— How is in vitro fertilization done today?
— In its essence, in vitro fertilization treatment is no different from what happens in the mother’s body when pregnancy is planned naturally. We take an egg, add sperm to it, and some of the fastest and most mobile ones fertilize the egg independently.
— In what cases is this procedure necessary?
— The main symptoms are blockage of the fallopian tubes, high risk of genetic abnormalities in the fetus, small number of eggs and the serious male factor in which the sperm cannot fertilize an egg on its own. In the latter case and if other methods fail, ICSI is often performed.
— How is the ICSI procedure performed, what is its difference from the classical in vitro fertilization method?
– During ICSI (ICSI – intracytoplasmic sperm injection – intracytoplasmic sperm injection), the most beautiful sperm is selected and injected into the egg.
Pre-implantation genetic testing of the embryo is also possible during the ART (assisted reproductive technologies) program. Modern technologies make it possible to visualize the chromosome set of the embryo before its transfer into the uterine cavity. If the mother is over 35 years old and the father is between 40 and 45 years old, it is believed that this diagnosis can reduce the risk of miscarriage and having a child with various chromosomal abnormalities (Down syndrome, Edwards syndrome, Patau syndrome and Patau syndrome). others.
— Can you influence the sex of an embryo in a test tube, for example, take a sperm with an X chromosome (a girl) and attach it to an egg?
– We can’t do this. To find out which chromosome the sperm carries, the sperm must be destroyed. We create several embryos and now, when we examine all the chromosomes, we can learn the gender of the embryo from the preimplantation diagnostic data.
However, gender selection has been banned in Russia since 2012; This is necessary to ensure that there is no change in the birth of more boys or girls. However, there are exceptions.
– Which?
— We only select embryos with a high chance of implantation. Exceptions include sex-linked genetic diseases such as hemophilia. If there is a risk of a boy contracting this disease, then we will work with girl embryos.
— There are hypotheses that the likelihood of having a girl or a boy increases. For example, some believe that the sex of the child depends on the acidity of the vaginal secretion. And so they try to have a boy on certain days of the cycle. Does this really work?
— Such theories really exist. What you’re talking about suggests that sperm carrying the Y chromosome “likes” a more alkaline pH level. Typically, such an alkaline environment in the vagina is created after ovulation. On the contrary, “female” sperm feel more comfortable in an acidic environment. An increase in the acidity of vaginal discharge is observed throughout the entire menstrual cycle except the periovulatory period.
There is another one based on the fact that sperm with X chromosomes move slower and do not die longer than sperm with Y chromosomes. So, there is a myth that a couple who gets pregnant on the days of ovulation is more likely to have a boy.
But unfortunately all this is not confirmed. We do not have any evidence-based way to increase the likelihood of having children of one gender or the other, so we cannot influence this process.
— Another indication for in vitro fertilization treatment is secondary infertility. What’s this?
– This is the situation where the woman has been pregnant before but pregnancy has not occurred again within 12 months if the mother is under 35 years of age, or within 6 months if the mother is over 35 years of age. Moreover, it can be difficult to determine the reasons for this. Unfortunately, the fact that pregnancy was so easy in the past does not give us any guarantee that it will happen as easily today.
– Why does life become shorter after the age of 35?
— Let’s say we are in a hurry after 35 years, because the quantity and quality of eggs are decreasing. For this reason, the cause of infertility is diagnosed earlier and, if necessary, an in vitro fertilization program is started earlier. Especially if the patient is already showing signs of reduced egg supply.
— Is there an age limit for in vitro fertilization treatment?
— Yes, it is believed that an average of 42-43 years is the deadline for in vitro fertilization programs to produce a pregnancy. And at this age the probability of natural birth is 3-4%.
However, there is no age restriction in our country, officially we do not have the right to reject patients of any age. Another thing is that if you do not have your own eggs, then we are already moving to in vitro fertilization programs with donor eggs.
— Why is the birth rate so low after 40 years?
— In women of this age, in vitro fertilization may lead to a higher rate of complications during pregnancy and poor birth outcomes. There is an increased risk of cesarean section, gestational diabetes, preeclampsia, premature birth, and fetal growth restriction.
This is because with age we all experience blood thickening and other changes in the functioning of the body, and the burden of other concomitant diseases accumulates. There is also the problem of giving birth to twins. We do not recommend giving birth to twins after 40, but this carries risks for young people.
– Which ones?
— Twins immediately increase the risk of premature birth, prematurity, cerebral palsy, and autism, which develop as a result of fetal hypoxia. released recently big workAccordingly, the main cause of autism is premature birth. Since we can now care for children born at very early ages, we see children with ASD more often.
— What factors other than age negatively affect the outcome of the procedure?
— Many factors can affect the quality of eggs: smoking, obesity, chronic diseases, hormonal levels and even lack of some vitamins. But still the main factor is age. Moreover, even with natural pregnancy, the ability to become pregnant after the age of 30 decreases almost 2 times compared to 20-year-old women.
— Is it possible to somehow influence the quality of eggs?
— There are some studies showing that melatonin may affect egg and embryo quality. There is a theory that this is a hormone that slows down aging and prevents egg quality from deteriorating. In other words, to preserve reproductive function, women need to sleep 7-8 hours and have an early sleep chronotype, that is, go to bed and wake up earlier. This will help increase melatonin production. Folic acid and vitamin D can also be taken about 3 months before planning a pregnancy.
— You said that smoking affects the success of in vitro fertilization. So, if a woman smokes nicotine-free electronic cigarettes, do the risks still persist?
“Unfortunately, there is no such comprehensive study to compare the effects of nicotine and non-nicotine e-cigarettes on in vitro fertilization.
In any case, the vape contains plastic particles called PM2.5 and bisphenols, which are used as a hardening agent in the production of plastic. All of these can negatively affect the functioning of eggs, but more research is needed. So far there is little data on the impact of electronic cigarettes, microwave ovens and phones on women’s reproductive function.
— You mentioned the positive effect of vitamin D on egg quality. You had a scientific paper devoted to this topic, right?
— Yes, there are many studies on this subject, we tried to bring them together on common ground. The results are as follows: Adequate levels of vitamin D can have a positive impact on reproductive health and in vitro fertilization outcomes. This vitamin is also associated with seasonal differences in the effectiveness of assisted reproductive programs.
This is also thought to be related to anti-Müllerian hormone (AMH) levels. It is synthesized by the organs of the reproductive system and is responsible for sex formation in the embryo, as well as for the maturation of follicles in women and spermatogenesis in men. AMH levels have been shown to be 18% lower in winter than in summer, making it more difficult to get pregnant during the colder months. Taking vitamin D can eliminate these seasonal fluctuations.
It should be emphasized here that scientists have not yet come to a definitive conclusion about seasonality whether seasonality exists or not. But I believe that every woman has her own fertile month. However, despite conflicting results, we monitor patients’ vitamin D levels during winter and autumn. The main thing is moderation; Excessive levels of vitamin D can also be toxic.
— How do high doses of vitamin D affect the body?
– They may cause changes in the parathyroid gland. Hypercalcemia may occur; This can occur with increased calcium levels, which can be manifested by many nonspecific symptoms: increased fatigue, drowsiness, nausea, loss of appetite, anxiety, depression, and sometimes seizures. Reproductive health also suffers from this.
— Does sports help protect reproductive health?
— Of course, physical activity is extremely important for women. This is the maintenance of normal body weight, ensuring blood flow to the ovaries and endometrium. But there is a caveat.
If these are extreme activities, such as professional sports, a deficiency in fatty tissue occurs. It is replaced by muscle, which leads to the emergence of the so-called triple complex of female athletes or athletes.
– What kind of complex is this?
– This is a menstrual disorder. Decrease in fat tissue, menstrual irregularities, up to complete cessation of menstruation, and loss of bone mass. A common characteristic of the female athletic trio is low levels of estrogen, the hormone that controls bone density and the reproductive system.
We worked with sports medicine doctors and concluded that such patients should be prescribed estrogen replacement drugs if they cannot quit sports at this time.
However, if a woman does sports just to maintain her health, we still recommend that you avoid excessive exercise and keep body weight, especially fat tissue, within normal limits. We now have many patients who are underweight and suffer from anorexia. The risk of obstetric complications during pregnancy will be the same as with obesity. These include preeclampsia, anemia, poor labor, miscarriage, premature rupture of amniotic fluid, and the birth of a low birth weight baby.