In vitro fertilization, or IVF, is surrounded by many myths and prejudices. Someone considers it a panacea and salvation for many couples, but for some it is a way against nature. What is IVF really?

ECO

V last years infertility has become a serious problem. The number of families without children is growing. And, if earlier most of the pathologies accounted for women, now men's diseases account for 40-45%. Not uncommon and incompatibility of partners for an unexplained reason.

The frequency of ectopic pregnancies is growing, and after the removal of the fallopian tubes, there is no need to talk about independent conception. And if earlier in most cases it was impossible to solve the problem of infertility, today in vitro fertilization has come to the aid of doctors and patients.

The essence of IVF is to puncture the ovaries to take mature eggs and fertilize them with sperm. Embryos are cultured on a specific medium and after 3-5 days are transplanted into the uterine cavity. The continued success of IVF depends on whether they take root there.

In vitro fertilization is an expensive procedure. But that's not what stops some women. Many are afraid that it will harm their body or future children. Is it really?

The dangers of in vitro fertilization

To understand what negative consequences of IVF can lie in wait for a future mother and children, it is necessary to have a good understanding of the technology of the procedure.

First of all, hormonal stimulation of the ovaries is performed. This is done so that several eggs mature and, accordingly, the chances of success increase. Often, before starting stimulation, it is necessary to suppress the own ovarian function with medication.

After the maturation of germ cells, the ovaries are punctured, and fertilization occurs "in vitro". Partner sperm can be obtained both naturally and during testicular puncture.

In some cases, before the transfer of embryos into the uterine cavity, pre-implantation diagnostics is performed to identify possible chromosomal abnormalities. This is true if the woman is over 35 years old, the family has children with genetic diseases, or frequent miscarriages have previously been observed.

After the embryo transfer, the woman is under the supervision of doctors to control engraftment. If this process went without complications, in the future, the course of pregnancy practically does not differ from the usual one.

However, since the procedure is an invasive intervention in the female body, the consequences of IVF can sometimes be observed. Most often it is:

1. Side effects of hormone therapy.
2. Ovarian hyperstimulation syndrome.
3. Multiple pregnancy and related problems.
4. Ectopic pregnancy.
5. heterotopic pregnancy.
6. Malformations of the fetus.

Side effects of hormone therapy

Since the ovaries can only be stimulated with hormones, there is a risk of side effects and complications from such an intervention. Depending on the specific cause of infertility, in vitro fertilization can be performed using a long or short protocol.

In the first case, they first suppress their own ovarian function, and then stimulate superovulation. For suppression, Buserelin or Diferelin are usually used. These are blockers of the gonadotropic function of the pituitary gland. Against the background of their intake, the production of luteinizing and follicle-stimulating hormones completely stops.

However, these drugs can cause the following unpleasant symptoms:

• Dizziness and headaches, emotional lability, fatigue, depression.
• Tinnitus, hearing loss, visual impairment.
• Menstrual bleeding.
• Decreased sex drive, vaginal dryness, pain or discomfort during sex.
• Raise blood pressure, tachycardia, pain in the heart.
• Decreased appetite, nausea or vomiting, disruption of the intestines.
• An increase in blood sugar levels, a violation of lipid metabolism.
• allergic reactions, bronchospasm, pruritus, anaphylactic shock.
• Obesity or, conversely, weight loss.

Of course, all the unpleasant consequences of IVF do not happen at the same time and are not observed in all women. However, they should be known before starting the protocol.

In the second phase of the long protocol, as in the short protocol, ovarian stimulation is performed.

Ovarian stimulation

Stimulation of the ovaries is carried out by gonadotropins. The most commonly used drugs are Pregnyl and Puregon. Under their action, the growth of follicles and the maturation of eggs in them begins. Against the background of the use of these drugs, the following side effects may develop:

1. Obesity.
2. Abdominal pain.
3. Nausea and diarrhea, bloating.
4. Enlargement and soreness of the mammary glands.
5. Formation of cysts in the ovaries.
6. Thromboembolism.
7. Accumulation of fluid in the chest and abdomen - hydrothorax and ascites.

All these consequences of IVF are a manifestation of ovarian hyperstimulation syndrome.

ovarian hyperstimulation syndrome

Without ovarian hyperstimulation, it is impossible to get multiple mature eggs at ovulation. However, this procedure is fraught with the development of health complications, since interference with hormonal metabolism rarely goes unnoticed for the body.

Ovarian hyperstimulation syndrome develops when their activation becomes excessive. And it harms all organs and systems.

First of all, the changes affect the ovaries themselves. Their plethora, puffiness, increase in volume and morbidity are noted. In addition, in laboratory tests, signs of blood clotting can be noticed.

Because of this, the work of the urinary system is disrupted, it becomes difficult for the kidneys to excrete urine, the fluid begins to accumulate in the body cavities. Ascites and hydrothorax develop, which leads to malfunctions of the digestive and respiratory systems.

Ovarian hyperstimulation syndrome can occur in three forms:

• light;
• moderate;
• severe.

Light form

In this situation, the general well-being of the patient does not particularly suffer. She may complain of pain in the lower abdomen of a aching or pulling nature that resembles premenstrual syndrome.

Sometimes there are dyspeptic disorders - nausea and vomiting, loss of appetite, diarrhea. The expectant mother may feel fatigue, drowsiness or irritability.

As a rule, with a mild form of ovarian hyperstimulation syndrome, the protocol is not interrupted and additional drug treatment is not prescribed to the patient. Doctors recommend only bed rest and medical supervision.

Moderate form

In the moderate form, the symptoms become more pronounced. A woman not only complains of pain, she may feel enlarged ovaries, discomfort in the abdominal cavity. General well-being suffers, sometimes there is an increase in temperature to subfebrile figures.

The moderate form often requires hospitalization in the gynecological department for constant medical supervision, because ovarian hyperstimulation syndrome can progress.

Severe form

The severe form of the syndrome is a real hormonal storm in the female body. If the expectant mother is not hospitalized and intensive treatment is not started, the situation can worsen significantly.

The woman has a fever, respiratory failure due to the accumulation of fluid in the chest. Later, a violation of the kidneys and renal failure joins.

Fluid in the abdominal cavity is called ascites and compresses internal organs, disrupts the liver, impedes normal blood circulation, interferes with breathing.

In severe form, hemorrhages in the ovarian region, volvulus of the appendage, and thromboembolic complications often occur.

Treatment should be started as early as possible and always in a hospital setting.

Multiple pregnancy

If only one egg was fertilized in in vitro fertilization, the chances of success would be greatly reduced. That is why it is so important to get several germ cells and embryos. But often all embryos take root. In order to avoid pregnancy with four, five or more fetuses, many clinics expectant mother transfer no more than three embryos.

This leads to an increased risk multiple pregnancy. It is with IVF and ovarian stimulation for the treatment of infertility that the increase in the number of twins and three in recent years is associated.

But a few kids aren't so bad. Why is this fact dangerous for a woman's health?

Consequences of multiple pregnancy

If two children often meet during natural pregnancy, then triplets, as a rule, become a completely unexpected surprise for expectant parents.

In this situation, the load on the female body increases significantly, the consumption of vitamins and microelements such as calcium and iron increases. Often, a woman's chronic diseases worsen, her spine suffers.

When there are two or three embryos, the risk increases premature birth, it is not always possible to carry a pregnancy to at least 38 weeks. In addition, children are born small. They are at increased risk various diseases and adjustment problems due to prematurity.

In multiple pregnancies, delivery is usually by caesarean section.

There is another serious complication in the case of two and three children - the uneven development of the fetus. This is most often seen in triplets. One of the children may grow much more slowly, or he may have gross defects. This creates a danger for the normal development of the remaining embryos.

In such a situation, doctors offer future parents a reduction - a reduction in the number of fetuses. However, this operation, although designed to reduce the risk of complications for a woman, is a real test for her. It is practically impossible to calmly agree to the death of even one embryo, especially when the pregnancy is desired and long-awaited.

In the case of four or five fetuses, reduction is suggested to increase the chances of survival of the remaining children, since preterm births almost always occur in this case.

Ectopic pregnancy

Though ectopic pregnancy traditionally associated with natural conception, it also occurs with in vitro fertilization. The risk of this pathology especially increases after the removal of the fallopian tubes and the formation of a stump. Often, this is where the embryo can attach.

Before the tube ruptures, an ectopic pregnancy can be suspected by pain in the right or left side, in the lower abdomen. It can be both a feeling of discomfort and a pronounced pain syndrome. When conducting ultrasound the fetal egg is not visible in the uterine cavity, but an expanded tube is sometimes found.

If the doctor prescribes monitoring of chorionic gonadotropin, its level will be lower than with normal pregnancy, and the increase does not correspond to the gestational age.

The rupture of the tube is accompanied by severe pain, bleeding into the abdominal cavity. In this case, the woman may lose consciousness. This is a life-threatening condition that requires immediate hospitalization and surgical intervention.

heterotopic pregnancy

If ectopic pregnancy occurs more often during natural conception, then heterotopic pregnancy is typical just for in vitro fertilization.

This is the attachment of embryos in the uterine cavity and beyond, that is, a simultaneous uterine and ectopic pregnancy.

The heterotopic arrangement of the fetuses is a rare phenomenon, such a pathology is associated precisely with IVF, since in this case several embryos are planted. The likelihood of heterotopia increases if the patient has a history of chronic inflammatory diseases of the pelvic organs, adhesions, partial or complete obstruction of the fallopian tubes.

A previous ectopic pregnancy also increases the risk of a heterotopic location of the fetus, especially if the tube was not removed, but only partially excised, or a too long stump was formed.

Fetal malformations

Some doctors say that with in vitro fertilization, the number of children with malformations increases - splitting of the lip and palate, and other anomalies. This is also evidenced by the statistics. However, it is not possible to find out which factor leads to such pathologies. Moreover, it is impossible to say for sure that it is IVF that is to blame for the violation of fetal development.

With regard to chromosomal anomalies - Down syndrome, Edwards, Patau - a different situation develops. These genetic breakdowns are no more common in in vitro fertilization than in natural conception. But it is with IVF that it is possible to carry out pre-implantation diagnostics - the determination of the fetal karyotype. If a trisomy or other problem is detected, such an embryo will not be placed in the uterine cavity.

Pre-implantation diagnosis is also important for those couples who are carriers of genes for dangerous diseases and syndromes. The probability of having children with a chromosomal pathology is significantly increased. In this case, IVF with diagnostics is preferable for them over natural conception, even if the partners do not have reproductive health problems.

In vitro fertilization is currently the salvation for many infertile couples. However, it should not be forgotten that this is a serious medical procedure, and you need to be very careful when choosing a clinic and a reproductologist.

Couples dealing with infertility are well aware of what IVF is. According to worldwide statistics, about 25% of spouses planning the birth of children experience difficulty conceiving. In vitro fertilization gives partners the opportunity to have children even in the most hopeless situations.

ECO: what is it?

IVF is an abbreviation that stands for two words: in vitro fertilization, that is, in vitro fertilization. This effective method treatment of infertility in gynecology. Reproductive assistive technology has been used relatively recently. for a woman was carried out about 40 years ago. As a result, the Englishwoman Louise Brown was born. Over these decades, more than four million IVF children have been born in the world.

The IVF procedure involves the fusion of a sperm cell with an egg outside the woman's body. Special preparation is preliminarily carried out, the doctor selects its scheme based on existing health problems. Artificial insemination is considered a complex high-tech medical manipulation that requires the participation of doctors and compliance with all instructions of reproductologists.

"IVF baby" Louise Brown recently became a mother herself.

Women

WOMEN

First of all, you need to identify your ovarian reserve. This is a genetically laid down supply of eggs in the ovaries of a woman in the absence of pathophysiological changes in her reproductive system. Unfortunately, ovarian reserve decreases with age. Also leads to its decrease: operations on the ovaries, radiation exposure, antitumor chemotherapy. It is checked by the level of hormones AMH, inhibin B, FSH. Or in the first days of the menstrual cycle, you can count the number of antral follicles.

It is important to prepare the uterine cavity. The operation is done according to personal indications, if a woman has pathologies of the uterine cavity, such as synechiae or polyps, they must be removed before starting IVF. Also, hydrosalpinx, a fluid that accumulates in the fallopian tubes, negatively affects the effectiveness of the program, since this fluid has an embryotoxic effect. Treatment of this pathology should be carried out before the start of the IVF procedure.

You need to check the smear for the absence of infections. Give a smear for bacterial flora. According to the results, the doctor can prescribe treatment and hormonal examination. At best, do a complete examination so that if there are infections or a violation hormonal background correct this before starting the in vitro fertilization stages.

HORMONES WHICH SHOULD BE CHECKED FOR A WOMAN:

US RESEARCH MUST BE DONE TWICE PER CYCLE TO DETECT PATHOLOGIES.

As soon as you have passed all the examinations, fully prepared, the start of entering the IVF procedure takes place. 7-10 days before the start of the menstrual cycle, make an appointment with your doctor. You should have a pelvic ultrasound, assess the condition of the ovaries, the thickness of the uterine mucosa. At the end of all examinations, your attending physician should have a complete picture of your health, as well as the health of your spouse. For each patient, a personal card is created, which indicates the patient's state of health, the entire treatment regimen, drug dosages, and the dates of each subsequent visit.

On day 3-5 of the cycle:

FSH. This is a very important indicator. A set of drugs for further stimulation of a woman depends on its level;

For 3-4 days:

On any day of the cycle:

Prolactin

3-8 days of the cycle:

Estradiol

Androgens

On any day of the cycle:

thyroid hormones

men

DESCRIPTION OF PREPARATION FOR IVF STAGES MAN

The man must submit spermogram- This is an analysis of seminal fluid that determines the reproductive ability of a man. There is an opportunity to pass this analysis in our clinic. This analysis is done before the first stage of IVF, as the process of passing a spermogram is quite simple. Sperm is donated by ejaculation at the clinic on the day of its test. For this, the clinic has a special comfortable room, a special container is issued free of charge. If a man experiences discomfort and is not sure about the positive outcome of ejaculation in the clinic, it is allowed to do this at home. To do this, you need to buy a container specially designed for this at the pharmacy. After collecting the sperm within two hours, it is necessary to bring the seminal fluid for analysis.

Spermogram allows you to establish the fertility of a man, to identify existing diseases of the reproductive system. If, according to the results of the analysis, deviations from the norm of the spermogram are found, then a consultation with an andrologist is necessary in order to understand whether it is possible to correct the violations with which they are associated. Other medical problems are possible, such as genetic defects on the Y chromosome.

Such defects are sometimes the cause of male infertility. Men with a congenital absence of the channels through which sperm exits the testicles - the vas deferens - often men with this defect are carriers of the disease cystic fibrosis. If this problem is found, genetic testing should be performed.

Also, a man must pass a swab from the urethra. This analysis reveals diseases such as prostatitis, urethritis, sexually transmitted diseases. Full list analyzes you can find out in the article "Preparing for IVF: tests that need to be passed" . You should be tested for infections and latent infections (TORCH infections).

I WOULD LIKE TO REMIND THAT TO OBTAIN THE CORRECT RESULT YOU SHOULD OBSERVE THE FOLLOWING RULES:

Refrain from sexual intercourse. Optimal - 4 days.

Eliminate alcoholic beverages, sleeping pills and sedatives during this period.

Avoid visiting saunas, baths, hot baths.

BELOW WE PROVIDE THE EXECUTION OF THE CONCLUSIONS spermograms

		Normospermia (normozoospemia).	Sperm parameters are normal.
		Polyspermy.	Increased amount of ejaculate produced.

How to decide on IVF and stop being afraid?

Nature has endowed a woman with an excellent ability to bear children. But what if, for some reason, the long-awaited pregnancy did not occur? Most women seek help from specialists who, as a result, advise them to undergo artificial insemination.
But how to decide on IVF and overcome various concerns about this?

Do IVF? Myths and misconceptions

There are several misconceptions about this procedure that arise due to incompetence.
Let's dwell on the main ones.

1. This is very painful and dangerous.

In fact, this procedure lasts less than an hour and is performed under anesthesia. So pain basically excluded. Also, you should not be afraid of any complications, as experienced and competent specialists will be with you all the time.

1. IVF can be performed regardless of the woman's age.

It is believed that every woman has a certain number of eggs in her body. Childbearing age, of course, is determined individually in each case, but it is advisable to adhere to general indicators. From the age of 27, it gradually begins to deteriorate. Therefore, when thinking about whether to do IVF, one must remember that it is up to this age that the effectiveness of such a procedure will be much higher.

1. Artificial insemination is always the cause of multiple pregnancies.

This statement is also not entirely true. The fact is that with this procedure, the likelihood of having several children increases, but this does not mean at all that this will definitely happen. Such a process depends on many factors, and in one case several embryos can take root, and in another none.

1. IVF is performed as an independent one-time procedure.

This is not so, because the entire preparation period for such an operation is about 3 weeks. At the first stage, a woman is prescribed hormonal agents that stimulate the active work of the eggs, after which several of them are fertilized in the laboratory and after some time injected into the uterine cavity.

IVF: pros and cons

Disadvantages of IVF

All those who are thinking about whether to do IVF are most afraid of the negative aspects of this procedure. So, how does this manifest itself?

The main side effect that can happen during in vitro fertilization is. In addition, as a result of taking medications, the functions of the gastrointestinal tract, liver, or allergic reactions may occur. Sometimes doctors have to, which can then adversely affect pregnancy and cause miscarriage. Also, during the time of the female body, bleeding may occur or an infection may enter the uterine cavity. Another complication that can occur during IVF is an unsuccessful embryo transfer, and as a result,.

Among other shortcomings, one can single out the severe psychological state of a woman during this period, which consists in prolonged tension and anxiety, which in some cases can lead to neurosis, psychosis and other similar mental disorders. And of course, the big disadvantage is that such a procedure is very expensive, and not every couple can afford it.

IVF Benefits

The IVF procedure, for and against which there are many opinions and judgments, still has more pluses than minuses. After all, do not forget about the most important thing, for the sake of which this action takes place - about a small creature that will definitely appear, if you believe in it. And do not worry about the possible occurrence in the unborn baby congenital pathologies or abnormal conditions - this procedure does not affect this in any way.

In addition, artificial insemination allows you to bear a child even with sick people and with male infertility. The effectiveness of such a procedure has long been proven, therefore it is also an indisputable plus.

Contraindications to the artificial insemination procedure

It may also happen that, having considered a variant of the IVF protocol, for and against which you have formed different opinions, and came to the conclusion that it is still worth deciding on it, the specialist suddenly puts forward restrictions. It is better to foresee this in advance.

So, the contraindications for in vitro fertilization include the following:

• various inflammatory processes in the body;
• ovarian tumors of any nature (malignant or benign);
• serious diseases of the cardiovascular system;
• some kidney disease;
• oncological diseases;
• mental disorders.

Is it worth doing IVF? Correct mental attitude

Of course, whether IVF is worth doing or not is up to you. But, in any case, why not use the chance that nature did not give, but fate gave?

To make the right decision, just try to distract yourself from various stressful situations and other problems. For example, at work, you can take a vacation and allow yourself to spend as much time as possible in a pleasant and relaxing environment. You can walk and breathe the sea air, because it perfectly helps to shed excess negativity and find harmony with yourself. Feel how important it is to realize yourself as a mother, and what you are ready to do for the sake of your unborn baby. So the right decision will come by itself.

And if you, thinking about whether to do IVF, nevertheless came to a positive conclusion, you should not be afraid that you will be condemned by relatives or friends for agreeing to such an operation. You can only get support and understanding from them, because they love you, which means they are always on your side! If you have a fear of a possible one, remember that the percentage of successful pregnancy after artificial insemination is very high, because it is not for nothing that it is considered so effective!

Thus, we have considered the possible pros and cons of in vitro fertilization, as well as the most common misconceptions about this procedure. But how to decide on IVF, there is no clear recipe, since each woman must determine the significance of this protocol for herself.

How to prepare for IVF for a woman and a man?

How to prepare for IVF and where to start? To begin with, it is worth realizing the fact that it is necessary to do artificial insemination. This will take time. How many? For each couple - individually. This will be the first point of preparation.

In addition, you need to answer for yourself a lot of questions:

• How ? For many, the decision is difficult. We'll have to weigh the pros and cons.

• Is the man ready for such a turn? As practice shows, the male population needs more time to realize and make a decision.

• Will your husband be with you from the beginning to the desired result?

• Will you let your relatives know about it? The attitude towards in vitro fertilization in relatives may differ from your opinion.

• Who will be your support? The path ahead is not easy and long: preparation, if necessary, treatment (sometimes surgery), a lot of manipulations and procedures. Not necessarily the first attempt will bring the result. Sometimes women have to go through and survive 4 or more attempts. It will not necessarily be so for you. But it is better to be prepared for spontaneous abortion. Despite the fact that doctors are prudent about multiple pregnancy, it still happens with IVF. Carrying twins or triplets is more difficult.

• Does your budget, worldview and religion allow artificial insemination?

• How far are you willing to go? Do you accept artificial insemination with donor germ cells (sperm or egg), surrogate motherhood?

• Need to know a doctor? In the question: "How to prepare for IVF?" is the key point. Will you do the procedure in hometown Or even in another country? The decision depends on the appearance of an additional expense item (travel, accommodation) and the need to painlessly take a vacation or time off. Frequent visits to the clinic should be combined with work. For out-of-town and busy people, clinics develop examination programs in one day, but this is not enough. Repeated laboratory control, ultrasound, adjustment of appointments, surgical manipulations (,), ultrasound - this is all important and takes time and effort. In addition, the degree of qualification of the doctor and his experience in working with certain pathologies in the female genital area are very important.

When choosing a clinic, the equipment of the laboratory is important, the availability of certification for such procedures as,. These procedures are not carried out for everyone, but the need for them may arise.

Most likely, you will not only have these questions. You will become a frequent visitor to forums about artificial insemination. But it is better not to try on the examples considered there for yourself. Artificial insemination has many deep technical features, so the forum does not know exactly how in vitro fertilization will take place specifically for you and how to properly prepare for IVF for your couple. And only a doctor will know who needs to be trusted and listen to his recommendations!

It is true that all this will require a supply of health, strength and spiritual strength. Do not rush to take before going to the chosen reproductive clinic. There you will be strongly advised to be examined only by them. This approach is for a number of reasons. One of them is the responsibility for conducting and the reliability of the results. By becoming a client of the reproductive center, from now on you will share responsibility for success or failure along with.

The best thing that can be done is to collect all your analyzes, conclusions, epicrises, extracts, arrange them in chronological order and take them to the first consultation. The doctor will study them, ask questions about them.

How to prepare for IVF for a woman? Nutrition and lifestyle

A woman needs to adjust her habits and start eating the “right” food as early as possible.

• Convert weight to physiological number. Just go on a diet the best way. In nutrition, exclude fatty, fried foods and foods with easily digestible carbohydrates. Form a diet for yourself full of vitamins, useful substances, trace elements. It is necessary to limit the amount of salt consumed. Women with a body mass index less than normal are more likely to need to gain weight. You only need to do this after a visit to a reproductive specialist (if your doctor deems it necessary).

• Choose for yourself the most optimal physical activity or activity in the form of walks. The way of life should now become moderate. If you work hard in the gym - gradually reduce the load on the body, especially on the abdominal muscles.

• Make an effort to prevent a respiratory viral infection.

• Do not abuse bioadditives and vitamin complexes. It's best not to take them at all. - this is the maximum that you can afford to prepare for IVF on your own without a doctor's recommendation.

• If you know about the existence of any chronic diseases, you will need to tell the doctor about them at the consultation. You do not need to treat them yourself or follow the recommendations of the local doctor. At the clinic, you will be examined by a therapist who knows what medications can be prescribed before preparing for artificial insemination.

• Learn the tricks positive thinking and practice them daily. This will help to overcome difficulties and prepare mentally.
• Avoid overheating/hypothermia.

• Say goodbye to tobacco, coffee - now they are not the best companions on your way.

• Sexual contacts before entering the protocol are not limited. At the beginning of the preparatory period, the clinic will give recommendations on this matter.

If reversible changes occur in the reproductive system. It is enough for a husband to give up unhealthy food, bad habits for 2–3 months (a full cycle of spermatogenesis), and the sperm reserve will be updated.

• Avoid overheating. It is advisable to exclude visits to baths and saunas. Normal maturation of spermatozoa is possible only at a temperature of 34 ° C. Limit the movement behind the wheel of a car. Since, in addition to overheating, stagnation occurs in the inguinal region, leading to sperm thickening.

• Physical activity should be present, but it is undesirable to allow super-strong loads. With sedentary work, walking up to 5 km daily will be optimal.

• Avoid wearing tight and tight underwear. Although there is no sound scientific data on the effect of tight swimming trunks on the process of maturation of spermatozoa, it is desirable to remove all alleged negative influences when preparing for IVF.

• Sexual contacts before entering the IVF cycle on average once every three days. Before passing the spermogram and sperm on the day of the puncture, this is the “golden” rule.

Stages of preparation for IVF.