IVF Programs

IVF (ICSI) in a natural cycle is a stimulation protocol in which a woman does not receive hormonal medications for follicle maturation. The procedure is carried out under conditions as close as possible to the patient's natural menstrual cycle.

How it works:

1. Retrieval — The doctor monitors the growth of the dominant follicle (usually 1, rarely 2) using ultrasound and LH testing. When the follicle reaches the required size, a puncture is performed to retrieve the single mature egg.
2. Fertilization — The retrieved egg is fertilized using ICSI (injection of a single selected sperm directly into the oocyte cytoplasm).
3. Cultivation — The resulting embryo is cultured in an incubator until day 5 (blastocyst stage), after which it is transferred into the uterine cavity or frozen.

Who it is for: Patients with good ovarian reserve, unexplained infertility, those at risk of hyperstimulation, those with contraindications to hormonal stimulation, as well as those who prefer minimal intervention in their body.

Pros: No risk of ovarian hyperstimulation syndrome (OHSS), lower cost, physiological approach.

Cons: High risk of premature ovulation (cycle may be canceled), difficulty synchronizing with doctor visits, often only 1 egg (low chance of obtaining an embryo), need for precise monitoring.

IVF (ICSI) with minimal ovarian stimulation (also known as a "mild" or "gentle" protocol) is an intermediate option between a natural cycle and full stimulation. The patient receives low doses of hormonal medications for a short course (usually 5–7 days) to mature a limited number of follicles (typically 2–7, averaging 3–6 eggs).

How it works:

1. Retrieval — Oral medications (clomiphene, letrozole) are used in combination with low doses of gonadotropins. The risk of hyperstimulation is minimal. When 2–3 follicles grow to the required size, a puncture is performed.
2. Fertilization — All retrieved eggs are fertilized using ICSI (one morphologically normal sperm is selected and injected into each oocyte).
3. Cultivation — Embryos are cultured until day 5 (blastocyst stage) to select the most viable one for transfer or cryopreservation.

Who it is for: Patients with low or borderline ovarian reserve (low AMH), those who have failed previous high-stimulation protocols, those at risk of OHSS (e.g., with polycystic ovaries), women over 35–38 years old, as well as those who want to reduce the hormonal load on their body.

Pros: Significantly lower risk of hyperstimulation, fewer side effects (mood swings, bloating), lower medication cost, ability to perform cycles back-to-back without a break, more physiological.

Cons: Fewer eggs are obtained than with full stimulation (less embryo selection), may require 2–3 cycles for success, there is a risk of premature ovulation or insufficient response.

IVF (ICSI) with superovulation (also known as a "classic" or "full" protocol) is the standard and most effective IVF method, in which high doses of hormonal medications stimulate the simultaneous growth and maturation of multiple follicles in the ovaries (on average 8–15 or more).

How it works:

1. Retrieval — The patient undergoes a long course of hormonal stimulation (10–14 days) with GnRH agonists or antagonists combined with gonadotropins. The growth of 10–20 follicles is monitored using ultrasound and blood tests. After maturation, a puncture is performed to retrieve the eggs under intravenous sedation or general anesthesia.
2. Fertilization — All retrieved mature eggs are fertilized using ICSI (a single selected sperm is manually injected into each egg). This is especially important in cases of male factor infertility (poor morphology, low motility, low sperm count, after testicular biopsy).
3. Cultivation — The resulting embryos are cultured in special incubators until day 5 (blastocyst stage). This allows for the natural of weak embryos and the selection of the best ones for transfer or cryopreservation.

Who it is for: Patients with normal ovarian reserve, tubal, endocrine, male, and combined infertility, those who have failed gentler protocols, women under 38–40 years old, as well as in donor programs.

Pros: Maximum number of eggs in a single cycle (more embryos – higher quality, better selection for PGT), high pregnancy rate (leading among all protocols), the ability to freeze several embryos for the future.

Cons: High risk of ovarian hyperstimulation syndrome (OHSS) — up to severe forms requiring hospitalization; significant hormonal load on the body (mood swings, bloating, weight gain); high cost of medications and monitoring; more visits to the doctor and injections; contraindicated in cases of low ovarian reserve or a history of (estrogen-dependent) cancers.

A procedure in which previously frozen eggs (belonging to the patient herself or to an anonymous donor) are thawed, followed by fertilization using ICSI.

How it works:

• Thawing — cryopreserved oocytes (eggs) are carefully thawed in a special medium. The survival rate for quality cells is 70–90%.
• IVF (ICSI) — each surviving mature oocyte is fertilized by injecting a single sperm.
• Cultivation — the resulting embryos are cultured to the blastocyst stage (5 days) for transfer to the uterus or cryopreservation.

Who it is for:

• Patients who have previously frozen their eggs (social or medical freezing, for example, before chemotherapy).
• Couples using donor oocytes (since donor eggs are almost always stored frozen in banks).
• In cases of previous unsuccessful IVF attempts.

Pros: no need to stimulate and perform egg retrieval on the patient (when using her own frozen cells); transfer can be precisely planned; donor material is available without waiting for cycle synchronization.

Cons: some eggs may not survive thawing; the fertilizability of thawed oocytes may be slightly lower than that of fresh ones.

One standard portion of sperm from a screened anonymous donor, which has been frozen, quarantined (usually 6 months for repeat infectious disease testing), and stored in a cryobank.

What it includes:

• One straw/cryovial with frozen sperm, sufficient for one fertilization procedure (IVF, ICSI, or intrauterine insemination – IUI).
• Contains from 1 to several million motile sperm after thawing (depends on the donor and method).
• A certificate of quality indicating motility, morphology, and concentration.

Where it is used:

• IVF/ICSI (for fertilizing the patient's or donor's eggs).
• IUI (when there are no indications for IVF).
• In cases of male factor infertility (azoospermia, severe oligoasthenozoospermia), for same-sex couples, single women, and when there are genetic risks from the partner.

Important: Donors must undergo medical, genetic, and psychological screening. The sperm is certified according to FDA/Roszdravnadzor regulations.

Pros: complete absence of STD risk (after quarantine), ability to select a donor by phenotype, education, blood type and Rh factor; confidentiality; can be ordered online and delivered to the clinic.

One egg ready for fertilization, obtained from a donor (usually from an oocyte cryobank), thawed, and used for IVF/ICSI.

Features:

• Usually sold as a "single unit" — the patient pays for one egg, guaranteed to be mature (metaphase II).
• Often clinics offer not just one, but an entire cohort (4–6 oocytes) — to increase the chances of obtaining at least one viable embryo, since thawing and fertilization involve losses.

How it is used:

• Thawed on the day of ICSI.
• One egg (less often several) is thawed at a time.
• Fertilized with the partner's or donor's sperm.
• The resulting embryo is transferred to the patient.

Who it is for: patients for whom the use of their own eggs is contraindicated (premature ovarian failure, low AMH, genetic diseases, multiple IVF failures) and who need only 1–2 attempts (budget option). In practice, one egg provides one chance — if an embryo is not obtained, the payment is not refunded.

Pros: cheaper than a full donor program (stimulation+retrieval); fast.

Cons: high risk of not obtaining a viable embryo (post-thaw survival and fertilizability are not 100%).

A full program with a "fresh" (living) donor, carried out individually for a specific recipient patient. The donor undergoes a complete cycle of hormonal stimulation, puncture, and transfer of all obtained eggs (usually 10–15).

What is included:

1. Donor selection and screening — medical, genetic, and psychological testing; testing for infections (including HIV, hepatitis, syphilis, STDs). The donor must be healthy, 20–32 years old, usually anonymous.
2. Superovulation stimulation — the donor receives high doses of hormones (similar to classic IVF) to mature multiple follicles.
3. Egg retrieval — follicle puncture under sedation or general anesthesia. 10–15 mature oocytes are obtained.
4. Donor compensation — payment for time, risk, and discomfort (typically $2,000–$5,000 or equivalent in currency).

Who it is for: patients with depleted ovarian reserve, genetic diseases, repeated IVF failures, as well as same-sex couples. It is the choice for those who want to obtain the maximum number of eggs from a specific screened donor rather than purchasing oocytes from a bank.

Pros: large number of fresh eggs (10–15, not 4–6 from a bank); many can be fertilized at once, creating a reserve of embryos, including for future use; no thawing losses; higher chance of success in a single cycle.

Cons: more expensive than frozen oocytes; requires a donor (possible risks of asynchrony with the recipient's cycle); the donor may respond worse than expected; ethical aspects and bureaucracy (contract, informed consent).

Thawing and placing embryos into the uterine cavity (cryotransfer) is a procedure for transferring previously frozen embryos (usually at the blastocyst stage, day 5-6 of development) into the patient's uterine cavity in a natural or hormone replacement cycle.

How it works:

1. Endometrial preparation — the patient undergoes a cycle of uterine preparation: either in a natural cycle (tracking ovulation) or on hormone replacement therapy (estrogen + progesterone) to create an "implantation window".
2. Thawing of embryos — on the day appointed by the doctor (usually on day 19-21 of the cycle, 5-6 days after ovulation or the start of progesterone), the embryos are thawed in the laboratory. The survival rate for quality blastocysts is 95–98%.
3. Viability assessment — the embryologist evaluates cell integrity and the degree of blastocoel expansion after thawing. Damaged embryos are not transferred.
4. Transfer (placement) — one or two best embryos are loaded into a soft catheter and introduced into the uterine cavity through the cervical canal under ultrasound guidance. The procedure is painless and lasts 5–10 minutes.

Who it is for:

• Patients with cryopreserved embryos after a previous IVF protocol (fresh or frozen cycle).
• Those for whom fresh transfer is contraindicated (risk of hyperstimulation, high progesterone, thin endometrium, inflammation).
• In surrogacy and egg donation programs (embryos are already available).
• When PGT is needed (embryos are first frozen, then thawed after test results are received).

Pros:

• The endometrium is not exposed to high doses of stimulation hormones (more physiological).
• No risk of ovarian hyperstimulation syndrome (OHSS).
• Excellent embryo survival with modern vitrification methods.
• Pregnancy rates with cryotransfer are comparable to or even higher than with fresh transfer (according to some data).
• The transfer can be scheduled at a convenient time (delayed motherhood).

Cons:

• Additional hormonal preparation is required (in a replacement cycle).
• A small percentage of embryos may not survive thawing (2–5% for blastocysts, more for early-stage embryos — day 2-3).
• The cost of the procedure (thawing + transfer is paid for).

A surgical procedure performed on men with azoospermia (absence of sperm in the ejaculate) to extract sperm directly from testicular tissue. The obtained material is cryopreserved for subsequent use in IVF (ICSI).

How it works:

1. Anesthesia — the procedure is performed under intravenous sedation, local anesthesia, or general anesthesia (depending on the extent of the intervention and the clinic).
2. Sperm extraction — a tissue sample is taken from the testicle through a small incision in the scrotum or with a puncture needle (percutaneous method). Possible techniques:

• TESA (percutaneous aspiration) — needle puncture.
• TESE (open biopsy) — incision and collection of seminiferous tubules.
• Micro-TESE (microsurgical) — areas with viable sperm are located under microscopic magnification.

1. Cryopreservation — the found sperm are isolated in the laboratory, frozen using vitrification, and placed into storage.
2. Storage for 6 months — the standard initial storage period (extended for a fee).

Who it is for: men with obstructive or non-obstructive azoospermia, after failed attempts to obtain sperm from ejaculate, with congenital absence of the vas deferens, after vasectomy (when reversal is not possible), with anejaculation.

Pros: the only way to have their own genetic children for men with azoospermia; the ability to freeze material for future use; one biopsy session can provide several IVF attempts.

Cons: invasiveness, postoperative pain, risk of swelling, hematoma, infection, scarring; long-term testosterone reduction; chance of not finding sperm (especially in non-obstructive forms); ICSI is required.

A combination of two procedures aimed at improving endometrial receptivity (the ability to implant). First, a pipelle biopsy is performed to obtain endometrial tissue, from which autologous platelet-rich plasma (PRP) is then prepared and injected back into the uterine cavity.

How it works:

1. Pipelle biopsy — a thin flexible catheter (pipelle) is inserted into the uterine cavity without anesthesia, and a small fragment of the endometrium is collected under negative pressure (feels like strong menstrual cramps). Lasts 30–60 seconds.
2. PRP preparation — the tissue sample is processed in the laboratory, the platelet mass is isolated and activated to obtain growth factors (VEGF, EGF, PDGF, TGF-β).
3. PRP injection — the resulting plasma is injected into the uterine cavity through a thin catheter on day 5–7 of the cycle or 48–72 hours before embryo transfer.

Who it is for: patients with thin endometrium (less than 7 mm), chronic endometritis, repeated implantation failure (≥3 IVF attempts with good embryos), synechiae (adhesions) in the uterine cavity after curettage, and those who do not respond to standard hormonal preparation.

Pros: safe (autologous plasma, no rejection); stimulates endometrial growth, improves blood flow, reduces inflammation; increases pregnancy rates in "difficult" patients; virtually no side effects.

Cons: requires a laboratory for PRP preparation; the effect is not 100%; a relatively new technique (not all clinics offer it); additional cost on top of the main protocol.

A complete cycle of genetic testing of the embryo before transfer into the uterus. It includes assisted hatching (laser opening of the shell), collection of several cells (biopsy) at the blastocyst stage, and subsequent genetic analysis.

Procedure steps:

1. Assisted hatching — a micro-puncture or thinning is made in the embryo's shell (trophectoderm) using a laser on day 5 of development. This facilitates the release of biopsy cells and future implantation.
2. Biopsy collection — 3–5 cells are aspirated from the trophectoderm (the outer layer that will become the placenta) using a special micropipette. The embryo is not damaged; the inner cell mass (future fetus) remains untouched.
3. Genetic testing — the biopsy sample is sent to a genetic laboratory. Types of PGT:

• PGT-A (formerly PGD for aneuploidies) — counting the number of chromosomes, searching for extra or missing ones (Down syndrome, Edwards syndrome, Patau syndrome, etc.).
• PGT-M — detection of monogenic diseases (cystic fibrosis, phenylketonuria, hemophilia).
• PGT-SR (balanced chromosomal rearrangements) — for carriers of translocations.

Result and cryopreservation — embryos are immediately frozen after biopsy. Results arrive within 1–4 weeks. A genetically normal embryo is thawed and transferred in the next cycle.

Who it is for: patients over 35–38 years old (high risk of chromosomal abnormalities); for recurrent miscarriages (≥2 of unknown origin); for multiple failed IVF attempts (≥3); carriers of genetic diseases or balanced translocations; couples with severe male factor infertility; for those wishing to reduce the risk of Down syndrome and select only euploid embryos.

Pros: significant reduction in miscarriage risk (from 30–50% to 5–10%); increased transfer efficiency (60–70% implantation per embryo); elimination of genetic diseases; allows selection of the single best embryo (reduces multiple pregnancy).

Cons: expensive testing; risk of mosaicism (not all cells of the embryo are the same) – possible false positive or false negative result; small loss of embryos during freezing/biopsy; cryotransfer is required (fresh transfer is not possible).