IVF & Fertility
What is IVF?
IVF treatment is one of the most common assisted infertility treatments. Nowadays, different IVF treatments have been developed for the treatment of different types of infertility.
*In the process of IVF treatment, female egg cell (oocyte) and male semen cell (sperm) are fertilized in carefully prepared laboratory conditions outside the body, and a certain number of fertilized egg cells (embryos) is extracted and placed in the uterus.
Who are the Candidates of IVF?
Women with blocked fallopian tubes:
In this case, since the sperm cell does not have the chance to reach and fertilize the egg cell, in vitro fertilization is used.
Men with low sperm count or sperm motility, or decreased sperm rate:
The problems like low sperm count, sperm motility, or decreased sperm rate may appear separately or together in a male. If the sperm count or motility of the patient is normal but the normal sperm ratio is below the limit, the patient should be treated with IVF.
Patients for whom artificial insemination treatments have failed:
If the insemination treatment does not produce a successful result after three to four trials, the patient may prefer IVF.
Unexplained fertility cases:
20% of the total infertility cases may not be explained despite all research conducted. In such cases, IVF treatment is considered especially in female patients aged 36 years and over.
Women suffering from severe endometriosis:
Endometriosis is the disorder in which the tissue that forms the lining of your uterus (endometrium) - enabling women to menstruate regularly - grows outside of your uterine cavity such as in ovaries, abdomen or tubes. Cyst formation in tubes, adhesions in abdominal membranes and ovaries may occur as a result of bleeding that may occur during menstrual periods in the non-uterine regions. IVF treatment may be required in advanced endometriosis cases and IVF treatment may be the first choice for patients who have a history of endometriosis that is over 35 years of age and cannot conceive.
In Vitro Fertilization /Micro-injection Treatment
While the duration of IVF treatments may vary, the most common long process is applied. The treatment steps in the long processes are:
The patient starts to take birth control pills on the first day of first menstrual period after the patient decides to start treatment. The purpose of the contraceptive pill is to regulate the patient's menstruation cycle and to eliminate any chance of any ovarian cyst until the next menstrual period. The gonadotropin-releasing hormone (GnRH) analogue is added to the treatment on the 21st day following the menstruation cycle. GnRH, a highly effective anti-hormone, is provided as nasal spray or daily injection. The analogue suppresses the activity of the gland, which is called pituitary and controls the secretion of two important hormones, luteinizing hormone (LH) and stimulating hormone (FSH). These hormones stimulate a follicle production every month in a normal cycle. The given analogue temporarily stops the connection between the pituitary and the ovary. This application is continued until the collection of eggs. The birth control pill is used for 21 days and the new menstrual period will start after 10 days.
2. Stimulation of Ovaries
On the 3rd day of the new menstrual period, needle form drugs containing hormone are started to stimulate the ovaries. The purpose of using these drugs is to increase the possiblity of pregnancy by helping to develop more than one egg cell. *The stimulation process of the ovaries is approximately 12 days, but this process can vary from person to person because the response rate of ovaries to the drug might change. During this period, egg production is monitored closely with hormones injected every other day and ultrasound.
There is another treatment method; short process which is started on the 2nd or 3rd day of menstruation and lasts for 15 days in average. In this treatment process, the needles are applied to stimulate the eggs. On the 6th day of the use of the hormone-containing drug or when the follicles reach a certain size, the gonadatropin-releasing hormone antagonist is given as a preservative in order to prevent premature cracking of the follicles. This drug is applied to the abdominal area. Because the treatment time lasts shorter than the long process, has the same success rate as the long process and certain side effects such as hyper stimulation syndrome are seen less frequently, short process is preferred more frequently today.
3. Collection of Eggs
When the eggs reach a certain maturity and size, a different hormonal needle is used to crack the egg cells. About 34-36 hours after the injection of this needle, egg collection process is performed. In terms of the precision of this process, the timing of the needle is of great importance.
Egg collection process: After the patient is admitted on an empty stomach in the morning, the patient is anesthetized and eggs are collected for nearly 20 and 30 minutes. This procedure is painless because the patient is under anesthesia. For IVF, eggs are reached through vagina. For this procedure, a needle is used which is directed by ultrasound to suck the eggs out and direct it to the right place. Although the number of eggs may vary from 10 to 12 per patient, this number may vary between 1 and 40. There are very rare cases where no eggs can be collected. Due to the fact that the procedure does not require hospitalization, patients can go home after a few hours.
Collected egg cells are fertilized under laboratory conditions and according to sperm cell quality by using conventional in vitro fertilization (IVF) or micro injection method. Thanks to this fertilization, the embryo - the corner stone of the baby that develops in the womb - is generated. The fertilization detected under the microscope is formed in a process lasting about 12 to 15 hours. The result of this formation is reported to the patient and the day of the embryo transfer is determined.
5. Embryo Transfer
After 48-72, or even up to 120 hours depending on the condition, fertilized embryos (called pre-embryos or zygotes) are transferred. As the time of transfer is determined by the quality of the embryo, the times may vary. The embryos are gently passed through the cervix through a thin plastic tube and transferred into the uterus. The number of embryos to be transferred is decided together with the gynaecologist before the procedure and the transfer process is carried out accordingly. Because the procedure is simple and painless, the patient is discharged after a half-hour of rest. The patient will have progesterone, the hormone is applied to the vagina or inside the muscle until the pregnancy test that will be performed for approximately two weeks later. If the result of pregnancy test is positive; ultrasound is performed to see the gestational sac 10 days after the pregnancy test date.
IVF treatment, which has created miracles in the lives of parents-to-be who have not been able to conceive in natural ways for long years, makes the dreams of the expectant mothers come true and enables them to have healthy babies. Although IVF treatment is the most successful treatment among all reproductive treatment methods, it does not offer a hundred percent success guarantee. In cases where there are some health problems in the sperm of the father or in the eggs of the expectant mother, sperm donation or oocyte donation can be applied by the IVF centers.
Egg donation is called oocyte donation in medicine. In this method of treatment, egg cells from a donor are fertilized in the laboratory with the sperm of the father and the embryo is transferred to the future mother's womb. The oocyte donation, which resulted in success in 1984 for the first time, is applied in cases where there are unfavorable conditions in the eggs of the mother candidate.
Even women who have lost their egg reserves are able to have babies with oocyte donation, which is the only treatment that provides successful results in cases when the infertility is resulted from the egg-related problems of the mother. This method gives successful results even in women with menopause. This makes it possible for women to become pregnant when the biological clock prevents conception. Oocyte donation can be performed in all scenarios where the mother's eggs are inadequate or damaged. Treatment of oocyte donation is not performed in Turkey, so that parents who want to have this treatment prefer the IVF treatment centers in Cyprus.
In oocyte donation, firstly women who have given birth are preferred when selecting a donor. This shows that the donor's eggs are suitable for treatment. IVF centers need to perform sensitive and detailed research on the donor. The donor must not have a hereditary condition or family related health problems such as mental retardation. However, the donor also should not have any health problems and drug addiction. The health conditions of the egg donor are investigated by performing various tests by the IVF centers. The weight of the donor should be within the standards and the physical properties such as hair color, skin color and eye color are recorded. Thus, parents-to-be can choose the eggs of the donor who are compatible with their physical characteristics. In the oocyte donation, not all the eggs of the donor are taken for this treatment, so that the donor can become pregnant in the following periods.
Parents-to-be who will be treated with oocyte donation can make selection depending on who the donor is. The donor can be a familiar person or an anonymous person according to the family's wish. In order to prevent the difficulties that may occur after the baby is born, it is preferred that the donor is anonymous. In this case, the donor is preferred among those who granted their eggs previously to the IVF centers that provide egg donation treatment. In oocyte donation, egg-boosting treatments are applied to the donor, and after fertilization with the sperm, the embryo is transferred to the uterus of the recipient. Through this miracle treatment, many women are experiencing the joy of being a mother since 1984.