Eco without hormonal stimulation in a natural cycle. What is eco in the natural cycle? Eco in the natural cycle positive results

30.06.2021

When an infertile couple decides to undergo IVF, the future parents want the procedure to give a positive result as quickly as possible and be safe for the mother and the embryo. Since it is rare for a family to start IVF informationally unprepared, many couples see the solution to their problem by undergoing IVF in a natural cycle, which is rightfully considered the most gentle.

But is everything so simple in this method and is it always worth choosing it?

IVF in a natural cycle, or IVF without stimulation, is a method that is based on artificial fertilization of an egg obtained during the natural menstrual cycle, without the use of stimulating hormonal drugs, followed by implantation of the embryo into the uterus. In other words, doctors intervene in the process of embryo formation only at the stage of fertilization, which occurs outside the body of the expectant mother, and all care for the correct formation of the egg and its maturation rests entirely with the female body.

Protocols in natural cycles have great advantages over other types of in vitro fertilization.

Maximum physiological

The endocrine system of a healthy woman is unique; the body, through a complex combination of concentrations of sex hormones, creates the best conditions for the maturation and ovulation of the egg, which cannot be achieved with the help of hormonal drugs. When performing IVF in a natural cycle, drugs are not used to stimulate follicle growth and egg ovulation, therefore this type of in vitro fertilization is the most physiological.

There are scientific studies that prove that the embryo formed by fertilization of a “natural” egg is more viable.

The absence of the use of stimulating hormonal drugs during protocols in natural cycles has a positive effect on the general well-being of the woman. The kidneys, liver, and breast tissue of the expectant mother are not subjected to excessive physiological stress. There is no negative effect on the gastric mucosa (gastritis is a common complication of IVF with stimulation), the cardiovascular system (the woman is not tormented by surges in blood pressure and vegetative-vascular dystonia).

Does not lead to ovarian hyperstimulation syndrome

This is a pathological condition, which is based on the “overresponse” of the ovaries to the introduction of ovulation-stimulating hormonal drugs in the standard IVF protocol.

A high level of sex hormones leads to an increase in the permeability of the walls of blood vessels for the liquid part of the blood (a large amount of fluid accumulates in the abdominal and chest cavity), a drop in blood pressure, disruption of the heart, and the development of blood clots.

With IVF in a natural cycle, stimulating drugs are not used, so there is no risk of an “incorrect” response from the ovaries.

Prevents multiple pregnancies

With protocols in natural cycles, the expectant mother, as a rule, is implanted with one embryo. The transfer of 2 embryos is done very rarely, in the case of cryo-freezing of several eggs obtained in several natural menstrual cycles, followed by artificial insemination and growing of the resulting embryos.

Why are doctors against multiple pregnancies with IVF? This is due to the fact that carrying a baby after in vitro fertilization is often more difficult than with natural conception: there is a high risk of developing a frozen pregnancy, the threat of miscarriage, and premature birth. The more embryos in the uterus, the higher the load on the woman’s body and the risk of developing these complications.

In addition, when transferring several embryos (more than 2), the question arises of reducing some of them after selecting the most well-attached embryos. This is a great emotional stress for the expectant mother and is not always combined with the religious beliefs of the married couple.

There is no problem of storing (destructing) “extra” embryos

If IVF is carried out with stimulation, then a large number of mature eggs (up to 20) are immediately obtained, which are examined for abnormalities, then artificially inseminated, the resulting embryos are grown to 3-5 days of age and placed in the uterus. At these stages, “extra” embryos may appear that are healthy and viable (can be implanted into a woman), but are not among the “lucky ones” placed in the body of the expectant mother.

In this situation, the question arises about their preservation (cryofreezing) or destruction. This causes great medical, ethical, moral, religious and technical difficulties. With protocols in natural cycles, one embryo is obtained and such questions do not arise.

A large number of protocols in a row

Since IVF in a natural cycle does not use aggressive medications, it is possible to carry out several protocols in a row.

For comparison, with IVF with stimulation, if the result is negative, the following protocol is allowed to be carried out no earlier than after 2 months (2 menstrual cycles).

Financial side of the issue

The cost of IVF in a natural cycle is much lower than other methods of in vitro fertilization, which can be a decisive factor when choosing a method of infertility treatment for couples on a limited budget.

Indications and contraindications

A married couple can count on infertility treatment using IVF in a natural cycle in the following cases.

The expectant mother is under 35 years old. For older patients, a standard IVF protocol with stimulation is offered.
The woman has a regular menstrual cycle lasting 28-35 days, which is repeatedly confirmed by the results of ultrasound and blood tests for hormones.
The cause of infertility for a couple is obstruction of the fallopian tubes.
The expectant mother does not want to enter into the standard IVF protocol with stimulation (for any reason) or has a negative experience.
The woman has contraindications to ovarian stimulation (previous and operated oncological diseases, blood clotting disorders, severe liver and kidney diseases).
The expectant mother was faced with the problem of poor attachment of a healthy, high-quality embryo in the uterus during IVF with stimulation. In the absence of hormonal stimulation, the endometrium better “accepts” the embryo.
Poor response to hormonal stimulation (“weak” ovaries), when even with the maximum permissible doses of ovulation stimulants it is possible to obtain 1-3 eggs.

In what cases is it better for a married couple to abandon protocols in natural cycles?

The expectant mother is over 35 years old.
The “culprit” of a couple’s infertility is the man. The worse the quality of the sperm, the greater the chance of getting a non-viable embryo, and given that it is only 1, the risk is not justified.
Irregular menstrual cycle and lack of natural ovulation.

How is the IVF procedure carried out in a natural cycle?

In a healthy woman, in each menstrual cycle, 1 (very rarely 2) egg matures in the ovary. Submitting to the influence of sex hormones, a mature female reproductive cell ovulates approximately in the middle of the cycle, that is, leaves the follicle and descends into the fallopian tubes for further fertilization.

If the expectant mother is offered an IVF program in a natural cycle, then it includes the following stages.

Standard examination of men and women before any type of assisted reproductive technology.
Monitoring the growth and development of the dominant follicle using ultrasound every other day and biochemical urine analysis (ovulation test) and measuring basal temperature at home every morning starting 7-8 days from the start of menstruation.
36 hours before the moment of expected ovulation, an injection of the hCG drug is given, which promotes ovulation and the formation of a high-quality corpus luteum at the site of the burst follicle.
Retrieval of a mature egg using a puncture. The procedure is performed under local anesthesia or mild sedation.
Sperm selection and preparation for IVF or ICSI.
Artificial insemination "in vitro".
Growing the resulting embryo up to 3 or 5 days of age.
Transferring an embryo into the uterus of the expectant mother. After this, support in the form of progesterone drugs (duphaston, utrozhestan) can be prescribed.
Monitoring hCG levels 2 weeks after replantation.

The effectiveness of the method and possible reasons for failure

Despite all the advantages, IVF without stimulation has one significant drawback, which often outweighs the advantages: the likelihood of pregnancy is very low compared to the standard protocol.

The pregnancy rate during IVF in a natural cycle is 7% based on each protocol started; and for each embryo transfer – about 16%. In other words, out of 100 women who entered the protocol in natural cycles, only 7 will become pregnant. And out of 100 women who have an embryo implanted, only 16 will implantation.

Such low effectiveness is due precisely to the physiological nature of the process. In a healthy woman, even under the most favorable conditions of direct contact between the egg and sperm, the probability of fertilization is 80%. Since IVF produces 1 egg in a natural cycle, some expectant mothers fail already at the stage of artificial insemination.

Successful conception does not mean the formation of a healthy embryo. With IVF with stimulation, approximately half of the obtained and fertilized eggs are able to form a viable embryo, while the rest die without beginning to divide. Of the resulting embryos, another half is eliminated based on the results of genetic tests. With IVF, there is only 1 embryo in a natural cycle, which means that the chances of successful implantation of a healthy embryo are quite low.

In 10–15% of cases of all protocols started in natural cycles, they are completed early due to sudden ovulation of the egg. The doctor can “miss” the release of the female reproductive cell from the ovary for several reasons:

spontaneous LH surge;
the patient’s inability to regularly come for an ultrasound and perform biochemical urine testing (ovulation test) at home;
technical difficulties: insufficiently well-equipped IVF clinics, lack of highly qualified ultrasound diagnostic specialists.

If during the next ultrasound the doctor notices that the egg has left the ovary, the protocol is considered prematurely completed.

The in vitro fertilization procedure does not always mean taking large doses of hormones. There are protocol options that are more gentle for patients. In such cases, the embryo is transferred in the woman’s natural cycle. From a reproductive point of view, this method is as close to natural as possible. But statistics show that, unfortunately, his effectiveness is less.

Main differences from the classical procedure

The standard protocol procedure involves the mandatory use of hormones before actual fertilization to stimulate the ovaries. The woman takes a course of medications so that more eggs mature. This increases the chance of a successful outcome.

When a large number of oocytes mature, it is possible to obtain several high-quality embryos, and accordingly, it will be possible to select the best ones for transfer. In addition, the ovulation process is predicted in advance and doctors do not make mistakes with the day of puncture.

How does stimulation work before IVF:

upon entry into the protocol, the woman’s fertile potential is assessed, a protocol option is selected (long, short - with or without pituitary gland blockade, or) and the type of drugs that will be stimulated;
a course of antagonists aimed at stimulating the work of the ovaries is prescribed, usually it starts 3-5 days from the start of menstruation and continues for several days;
if necessary, after stimulating the growth of the eggs themselves, ovulation is induced using an injection of hCG;
after superovulation, material is collected - puncture;

What is eco in the natural cycle? This procedure differs from the classic one in that hormones are not used to grow the egg. A woman ovulates in the usual way. The egg matures independently in the dominant follicle.

At the moment when she is ready to leave the follicle (before the onset of ovulation), material is taken, further fertilization, embryo growth and replantation occurs. This is where the following difference lies - with stimulation there should be 5-8 follicles, sometimes 10-12, ready for ovulation for doctors to perform a puncture, but with IVF only one, rarely two, mature.

An important distinguishing feature of this procedure is the minimization of side effects. The syndrome does not occur, there is no risk of multiple pregnancy, and the question of using the remaining embryos does not arise.

How many eggs are there in one follicle when stimulated? A follicle is a kind of shell, a chamber where the egg matures. One follicle - one egg. Sometimes a situation may arise that an oocyte does not grow in the follicle, it is empty, then this is a reason for a protocol with stimulation.

Conditions for the protocol

The natural IV cycle is used mainly by young women under 30-35 years old who have regular periods. The procedure is indicated for those whose infertility is associated with obstruction of the fallopian tubes or with the presence of problems on the part of the partner, if there is a history of previous oncological diseases, in previous protocols there was no response of the ovaries to stimulation or they ended unsuccessfully, cryopreserved embryos remain, the risk of OHSS confirmed.

How does ecology work in the natural cycle?(text is required or make the list title below, in this form “a question is stupidly inserted”)

Stages of artificial insemination in the European Center:

preparation for eco in the natural cycle. Includes a complete examination of the couple;
monitoring follicle growth. Starting from the 6-7th day of the cycle, ultrasound and biochemical urine analysis are performed every other day. Basal temperature is measured daily;
determining the right moment to collect an oocyte - assessing its size, predicting expected ovulation. This stage is very important. Since it requires sufficient experience from the doctor. In the EC, you can easily miss the moment when the egg leaves the follicle;
egg puncture. Sperm selection and preparation;
implementation of fertilization;
embryo cultivation 2-3 days;
implantation of embryos into the patient. At this stage, drug support with hormones is prescribed in rare cases;
confirmation of pregnancy.

The IVF program in a natural cycle brings less results for obvious reasons - there is a high risk of not receiving oocytes during puncture, there is no guarantee that the resulting 1-2 eggs will be fertilized and successfully cultured. Therefore, low rates are not a consequence of the fact that the pregnancy did not occur or ended unsuccessfully.

To obtain a larger number of eggs, reproductive specialists resort to IVF with minimal stimulation. The amount of hormonal drugs and the burden on the woman are minimized.

The so-called Japanese protocol operates according to a similar scheme. The effect of superovulation is not achieved, but the number of follicles increases to several. Only there is a difference - the transfer must be carried out next month with frozen embryos. Stimulation in the natural cycle does not place an excessive burden on the woman’s body, but increases the chance of successful completion of the protocol.

To avoid the situation of obtaining an immature egg during puncture, IVF in a natural cycle is more often practiced with some additions at this stage. At the moment when the follicle size reaches 18-20 mm, on average 32-36 hours before ovulation itself, the hCG drug is administered. Sometimes before this stage, when the follicle size is 15 mm, it is possible to administer a GnRH and FSH antagonist.

Such minimal stimulation during IVF lasts only 2-3 days. But, on the other hand, these manipulations make it possible to exclude spontaneous ovulation and ensure the receipt of a fully mature oocyte.

Helpful information

Fertilization in the natural cycle often involves the use of the ICSI method. Embryos are rarely cultured to the blastocyst stage and transfer occurs on day 3. In such protocols, puncture is optionally performed without anesthesia. The embryos that were obtained turn out to be stronger and the resulting IV pregnancy in a natural cycle has a greater chance of proceeding successfully.

It is possible to perform more protocols in a row on one patient without harm to health. Mothers who have done IVF in a natural cycle note that along with hormonal stress, psychological stress also decreases.

Since its invention, in vitro fertilization has always been performed in a natural cycle. Gradually, in order to increase productivity, hormonal drugs began to be used to create and control artificial ovulation. But more and more often the question arises about the need to develop ART towards methods of conception that are closer to natural ones.

How long does the eco protocol last? Depending on which option is chosen, the fertilization procedure can last from several days to weeks. The short protocol lasts up to 4 weeks, coincides with the woman’s cycle, ovarian stimulation occurs within 10-14 days. The long protocol lasts on average two to three weeks longer, since it begins before menstruation, stimulation of egg growth continues, as in the short one.

With the natural clean protocol, ovarian stimulation is not performed. Thus, its duration is from puncture to result, and in the case of minimal stimulation, the period increases by another 3-4 days.

How much does eco cost in the natural cycle? The high cost of in vitro fertilization is due to the high prices of the drugs used in the protocol. Reducing the amount of hormones to stimulate superovulation or their complete absence significantly reduces the cost of IVF in the natural cycle. On the other hand, possible repetition of protocols leads to increased costs.

When choosing an artificial insemination protocol, any woman is looking for an option with minimal risks and maximum results. Sometimes this interferes with getting results.

It is necessary to clearly understand which option is suitable for a particular patient, take into account all individual situations, and adequately assess the state of health and capabilities. Don’t despair if this means you need to prepare more carefully and the long-awaited child will definitely be born!

IVF in a natural cycle

According to current Russian statistics,

IVF in a natural cycle ends in pregnancy in 7-10% of cases.

Nevertheless, this technique remains one of the most popular due to the minimal hormonal load on the female body. It is noteworthy that the world's first in vitro fertilization procedure took place precisely according to the EC protocol. As a result, a girl was born - Louise Brown, completely healthy, and currently the mother of two children. Those who plan to apply for such reproductive technology should understand its features and risks.

What is IVF in a natural cycle?

The protocol for in vitro fertilization in the natural cycle is as close as possible to the natural process of conception. It is considered one of the most gentle and at the same time ineffective, which is due to the peculiarities of the technique. In standard IVF options, using a long or short protocol, hormonal therapy is prescribed to stimulate superovulation, which has a lot of adverse consequences for the body. Depending on the woman’s sensitivity to medications, during the puncture process the doctor can obtain up to 10-20 eggs - this is more than enough for insemination in the laboratory and selection of the highest quality embryos for transfer to the uterus.

In the case of an IVF program in a natural cycle, hormonal drugs are prescribed in small quantities or not used at all.

For fertilization in the laboratory, only 1 or 2 eggs that have matured in the current cycle are used. Simply put, the doctor intervenes in pregnancy only at the stage of fertilization and the return of the embryo to the uterine cavity.

Modern technologies minimize risks and stress on the body

IVF at the EC has several significant advantages:

reducing risks to women's health due to minimal impact on hormonal activity;
ovarian hyperstimulation and complications associated with this syndrome are excluded;
the endometrium better “receives” the implanted embryo, implantation of the embryo is faster and of better quality;
breaks before repeated procedures are not required: the absence of hormonal therapy allows you to maintain the body’s condition at the desired level, and the transfer can be repeated for several months in a row;
the risk of multiple pregnancy is minimized;
the chances of maintaining pregnancy in the first and subsequent trimesters increase;
the price of IVF in a natural cycle is significantly lower compared to other protocols, but the final “cost of pregnancy” will be high if it is necessary to repeat cycles of puncture, fertilization and transfer many times.

Advantages of the IVF EC protocol

The peculiarities of this reproductive technology are associated with some difficulties that affect low efficiency:

the doctor cannot fully control the LH peak, the degree of maturity of the oocyte and the moment of ovulation itself - and whether the long-awaited pregnancy occurs or not largely depends on these factors;
puncture often turns out to be meaningless - due to incomplete maturation of the egg, the doctor cannot “pick up” an oocyte that has not yet separated from the walls of the follicle, and “empty” follicular fluid enters the needle;
even if an egg can be obtained, the oocyte may turn out to be degenerative or immature;
It is not possible, as with conventional protocols, to stimulate the maturation of the egg or, conversely, to slow it down;
by the time of the puncture procedure, the follicle may be empty if ovulation has already occurred.

In order for IVF in a natural cycle to result in pregnancy, the conditions must be ideal - the doctor must take one high-quality oocyte, fertilize it, obtain a high-quality and viable embryo and transfer it back to the uterus.

The probability that all parameters will be met is 1 in 10. Nevertheless, this is a relatively high success rate, especially considering that the expectant mother’s body is not subject to aggressive stimulation.

Long-awaited pregnancy without risks

Indications

IVF in a natural cycle without stimulation can be recommended for women who have maintained physiological ovulation - that is, patients 18-35 years old, with a regular menstrual cycle of 28-35 days and stable ovulation. The last 2 parameters must be confirmed by hormone tests and ultrasound control. This protocol will also be preferable when:

high risk of developing hyperstimulation syndrome;
insufficient “response” of the ovaries to hormones;
unsuccessful embryo implantations in previous attempts;
infertility due to tubal factor or partner problems;
previous oncological diseases and thromboembolism;
the presence of any tumors in the hypothalamic-pituitary system;
diseases of the liver and pancreas;
the presence of artificial valves in the heart.

In addition, the indication for choosing this reproductive technology may be the depletion of the ovarian reserve, in which “nature” itself selects the follicle with the highest quality oocyte in a particular cycle.

To successfully implement this technique, partners must undergo a full examination. In particular, for women, hormonal studies are fundamentally important: in vitro fertilization makes sense only when the level of FSH (follicle-stimulating hormone) is more than 8.5 IU/l and estradiol is more than 100 pmol/ml.

Who is the procedure suitable for?

How is IVF performed without stimulation?

Any in vitro fertilization technology begins with a full examination, which includes clinical tests, hormonal and functional tests, and ultrasound. In the absence of contraindications, the procedure is carried out according to the following scheme:

From the 7-8th day of the cycle, control of the growth of the dominant follicle begins - with the help of regular biochemical urine tests, ultrasound every 2 days and daily measurement of basal temperature.
36 hours before the onset of ovulation, the woman is injected with hCG, which stimulates the release of the follicle with the formation of a “high-quality” corpus luteum, which is subsequently necessary for the development of the embryo in the uterus.
The mature egg is collected using a puncture under local or light general anesthesia.
Sperm is collected from the partner and prepared for IVF or ICSI.
After fertilization in the laboratory, the embryo matures within 3-5 days in a nutrient medium.
The embryo is implanted in the uterus; to maintain pregnancy in the first stages, auxiliary drugs with progesterone, for example, Utrozhestan or Duphaston, can be prescribed.
14 days after the transplantation, the woman takes an hCG test, which will show whether pregnancy has occurred or not.

All questions should be asked to your doctor

Features of IVF in the European Center

In terms of effectiveness, IVF in a natural cycle is inferior to protocols with hormonal stimulation, but still has good results. According to doctors, this technology requires precision and high professionalism. The clinic’s equipment must be the most modern: special environments are required for embryo maturation, and advanced high-precision equipment is required for puncture, fertilization and transfer. An individual approach is especially important: this technique must be 100% adapted to all the health characteristics of the patient. It is impossible to predict in advance the number of necessary repetitions of procedures: the quality of oocytes, maturation times and other nuances depend on the characteristics of the body of a particular woman.

Unlike classical protocols, IVF in a natural cycle allows you not to think about the problem of unnecessary eggs.

With full hormonal stimulation, an average of 10-20 eggs are taken for fertilization, 3 of them are transplanted into the uterus, the remaining 7-17 may turn out to be of high quality and viable, but will not be among the “lucky ones”. The need to destroy them or cryo-freeze is a complex ethical and moral issue for many future parents, which disappears by itself in the case of the EC protocol.

Advantages of the EC protocol

Current IVF technologies in the natural cycle are often carried out using gentle drugs for greater efficiency. For example, “Peregnil” and “Ovitrel” are prescribed to accelerate the maturation of eggs, and “Orgalutran” and “Cetrotide” are prescribed to prevent early ovulation. According to individual indications, microdoses of hormones can be prescribed to stimulate the maturation of not one, but several oocytes. This will make it possible to select the highest quality and most viable embryo after fertilization in the laboratory. IVF in a natural cycle can be combined with the use of cryopreserved oocytes, donor eggs and sperm. Methods of “accumulating” a woman’s own oocytes for further transplantation of a group of embryos are also practiced. This approach increases the chances of success with a minimum number of repeat cycles.

By the way, modern developments in the field of IVF protocol in a natural cycle are also aimed at finding methods that will allow the “ripening” of oocytes in a nutrient medium after ovarian puncture. This will reduce the hormonal load on a woman’s body and at the same time increase the percentage of successful operations and a successful pregnancy.

Video: What is IVF in a natural cycle?

IVF is usually accompanied by the use of hormonal drugs to stimulate the ovaries. Sometimes the doctor may decide to perform artificial insemination in a natural cycle. For those who are preparing for artificial insemination using the IVF method in a similar cycle, it is imperative to know what it is and how it is done.

This approach is considered the most gentle for a woman’s body. The method almost completely replicates the natural one. The only differences are ovarian puncture and embryo transfer. However, not everything is as wonderful as it looks at first glance.

According to statistics, in vitro fertilization performed in this way has a much lower chance of success compared to the classical procedure.

What is the difference from regular IVF?

The most important difference is the absence of taking hormonal drugs, as with conventional IVF. In the classic version, hormonal stimulation of the body is carried out before fertilization, thus increasing the likelihood of a favorable result. Thanks to artificial stimulation, a woman’s ovaries produce much more high-quality eggs, which has a beneficial effect on the final result.

With a large number of high-quality oocytes, it is possible to grow more embryos suitable for fertilization, which will then undergo a selection procedure and the best of the best will be selected for subsequent implantation into the uterus. Among other things, it is easier for doctors to monitor ovulation and calculate the moment for puncture.

Stages of IVF with stimulation:

After the doctor assesses the woman’s health, a plan will be drawn up to prepare for the procedure. The most suitable type of protocol will be selected and suitable drugs for stimulation will be selected. Protocols are long, short (with or without pituitary blockade) and natural.
After the doctor calculates the course of conventional IVF, stimulation of the ovaries with antagonists begins. You need to start taking medications on the 4th day of your period. The duration of the course is prescribed by the doctor, usually it lasts only a few days.
Sometimes it may be necessary to induce ovulation with injections of human chorionic gonadotropin. This is stimulation of artificial growth of eggs.
At the last stage of superovulation stimulation, a puncture is performed and mature eggs are removed from the ovaries for subsequent fertilization.

These are the main stages of IVF with a long or short protocol with stimulation with hormonal drugs.

Many women do not quite understand what IVF is in a natural cycle and how it differs from a regular procedure. The most important difference is the lack of hormonal preparation of the body and stimulation of the ovaries. In addition, ovulation is not controlled; it goes away on its own, as does the growth of the egg.

During a natural cycle, a puncture is performed just before the onset of ovulation, at which point the oocyte has already developed and is preparing to leave the ovarian follicle. A significant difference is the number of eggs obtained for fertilization. With EC, basically, only one suitable oocyte is obtained, sometimes there are 2. Judging by the reviews of women, doctors say that the probability of fertilization with EC will be less than 15%.

As a result of puncture during IVF in a natural cycle, very few suitable eggs are obtained; at best, there will be from one to two pieces.

With regular in vitro fertilization with egg stimulation, there can be from 7-11 pieces. That is, the chances of getting pregnant are much greater.

The advantage of a natural cycle with in vitro fertilization is that unpleasant side effects are reduced to zero. The woman will not have ovarian hyperstimulation syndrome, the patient will not rack her brains over the fate of the remaining embryos, and there will be no multiple pregnancy. All this allows us to say that this method is very gentle. However, it is not suitable for everyone. Everything will depend on the individual characteristics and capabilities of the body.

A common question when planning such a procedure is: “How many eggs will mature in one follicle with and without stimulation?” First you need to understand that a follicle is a cavity on the body of the ovary in which the egg matures and develops. In the normal course of events, one egg should appear in one follicle. This should happen both with and without stimulation. It happens that the follicle is empty - this is an indication for the use of hormonal stimulation. When stimulated, more follicles mature, and therefore more eggs.

Who is it suitable for?

A characteristic feature when a doctor chooses such a scheme is age. If a woman is between 30 and 35 years old and has a regular menstrual cycle without deviations lasting from 28 to 35 days, then she is suitable for this IVF program. In addition to these conditions, there are also additional requirements for the procedure.

IVF in a natural cycle is done if:

the diagnosis of infertility was made due to tubal factor (there is obstruction of the fallopian tubes);
the level of female sex hormones is normal (estradiol level should be at least 100 pmol/ml, follicle-stimulating hormone concentration at least 8.5 -8.7 IU/l);
there are contraindications for artificial insemination with hormonal stimulation;
women say in reviews that the natural cycle is used if oncological pathologies were previously detected (for example, thromboembolism, kidney or liver disease);
there was myocardial surgery with implantation of an artificial heart valve;
the embryo develops and takes root better without hormonal stimulation;
a woman is prone to developing ovarian hyperstimulation syndrome;
The patient has a weak response to hormonal stimulation of the ovaries. In such a situation, even despite the completed course of hormone therapy, very few suitable eggs mature (from 1 to 3 pieces).

IVF at the European Center is not suitable for everyone; there are many restrictions, please read them carefully.

Who is not suitable for?

There are a number of contraindications. If they are present, in vitro fertilization is not carried out in a natural cycle.

Contraindications:

patient over 35 years old;
in a married couple, the man is infertile (the sperm is of very poor quality, read more about the spermogram in our separate article);
lack of ovulation;
disruptions in the menstrual cycle.

After 40 years

The selection of a suitable IVF protocol is made for each woman individually. Much, of course, will depend on the age of both partners, on the result and the number of previous attempts (if any). The doctor will check whether there are any contraindications to hormone therapy. It is important to consider the presence and number of frozen embryos. In practice, there are exceptions that allow IVF to be carried out in a natural cycle even after 40 years.

Stages of artificial insemination in the European Center

Many expectant mothers are interested in how exactly IVF works in a natural cycle. There are a total of 8 stages of this procedure. Depending on the clinic, the number and features of these stages may vary slightly.

Artificial insemination takes place in several stages.

IVF program at the European Center in stages:

The program begins with preparation and a complete medical examination of the couple.
Further, from the end of the first week of the cycle, the development of the follicle and endometrium is monitored using urine tests and ultrasound diagnostics. Follicle growth can also be judged by measuring basal temperature.
The next step is the exact selection of the right moment for puncture. By monitoring the levels of estradiol and luteinizing hormone, a fertility doctor with sufficient experience can accurately determine when exactly the egg needs to be retrieved. In a natural IVF cycle, it is quite difficult to determine this moment.
Puncture. Very often, before a puncture in the natural cycle, 35 hours before ovulation, at the time the follicle develops to a size of 17-21 mm, hCG injections are given. If the follicle does not reach the desired size before ovulation, a GnRH and FSH antagonist will be administered.
Sperm collection and egg fertilization.
Embryo cultivation occurs within two to three days.
Replantation (transfer) of embryos into the uterine cavity.
The final stage of all IVF in the EC is confirmation of pregnancy 14 days after the transfer.

Chances

The effectiveness of IVF in the natural cycle is much lower. It is extremely difficult to obtain good oocytes in the required quantity. Even if they are obtained, the chances of their successful fertilization and further growth are very small. That's why 8-9 attempts out of 10 fail with this approach to artificial insemination. One plus is minimal stress on the body and quick recovery for the next attempt.

Japanese protocol

There is another way to increase the effectiveness of in vitro fertilization in a natural cycle. The so-called Japanese protocol allows you to increase your chances several times. With this type of protocol, the emphasis is not on the quantity, but on the quality of embryos. This is achieved by the method of cryopreservation of eggs and their subsequent replantation after several cycles (from 1 to 4).

The Japanese method of IVF is carried out during a natural cycle. Oocyte collection lasts 3-4 months. The collected eggs are frozen until replantation.

With the Japanese protocol, a woman undergoes gentle hormonal stimulation to collect a larger number of suitable oocytes. Each cycle, the eggs are punctured. They are then fertilized and frozen using vitrification technology to protect them from crystallization and preserve their molecular structure. After 4 cycles, reproductive specialists will have 4-5 embryos in the cryobank, which are implanted into the uterine cavity in the next cycle. With standard IVF, twice as many embryos are produced in just one cycle.

You need to know this

Most often, during a natural cycle, the ICSI method is used (read more about it). Replanting is done on the third day; very rarely five-day-old embryos are transferred. With this protocol, puncture is often done without the use of anesthesia. At the request of the patient, anesthesia can be used.

Repeated procedures will not bring serious complications. The number of protocols is unlimited. Many expectant mothers say that this method of artificial insemination is much easier to bear psychologically and physically, because the hormonal load is minimized. After the procedure there is no strong nagging pain in the lower abdomen.

At the dawn of its introduction, IVF was done exclusively in the natural cycle. Later, when hormonal ovarian stimulation technologies became available, doctors began to induce superovulation to increase productivity by collecting more oocytes per cycle. Nowadays, there is a tendency to move towards the original methods, in which the conditions for artificial fertilization should be more natural.

Duration

A very popular question among expectant mothers is related to the duration of the course. The duration will depend on the type of protocol selected. There are three duration options in total.

How long will IVF last:

The duration of the short protocol reaches 30 days. Stimulation from 10 to 14 days;
the duration of the long protocol is 45-53 days. Starts before the onset of menstruation. Hormonal stimulation of the ovaries lasts up to two weeks;
The natural protocol does not involve hormonal preparation of the ovaries. Therefore, IVF lasts on average 2 weeks. This is the time from puncture to confirmation of pregnancy. Sometimes, if a little stimulation is needed before the puncture, it may take another 6 days.

This is what the calendar looks like, instructions for IVF in a natural cycle.

Price

Another important point is the price. How much does IVF cost in a natural cycle if there is no hormonal stimulation? It is clear that it is cheaper than the usual protocol. The average for Moscow and St. Petersburg varies from 66900 to 91000 rubles. Many clinics give three attempts included in the price.

You need to understand that with a natural cycle, only 1-2 women out of 10 will be able to get pregnant. Therefore, additional funds should be included in the budget. A woman’s desire to minimize risks during the procedure is understandable, but if possible, it is better to do full-fledged IVF.

Self-preparation

In order to properly prepare for fertilization in the EC, you must know how to do it correctly. Simple rules will significantly increase the chances of a successful pregnancy. Both partners must undergo training - this is very important. Let’s take a closer look at what assistance the body can provide in the process of preparing for the protocol.

Nutrition

A woman should make her body as healthy as possible. The result can be achieved in several ways. Among these methods is a special diet. The diet should include more vegetables and fruits. It is convenient to prepare for artificial insemination in the summer season, when seasonal fruits and vegetables begin to be sold. Cherries have very few calories, which is useful for those who want to maintain their figure (64.3 kcal per 100 grams). These wonderful fruits contain a lot of vitamin C, A, PP (niacin), E, group of B vitamins of both types.

Another super useful berry for preparing for conception using IVF in a natural cycle is watermelon. Its pulp is also very low in calories, but very high in much-needed folic acid. This acid is the main active element in many medications for the treatment of female and male infertility.

Bad habits

Abstinence from alcohol and tobacco is mandatory. The body suffers greatly from these poisons. It has a very strong negative impact on the reproductive organs of both men and women. According to statistics, if a woman or man smokes or abuses alcohol during the preparatory period, the probability of pregnancy will decrease from 10 to 3%. You should pay special attention to this!

Physical exercise

An active lifestyle normalizes blood circulation in the pelvic organs. This is very useful for men (spermatogenesis improves). It is imperative to take into account that playing sports should not be exhausting. If you neglect this rule, you can get the opposite effect. Dancing, walks in the park or yoga are great for those preparing for IVF at the EC. Physical activity should not be done every day. It is enough to devote an hour to them several days a week.

By following these tips, you can quickly get your body's functioning in order, which will help you become more likely to get pregnant.

In vitro fertilization, carried out during natural cycles, does not involve the use of medications that promote the maturation of several follicles at the same time. In vitro fertilization is carried out in natural cycles only for those patients suffering from infertility who have maintained normal ovulatory cycles.

If a woman has fertile function, then every month her body forms one follicle with an egg ready for fertilization. If necessary, egg fertilization can be performed artificially.

At the same time, some women of reproductive age experience anovulatory cycles, in which the formation of a follicle with a mature egg does not occur. A small number of women are capable of releasing two or even three eggs each month instead of one.

At first glance, in vitro fertilization without stimulation is very easy to implement. To do this, you just need to take an egg, perform its in vitro fertilization, and then implant a mature embryo into the uterine cavity. It would seem that there is absolutely no need to use hormones that help stimulate ovulation. At the same time, women diagnosed with infertility would not be exposed to such risks as ovarian hyperstimulation, as well as the development of multiple pregnancies.

However, in fact, in this situation there are many nuances that are not entirely clear. And IVF without stimulation has both advantages and certain disadvantages.

1. A mature egg is a chance for success

Fertilization of an egg in vitro and the development of an embryo can be carried out successfully only if a mature egg is used. While inside the follicle, the egg matures at a certain point. If we are talking about a natural cycle, then this moment occurs after the maximum concentration of luteinizing hormone (LH). With artificial stimulation of ovulation, the maturation of the egg occurs after the administration of an ovulatory dose of human chorionic gonadotropin, for example, prophase, pregnyl, choragon. The follicle is collected 36 hours after ovulation was stimulated by hCG.

Performing in vitro fertilization without stimulation is a very delicate job that requires a doctor to have enormous knowledge and experience. Early administration of an ovulatory dose of hCG is fraught with a decrease in the quality of the egg. Being late with the injection may cause the puncture to be performed after ovulation. Doctors will be able to notice that the follicle is ruptured only with the help of an ultrasound, which is performed before the puncture. Rupture of the follicle means that the puncture should be canceled, which means waiting for the next cycle.

It occasionally happens that no egg is found in the fluid obtained during puncture. As a rule, such a situation develops very rarely, which is facilitated by timely ultrasound monitoring of the follicle.

2. Fertilization of the egg - to be or not to be?

Fertilization of the egg, unfortunately, does not always occur. In vitro fertilization, carried out in stimulated cycles, ends unsuccessfully in almost every second case. 40% of eggs are not fertilized.

Success at this stage is largely determined by the quality of the egg itself. If it is high, then the chances of obtaining a viable embryo will also be high.

However, a good sperm analysis is not a guarantee that the quality of the resulting embryo during ICSI will improve significantly. With ICSI, success can be achieved even when the man’s spermogram is not very good.

Of course, success largely depends on what equipment is used when performing in vitro fertilization, what media are used, as well as on the professionalism of the doctor.

3. Embryo transfer

Regardless of which cycle in vitro fertilization is performed, this stage is performed in the same way. If it is planned to transplant only one embryo, then, as a rule, it is not brought to the blastocyst stage, but a two- or three-day embryo is transplanted.

4. Medication support – is it necessary?

If in vitro fertilization is performed without stimulation, then the prescription of drug support is considered inappropriate. This usually does not affect the results of implantation. But psychological support will never be superfluous.

5. Blood test for hCG

The analysis is performed in the same way as with the standard procedure, on the 12th day after the transfer.

6. Success of the procedure.

The success of in vitro fertilization, carried out without stimulation, has the following indicators: when taking into account the begun cycle - 7%, when taking into account the already performed embryo transfer - 16%.
The higher the quality of the transplanted embryo, the greater the chances of success. But how much higher they are - there are no exact statistics.

7. Financial costs

Fertility clinics consider the basis for receiving payment for in vitro fertilization to be a good quality embryo. If the puncture was canceled, for example, due to ovulation having already taken place, then the patient will only need to pay for the ultrasound procedure (about 300 rubles for each study, as a rule, there are several of them).

If after the puncture the egg was not found, then you will be charged only for the puncture itself (about 4,500 rubles).

If fertilization of the egg does not occur, or division of the embryo is not noted, then the patient will need to pay for the procedure in full. They will only deduct the cost of embryo transfer, which is approximately 4000-4500 rubles.

As a rule, fertility clinics do not make much difference in price between in vitro fertilization without stimulation or in vitro fertilization with stimulated cycles. The only exception is the cost of medications that are used to stimulate ovulation. On average, the in vitro fertilization procedure costs patients from 20,000 to 45,000 rubles.
It is not entirely clear what explains this price equalization. Since during natural cycles only one egg is transplanted, doctors use a smaller amount of special media, and less time is also spent on performing all manipulations.

True, there are exceptions. Some fertility clinics offer completely different prices for in vitro fertilization without stimulation. If ICSI is performed on a single egg, the cost of the procedure can be much lower.

8. Deadlines.

When performing IVF without stimulation, the number of visits to fertility clinics may be 1-2 less.

9. Emotional stress

Patients note that when performing the in vitro fertilization procedure without stimulation, emotional stress is significantly less.
The reason is that the woman subconsciously expects less from this particular attempt; the fact that no hormonal medicinal effects on the body were performed during the procedure is of no small importance. But in any case, the level of these experiences can be very individual.

10. If there are several attempts

Carrying out the in vitro fertilization procedure without stimulation is fraught with a large number of attempts until one of them ends in pregnancy. With IVF with ovulation stimulation, success may occur earlier.
It is impossible to make accurate calculations for each couple, each situation is very individual, the quality of the resulting embryos depends on how the body works.

Therefore, the cost of IVF without stimulation may be higher than for a procedure using stimulation, but the final amount depends on the pricing policy of a particular infertility clinic.

11. IVF in natural cycles. How do Russian reproductive doctors feel about him?

What is the attitude of reproductive specialists in our country towards the IVF procedure without stimulation? After interviewing more than 20 of them, we found out that almost all of them were very skeptical.
Many of them are confident that with the help of in vitro fertilization with stimulation, pregnancy can be achieved much faster. In addition, reproductive specialists are convinced that the procedure without stimulation is more expensive for patients than the standard IVF procedure. True, none of them made special calculations. Some doctors have never had to deal with the procedure of in vitro fertilization without stimulation in practice.

Those same specialists who have quite a solid experience in performing IVF without stimulation are confident that the effectiveness of this procedure is high only when it is possible to obtain a high-quality embryo. At the same time, with in vitro fertilization with stimulation, there is the possibility of choosing from several embryos, which determines higher chances of success.

12. The reason for the lack of love for IVF in natural cycles

There are several reasons for this. Firstly, IVF without stimulation is less effective, especially for the first attempt. This reduces the performance of not only the fertility doctor himself, but also the infertility treatment center where in vitro fertilization is performed.
The second reason is the higher complexity of performing the in vitro fertilization procedure without stimulation. In order to increase the chances of success, you should very carefully calculate the moment required for the injection of hCG. The further a patient lives from a fertility clinic, the more difficult it is to determine the right time.

The third reason is misunderstanding between the doctor and the patient. Reproduction specialists tend to believe that a woman suffering from infertility wants to have a child as quickly as possible. In fact, this is not always the case; for example, young patients may well wait for a more convenient moment.
If you prefer in vitro fertilization without stimulation, do not expect your doctor to figure it out on his own. Explain your wishes, tell them that you agree to wait.

13. IVF in natural cycles. Who is it shown to?

The success of in vitro fertilization without stimulation is due, firstly, to the high quality of the egg. In fact, this procedure is very often recommended for those couples who are tired of fruitless attempts at IVF with stimulation. As a rule, the cause of failure was a “poor” response of the ovaries to the procedure for stimulating ovulation, which resulted in the maturation of a small number of follicles.

What is often not taken into account is the fact that the chance of obtaining a high quality egg is very low. In vitro fertilization without stimulation is best used for healthy patients whose causes of infertility are, for example, the absence of tubes, or for male infertility. For such a woman, pregnancy can occur after the first embryo transfer.

14.What is the difference between the two IVF procedures?

All this time we have been talking about a procedure in which no medications are used. The exception is hCG preparations, the use of which is mandatory for normal follicle maturation, as well as for determining the moment of puncture.
Today, however, many doctors in the process of in vitro fertilization without stimulation use drugs in small doses to stimulate the maturation of not one, but several follicles.

As a result, there is no clear division between in vitro fertilization without stimulation and IVF with stimulation, since stimulation is used everywhere, only its intensity differs. This boundary becomes even more precarious if GnRH antagonists, such as cetrotide or orhalutran, are used.

Speaking about “gentle” stimulation, reproductive specialists talk about ovulation stimulation, which is achieved with the help of small doses of medications that promote the maturation of a maximum of 7-8 follicles.

15. IVF in natural cycles. Development prospects

When carrying out the in vitro fertilization procedure without stimulation, it is not always possible to obtain a mature egg. This is one of the main reasons for the low effectiveness of this method.
If techniques aimed at maturation and in vitro fertilization of the egg are further developed, IVF without stimulation will become more effective.

Conclusion.

Meanwhile, modern reproductology began precisely with in vitro fertilization without stimulation. Patients have great confidence in this procedure because after it there are no complications, and there are no negative sensations during all manipulations.
Fertility doctors strive to minimize possible complications and risks that may arise during or after treatment.
This is already becoming a global trend. Thanks to this, in vitro fertilization without stimulation may well regain its former popularity.