the uterus or use a different catheter. Other studies show that patients who have experienced uterine cramps and post-transplant pain are less likely to become pregnant and need to calm their uterus after the catheter is inserted (allow it to adjust) but before embryo transfer, or achieve this with medication.

The concept of implantation. If you do not have bleeding in your anovulatory cycle and there is bleeding in ovulatory cycle, this means that you have implantation, but nothing more.

It is very difficult to identify the reasons for implantation failure, they may be:

Egg quality problem;

Problems with sperm, such as DNA fragmentation;

Male or female karyotype defect;

Infection, such as mycoplasma/chlamydia/ureoplasma, prevents the uterus from accepting the embryo;

Poor endometrial quality/anatomical problems with the uterus, such as poor blood flow, scarring, adhesions, polyps, fibroids;

Increased number of killer cells;

Endometriosis or other inflammation;

Hormonal problems such as hypo- or hyperthyroidism, poorly controlled diabetes or progesterone problems, thyroid antibodies or other hormonal antibodies lead to problems with egg quality and/or implantation. Women who suffer from an immune reaction to implantation may feel following symptoms: flu-like symptoms, joint pain, elevated temperature bodies, skin rash, sore throat approximately 6-10 days after the puncture. These may be signs of increased inflammatory cytokines and NK activity. However, it happens that immunity is the cause of implantation failure and no symptoms are observed. In cases where the cause of failure of implantation/pregnancy is immunity, your doctor should offer you the following diagnosis:

1. Thyroid (TSH, free T4 and antithyroid antibodies), for immunity (ANA, rheumatoid arthritis / lupus screening), vitamin D deficiency, coagulation (including antiphospholipid antibodies).

2. Tests that are done only in special laboratories: killer cell analysis, TH1: TH2 cytokines, LAD / anti-paternal genetic antibodies, HLA-DQA ratio, genetic thrombophilia (MTHFR, factor II prothrombin, factor V Leiden, PAI-1)

Heavy bleeding (not spotting) before the pregnancy test day while on progesterone support may be due to improper absorption of progesterone or abnormal metabolism of progesterone by the body. This often occurs in patients with high levels of a class of cells called CD19+ 5+, which are often associated with anti-hormonal activity. For unknown reasons, but possibly related to stimulation, low progesterone levels are typical in patients diagnosed with chlamydia. The easiest way to treat this problem is to use a high dose of progesterone starting 6-7 days after the puncture.

Step 10

What else to do when everything seemed to go perfectly. When we're talking about about an unexplained repeated failure of implantation, then the first thing you need to check is, perhaps some trivial study/diagnosis was missed:

2. thyroid(TSH, free T4, thyroid antibodies). TSH values should be about 0.9-2 and T4 is within normal limits. If thyroid antibodies are elevated, research suggests there may be an increased chance of IVF success when steroids, thyroxine, and blood thinners are used in the protocol. Vitamin D deficiency (fertility decreases and the immune system fails when there is a lack of vitamin D), ANA (elevated ANA can often be associated with autoimmune infertility, which can be treated with steroids, blood thinners and sometimes intralipid drips) blood clotting tests including antiphospholipid antibodies (elevated APLAs can be corrected blood thinners and steroids; other blood clotting problems (blood clots) can often be treated with blood thinners).

3. Basic hormonal background: 1-3 days FSH, LH, estradiol, prolactin, SHBG, DHEAS. If FSH and/or estradiol is high, this reduces egg quality and ovarian response, but pregnancy is possible with the right IVF protocol. If prolactin is high, you need to see an endocrinologist to make sure there is no serious reasons, but, nevertheless, your doctor will need to lower prolactin using medications such as bromocriptine or dostinex. Some studies suggest that IVF success will not be greatly affected by untreated elevated prolactinin, but the higher the prolactin, the more will need to be treated. If LH is high and/or SHBG is low, mixed drug stimulation can keep LH levels low. If DHEAS is low, poor egg quality and/or poor ovarian response can be prevented by taking a course of DHEA for 3 months.

4. Sperm analysis for DNA fragmentation. If the % DNA fragmentation is higher than ideal, in this case a lifestyle change (health diet with large quantity vegetables, omega 3, which is found in fish, nuts and seeds (not fried), avoiding smoking, alcohol and taking even prescribed medications such as anti-depressants) can help. However, frequent ejaculation, a course of antibiotics and a high dose of antioxidants before retesting after 60 days can be quite beneficial. Some andrology specialists compare sperm values ​​taken 2 hours after the first ejaculation as this sometimes improves sperm quality (but at the cost of a reduced sperm count). Attentive visual diagnostics uterus for physical abnormalities - detailed examination by an experienced doctor, 3D examination or hysteroscopy. If a detailed examination reveals the presence of scars, septa, adhesions, polyps or fibroids in this case, some doctors suggest immediate surgical removal. Others may be more conservative and insist that they have had patients with a similar diagnosis and become pregnant. This position may not be useful for patients who have not undergone implantation. And just because a particular patient managed to become pregnant despite such a defect does not mean that a patient with lower fertility will be able to achieve the same result without the intervention of surgery. You need to understand that good surgeon will increase your chances of success, a bad surgeon can only worsen your situation.

6. Check for infections (usually more accurate female diagnostics) for chlamydia, mycoplasma, ureoplasma, etc. – many doctors may miss this diagnosis as meaningless, others do only a basic test for chlamydia from urine or vaginal smear. This is because most doctors work with patients who have transferred from other clinics after failure to conceive and endless treatment with antibiotics. There is a generally accepted concept that antibiotics do not increase the chance of pregnancy during IVF. However, it ignores the fact that most patients manage to get pregnant only after the 3rd attempt.

7. diagnosis: For genetic thrombophilias (PAI-1, prothrombin II, factor V Leiden, MTHFR), which can be easily treated with blood thinners (and sometimes high doses of folic acid, B6 and B12); Killer cells and their ratio - which can be treated with various combinations of Intralipids, steroids, Clexane (enoxyparine), (and possibly Xumira and/or IVIG (Bioven)); TH1:TH2 cytokines - which can be treated with steroids, antioxidants, intralipids and possibly Xumira and/or IVIG (Bioven); HLA DQA - which can be treated with intralipids.

Step 11

Interventions that your doctors might have neglected The main intervention is a thorough investigation and a very carefully selected IVF protocol for you: for example, for a normal or high response/response for a normal or long cycle, propose a short protocol or select a protocol so as to reduce LH in those patients who have elevated LH or have polycystic ovary syndrome, or introduce LH in case of its deficiency.

For patients with a short cycle, and in particular with a short follicular phase, a long protocol (to avoid the danger of developing a dominant follicle earlier than necessary) - paying attention to LH, so that it is sufficient so that the follicles can develop normally.

In case of poor reaction/response for a normal or long cycle, do a protocol with the introduction of LH and increase the dose if necessary, or use IVF in a natural cycle with drug stimulation or an estrogen protocol.

Other interventions that may increase the chances of implantation: Use a 5-day letrozole protocol for patients with mild/moderate endometriosis, hydrosalpinx, or unexplained failure to implant.

Endometrial cleaning 2 weeks before embryo transfer - mainly for patients with unexplained failure to implant - is increasingly used in the US - some clinics do deeper endometrial cutting 4 weeks before transfer. Irrigation/saline rinse 2-3 days before embryo transfer (or hysteroscopy at the beginning of the treatment cycle / at the end of the previous cycle) – mainly for patients with unexplained failure to implant

You may need information: "Menstrual cycle after unsuccessful IVF"

As you know, IVF is a rather complex and expensive procedure that takes a lot of time and money, but, alas, does not guarantee a positive result.

The reasons for failure can be different, both physiological and psychological. And if your doctor helps you figure out the first ones, then psychological problems, as a rule, remain unattended in the process of preparing for IVF. However, their influence on the result is very great!

How to find out: is your infertility a consequence of psychological problems?

How to eliminate the influence of negative psychological factors during the IVF process?

How to increase your chance of IVF with psychological help?

Online diagnosis of psychosomatic causes of infertility in women will help you answer these questions.
Based on the test results: identification of psychological barriers to pregnancy; recommendations from practicing psychologists.