What to do before and after artificial insemination

Unfortunately, many couples of reproductive age are faced with the problem of infertility these days. As you know, infertility is a consequence of any disease that is currently present in the body or was previously present. Therefore, to eliminate infertility, a couple must undergo a series of examinations to help identify the cause of this condition. Based on the results of the examination, the attending physician will prescribe measures to eliminate infertility, which include stimulation of ovulation with an injection of hCG.

When is ovulation stimulation indicated?

Stimulation of ovulation is one of the methods for eliminating infertility. It can be indicated for regular anovulatory cycles, as well as when performing assisted reproductive technologies.

Stimulation of ovulation can be carried out for conception in a natural way, with artificial insemination, as well as during in vitro fertilization. Before ovulation stimulation, the couple must undergo examinations to identify the causes of infertility. Since problems with the reproductive system can affect both women and men, both partners are examined. During diagnosis, the causes of anovulatory cycles can be identified, which can be sufficiently eliminated to restore natural ovulation (endocrine system disorders, inflammatory or infectious diseases, etc.). It is also important to check the “capacity” of male reproductive cells. Sometimes pregnancy may not occur not only due to anovulatory cycles, but also due to impaired spermatogenesis.

To detect anovulation, a woman will be prescribed the following tests over several cycles:

• measurement of basal temperature;
• ultrasound examinations;
• blood tests for hormone levels.

Without normalizing the level of prolactin, thyroid hormones, and male sex hormones, ovulation stimulation is not carried out.

HCG: role in the body

The main function of hCG is a signal that a woman’s body needs to be rebuilt in connection with the onset of pregnancy. It affects sex hormones, activates increased production of estradiol, progesterone and estriol, which change the hormonal background of the expectant mother. By monitoring the activity of hCG, you can assess how the fetus is developing and what the likelihood of miscarriage is.

Human chorionic gonadotropin (hCG) from day 1

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Starting from week 7, gonadotropin is responsible for the development of the corpus luteum, maintaining its functionality. There is an assumption that it suppresses the mother's immune system, due to which the fetus is not rejected.

Reference! The pregnancy test strip is based on a method for assessing the level of human chorionic gonadotropin in the blood. But in this case, the material being studied is urine, and in it the concentration of the hormone increases more slowly. Therefore, if a blood test can detect pregnancy on the second day after fertilization, the test can do this only after 7 days.

Stimulation of ovulation with hCG injection

Stimulation of ovulation begins with non-steroidal antiestrogens or gonadotropic drugs. The choice of drug will depend on the method of eliminating infertility during which stimulation occurs. On average, drugs are prescribed for up to 12 days. This will depend on the response of the ovaries to the therapy. During the period of ovulation stimulation, to monitor the growth of follicles, the woman will undergo an ultrasound scan every 3-4 days until the follicles reach the required size of 18-20 mm.

Next, the patient is prescribed an hCG injection. HCG completes the process of follicle maturation and “turns on” the mechanisms of ovulation. HCG also prevents regression of follicles and the appearance of follicular cysts, which can form due to non-opening of a mature follicle.

After an HCG injection, ovulation occurs within 24-36 hours. Next, the patient is assigned a schedule of sexual intercourse (in the case of natural fertilization), insemination, or a date for ovarian puncture (in the case of IVF).

How does hCG increase during an ectopic pregnancy?

The level of the hormone gradually increases in the first period after conception. The fertilized egg, regardless of where it is attached to the tube, ovary or abdominal cavity, develops for some time. Therefore, hCG levels during an ectopic pregnancy are within normal limits for the first few days or weeks.

The problem can only be tracked by measuring the level of gonadotropin from 7-8 weeks, because the dynamics of its increase will be much lower, which will allow one to distinguish normal fetal development from pathology. Gynecologists have established a number of specific standards, on the basis of which the level of the hormone is determined. Any deviation from the derived values ​​indicates that some pathological process is developing in the pregnant woman’s body.

As already mentioned, initially an ectopic pregnancy proceeds in the same way as a normal one. Moreover, it will not be possible to determine exactly where the egg has attached based on the amount of the hormone in the blood. But in order to exclude the possibility of this pathology closer to the 12th week, when gonadotropin levels already deviate greatly from the norm, the doctor prescribes repeated tests.

Artificial insemination

Artificial insemination is the intrauterine injection of sperm from a partner or donor to achieve pregnancy. Artificial insemination, in most cases, is performed on women with immunological infertility, when the secretion of the cervical canal contains antisperm antibodies that destroy sperm. Also, artificial insemination can be performed on women without a husband or partner who decide to have a child. The artificial insemination procedure can be carried out with stimulation of ovulation and in the natural cycle.

Analysis for hCG in non-pregnant women

The level of human chorionic gonadotropin can increase in the body of non-pregnant women with the development of the following pathologies or physiological conditions:

1. Tumors in internal organs.
2. Neoplasms or other pathologies of the ovaries.
3. Tumors of the uterus.
4. Hydatidiform mole is a pathological pregnancy.
5. A tumor that occurs when the chorionic epithelium becomes malignant.
6. Miscarriage or abortion less than a week ago.
7. Use of hormonal medications that contain gonadotropin. As a rule, they are prescribed at the preparatory stage before IVF.
8. Childbirth - After childbirth, gonadotropin levels remain elevated for approximately 7 days. After which it gradually decreases and reaches 5 mU/ml.
9. Menopause - after the final cessation of menstrual bleeding, hCG can increase to 14 mU/ml, which is a normal value for a woman during this period.

In Vitro Fertilization

When performing in vitro fertilization, ovulation stimulation is carried out to obtain the maximum number of mature eggs. This process is called superovulation. There are several methods (protocols) for IVF. However, any of them use gonadotropic drugs that stimulate the growth of follicles and eggs, as well as an injection of hCG. IVF methods will differ in duration and dosage of drugs. The choice of the required IVF protocol is made by the attending physician based on the patient’s health condition.

A long IVF protocol begins with the introduction of pituitary blockers - gonadotropin-releasing hormone drugs. This is necessary to control a woman’s natural hormonal levels.

From the 3-5th day of the menstrual cycle, gonadotropic drugs are prescribed to stimulate follicle growth. These drugs will contain synthetic analogues of follicle-stimulating hormone, which is normally produced by the pituitary gland. Additionally, luteinizing hormone may be prescribed, which is necessary to prevent premature ovulation.

When the follicles are mature (as determined by ultrasound), the woman is given an injection of hCG. After the hCG injection, the ovaries are punctured approximately 36 hours later (more precise timing is determined by the attending physician in each individual case). Ovarian puncture is a minimally invasive procedure used to collect eggs. During IVF, it is important to obtain eggs before they are directly released into the abdominal cavity, otherwise in the future it is almost impossible to collect them and stimulation will need to be repeated again. The procedure is carried out under general anesthesia, so you cannot eat (6-8 hours before) or drink (2 hours before). During the puncture, a special needle is inserted into the woman’s ovaries through the vagina under ultrasound guidance. When the needle reaches a mature follicle, eggs are collected with follicular fluid. The manipulation is repeated with each mature follicle.

For further IVF, the man must provide sperm material that was obtained on the day of the puncture. If donor sperm is used, it must be ready for use on the same day.

Selected eggs and specially processed ejaculate are placed on a medium in a Petri dish for fertilization. The medium in the Petri dish is as close in composition as possible to the natural environment of the fallopian tubes, where conception should occur. After fertilization, the highest quality zygotes continue to be cultured until they reach the blastocyst stage. Cultivation lasts 3-5 days. The embryos are then transplanted into the woman’s uterus for further implantation and development. Usually 1-2 embryos are transferred, which increases the likelihood of a positive outcome of IVF.

In Kaliningrad, IVF and other methods of reproductive technologies can be done at the IVF Center clinic, whose specialists successfully treat infertility of any etiology.

Cost of hCG analysis for ectopic pregnancy

The Healthy Family clinic has created comfortable conditions for pregnant women to undergo all examinations. At the center, a woman can take the necessary tests, consult with specialists and undergo examinations without queues or long waits.

The center employs only highly qualified specialists who will provide the expectant mother not only with complete comfort, but also with accurate results of all examinations performed. The cost of one blood test is 400 rubles. But it is worth considering that to determine the pathology, the increase in hCG during an ectopic pregnancy is best monitored over time. Therefore, after a few days, specialists may schedule a repeat study.

If you are still looking for where to get tested for hCG, contact. Specialists will advise you in advance and answer all your questions.

Pregnancy after hCG injection

In order to check whether pregnancy has occurred, after the hCG injection, appropriate tests are prescribed after a certain time:

• 2-3 weeks from ovulation - with natural fertilization;
• 2 weeks from the introduction of sperm - with artificial insemination;
• 14 days – after embryo transfer after IVF.

You can find out whether pregnancy has occurred using a “home” cavity test, which reacts to an increase in the level of hCG in the urine. However, the most informative is the analysis of the level of hCG in the blood, which is monitored over time. Using a blood test for hCG levels, you can determine the quality of pregnancy, its fertility, and also identify the threat of ectopic pregnancy or miscarriage.

During pregnancy, hCG levels will continually increase tens of thousands of times, reaching a maximum peak of approximately 200,000 mIU/ml by the 12th week. Next, hCG will gradually decrease, but its level will still be high compared to the norm for a non-pregnant woman (0-25 mIU/ml). A sharp decrease in hCG levels in the first trimester may indicate a threat of miscarriage, ectopic pregnancy, or fading pregnancy.

During multiple pregnancies, the hCG level will increase depending on the number of fetuses: twofold for twins, threefold for triplets, etc.

HCG for ectopic pregnancy

During normal, correct development, the fertilized cell leaves the fallopian tube and attaches to the thickness of the uterus, where it subsequently grows. The pathological process differs in that there is no exit from the tube or the cell is fixed in another place. The most common causes of this condition are:

Obstruction of the fallopian tubes. It can be caused by infectious diseases of a chronic nature, mechanical termination of pregnancy.

Undeveloped fallopian tubes. This feature includes narrowed lumens of the pipes, which prevent them from contracting normally.

In the early stages, the abnormal placement of the egg may not cause any symptoms. Most often, the pain is similar to indigestion or appendicitis. But as VD develops, it can provoke the manifestation of the following signs:

• vaginal bleeding;
• severe pain concentrated on one side of the abdomen;
• vomiting;
• diarrhea;
• painful bowel movements;
• weakness.

In case of early ectopic pregnancy, hCG begins to be produced immediately after the embryo is attached, so its increase is diagnosed 5-7 days after conception. The hormone itself is a glycoprotein consisting of two parts alpha and beta. The first, in its structure, resembles LH and is similar to thyroid-stimulating hormone. And beta particles are unique and it is by them that the hormone is distinguished from others. From the fifth week of pregnancy, the hormone stops menstruation and increases the body's resistance to stress, and also prevents rejection of the attached embryo. HCG also affects the activity of the adrenal cortex, causing it to produce more glucocorticoids. In addition, the body activates the production of hormones responsible for maintaining pregnancy. An egg that does not reach the uterus, as it increases in size, can rupture the tube and cause profuse internal bleeding. The first symptoms of this condition:

• Pain in the abdominal area.
• Balance problems.
• Nausea.

If the woman is not given first aid soon, she may die.