Analyzes for eco. Mandatory analyzes include three areas of analysis. The therapist issues such a certificate on the basis

Many couples who are desperate to become parents naturally, decide to undergo the procedure in vitro fertilization.

But on the way to their dream, people encounter certain bureaucratic delays. How to avoid them and whether it is difficult to get a quota for IVF, you will learn from our article.

What is the difficulty of obtaining a quota for IVF?

In vitro fertilization is a procedure controlled by law Russian Federation. In particular, as part of family support, the state provides quotas designed to carry out medical procedure at the expense of funds from the federal and regional budgets.

This includes financing both the entire event and individual stages, such as: preparation and stimulation of the ovaries, puncture biological material, embryo development, its introduction into the patient’s uterus. If the diagnosis is made due to male factor, IVF is performed with donor egg, which is also financed from the budget.

This practice is not new in the world, but on the territory of the Russian Federation and near abroad it is just getting developed. Thus, in Ukraine, only couples who are not sufficiently financially secure or women with the absence of fallopian tubes have the right to free artificial conception.

In Belarus, a preferential loan is provided for the procedure. In Kazakhstan, such a case is provided once; you can go through the stages of treatment only in Astana and Almaty.

Because artificial insemination quite expensive (from 106 to 160 thousand rubles), married couples try to get a quota and encounter some difficulties. Both spouses need to undergo dozens of tests. There are also certain requirements for the level of health of both husband and wife. So it’s unlikely that you’ll be able to get benefits quickly and without problems.

And the main difficulty is to get confirmation from one of the spouses of a specific infertility analysis. For example, if you cannot conceive a child for unknown reasons, free treatment is not provided. The patient’s opinion regarding the clinic where she wants to undergo insemination is not always taken into account.

Scheme for obtaining a quota for compulsory medical insurance

The rules for obtaining a quota in Russia can be found in the relevant order of the Ministry of Health.

According to the order, a woman must:

• have a medical insurance policy;
• be registered in the compulsory medical insurance system;
• provide confirmation of the diagnosis and a list of necessary documentation.

When submitting documents to the Ministry of Health, you need to be patient and nervous, since the wait in line lasts from a month to a year. But every year there is a positive trend in the situation with advancement in queues. In 2018, many private prenatal centers and clinics are actively participating in the program, which allows women to undergo the procedure within the current time frame.

Now free fertilization is available not only to married but also to single women. Also, many cities in the country provide regional and municipal quotas for artificial insemination. Even women from remote regions can stand in line and get the opportunity to be observed and treated in clinics in the capital; They will not have to change their registration and place of residence for this.

Where to start the process of applying for preferential treatment? The married couple must go through a complete medical examination and provide the commission, decisive issue about free treatment, a list of all documents and certificates.

Collecting medical documents from a therapist

The therapist issues a certificate confirming that the expectant mother has no contraindications to IVF.

The therapist issues such a certificate based on:

• examination by a narcologist and psychiatrist;
• results of general urine and blood tests;
• ECG results;
• fluorography results.

Documentation from a gynecologist

The main conclusion about infertility is issued by a gynecologist. In order to confirm the analysis, you need to go through the following procedures:

• take blood tests for blood group, hepatitis, syphilis, HIV;
• coagulogram for blood clotting;
• test blood for hormones, in particular AMH, since a patient with low AMH cannot conceive a child;
• undergo a cytological examination;
• take a smear for vaginal microflora and urine culture;
• undergo an ultrasound of the thyroid gland and pelvic organs;
• to take a photo mammary glands and undergo examination by a mammologist;
• do an endometrial biopsy and hysteroscopy;
• get tested for TORCH infections (diseases that can be transmitted to a child during fetal development).

Some clinics may order additional tests.

Checking males

A report on the man’s health status is also required. In addition to the basic tests, it is necessary to take a spermogram from him. The man is also being examined by a therapist, psychiatrist, narcologist and urologist.

All tests and conclusions provided by spouses must have current expiration dates. Within three working days, the gynecologist prepares an extract indicating final diagnosis. The extract must be signed first chief physician establishments, then the chief reproductive specialist or gynecologist of the region. After this, a package of documents is prepared for the Ministry of Health.

Documentation for the commission of the Ministry of Health

To give consent to participate in the program or to refuse - such a decision is made by a special commission of the Ministry of Health.

Documents that need to be provided to the commission include originals and copies of:

• passports;
• individual personal account insurance number (SNILS);
• medical insurance policy;
• extracts from the medical history.

On site, you need to fill out application and consent forms for working with personal data.

How much to wait

Studying documents and making decisions takes place within the time limits established in different regions.

Typically the waiting period is 10 working days.

The patient is informed about the commission conclusion within three working days. She is given a written conclusion in hand and a notification is sent by email.

For what reasons can they refuse?

Unfortunately, after all the tests and procedures, endless queues to see doctors, the commission may deny the right to free artificial insemination.

Grounds for refusal:

1. Medical contraindications. IVF cannot be performed in case of diseases from the list approved by the Ministry of Health: hepatitis, tuberculosis, diabetes, blood diseases, diseases nervous system, heart disease, uterine tumors. Couples where both partners are HIV positive are denied.
2. Incorrectly completed documents. In this case, they need to be redone, formatted accordingly, and the application must be submitted again.
3. Diagnosis: infertility for unknown reasons.

Exist age restrictions from 19 to 39 years old. After 40 years of age, benefits for IVF are not provided.

A fertility doctor of the highest category tells in detail about who is entitled to free IVF:

For how long is the quota for IVF under compulsory medical insurance valid?

After the commission approves the application for participation in the quota program, a referral is issued with which you need to go to the clinic to see a fertility specialist. A referral for free in vitro fertilization under compulsory medical insurance is valid for three months, under VMF (high-tech medical care) - year.

The IVF procedure within the framework of VMP is financed from the federal budget in following cases: if both spouses are infertile, after an unsuccessful process of infertility treatment, with infertility of unknown origin.

What to do if you receive a refusal

Many women, having been refused by the Ministry, do not know where to go with their problem.

If the failure is not related to medical indications, the patient has every right to contact the insurance company, the health department and the prosecutor's office with official complaint. In addition, you can apply for free IVF again.

FAQ - answers to frequently asked questions

In each region, the situation with quotas for in vitro fertilization in each region is different. But in various thematic forums this issue is discussed by citizens very actively.

Both those who have undergone artificial conception and those who have been denied this will take part in the discussion. Expectant mothers want to know the answers to many questions in search of solutions to their problems.

Is it possible to get a quota for IVF multiple times?

If the legislation of many European countries provides for a specific number of repeated applications for a quota; in Russia there are no such restrictions. Married couples can apply for a quota for in vitro fertilization an unlimited number of times.

But practice shows that it is impossible to make more than two attempts a year. This is due to the fact that after an unsuccessful artificial conception, the female body needs to be given time to rest and recover. When you reapply for the program, you will need to take some tests again.

Also, the legislation of each region provides for a certain number of places for fertilization, financed from the budget. Therefore, if treatment took place, for example, at the end of the year, in December, you can re-apply only for the next year.

What happens if pregnancy does not occur after fertilization?

According to statistics, pregnancy occurs after the first IVF procedure only in 30% of cases. Then the second attempt is made in the order of waiting in line, but not more than twice a year. Most often, a negative result is obtained due to the body’s reaction to the injected drugs. If the procedure is repeated in the same year, the patient does not need to undergo full examination, you just need to retake expired tests.

What is the difference between a federal quota and a regional one?

The difference between these quotas is that an application for carrying out the procedure within the regional budget can be submitted once, but at the federal level - an unlimited number of times. Regional quotas are given only to those women who are legally married, federal quotas to women who have not registered their marriage.

Within the framework of the federal quota, the patient has the right to choose the clinic in which she will undergo the procedure (subject to the participation of the clinic in the program), and within the regional quota this means treatment in medical institution in a specific area.

Conclusion

The destiny of every woman is to become a mother, and this opportunity is supported by the state.

Unfortunately, the legal and financial illiteracy of women often becomes a reason for preventing officials from obtaining free treatment. If married couple decided to take such a serious step, you need to remember that no state commission or medical institution has the right to infringe on them.

Well, good luck to everyone in achieving results in eco-friendly compulsory medical insurance!!!

Added by moderator:

So, I will tell you the stages of obtaining a referral for IVF under compulsory medical insurance first-hand))

I describe point by point what to do and in what order.

1. The first step is to decide on the clinic where we want to do IVF, based on the experience of friends and forums.

2.Choose a doctor. I highlighted this point separately, because you shouldn’t go to the first fertility specialist you come across, you should like him and you should trust him.

3. Sign up for initial appointment to the IVF clinic, to the doctor from step 2, usually the very first appointment is free. We bring with us all the papers we have, and my husband’s husband too.

The reproductive specialist looks at the ultrasound, voices preliminary diagnosis according to which you will go for IVF (diagnoses and codes are indicated in the order on the 1st page). You tell them that you want to do IVF with them under compulsory medical insurance, if everything is OK according to the ultrasound, he prescribes vitamins and medications necessary before the protik (Folk, Omega, for blood, OK if necessary), as well as additional ones. studies (for example, karyotype, etc.) If fibroids/polyps are found, they will prescribe a hysterectomy.

My example: I went to 100,500 times ultrasound in my city, everything was “excellent”, but only in the clinic ECO , they found me to have hydrosalpix, which was later confirmed by laparoscopy. I was also prescribed tablets to improve the quality YAK , which you need to drink 3 months before the protocol. Well, my husband was prescribed vitamins and medications to improve SG .

4. We go to the clinic at the place of residence, to the therapist, and inform that we need a conclusion for IVF. The therapist writes out directions for tests, for free: OA of blood, OA of urine, AK from a finger, sugar, Flushka, ECG, coulogram. We hand over everything, if everything is OK according to the tests, the therapist gives a certificate “Hello, ECO and pregnancy is not contraindicated,” We take the certificate and tests, do not forget about the stamps on them. We also visit an endocrinologist, gastroenterologist, etc. when indicated. (who is in pain)

5. While we are going to the clinic for point 4, we are sending my husband to take tests: SG + March test and bacterial cultures are paid, the rest is free, directions can be obtained from a therapist. WITH ready results goes to a urologist (at the clinic, if not, then for a fee), where they give a certificate: “ Diagnosis, ECO not contraindicated"

Certificate from a urologist

Spermogram

Certificate from a mental health center

Blood type

Chlamydia culture

PCR Herpes 1.2

Bacterial culture of ureaplasma

Bacterial culture of Mycoplasma

Hepatitis

General smear

5. With the documents of paragraphs 4 and 5, we go to the residential complex at the place of residence. We inform you in a pitiful voice that you do not have children, that you have been infertile for 100 years, that you are eligible for IVF under compulsory medical insurance.

A good G, immediately gives directions for tests and ultrasound, a bad one begins to appear. We are not at a loss, we pull out the order printed in advance, point our finger that you are entitled to IVF and that the examination for discharge is carried out free of charge. If it still doesn’t work on her, go to the manager, or to the local Ministry of Health. One call to the Ministry of Health was enough for me to next appointment I was given all the directions)))

I handed over:

Blood type

Hepatitis

HIV analysis

Prolactin

Progesterone at 21dc

Homocysteine

AMG at 3 d.c.

Cologram

Clinical blood test

General analysis urine

Biochem. AK

Flora smear

Sowing tank

Cytology

Intramorning infections TORCH

Mammography + certificate

Ultrasound of the thyroid gland

Pelvic ultrasound

• The extract is ready, we’ll find out how it gets to the Ministry of Health, either they will take it themselves, or you will, it’s different in each region.

6. That’s it, an extract from the Ministry of Health, you already have a phone number, we’ll find out when the commission is completed. We wait. The next day we call and ask if the commission has passed and where you can pick up the referral. Now you can call the reproductologist (we already became friends in step 2) and agree on the start date of the protocol.

I was told to come to 2-3 days as soon as I received the direction.

7. We receive a referral and a copy of the extract

They gave it to me a week after the commission and wished me good luck.

8. We send a referral, extract, SNILS, insurance policy, passport to the clinic, wait

and enter into the pregnancy protocol.

Result: I received the referral after 2.5 months. Pipe factor + MF . My mistake was that I went to the residential complex first, and not the clinic, my tests were not very good, I had to undergo a course of injections. On May 19, I had my first appointment at the residential complex, from June 10-20 I was treated, on June 20, all the papers were with G, she filled them out in 5 days, for almost 3 weeks my extract was lost with the head of the residential complex, she forgot to send it to the Ministry of Health. And I waited another week for a referral after the commission.

The completion of collecting documents and signing the extract can also occur according to this principle:

Look, here is the algorithm:

1. Take a therapist’s conclusion that IVF is not contraindicated for you.

2. With a therapist’s report, a stick, reports from a psychiatrist and a narcologist, tests (hormones, HIV, syphilis, all blood, infections, SG) you go to the gynecologist.

3. Complete all applications to submit to your district gynecologist.

4. You go to the manager of your residential complex and endorse these statements (I can take a photo of them in a minute, with sadness, etc., to make it clearer).

5. With certified applications and a package of documents, you go to the DISTRICT gynecologist (we just don’t have an appointment, you sign up if they told you!).

6. You hand over all documents and statements to him (the district officer).

If there are no comments on the package of documents, you are told the date when to come for the results! Whether they take you into the program or not.

On the designated day you come to the district gynecologist. He announces the verdict.

If everything is ok - you choose a clinic, enter it, she makes herself a copy of the documents, gives you the originals and you sign up for the chosen clinic and the reproductive specialist will tell you when you enter the protocol.

Ask! I will help with all I can!!! Do not be shy!

In the residential complex, we collect the docks, they certify them and take them to the district. All...

No, you need to go to a narcologist and a psychotherapist separately, I forgot.

Another option:

If you don’t really want to go to MONIiAG, then here is my scheme for regional students:

the main point is that if you go in the direction through the residential complex, then you will not get anywhere except to MONIiAG or the Balashikha PC, and there is also an incredible queue there...

There is a second way - directly through the Ministry of Health of the Moscow Region and there are already 6 clinics to choose from - MONIiAG, PC in Balashikha, Almazov Center in St. Petersburg, International clinic"Family" (this is Bio-optima), Prior Clinic, Kulakov Center.

We chose the Federal State Budgetary Institution NTsAGIP named after V.I. Kulakova

Scheme using the example of our clinic:

-> first we go to an appointment in Kulakova with the available tests, etc., we take there a list of tests for IVF according to compulsory medical insurance, then we collect the missing tests (most of them can be done for free through the LCD),

-> then again to Kulakov with all the tests, we receive a petition from the clinic for the Ministry of Health of the Moscow Region,

-> take the application, passport, compulsory medical insurance policy, SNILS and go to the Ministry of Health of the Moscow Region for a referral for IVF.

Letter from the Ministry of Health.

17.04.2017

About 15% of couples in Russia suffer from infertility, and assisted reproductive technologies have given many of them the opportunity to become happy parents. Thanks to in vitro fertilization, pregnancy occurs in more than 40% of cases. An examination before IVF - under compulsory medical insurance or under a contract - is necessary in order to prepare the couple for the procedure and choose the optimal protocol. All studies are divided into three groups:

• tests to help identify the cause of infertility;
• tests, thanks to which the doctor determines the absence of contraindications for one or another type of in vitro fertilization;
• preventive tests that will help make the chosen ART effective and safe.

Determining the causes of infertility

The initial examination and identification of indications for the use of assisted reproductive technologies begins with studying the hormonal background of partners and determining the hormonal status. A woman is recommended for 3-5 days menstrual cycle donate blood from a vein to determine hormones:

• follicle-stimulating (FSH) - reflects the state of the reproductive system and serves as a marker of many deviations in its functioning;
• luteinizing hormone (LH) - a peptide hormone that literally triggers ovulation and causes the ovaries to produce estrogens;
• somatotropic (GH) - specific hormone reproductive system, which affects the function of the genital organs;
• thyroid stimulating hormone (TSH) - regulates the menstrual cycle;
• T3-T4 - a group of thyroid hormones that affect metabolism;
• prolactin - maintains pregnancy and prepares the woman’s body for lactation.

Tests are necessary not only for conception, but also for maintaining pregnancy

On days 20-22 of the menstrual cycle or about a week after ovulation, if its day is known, it is necessary to be tested for estradiol and progesterone. In parallel, OAC and Rh factor testing are prescribed.

Before taking all these tests, simple preparation is necessary: ​​eliminate alcohol and smoking, minimize physical exercise. You may need to give up some medicines affecting the test result - such a measure must be agreed with the doctor.

To exclude female factors infertility may be recommended and instrumental studies. First of all, this is a transvaginal ultrasound, during which the condition of the ovaries and uterus is studied. If tubal obstruction is suspected, hysterosalpingography and laparoscopy are performed. To examine the endometrium, hysteroscopy and biopsy are prescribed diagnostic curettage And histological examination the received material. If there are problems with the endometrium, the fertilized egg will not be able to implant and pregnancy will not occur. The woman should also undergo a mammogram and ultrasound of the mammary glands.

Ultrasound during examination before IVF allows you to assess the condition of organs

List of tests for IVF to identify contraindications

To exclude relative and absolute contraindications for the chosen ART, you need to undergo a standard examination, which includes fluorography, ECG, several types of ultrasound (of organs) abdominal cavity, pelvis, thyroid gland). Also, a woman should consult a therapist and, if she has any chronic diseases, visit specialized specialists, receiving conclusions about the absence of contraindications for IVF.

The second stage is tests for antibodies to viruses and infections that can harm the fetus or mother in the event of pregnancy. These include the so-called TORCH diseases - herpes, rubella, toxoplasmosis and cytomegalovirus. Additionally, you need to donate blood for antibodies to syphilis, hepatitis and HIV.

Third step - comprehensive examination before IVF for urogenital and chronic diseases. A mucosal smear will help detect or exclude chlamydia, ureaplasmosis, mycoplasmosis, dangerous forms HPV. A smear is taken from the woman for flora, which will show the presence and activity in the vagina of yeast, staphylococci, streptococci, gonococci, coli, Trichomonas - all of them can have an indirect Negative influence on the fetus while it is not yet protected by the placenta. Colposcopy of the cervix is ​​necessary to exclude oncology.

It is important to exclude contraindications for IVF

The fourth stage is general clinical analysis and “biochemistry” of blood. They will indicate the presence of problems in the functioning of a particular organ, identify hidden inflammatory or pathological processes. A hemostasiogram is needed to assess blood clotting, an indicator that is fundamentally important for pregnancy and the life of the mother and child.

Tests before IVF may show some abnormalities, and this is not a cause for concern. The vast majority of diseases can be treated successfully with a suitable protocol.

Increasing the effectiveness of IVF

Many tests before IVF, which will allow you to carry out the protocol as efficiently as possible, achieve a long-awaited pregnancy, and most importantly, maintain it, intersect with research into the causes of infertility. The expanded program for increasing the efficiency of in vitro fertilization, in addition to the tests from the list above, includes specific tests, for example, for markers of spermatogenesis genes, compiling a woman’s androgen profile. Also, the expectant mother may be recommended to be examined for polymorphism of vascular tone genes associated with a predisposition to hypertensive conditions. They, in turn, can provoke problems with placental function, preeclampsia and heart attack.

Examination before IVF increases the chances of long-awaited pregnancy

Examination before IVF according to compulsory medical insurance

To become a participant in the in vitro fertilization program under the state quota, a couple must undergo examination at medical institution and have a conclusion with a recommendation for ART. In 2017, quotas are provided in all regions under several conditions:

• both partners have compulsory medical insurance policies, are citizens of the Russian Federation and do not have children together;
• woman's age - less than 47 years;
• presence of indications for IVF, including with ICSI (female infertility due to obstruction or absence of fallopian tubes, endocrine factors, lack of ovulation and other prerequisites, male infertility, a combination of female and male factors, etc.)

Upon receipt of a quota, all tests for IVF under compulsory medical insurance can be taken free of charge at a clinic participating in this program. A single woman or a couple in which the man is infertile can apply for subsidized ART, but in this case, the use of donor biomaterial and associated medical procedures and research are paid for separately.

The procedure for obtaining a quota for ART, a list of tests for IVF under compulsory medical insurance and other nuances of participation in the program with federal support are set out in Order No. 107n of the Russian Ministry of Health “On the procedure for using assisted reproductive technologies, contraindications and restrictions on their use.”

Most tests for IVF under compulsory medical insurance can be taken free of charge

Tests for IVF for a man

The partner, in addition to standard tests for the Rh factor and sexually transmitted diseases, undergoes several tests and examinations before IVF. These include:

• a smear from the urethra to study the flora - some of its changes directly affect the quality of seminal fluid;
• spermogram - assessment of certain sperm parameters helps to exclude many male factors of infertility;
• antiglobulin reaction - specific analysis, which is prescribed when sperm agglutination is detected during a spermogram.

The shelf life of tests before IVF depends on the type of study and the requirements of a particular clinic; this issue must be agreed with the attending physician. He will also provide a detailed and comfortable schedule for the examination for the couple and each partner individually. It is also necessary to strictly follow all the specialist’s recommendations regarding preparation for each study. If they are violated, the tests may be incorrect, which means that the chances of a successful result of in vitro fertilization will be lower.

The man is also undergoing examination

Tests after IVF

The standard in vitro fertilization scheme includes a preparatory stage (with hormonal stimulation or natural cycle), oocyte puncture, invitro fertilization of eggs with the seminal fluid of a partner or donor, cultivation of embryos for 3-5 days and transfer to the uterus. After the replantation, on days 12-14, a post-IVF control test is taken - a test for human chorionic gonadotropin(hCG). It is also called the “pregnancy hormone” because it begins to be produced only when the embryo is implanted into the endometrium. It is necessary that such a study be carried out in dynamics: the increase in hCG levels must occur at a certain rate. This is the only way to diagnose not only the onset, but also the development of pregnancy.

The doctor will tell you what other tests are needed during IVF if the transfer and implantation of embryos is successful. It is extremely important to follow all recommendations regarding lifestyle, preparation for examinations and behavior after each medical procedure. The results of the chosen protocol and the chances of a long-awaited pregnancy largely depend on the discipline of the partners.

Since 2016, infertility has been included in the number of cases subject to compulsory health insurance. Thus, citizens can receive an expensive IVF procedure, fully paid for from the compulsory medical insurance fund. Besides insurance policy You must have a medical certificate declaring the couple infertile and a completed health examination sheet for both partners. What types of tests and studies need to be taken before IVF for both men and women? What is the compulsory medical insurance survey sheet used for, what data is entered into it? What is the complete list of tests and studies that need to be taken for the IVF procedure under compulsory medical insurance? We will answer these questions in this article.

Regulatory framework for IVF under compulsory medical insurance

At the end of October 2012, the Russian government decided to include IVF in the free state medical care program. Since 2013, in vitro fertilization has been financed through mandatory funds. health insurance. The state is interested in increasing the birth rate and is ready to help childless families who want to have offspring. These intentions are confirmed in the relevant regulations:

• Order of the Ministry of Health of the Russian Federation dated August 30, 2012 No. 107n “On the procedure for using assisted reproductive technologies, contraindications and restrictions on their use” is still the main document for preparing for the in vitro fertilization procedure. According to this order:
  • not only registered married couples, but also civil partners, as well as single women have the right to treatment of infertility using ART;
  • for admission to the IVF procedure, a diagnosis of “infertility” and a conclusion about the ineffectiveness of the treatment are required;
  • a basic list of tests for partners has been established. Based on their results, couples with the highest probability of pregnancy are determined - they are the first to receive the right to pay for IVF under compulsory medical insurance.
• Order of the Ministry of Health of Russia N 565n dated August 12, 2013 “On approval of the list of types of high-tech medical care” - in accordance with it, the list of causes of infertility subject to IVF treatment was expanded, including HIV infection;
• The program has been operating in Russia since 2015 and guarantees state aid in the treatment of infertility for everyone with a compulsory medical insurance policy.

In accordance with the regulatory legal acts listed above, a patient who has received a referral for IVF is included in the waiting list in order of priority and has the right to choose a clinic - public or private - from the list of participants in the program. Moreover, in case of failure, the citizen can be included in the queue again for a repeat procedure.

What types of infertility does IVF treat?

The first step to obtaining a referral for an IVF procedure is to establish a diagnosis of infertility. Gynecologist antenatal clinic or a paid clinic prescribes necessary examinations to find out the cause of a woman’s infertility. Such examinations include:

• Study of the hormonal background of the body (the level of eight hormones is determined);
• Ultrasound of the uterus and ovaries;
• Laparoscopy and hysterosalpingography - to check the condition of the fallopian tubes;
• Hysteroscopy - examination of the inner surface of the uterus.

A man's fertility is checked using such laboratory research, such as Kruger spermogram, general urine analysis, and also in mandatory check hormonal levels. Once the diagnosis is made, a course of treatment lasting up to two years is carried out. If pregnancy has not occurred during this period, the attending physician gives recommendations for the use of ART. His vote is taken into account by the commission of the Infertility Treatment Center, which can refer the couple to the clinic for this procedure. To be referred for IVF by Compulsory medical insurance necessary is not only a confirmed diagnosis, but also a conclusion about the ineffectiveness of the forms of therapy already performed.

With the increase in the number of protocols, the effectiveness of IVF increases: the first time, pregnancy occurs in 33% of women aged 25-40 years, after the second procedure - in 48%, and after the third - in 54% of women. Pregnancy ends with a successful birth in 80-85% of cases, and in 31% happy couples Twins and even triplets are born.

Diagnosis of infertility unknown origin placed in approximately 15% of cases. In such a situation, the couple may be offered IVF treatment, especially if there is no effect from other treatment methods, since in some married couples there is actually a kind of block that prevents fertilization. In 2017, the following diagnoses are indications for IVF: female infertility(with code name according to ICD-10):

• Obstruction of the fallopian tubes - N 97.1;
• Uterine pathologies - N 97.2;
• Diseases cervical canal- N 97.3;
• Insufficient quantity or low mobility of sperm in a partner - N 97.4;
• Ovarian cystosis - E 28.2;
• Congenital ovarian dysfunction - E 28.3;
• Impaired ovarian function as a result of treatment - E 89.4;
• Endometriosis - N 80;
• Uterine leiomyoma - D 25.

Modern medicine has a fairly large arsenal of drugs used to treat infertility. At the same time, it is necessary to understand that the choice therapeutic method primarily due to the reasons that led to infertility. It is worth remembering that an extract from the antenatal clinic containing a diagnosis of “infertility” indicating the ICD-10 code is the first document in the list necessary papers to undergo the IVF procedure.

Compulsory medical insurance examination sheet

To prepare for IVF, both partners receive an examination sheet - a form with full list necessary tests. They must identify whether there are factors in the couple’s health that would make the IVF procedure impossible or would sharply reduce its effectiveness. Indicators of reproductive capacity of partners are first on the list. For a woman, this is the level of AMH in the blood - the so-called Anti-Mullerian hormone. It shows how many active eggs capable of fertilization there are future mom. Currently in Russia there are no legal restrictions for IVF based on age - the ability to conceive is indicated by normal level AMH (1-2.5 ng/ml). An indicator of male reproductive ability is a spermogram. If she detects sperm pathology, then in order to conceive she will need an expensive ICSI procedure, the costs of which are not covered by compulsory health insurance funds. The commission's decision will obviously not be in favor of this couple.

An example of the influence of the AMH indicator on admission to the IVF procedure

1. Patient N, age 28 years. AMH level is 8 ng/ml. This exceeds the norm by 2.5 times and indicates hidden pathology, exacerbation chronic disease or exhaustion of the nervous system.
2. Patient S, age 35 years. AMH level - 0.3 ng/ml. This is almost 3 times lower than normal and is not enough for effective fertilization.
3. Patient R, age 41 years. AMH level - 1.8 ng/ml. This is quite normal. For mammography and karyotyping, which are mandatory for patients of this age category, no pathologies were found.

Thus, highest probability Despite her age, patient R can receive a referral for IVF.

The second block of research is lab tests for determining infectious diseases: test for the presence of antibodies to pathogens in the blood and collection of smears from the external genitalia. These procedures are included in the list of mandatory for both partners.

The third block of the examination concerns the somatic status of the woman - how healthy she is to bear and give birth to a child. This includes fluorography, ECG, general blood test, urine test, examination by a therapist, etc. In total, a woman needs to undergo up to 30 years before the IVF procedure. various studies. This can be done in a short time in paid clinic- convenient, but expensive. It's best to contact your area's insurance agent and find out which necessary procedures You can't do it for free in the region. By combining tests in a paid clinic with free procedures under your insurance policy, you can undergo a full medical examination within 1.5-2 months. Analysis results from short term actions are entered into the examination sheet later than anything else - before visiting a therapist. He, the last of all specialists, has the right to vote in assessing a woman’s ability to bear a child.

List of analyzes and studies and their validity periods

Before planning a pregnancy, it is necessary to undergo a series of examinations and tests, which will allow you to identify and solve existing problems at the preparatory stage. The standard list of tests and studies carried out as part of the IVF procedure under compulsory medical insurance is presented in the table below.

Table - Examinations and tests required for IVF in 2017

The next step after taking the tests is to contact the Ministry of Health commission at the city or regional Infertility Treatment Center. Add to list necessary documents The application includes an extract from the medical history indicating the diagnosis and methods of treatment, an extract on the health status of the patient and her partner with all the results of the examination, a copy of the insurance policy, copies of passports, as well as an application requesting referral for treatment using ART. If the commission, which has the voting right, agrees to this, the patient is put on the waiting list. After this, all that remains is to wait for a referral for a procedure that gives the woman a chance to become a mother.

Many couples sooner or later want to have a child. When multiple attempts fail, most couples resort to in vitro fertilization. Such manipulations allow an infertile couple to conceive a child.

However, not every infertile person has enough for this. Money. The state comes to the aid of such people.

It made sure that even such infertile couples could have children, completely free of charge. The IVF procedure under compulsory medical insurance is included in the list medical services that can be provided under the policy.

Thus, the IVF procedure becomes completely free and infertile couples have a chance to become parents without investing a lot of money in it.

What is included in the IVF procedure under the policy?

• The very first stage that a woman will have to go through in order to have a child is stimulation of the ovaries with hormones. This procedure harms the body more than artificial insemination. However, when stimulated, the ovaries produce large quantity eggs, resulting in a greater chance of fertilization;
• The second step is the collection of these eggs. Since more eggs have been produced, there will be more choice. This will help avoid a diseased embryo or chromosomal abnormalities of the fetus in the future;
• The next stage is the fertilization of the egg with a sperm (the state pays for fertilization exclusively with “native” sperm, and not with donor ones). This procedure is carried out in the laboratory, under powerful microscopes. A needle thinner than a human hair is used to pierce the egg and inject sperm into it;
• The last stage of IVF, which is paid for by the state, is the implantation of the embryo into the uterine cavity.

The use of donor genetic material or intracytoplasmic sperm injection is not paid for by the state.

However, if medications necessary to maintain pregnancy are needed, the state can pay their cost. The compulsory medical insurance policy also provides a guarantee for all necessary tests and studies.

Who is suitable for the IVF procedure under compulsory medical insurance?

In order to receive government support for in vitro fertilization, you must meet certain parameters:

• The patient's age must be more than 18 years and less than 40 inclusive. After 40, the procedure becomes dangerous for female body and for the child. This is due to the fact that what older woman, the higher the risk of developing intrauterine and chromosomal abnormalities in the fetus;
• Having a diagnosis of Infertility or other physical anomalies that interfere successful conception child. Anomalies mean the presence of adhesions in fallopian tubes, partial or complete obstruction, absence ovulatory cycle or maturation of follicles;
• The patient must weigh at least 50 kg and no more than 100 kg. For successful pregnancy fetus, the woman must have the necessary life resources. IN otherwise the procedure will not be successful. In addition, severe exhaustion or vice versa, heavy weight, will indicate the presence of failures in hormonal background. This will also have a bad effect on pregnancy and the unborn child;
• The woman's husband must have normal amount sperm and good results according to spermogram. Only in this case will it be possible to select healthy sperm for implantation into the egg.

Necessary examinations for women

It is advisable to take tests for IVF under compulsory medical insurance 1 month before the procedure. In this case, the woman will have time to receive the results and will not miss the deadline for submitting them.

• Culture for the presence of chlamydia, ureaplasma, microplasma in the body. This list of diseases will interfere with the normal “engraftment” of the embryo in the uterine cavity. They can also infect the fetus in the future;
• Analysis for the presence of cytomegalovirus or herpes simplex virus in the urethra, which has reached type 1 or 2;
• Fluorography;
• Scraping from the cervix for the presence of endocervix and ectocervix;
• Examination and conclusion of a general practitioner;
• Electrocardiogram;
• Ultrasound examination of the thyroid gland. In some cases, it is necessary to undergo examination of the parathyroid glands;
• Women under 35 years of age must pass ultrasonography mammary glands. Women over 35 need to have a mammogram. This is necessary to exclude cancerous tumors.

Test results are valid for 6 months:

• It is necessary to donate blood biochemical analysis. Glucose, cholesterol, urea, keratin, quantity will be checked total protein And total bilirubin in blood;
• Donate blood for follicle-stimulating hormone. It controls the production of eggs in the ovaries and the maturation of follicles. After the follicle has matured, FSH reaches its most of great importance and under its action the follicle bursts, releasing the eggs out;
• Blood for luteinizing hormone. It is necessary for the correct functioning of the reproductive system as a whole. This hormone is present in both male and female bodies;
• Blood for the amount of prolactin. The hormone is necessary for the embryo to stay in the uterus and for further lactation. It is the main hormone of reproduction and reproduction;
• Blood test for hormones produced thyroid gland. Hormones must be normal, since the correctness of the protein produced depends on them. Protein - how construction material. In order to “create” a new person, such a hormone is vital;
• Donate blood for the presence of estradiol. This hormone is produced by the ovaries and adrenal glands. In a pregnant woman, it is formed in the placenta. The presence of the hormone allows us to say that the woman’s body is working correctly and is able to produce it on an ongoing basis. This is necessary for the successful “engraftment” of the embryo and its gestation.

• Analysis for the presence of syphilis pathogens. If a woman is diagnosed with syphilis, she will be prescribed appropriate treatment. This is necessary to avoid infection of the child in utero;
• Blood test for HIV infection;
• Blood test for Hepatitis B and C;
• A woman must undergo a complete gynecological ultrasound examination of the pelvic organs. It will help identify existing diseases and determine possible complications and risks during pregnancy. Most often, women do not even suspect the presence of any serious problems and only ultrasound can show a clear picture.

Test results are valid for 1 month:

• A woman needs to take a smear to check the vaginal flora. The doctor must make sure that the woman is healthy and does not have sexually transmitted diseases;
• General blood analysis;
• General urine analysis. This study will show the quality of work and help identify early stage pyelonephritis;
• Hemostasiogram (or coagulogram) is a test for blood clotting. Determining the clotting time will help avoid bleeding during pregnancy and the birth process.

Analyzes that are valid indefinitely:

• Analysis for blood group and Rh factor. Such a study is necessary to exclude Rh conflict between mother and fetus. Otherwise there will be big chance miscarriage or biochemical pregnancy;
• Blood test for herpes simplex virus antigens;
• A blood test for immunoglobulins class M and G. Such a study should show the presence of antibodies to the rubella virus.

Necessary examinations for men

It is advisable to take tests for quota IVF 1 month before the procedure. In this case, the man will have time to receive the results and will not miss the deadline for submitting them.

Test results are valid for 1 year:

• Examination of a man’s ejaculate for the presence of herpes simplex virus types 1 and 2 or cytomegalovirus;
• Culture for the presence of chlamydia, ureaplasma and microplasma;
• Smear for the quality of flora from the urethra. This is necessary to ensure that there are no sexually transmitted diseases;
• Spermogram. This is a study of male ejaculate laboratory method under the most powerful microscope. During the research, the laboratory assistant needs to determine the number of sperm, their mobility and their condition. Also assessed appearance ejaculate in general. The sperm count should be 20ml/ml. All of them should be well mobile, without broken flagella or forked heads. Fertilization requires the healthiest sperm. The total volume of the ejaculate itself should be 2 ml or more. Therefore, before taking a spermogram, I recommend abstaining from sexual intercourse 3 days before collection. It is also recommended not to drink alcohol or smoke;
• A conclusion from a urologist-andrologist is required.

Test results are valid for 3 months:

• It is necessary to donate blood for Hepatitis B and C;
• Blood for HIV;
• Test for the presence of syphilis.

Tests that are valid indefinitely

• It is necessary to donate blood to determine your blood type and Rh factor. This is necessary to avoid Rh conflict in the fetus and mother;
• Blood test for PCR.

Video: Tests before IVF

After collection necessary tests, the woman at the antenatal clinic is given an extract. It contains the results of an examination of an outpatient before IVF under a compulsory health insurance policy. This extract indicates the woman’s health status at this moment, test results and the man’s health status, and his diagnosis. This list is sent to a commission that will decide the need for IVF under compulsory medical insurance.