The world’s first IVF was born in 1978, and after almost 40 years of development, 6 million IVF babies have been born in the world so far, with the earliest (1978) IVF babies having given birth to their own healthy babies in natural pregnancies. The first three IVF babies in our country are also 30 years old. Today we will talk about the issues that need to be taken care of during IVF pregnancy.
1. Progesterone supplementation
Probably the biggest difference between IVF pregnancy and normal pregnancy is that IVF pregnancy needs to be supplemented with progesterone medication (called luteal support) under the guidance of a doctor.
This is because.
(i) During ovulation promotion, gonadotropin-releasing hormone agonists or antagonists are used to inhibit pituitary function in order to prevent the eggs from expelling on their own, which will cause a decrease in the level of luteinizing hormone, resulting in a poorly developed and dysfunctional corpus luteum and thus a decrease in progesterone levels.
(ii) During egg retrieval, a large number of granulosa cells are lost, which reduces the effective components of the corpus luteum and leads to malfunction.
(iii) For women undergoing frozen-thaw embryo transfer, as there is no follicle growth and corpus luteum formation during the artificial cycle, they must rely on exogenous supplemental progesterone to maintain the progesterone levels needed for embryo implantation and development.
Because of these three points, mothers-to-be undergoing IVF assisted conception are very often luteal insufficiency, so progesterone supplementation is necessary. Exogenous supplementation of progesterone can increase the local progesterone levels in the serum and uterus to compensate for the above deficiencies.
Progesterone can be divided by route of administration into three types: intramuscular injection, transvaginal administration and oral administration. Progesterone preparations for injection and progesterone preparations for vaginal use are commonly used clinically as progesterone support drugs, while oral preparations are mostly used as supplemental treatment in the process of dosage adjustment.
Generally, the placenta forms during the seventh week of pregnancy (i.e., the fifth week of embryo transfer) and begins to secrete estrogen and progesterone, gradually replacing the function of the corpus luteum. Therefore, the body’s estrogen and progesterone levels should be monitored around the seventh week of pregnancy, and the dosage of progesterone should be adjusted under the guidance of the doctor. Generally, the amount is reduced by 1/3 each time and once a week; mostly luteal support is stopped around the 10th week of gestation. As there is no luteal production in the frozen embryo transfer in artificial cycle, the luteal support should be slightly longer, usually need to support until 12 weeks.
2. Calculation of the due date of IVF
Medically, the due date is calculated from the first day of the last menstrual period and pushed back about 280 days (40 weeks). For mothers-to-be with IVF pregnancy, the day of egg collection is pushed forward 14 days as the time of last menstruation. The month of the last menstrual time plus 9 or minus 3 will be the month of the expected delivery, and the day of the last menstrual time plus 7 will be the day of the expected delivery. For example, if the day of egg collection is March 30, 2017, then the time of last menstruation is counted as March 16, 2017, the month of expected delivery is 3+9=December, and the day of expected delivery is 16+7=23, which means the expected delivery date is December 23, 2017.
It is important to note that the IVF estimate is only an approximate time, only about 50% of pregnant mothers will deliver on the day of their due date, it is normal to deliver 2 weeks earlier or later than the due date. Clinically, a full-term baby refers to a fetus that is 37-42 weeks of gestational age, and about 80-90% of pregnant mothers deliver within this time frame.
3. Medication during IVF pregnancy
It is generally believed that the use of medication or X-ray exposure before 4 weeks of pregnancy (within 28 days from the first day of the last menstrual period) will have only two results for the baby in the womb: one is that the baby receives all the adverse effects and miscarries naturally; the second is that the baby receives no adverse effects and grows naturally. This is the internationally recognized “all or nothing” theory of early pregnancy. That is to say, this period of medication or X-ray, there will not be people worried about the results of the birth of deformed babies. However, there are exceptions to this theory. Some drugs, such as ribavirin and isotretinoin, need to stay in the body for a long time before they can be excreted, even if they are taken before the 4th week of pregnancy, they will continue to act on the body after the 4th week of pregnancy, which may increase the risk of fetal malformation.
The period of 4-12 weeks of pregnancy is a sensitive period for fetal development and the differentiation of fetal body tissues and organs, which is most vulnerable to the effects of drugs.
If you have to use drugs, you should try to choose safe drugs that have been in clinical use for a long time. The term “safe” refers to the use of medications that are rated A or B by the U.S. Food and Drug Administration (FDA) for safety during pregnancy.
The current reference for medication use during pregnancy is based on the FDA’s Safety in Pregnancy Classification, which is based on the following criteria.
Grade A: In studies with controlled groups, no evidence of fetal harm was seen in women in the third trimester (and no evidence of harm in the subsequent 6 months), and there is likely to be little effect on the fetus.
Grade B: No effects on the fetus were seen in animal reproduction studies (no controlled studies in pregnant women). Side effects were demonstrated in animal reproductive studies, and these side effects were not confirmed in women in the third trimester (and there was no evidence of harm to the subsequent 6 months).
Class C: He has demonstrated fetal side effects (teratogenic or embryonic killing) in animal studies, but has not been studied in women in control groups, or has not been studied in women and animals in parallel. This class of drugs should only be used after authoritative evidence that the benefits to the woman outweigh the risks to the fetus.
Class D: by clear evidence of harm to the fetus, despite the harm, but with absolute benefit to the pregnant woman with the drug (for example, the pregnant woman is threatened with death or has a serious disease and therefore needs to use it, such as the application of other drugs that are safe but ineffective).
Class X: Studies in animals or humans have shown that he can cause fetal abnormalities. Or it is considered from experience that in humans, or in humans and animals, is by harmful. The application of this class of drugs in pregnant women is clearly not beneficial. This class of drugs is contraindicated in patients who are pregnant or will become pregnant.
Therefore, you must communicate with your doctor before using the drug and avoid self-medication. If you use the drug on your own, you must look at the instructions of the drug, which usually have FDA classification and instructions for use in pregnant women.
However, it should also be noted that if you have an infection or other serious illness during pregnancy, you still need to treat it with medication in a timely manner, otherwise it is not good for the pregnant woman and the fetus. It is a good idea to visit the doctor and communicate with him/her.
4.Checkups during IVF pregnancy
If there are no other special circumstances after pregnancy, IVF patients should undergo obstetrical examinations according to the requirements of normal obstetrical examinations. Some of them are routine checkups, while others are regular testing items. Routine checkups include going to the hospital, such as urine sample, weight, measurement of abdominal circumference and height, listening to fetal heartbeat and fetal movement. For example, ultrasound, blood tests, Down’s syndrome screening, fetal heart monitoring and umbilical cord blood flow are tests that need to be done after a certain stage of pregnancy.
5. Some issues related to IVF pregnancy.
Early abortion curry.
Many IVF patients will have a small amount of vaginal bleeding, most patients are very nervous, in fact, first of all, we should clarify the cause of bleeding, to exclude the possibility of miscarriage or ectopic pregnancy, if intrauterine pregnancy and embryo survival is recommended bed rest and the application of fetal preservation drugs to actively protect the fetus. If incomplete or inevitable miscarriage is found to have occurred, the uterus should be cleared in time to avoid excessive maternal bleeding. If the examination confirms that the pregnancy is ectopic, the patient should be hospitalized for observation and, if necessary, surgical treatment.
Early pregnancy reaction.
The most important physical change in early pregnancy is the early pregnancy reaction, so you should take more rest after pregnancy, get enough sleep and relax to cope with the early pregnancy reaction. In addition, eat a diversified diet to achieve balanced nutrition. Folic acid and vitamins should be supplemented. One of the more important maternity tests during early pregnancy is the nuchal translucency screening, which can be performed between 10 and 13 weeks of pregnancy to find out whether the fetus is at high risk for Down’s syndrome.
Miscarriage.
After IVF transplantation, it is important to pay more attention to rest, reduce activities, prohibit sexual intercourse, also avoid unnecessary vaginal examinations, regular luteal support to reduce the stimulation of the uterus, and also avoid excessive mental tension to avoid miscarriage.
Fetal malformations.
In IVF treatment, whether using self sperm, self eggs or donor sperm or eggs, their babies are the same as those obtained by natural conception in terms of eugenics and birth defect rates. IVF is the first step in conceiving a life, and the later maternity check-up’s are especially important to greatly reduce the incidence of birth defects! There are many causes of fetal malformations, and we cannot completely avoid birth defects, but it is important to do a good job of maternity checkups to try to avoid birth defects.
6.What are the precautions to be taken in the early, middle and late stages of IVF pregnancy?
In the early stage of pregnancy, the first thing is to follow the doctor’s prescription for luteal support and review to exclude ectopic pregnancy, after that, the most important physical change is the early pregnancy reaction, so you should take more rest, get enough sleep and relax to cope with the early pregnancy reaction. In addition, you should eat a varied and balanced diet. Folic acid and vitamins should be supplemented, and one of the more important maternity tests during early pregnancy is the nuchal translucency screening, which can be performed between 10 and 13 weeks of pregnancy to find out whether the fetus is at high risk for Down’s syndrome.
The most important change during this period is that the mother-to-be will feel the fetal movement, so she should always pay attention to the changes in fetal movement and develop the habit of regular exercise, in addition, she should change her sleeping position in the middle of pregnancy, try to lie on her left side and strengthen the intake of calcium and iron. There are many items in the mid-pregnancy maternity check-ups, and you should check them on time to prevent any missed diagnosis of hyperemesis and gestational diabetes.
The most important thing that you should be alert to in late pregnancy is the occurrence of preterm labor. Expectant mothers should communicate more with medical staff to understand what is redness, water breakage and overdue pregnancy, prevent edema and perform proper exercises to help smooth delivery. For IVF patients, twin-born patients should establish early contact with their doctors and elective cesarean delivery if possible, while single-born patients should choose the appropriate delivery method according to their specific situation.
There is actually no big difference between IVF pregnancy and natural conception, and the things that need to be paid attention to in a natural pregnancy should also be paid very close attention to in an IVF pregnancy, as long as you follow the doctor’s instructions for medication and regular review, the doctor will give appropriate advice at all stages.