In our country, now one of the leading methods of artificial insemination is in vitro fertilization, which allows most childless couples to become parents, while complying with all IVF rules and following all the doctor's recommendations is mandatory. After the fertilization procedure in the "test tube" and after replanting the embryos, the woman is shown hormonal therapy, while the result of the protocol depends on the dose and the correctness of the selected drugs and the likelihood of pregnancy increases.

What is HCG test after IVF?

Pregnancy support after IVF is reduced to the use of several groups of drugs, including vitamin therapy, hormonal therapy and anticoagulant treatment. In the body of a woman who has entered the IVF protocol, when hyperovulation is stimulated, a number of significant hormonal changes in the body go through, which have a direct effect on the development and bearing of pregnancy. In order to correct the hormonal background, which is artificially created in a woman's body, it is necessary to resort to additional laboratory tests, with the help of which the level of the main pregnancy hormones - progesterone and estradiol, which is the main marker of ovarian hyperstimulation syndrome - is determined. Therefore, all the recommendations of the attending physician should be strictly observed, since the mutual understanding between the doctor and the patient throughout pregnancy is one of the moments of a favorable fertilization outcome. And if a woman at the time of IVF already has a concomitant extragenital pathology, then drugs are also used to support pregnancy, aimed at stabilizing and normalizing a concomitant disease, which may cause abortion.

Support after IVF transfer

Post-transfer support: IVF usually has a positive result if the treatment is selected correctly and all groups of drugs are used in full, since the drugs used after embryo transfer are necessary for implantation, development and maintenance of pregnancy.

Among the vitamin preparations after embryo transfer, vitrum, elevit prenatal and femibion \u200b\u200bare widespread. Moreover, these drugs are almost identical in composition, so the choice is sometimes made by the woman herself. As for the intake of folic acid, its intake is no different from the management of pregnancy that has occurred naturally. The action lies in the fact that it to some extent prevents the pathology of the nervous system, participates in the development of all organs and systems, and also prevents the termination of pregnancy in the early stages. To relax the nervous system and prevent hypertonicity of the myometrium after replanting embryos into the uterine cavity, magnesium preparations are used, among which "magnesium B6" and "Magnesis" are widely used.

Waiting for Eco by Oms

Progesterone support after IVF contributes to the strong implantation of the embryo in the uterus and the restructuring of the woman's body for the development of pregnancy. Most often, utrozhestan is used in the form of tablets or vaginal tablets or kraynon in the form of an intravaginal gel. The choice lies only with the doctor - reproductologist, who selects the dose of the drug depending on the purpose, indications and general condition of the body.

Functions of progesterone after IVF pregnancy

Among the main functions of progesterone on the body of a pregnant woman, the following are distinguished:

• a change in the structure of the inner layer of the uterus - the endometrium, the state of which has a very important role at the stage of embryo replanting
• helps to reduce the contractile activity of the uterus, while the cervical canal is tightly closed and the risk of termination of pregnancy is minimized.

Considering this, it should be understood about the importance of progesterone support after in vitro fertilization in order to maintain and prolong pregnancy.

The dose, drug and duration of admission are determined by the reproductive specialist in each case individually and depends on the history, type of protocol, age, hormonal background of the woman.

IVF support after embryo transfer is also carried out with synthetic progesterone - dyufastone, which helps to maintain pregnancy and ensures its normal development.

The use of progesterones has a number of significant advantages:

• no feminization in boys
• girls also lack virilization
• does not have a pathological effect on the liver
• does not affect blood clotting
• does not cause rash and the appearance of hair on the body, the voice does not change
• also has no significant effect on metabolism
• adrenal atrophy, as one of the severe complications of progesterone intake, is not observed

All these properties of duphaston indicate its widespread use in in vitro fertilization - after the transfer of embryos from a test tube into the uterine cavity. Another of the significant advantages of using duphaston is the absence of its teratogenic effect on the fetus.

Support after IVF is carried out only according to indications and is prescribed only by a reproductologist. To compensate for the deficiency of natural estradiol after in vitro fertilization, proginova is used, a drug that contains synthetic estradiol, which promotes embryo implantation into the endometrium of the uterus.

Such conditions in a woman as endometriosis, the presence of malignant tumors in the liver, diabetes mellitus, blood hypercoagulability and obesity are strict contraindications for its appointment.

What does the HCG test after IVF mean?

Medication support

After the IVF procedure, not only medical support is needed, but also the following doctor's recommendations must be followed, which will allow you to give birth to a healthy baby:

• rest during the day
• avoid physical activity
• avoiding hot baths and cold showers
• do not contact infectious patients
• full and balanced nutrition should be until the end of pregnancy
• drug therapy only as prescribed by a reproductive specialist, it is forbidden to take medications on your own
• regular walks in the fresh air
• regular bowel movements prevent the threat of abortion
• avoid nervous shocks and psychoemotional overstrain.

IVF pregnancy support is primarily based on medication support in the form of hormones that help the corpus luteum to function, which promotes embryo implantation and endometrial growth, which are essential for early pregnancy.

IVF support can only be canceled by the doctor who maintains your IVF protocol. In most cases, hormonal drugs are canceled before 12, and sometimes up to 16 weeks of pregnancy, when the placenta begins to function independently and ensure the development of the embryo and fetus. The withdrawal of drugs is gradual, under the control of laboratory tests and the woman's well-being, symptoms of abortion, or from the IVF protocol and the woman's age.

This cancellation of drugs will increase the chances of a favorable pregnancy outcome.

The use of hormonal drugs after IVF is highly effective, but their independent and uncontrolled use causes serious complications, therefore, a doctor's examination, the woman's trust and punctuality allow avoiding serious consequences and giving happiness to a childless couple.

It should be remembered that pregnancy support after IVF is different from natural pregnancy management. in the first trimester of pregnancy, the following recommendations should be followed:

• constant hormonal control
• individual selection of drugs for hormonal correction, which allows successful implantation of the embryo and its development
• you can not arbitrarily prescribe yourself or cancel drugs, as this in most cases leads to termination of pregnancy
• ultrasound examination is carried out quite often, unlike independent pregnancy, when ultrasound is performed at the end of the first trimester once
• cancellation of drugs is also carried out strictly individually only by a reproductive specialist.

In the second trimester of pregnancy with IVF, the intake of drugs is often canceled, but also only with the decision of the doctor, ultrasound is performed 2 times, but sometimes more, since IVF is an artificial pregnancy, which is the only chance of having a child, therefore, all the efforts of the doctor and the woman aimed at preserving it.

in the third trimester, eco-pregnancy support is aimed at prolonging it and preparing for childbirth. while monitoring the amount of amniotic fluid, fetal heartbeat.

What happens after a week after IVF?

The duration of maintenance hormone therapy after IVF depends on the form of infertility, the presence of concomitant pathology of the reproductive system. Basically, it is prescribed immediately after the puncture of the oocytes, followed by the washing of the eggs and continues for two weeks, after which the diagnosis of pregnancy is carried out by the level of hCG blood and only then the issue of its prolongation or cancellation is decided.

Estradiol is indicated for complete hormone replacement therapy in the absence of ovulation, in protocols using GnRH agonists, while the use of chorionic gonadotropin increases the likelihood of successful implantation and the development of pregnancy, but it is used only at the risk of developing ovarian hyperstimulation syndrome.

With the appearance of spotting spotting from the genital tract before the presence of indications of the level of hCG, it is not recommended to cancel or reduce progesterone support, as this leads to dysfunction of the corpus luteum and the development of the threat of termination of pregnancy. And if the bleeding is profuse, then progesterone support is canceled, as this indicates the absence of implantation.

Is it possible to determine the gestational age of IVF?

If you still want to have a baby, and pregnancy does not occur, then you should not waste time hoping, but get tested. And if you have a diagnosis of infertility, then register on our website and apply for a free in vitro fertilization protocol under the compulsory medical insurance policy, and then the likelihood of the birth of your genetic healthy child will increase significantly and will give you and your partner the opportunity to become happy parents.

A woman's desire to become a mother is conditioned by nature, but, alas, sometimes for a number of reasons, pregnancy does not occur naturally. Modern medicine offers couples who want to become parents, not only an in vitro fertilization procedure, but also effective methods for maintaining pregnancy. How this happens and what you need to know about support after IVF will be discussed below.

Why do you need support after IVF

It is known that often problems with conception are associated with a violation of the level of female sex hormones, which causes the termination of pregnancy. That is why, before and after the IVF procedure, a woman is shown to take hormonal drugs. Hormonal support is designed to accelerate the transformation of the endometrium and ensure the preservation of pregnancy.

Did you know? For the first time, the transfer of an embryo into a woman's uterus was carried out by British specialists from Cambridge. In 1978, the first test-tube baby, a girl, Louise Brown, was born.

Post-embryo transfer support drugs

Medical support after embryo transfer is necessary and imperative, especially in the first weeks after pregnancy is confirmed. The main hormones that ensure the normal bearing of the fetus are estradiol and progesterone, and preparations containing these hormones are included in the IVF program.

"Divigel" is an alcohol-containing preparation in the form of a gel, which is a source of synthetic estradiol, which is aimed at replenishing hormones before the IVF procedure. The drug is prescribed to thicken the endometrium and prepare the uterus for embryo transfer, as well as to increase estrogen levels to avoid fetal rejection.

Divigel improves the functionality of the female reproductive system and helps create ideal conditions for pregnancy. The drug has a transdermal effect and is intended for topical use, it is applied to dry, clean skin of the lower body, with an area of \u200b\u200bat least a palm.

Important! The place of application of the gel periodically needs to be changed, while it should not be applied to the area of \u200b\u200bthe mammary glands, face and mucous membranes of the body.

This tool belongs to the sources of a synthetic analogue of the hormone progesterone. Available in tablet form. Due to the fact that the drug does not have an androgenic effect and does not affect ovulation, it is considered relatively safe in preparation for IVF and during further gestation.

A drug containing micronized progesterone. It is prescribed in IVF programs for luteal insufficiency. It is produced in the form of tablets for sublingual use, or in the form of vaginal tablets.

A source of progesterone in the form of a gel for intravaginal administration. The tube is equipped with a special applicator. This form of application allows the hormone to be rapidly absorbed through the mucous membranes of the vagina and saturate the body after 3 days of use.

Progesterone oil solution

The drug is available in ampoules in the form of an oily solution of the hormone progesterone for injection. Typically, injections are given subcutaneously or intramuscularly according to the schedule prescribed by your doctor.

Important! With the introduction of progesterone in the form of an oil solution, soreness, induration and redness at the injection sites are often observed, which must be notified to the attending physician.

When to cancel pregnancy support with IVF

As you know, medical support after embryo transfer into the uterine cavity is the key to successful implantation of the future fetus. Women undergoing IVF are prescribed hormones already at the planning stage, and they must be taken until 14 days after the embryo is inserted.
After confirming the onset of pregnancy based on the results of a blood test for the hCG level, the doctor who performed the procedure can correct the support scheme or cancel it altogether. Usually, progesterone drugs are taken throughout the first trimester of pregnancy, estrogens are taken up to 8 weeks. In some threatening cases, the woman is forced to continue support throughout the gestation period.

Supportive therapy can be canceled only with the permission of the reproductive physician and according to the scheme prescribed by him. The peculiarity of sex hormones is that the process of their cancellation should take place with a gradual decrease in dosage until the full completion of the intake, abrupt cancellation is unacceptable in order to avoid negative consequences due to a jump in hormone levels.

Did you know? During IVF it is technically possible to plan the sex of the unborn baby, since reproductive specialists know the chromosomal set of sperm, however, the ethical laws of medicine prohibit the selection of suitable embryos by gender, so you cannot "order" a son or daughter.

Why are there no periods after canceling support?

In case of an unsuccessful IVF protocol, support is canceled and after that, normally within 3-5 days, menstruation should begin, if this did not happen, you should consult a doctor in order to clarify the reasons:

• it is possible that the embryo has taken root somewhat later than the designated date;
• there is a high probability of an ectopic pregnancy;
• stress suffered after an unsuccessful procedure, nervous tension, depression can lead to a failure of the cycle;
• a temporary failure of the hormonal background after the cancellation of support can cause instability of the cycle, while, if no other reasons are identified, hormones should return to normal within 3-6 months.

So, the features of drug support during in vitro fertilization were considered above.

This information will help to understand the peculiarities of the effect of sex hormones on the stimulation of the reproductive system and will rationally assess the need for their use.

For citation:Zaidieva Z.S., Prozorov V.V., Karapetyan T.E. Progesterone support in planning pregnancy in women with high infectious risk // BC. 2006. No. 1. P. 25

Currently, the incidence of infectious diseases in obstetrics and gynecology does not have a clear downward trend. In many countries of the world, including Russia, an increase in sexually transmitted infections has been noted, which firmly occupy a leading place in the structure of obstetric and gynecological morbidity. Despite the significant progress achieved in the diagnosis, therapy and prevention of these diseases, their frequency, according to various authors, will increase from year to year. The latter is also associated with an increase in immunodeficiency states against the background of a deteriorating environmental situation, malnutrition, frequent stress, pharmacological boom with uncontrolled use of drugs, primarily antibiotics, etc. Most often, infectious pathology is caused by several pathogenic factors - viruses, microbes, fungi, protozoa, which cause diseases similar in clinical course, but different in pathogenesis and methods of treatment.

Formation of inflammatory diseases of the pelvic organs, urinary system; psycho-emotional disorders and immuno- and interferon-deficiency states - this is not a complete list of problems typical for patients with urogenital infections. These features are at the same time an unfavorable pregravid background, which is not able to ensure the development of adequate compensatory-adaptive reactions necessary for a full-fledged gestational process in most of these patients.
However, there are not so many works devoted to the preparation of women with bacterial and / or viral infections for pregnancy.
At the same time, the most important stage on the way to obtaining healthy offspring is the correct pre-gravid preparation of women. Therefore, it is necessary to start carrying out measures to combat the infection and correct the disorders of the body's homeostasis caused by it before pregnancy.
They should include:
I. Identification of patients with infection who are at risk for the development of obstetric complications. This group should include women with a history of:
1) chronic inflammatory diseases of the appendages and uterus, ectopia of the cervix, frequent recurrent colpitis;
2) developmental anomalies and chronic inflammatory diseases of the urinary organs, dysuric disorders of unknown etiology;
3) sexually transmitted diseases (herpes, cytomegalovirus, chlamydia, mycoplasmosis, ureaplasmosis, candidiasis, etc.);
4) chronic extragenital foci of infection with frequent relapses;
5) tendency to frequent acute respiratory viral infections;
6) reproductive dysfunction (infertility, ovarian dysfunction, spontaneous miscarriages, non-developing pregnancies);
7) complicated course of previous pregnancies, childbirth, the postpartum period (chronic placental insufficiency, chronic hypoxia and / or intrauterine growth retardation, premature birth, antenatal fetal death, anomalies of attachment and separation of the placenta, purulent-inflammatory diseases of puerperia, etc.) ;
8) adverse perinatal outcomes (intrauterine or neonatal infection, malnutrition or malformations of the newborn, impaired early neonatal adaptation and / or subsequent physical and neuropsychic development of the child).
II. Thorough clinical and laboratory examination of women at risk with verification of genital or extragenital infection, regardless of the level of damage to the reproductive system, at least two modern methods of laboratory diagnostics, examination of the immune and interferon status, etc .;
III. Conducting complex treatment, which should include both etiotropic types of therapy (a complex of antibacterial or antiviral treatment) and treatment of concomitant diseases.
IV. Planning and preparing for pregnancy.
As you know, planning and preparation for pregnancy is possible only with persistent and prolonged (more than 6 months) remission of an infectious disease, as well as after elimination of disorders in the reproductive system, taking into account the main factors of abortion.
Progesterone plays a fundamental role in preparing the uterine mucosa for implantation.
Currently, more and more researchers come to the conclusion that there is a close relationship and mutual regulation between the endocrine and immune systems against the background of the existing infectious process, which is realized in the endometrium at the early stages of implantation. It has been proven that progesterone contributes to the complete secretory transformation of the endometrium, which is necessary for the introduction of the blastocyst. In addition, during pregnancy, gestagens ensure the growth and development of the myometrium, its vascularization and relaxation by leveling the effect of oxytocin and reducing the synthesis of prostaglandins.
There is a growing body of evidence that the immunomodulatory effects of hormones are essential for maintaining normal endometrial function. The results of recent studies clearly indicate the immunological role of progesterone and dydrogesterone in maintaining pregnancy, carried out by them by stimulating the production of a blocking factor induced by progesterone.
It is generally accepted that a woman's immune system must recognize it for a normal pregnancy to happen. In a normal pregnancy, progesterone receptors are present in peripheral blood lymphocytes, and the proportion of cells containing such receptors increases with increasing gestational age. In the event of a threat of termination of pregnancy, the proportion of cells containing progesterone receptors is significantly lower than in healthy women at the same stage of pregnancy.
Complications at the initial stages of gestation can be a consequence of both defective steroidogenesis and insufficiency of the endometrial receptor apparatus. These disorders are very often observed in women with infectious diseases of the reproductive system. In such situations, the therapeutic approach should take into account the etiology of the formation of the defective luteal phase and neutralize unfavorable predisposing factors. In case of a chronic inflammatory process in the uterus and appendages, in addition to prescribing individually selected etiological therapy, immunomodulatory therapy, hormonal correction is necessary, which allows the endometrium to normalize and ensure adequate blastogenesis and placentation.
All of the above indicates that in the presence of genital infection, the appointment of gestagenic support is necessary, since there is evidence of an increase in the expression of progesterone receptors under the influence of an increase in its concentration in the blood. In addition, a number of researchers point to the anti-inflammatory effect of gestagens, which suggests a pathogenetically justified use of these drugs in women of a high infectious risk group.
A modern effective gestagenic drug is Duphaston (dydrogesterone). The latter is a progestogen, which, in terms of molecular structure and pharmacological action, is analogous to endogenous progesterone and therefore has a high selective affinity for its receptors. The main metabolite of Duphaston is 20 a-dihydroxyhydrogesterone, which also has progestogenic activity.
Many orally active progestogens, such as dl-norgestrel and norethisterone, have been synthesized from testosterone or 19-nortestosterone. Therefore, these progestogens may have side effects such as androgenic effects, masculinization of the female fetus, impaired liver function and blood lipid spectrum.
Duphaston is not a testosterone derivative. Its structure differs from the structure of most synthetic progestogens, which explains the absence of the side effects characteristic of most progestogens.
The molecular structure of Duphaston (dydrogesterone) is almost identical to that of natural progesterone (Fig. 1). However, in the Duphaston molecule, the hydrogen atom bonded to the 9-position carbon is in the b-position, and the methyl group bonded to the 10-position carbon is in the a-position, which is the opposite of what is observed in the progesterone molecule. In addition, the Duphaston molecule has a second double bond between carbon atoms in positions 6 and 7 (configuration 4,6-diene-3-one). The advantages of Dufaston's structure are higher bioavailability of the drug and high affinity for progesterone receptors when administered orally and the absence of metabolites with androgenic or estrogenic activity.
Duphaston is a highly effective progestogen for oral administration, since in its molecular structure and pharmacological action it is close to endogenous progesterone and, as a result, has a high affinity (affinity) for progesterone receptors. Dydrogesterone at a dose of 20–30 mg causes a full-fledged secretion phase in the endometrium.
Unlike other synthetic progestogens, Duphaston:
- does not cause feminization of the male fetus and does not have side effects on liver function and blood clotting;
- does not cause such manifestations as acne, coarsening of the voice, hirsutism and masculinization of the genital organs of the female fetus;
- does not cause metabolic effects, for example, changes in the lipid spectrum of blood and glucose concentration;
- does not affect the activity of the pituitary-ovarian system and does not cause adrenal atrophy.
The aim of this study was to study the effectiveness of the drug Duphaston in women of the high infectious risk group in a complex of drugs in the preparation and planning of pregnancy.
The analysis of the initial clinical characteristics, the features of the course of the 1st trimester of pregnancy in 97 women with a high infectious risk and a burdened obstetric history was carried out. Group 1 - 52 women of the high infectious risk group who received Dufaston in 3 menstrual cycles before the planned pregnancy at a dose of 10 mg 2 times a day, group 2 - 45 women of the high infectious risk group who received Dufaston from the first weeks of gestation. All women during the gestational period underwent general clinical, laboratory, functional research methods.
Analysis of the clinical characteristics showed that the age of pregnant women averaged 27.1 ± 1.2 years in group 1. The study of weight-height ratios in the examined women did not reveal any deviations from population norms; the average body weight before pregnancy was 60.7 ± 1 , 2 kg, average height - 165.9 ± 1.9 cm. The average age of the onset of menarche in both groups was almost the same and averaged 12.4 ± 0.7 years.
When analyzing the structure of gynecological diseases, it was noted that the incidence of colpitis was significantly higher than in the population, both in women in group 1 and in pregnant women in group 2 (63.4 and 62.2%, respectively). Ectopia of the cervix (34.6 and 28.8%), endometriosis (11.5 and 13.3%), uterine myoma (9.6 and 8.8%) were found with a high frequency in women of both groups. The frequency of endometritis averaged 25%, chronic salpingo-oophoritis - 27%, ovarian dysfunction - 8.4%, infertility - 4.4%.
When analyzing the reproductive function of the surveyed women, it was revealed that the frequency of spontaneous miscarriages in the early stages was approximately the same in both groups (26.9 and 26.6%), as well as pregnancy losses in the late stages of gestation (11.5 and 17.7%). ) and the frequency of recurrent miscarriage (15.3 and 13.3%).
Patients of both groups had a complicated course of the first trimester of pregnancy, the data on which are presented in Table 1.
As can be seen from the presented data on the course of pregnancy in the first trimester of gestation, the patients of group 2 were significantly more likely to have early toxicosis and the threat of termination of pregnancy.
The data obtained during the ultrasound examination in the first trimester of pregnancy are presented in table 2.
As can be seen from the data presented, during ultrasound examination, chorionitis and chorionic detachment were significantly more frequent in the group of women who did not receive Dufaston therapy. The noted fact once again confirms the available literature data on the anti-inflammatory effect of gestagens, which managed to be more fully realized in women of group 1, since ultrasound signs of inflammatory changes in the chorion and the signs of its detachment that arose against this background were significantly more frequent and were more pronounced in pregnant women of group 2.
Myometrial hypertonicity was observed with approximately the same frequency in both groups. However, it should be noted that in women who did not receive gestagenic support at the pre-gestational stage, hypertonicity was more often combined with clinical signs of threatened abortion. In the same group, despite the inclusion of the drug Duphaston from the initial stages of gestation, it was not possible to avoid pregnancy loss (2.2%). When carrying out a genetic study of abortions, no karyotype anomalies were revealed. In turn, the histological examination indicated the presence of inflammatory changes, which made it possible to confirm the role of the infectious factor in the etiology of these gestational losses.
The duration of taking Duphaston in pregnant women of group 1 averaged 15.2 ± 1.2 weeks, group 2 - 18.1 ± 1.4 weeks. The above indicates that the need for treatment with gestagens during pregnancy is reliably reduced when this type of therapy is included in the complex of therapeutic and prophylactic measures at the pre-gestational stage.
Thus, on the basis of our study, it was revealed that the appointment of gestagenic support is a necessary component of therapy aimed at prolonging pregnancy in women with infectious diseases and aggravated obstetric and reproductive anamnesis.
Therapy with gestagenic drugs in this contingent of women should be started when planning and preparing for pregnancy. The recommended scheme is 10 mg Duphaston 2 times a day from 16 to 25 days of the menstrual cycle for at least 3 months (according to indications, the dosage of the drug and the duration of therapy may vary). This will significantly reduce the risk of developing complications such as the threat of termination, chorionitis, chorionic detachment, undeveloped pregnancy, etc. Full-fledged pre-conceptual therapy and the appointment of the drug in the first trimester of gestation will contribute to the adequate formation of the feto-placental system and will further avoid complications such as placental insufficiency, intrauterine growth retardation, intrauterine infection, etc.

Literature
1. Demidova E.M. Habitual miscarriage (pathogenesis, obstetric tactics): Diss. ... doct. honey. Sciences. - M. – 1993.
2. Zaydieva Z.S., Karapetyan T.E. Dyufaston in the complex of therapeutic and prophylactic measures in women of high infectious risk group. // Russian medical journal. – 2005.– T.13, No. 17 (241), С.1150–1152.
3. Kulakov V.I., Ordzhonikidze N.V., Tyutyunnik V.L. Placental insufficiency and infection. M .: 2004.- 494s.
4. Sidelnikova V.M. Habitual loss of pregnancy. - M .; Triad-X, 2002.– 304s.
5. Tyutyunnik V.L. The effectiveness of preparation and planning of pregnancy in women with infection. // Obstetrics and gynecology. –2004 .– № 4.– С.33–37.
6. Bick R.L., Madden J., Heller K.B., Toofanian A. Recurrent miscarriage: causes, evaluation, and treatment. // Medscape Women`s Health. – 1998.– Vol. 3, no. 3.– P.2-13.
7. Klentzeris L.D. The role of endometrium in implantation. // Hum. Reprod. – 1997.– Vol. 12.– P. 170–175.
8. Szekeres-Bartho J., Faust Z., Varga P. et al. The immunological pregnancy protective effect of progesterone is manifested via controlling cytokine production. // Am. J. Reprod. Immunol.-1996.-Vol. 35, No. 4.– P.348–351.

Even after embryo transfer, a long-awaited and so expensive pregnancy can often fail. Therefore, correctly selected medical support after IVF often serves as a lifeline that can “keep afloat” a problematic pregnancy.

A positive pregnancy test after IVF pleases any couple, but this is only the beginning of a long journey to the birth of a healthy baby. Pregnancy did not occur naturally for some serious reason, so certain efforts are needed to maintain it in the female body.

The first trimester of pregnancy is especially important for a woman. Only by stepping over it and keeping the pregnancy, the expectant mother can breathe out a little.

It is known that a third of all pregnancies after IVF end with interruption in the first trimester. Negative factors in maternal health or fetal health can be the reasons for this trouble. After all, most women cannot get pregnant on their own precisely because of violations in their state of health. And artificial hormonal stimulation for the onset of pregnancy contributes to a hormonal shift in the female body. All this increases the risk for the normal bearing of the fetus. It is especially important throughout pregnancy after IVF to determine and timely adjust the amount of two main female hormones in the blood of a pregnant woman:

• Progesterone.

The reasons for termination of pregnancy after IVF can be the following factors:

• endocrine disorders;
• immunological shifts;
• improper management of pregnancy;
• mother's age;
• chromosomal abnormalities;
• immune conflict;
• antiphospholipid syndrome;
• infections that have arisen during this period.

It is especially important for a woman to be under medical supervision during the first 6 weeks of pregnancy. On average, after IVF, only 60-80% of women reach childbirth. The causes of fetal miscarriage are usually miscarriage or.

Most of these tragedies occur in exactly 1 trimester. After this period, such a risk for a woman is significantly lower.

There is an opinion of some reproductive specialists that hormonal support after IVF is not needed during normal pregnancy. After all, any have a high cost and a lot of side effects. However, even these specialists consider hormonal support necessary for many pathologies of gestation.

That is why drug support is so often needed to maintain pregnancy after IVF.

Progesterone support after successful IVF

Progesterone is one of the most important. Its main functions at this moment are:

• creation of the most favorable conditions for the endometrium for reliable fastening of the embryo;
• reducing the risk of endometrial contraction, preventing the risk of abortion;
• maintaining the cervical canal closed.

Currently, women after IVF are prescribed progesterone in the form of regular or vaginal tablets. Progesterone in the form of injections at this point is extremely rarely used due to the inconvenience for the expectant mother. In addition, prolonged injection often leads to soreness, bruising, or even abscesses at the site of administration of the drug.

Progesterone Support Drugs

1. Duphaston. It is used in pill form. It is believed that this medicine can be used for a long time without the risk of harm to the mother or fetus. However, some reproductive specialists are wary of prescribing it to pregnant women. Duphaston should be taken every day, at the same time. Its dose ranges from 30 to 60 mg.
2. ... This is the most popular drug for hormonal correction of the female body. It is invented by the French company Besins and is micronized progesterone. This medicine is obtained from plant materials. It is used in the form of vaginal capsules. At the same time, 600 mg of the micronized preparation is comparable to 6 injections of progesterone. To prevent leakage, it is advisable to place the capsule as deep as possible, closer to the cervix. Most often, the drug is used in 1 capsule (200 mg) two to three times a day at regular intervals (600 mg per day). Sometimes the doctor may prescribe an increased dose of this drug: a capsule 4 times a day with a parallel double injection of a 2.5% oil solution of the same drug.
3. Progesterone in the form of an oil solution (1 ml of 2.5% or 1%) can be administered in the form of intramuscular or subcutaneous injections. But the method of taking in the form of "oil injections" can cause pain during injection and increase appetite. After a week of injections, women complain of pain in the buttocks from injections.
4. Lutein. Contains all the same progesterone, but it is used sublingually 3-4 times a day, 100-150 mg (under the tongue) or intravaginally 2 times a day, 150-200 mg (inside the vagina). The dose for hormonal support is determined by the doctor.
5. Cryinon. This is a gel for vaginal use with progesterone. It is introduced with a special applicator. This type of support is good in that it provides saturation of the body for 3 days after ingestion. This drug flows out of the vagina less than Utrozhestan, especially in summer. Also, this medication has a minimal effect on the liver.

Features of use

Any hormonal drugs must be taken taking into account their "insidiousness", since their thoughtless intake or cancellation can harm the health of a woman or a fetus.

Therefore, there are a number of rules when using progesterone-containing drugs:

1. Progesterone preparations are usually started on the day of the woman's egg collection, continuing until pregnancy is confirmed, and then until 12 weeks of pregnancy. When prescribing their dosage, the doctor must take into account all the individual factors of the pregnant woman (endometrial thickness, own level of progesterone, etc.)
2. The use of this group of drugs can bring some inconvenience to a woman's life: the need to inject the drug into the vagina or inject several times during work.
3. The appearance of "side effects" when using drugs for progesterone support in pregnant women in the form of weight gain, increased appetite, dizziness or weakness.
4. Cancellation of drugs containing progesterone is carried out according to the cancellation scheme (with a gradual dose reduction). In no case should you abruptly stop taking these drugs. Before canceling the drugs of this group, a blood test is most often prescribed to determine the level of the hormone in the woman's body. It is most often possible to completely abandon progesterone support at a gestational age of 14-15 weeks. But at the same time, there should be no deviations in the body of the expectant mother. In addition, the woman must have a fully formed placenta, which takes over all the functions of maintaining pregnancy. If a woman has risks of threatened abortion during this period, then progesterone support can last up to 20 weeks.

Estradiol after IVF

Estradiol is also a natural estrogen. It is produced in the corpus luteum of the ovaries and partially in the adrenal glands. It is this hormone that is responsible for the formation of female sex differences. After IVF, estradiol, along with progesterone, is responsible for maintaining pregnancy.

When combined with progesterone, estradiol is able to keep the endometrium in an ideal state for pregnancy.

If the analysis reveals that this hormone is not enough in the blood, then it is introduced additionally in the form of drugs. The rate of estradiol after IVF is approximately 5,000 - 10,000 pmol / l. After embryo implantation, estradiol is responsible for the thickness of the endometrium.

It depends on the thickness of the endometrium whether the embryo can normally be fixed in the uterus so that a woman can bear the fetus until the end of its ripening.

Also, estradiol after fertilization with IVF is responsible for such crucial processes:

• ensuring the growth and stretching of uterine tissues;
• the formation of the bone skeleton of the future baby;
• normal work of the fetoplacental system;
• stimulation of metabolic processes;
• delivery of nutrients to the embryo;
• activation of blood circulation in the uterine tissues.

Along with progesterone, estradiol creates favorable conditions for pregnancy, supports metabolic processes between the mother and the fetus, controls normal blood pressure and participates in labor.

If the estradiol level drops sharply afterwards, then there is a serious risk of premature birth and miscarriage.

In no case should the dose of hormonal drugs be exceeded. No hormone will make a good embryo out of a bad one, but hormones can harm the fetus.

It is because of the possible toxic effect on the embryo that a woman should not independently prescribe, cancel or increase the dose of hormonal drugs during pregnancy.

After effective IVF, reproductive specialists use estradiol in the form of tablets (, Estrofem) and the form of a cutaneous gel (, Estrogel).

Proginova

This hormone replacement drug should be canceled immediately upon the onset of a normal pregnancy. So it says in the instructions. However, with an IVF program, this drug can be used for up to 3 weeks. It all depends on the scheme chosen by the attending physician. Usually the dose of Proginov ranges from 0.5 to 7 tablets per day.

It is important to use the drug at the same time, without lowering or increasing its dose yourself.

Proginova is called to maintain the level of estradiol in the woman's body stable and not dependent on infections, stress or exacerbation of chronic ailments in the expectant mother.

In any case, cancel this drug no later than 15 weeks of pregnancy. It is canceled very gradually, reducing the dose every 3 days, starting with ¼ of the pill.

Other forms of using estradiol during IVF are Estrofem tablets, Microfollin, Divigel or Estrazhen gel, Klimar patch.

The peculiarities of the abolition of these drugs is also the principle of gradualness, so as not to harm the body of the mother and the unborn baby.

Other IVF drugs

In addition to hormones, other drugs are also used in the practice of reproductive medicine. The most common ones are:

• Adrenal cortex hormones (Dexamethasone, Prednisolone, or Cortisol) are often used to create immune bonds between the mother and the fetus she is carrying, and to lower androgen levels. Also, these drugs eliminate the factors of the development of antigen k, eliminating fetal hypoxia and preventing premature birth in a woman.
• Gonadotropin preparations for physiological maintenance of pregnancy mechanisms. In this case, two types of these hormones are used: HMG and FSH preparations. Most often, clinics use drugs "", "Elonva", "", "". All these drugs are perceived by the body as natural and do not cause reactions from the immune system. However, when taking them, there may be side reactions (fatigue, anxiety, flatulence, etc.). Also, when taking gonadotropes, there may be a danger of ovarian hyperstimulation
• HCG preparations duplicate the natural hormones of the female body and contribute to the development of fetal preservation mechanisms. As analogues of hCG, Profazi drugs or are used.
• Blood-thinning drugs (Aspirin, Heparin, Curantil) are often prescribed to pregnant women to maintain normal blood density and reduce platelet aggregation. These drugs are prescribed under the control of a blood test. They ensure normal blood circulation in the uterus and placenta, preventing oxygen starvation of the fetus.
• Antihypoxant vitamins (folic acid, vitamins A, B and E, beta-carotene) are prescribed for vitamin support of the mother and the unborn baby's body, supporting their immunity at a sufficient level.

No pregnancy after IVF should be left to chance. The in vitro fertilization technique is used by women with pathologies that, without modern technologies, would be doomed to permanent infertility. As a rule, in these difficult situations, the body does not have the resources to help a woman not only become pregnant on her own, but also to maintain the incipient pregnancy.

If a woman has already decided on IVF, then in most cases she will not be able to endure the pregnancy that she has inherited so dearly without medication. The main thing is to trust a good doctor and take all medications according to the schemes prescribed by the doctor. But all this is done in order for a woman to experience great happiness to finally become a mother.

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Every year the number increases all over the world. Good or not, it is impossible to say for sure. Such is our harsh reality that a combination of unfavorable factors, and these are bad ecology, unhealthy diet, past illnesses, stress - leads to an increase in the number of married couples experiencing problems with conception. In vitro fertilization for many becomes the only chance to become parents and to acquire long-awaited offspring. The IVF procedure includes several stages: after the embryos that have grown under artificially created conditions are transferred into the womb, the woman is prescribed hormonal support with progesterone preparations.

What is progesterone for?

To understand why we are prescribed such large doses of drugs containing progesterone and its derivatives, we need to know its effect on the female body.

• Progesterone organizes secretory endometrial modification, most favorable for embryo attachment.
• Reduces the ability of the myometrium to contract, therefore, eliminates the risk of miscarriage.
• Plays a role in the tight closure of the cervical canal.

What drugs are prescribed for progesterone support

Currently, it is customary to prescribe progesterone medications in the form of tablets or vaginal suppositories (capsules). The use of injectables is discouraged due to the inconvenience of use and in the form of hematomas and abscesses after long courses of injections, although it is also common.

1. Duphaston (dydrogesterone) is an artificially created analogue of the hormone progesterone. It is administered orally in pill form. This drug is safe for the mother and fetus, even with long-term use. Usually the daily dosage is 30-60 mg. Duphaston is taken orally at the same time every day.
2. Utrozhestan is a widely prescribed drug for hormonal support in artificial insemination cycles. It contains natural progesterone, which is obtained from plant materials. In IVF protocols, Utrozhestan is prescribed in capsules for vaginal use. At the time of its introduction, it is advisable to try to place the capsule as deep as possible into the vagina, closer to the cervix, in order to minimize leakage outward. The recommended dose is 600 mg (1 capsule 200 mg three times a day at regular intervals). In some cases, according to indications, a large daily dose of the drug is prescribed: 800 mg (4 capsules per day, 200 mg each) in combination with injections of a 2.5% oily solution of progesterone twice a day.
1. with endometriosis;
2. if there are malignant neoplasms of the liver;
3. with diabetes mellitus of any type;
4. with increased blood clotting ability;
5. if a pregnant woman is overweight.

You cannot cancel the drug yourself, as this can have consequences up to termination of pregnancy. The dosage is reduced gradually, the individual course is calculated by the doctor.

Another progesterone drug is Crainon. It comes in the form of candles or gel. Most often, candles are assigned, their use is easier. The drug can be used once a day, which is more convenient for patients than multiple doses.

Conclusion

Prescription of the medicinal product should be carried out by a doctor. It is unacceptable to prescribe independently, to replace the drug with a similar one, to change the regimen or to completely cancel it. Self-medication in this case threatens to disrupt the long-awaited pregnancy.

Video: Pregnancy management after IVF

After the final stage of in vitro fertilization - embryo transfer - hormonal support is mandatory. It is aimed at maintaining optimal levels of hormones responsible for the onset and development of pregnancy. The fact of the birth of a new life is confirmed by a blood test for hCG (human chorionic gonadotropin) 14 days after the embryo transfer. Control tests for hormones are also taken, after which the question of the need for their further administration is decided.

Progesterone support after embryo transfer

Post-embryo transfer support with progesterone is prescribed on the same day. Progesterone is formed in the ovaries by the corpus luteum, which appears at the site of punctured follicles. Its peak in the blood is observed 5-6 days after the puncture. Performs the following functions:

• Modifies endometrial secretion, creating favorable conditions for embryo implantation.
• Reduces the contractile activity of the myometrium.
• Affects the tight closure of the cervical canal.

Progesterone support after embryo transfer is carried out to prevent impairment of these functions, as dysfunctions can lead to miscarriage. Medicines are prescribed in an individual dosage according to certain schemes, the choice of which depends on the characteristics of the IVF procedure, and the initial indicators of progesterone in the blood. Support after embryo transfer is carried out with Dufaston (tablet form), Utrozhestan (vaginal suppositories) or Progesterone injections.

Post-embryo estradiol: hormone support

Estradiol is formed in the ovaries and serves as a stimulant for endometrial growth. Under its influence, the optimal structure of the uterine mucosa is created, which is necessary for the correct attachment of the embryos. If the ultrasound reveals an insufficient thickness of the endometrium, drug support is prescribed before the embryo transfer and continues after it. A decrease in estradiol leads to a decrease in progesterone production.

Medicines with estradiol analogues are prescribed in the form of gels or tablets. They are widely used:

• Divigel;
• Estrogel;
• Proginova.

Their doses are selected for each patient individually, based on the test results and ultrasound data.

Post-transfer hormonal support is provided until 12-14 weeks of gestation. In the future, the formed placenta takes over the function of producing hormones. If, during the examination, a lack of hormonal substances persists, maintenance with artificial analogs continues for a longer time. The duration of therapy is determined by the attending physician.

After embryo transfer, it is important to follow all the doctor's instructions and follow his recommendations. Self-canceling or renewing drug support is not allowed. This can lead to serious consequences and, as a result, an abortion.