The number of infertile couples has increased due to stressful living conditions, unnatural diet and smoking habits. Today, one out of every 6 to 7 married couples does not have a child and has to seek medical help. Among the causes of infertility, there may be female and male causes, but sometimes pregnancy cannot be achieved even if there is no significant problem in both.
In Vitro Fertizilation - IVF
In this technique in which fertilization occurs outside a female's body, embryos are developed in a laboratory and then implanted /transferred to the patient's uterus.
This process which should be coordinated by a professional team includes development of a treatment specific to individual needs and requires a good and advanced technological infrastructure in the fertility clinic.
Who Needs In Vitro Fertilization?
If any of the following factors exist, couples can choose to have in vitro fertilization (IVF) treatment.
Factors related with women;
- Damaged or blocked fallopian tubes including a previous tubal ligation Failed intrauterine insemination
- Immunological factors
- Endometriosis related infertility
- "Unexplained" infertility
- Factors related with men;
- Low sperm motility (sperms are not moving quickly and efficiently) Low sperm morphology (abnormally shaped sperm)
- Low sperm count
- No sperm in semen (azoospermia)
- "Unexplained" infertility
- IVF Step by Step
- Pre-Treatment Preparations
We have clinic determines and offers treatment options specific to each person. With the mission of establishing the cause of infertility, diagnosis and implementing treatment alternatives; sperm and hormonal condition of the male patient is analyzed and if necessary an urological examination is done.
For female patients, first cervical canal and endometrial cavity are examined. Then menstrual cycles are checked and potential changes in fallopian tubes are observed. Couples are also evaluated in detail for sexual health. It is also important to ensure that both patients are biologically and psychologically ready for the process and that IVF is the right solution for the infertility problem.
Ovarian Stimulation
For correct management of the assisted conception process and to increase probability of pregnancy, the number of oocytes that is needed is higher than the number that a health woman normally produce. Our team of experts effectively manages the process in which patients are monitored with vaginal ultrasound, blood tests and medical combinations to retrieve optimum oocyte harvest both in terms of number and quality.
Treatments last in average for 8 to 12 days.
Egg Retrieval - Sperm Capacitation
Egg retrieval procedure is scheduled 36 hours after a trigger injection is given unless the treatment involves donor eggs. For the comfort of our patients local anesthetic agents are not used and the procedure is done under general anesthesia. Mature eggs are retrieved with the help of ultrasound images using a special fine needle in a procedure which lasts approximately 10-15 minutes.
Semen sample is asked from the male husband on the same day of this operation.
The male husband should abstain from ejaculation with masturbation for 3 days before giving semen sample to ensure high quality sperm.
In addition to this, if there are sperm samples which were taken previously from the husband and then frozen, they should be thawed and prepared.
Fertilization Process in the Laboratory
It depends on spermatozoa concentration, motility and morphology which are found through tests to decide whether classic IVF or ICSI treatment should be used.
In this procedure eggs retrieved from the ovaries are placed in an "embryo culture" medium together with sperms and this medium is kept in an incubator for 24 hours. Eggs are incubated after being fertilized to decide the number of embryos at the pronucleus stage (PN). 2 pronuclei representing male and female chromosomes in the cell is the first sign of successful fertilization. A sensitive process starts for the embryos observed for development; minimum contact and maximum care is necessary for embryos for which several conditions including humidity, gas concentration and heat are very important for development.
After the period of 72 hours, our embryologists provides information to the patients including number of fertilized eggs, embryo quality (with 6-8 cells), the benefits of embryo culture until the day 5 for blastocyst transfer and suitability criteria. Embryonic genome activation starts with the 6-8 cells stage; extended embryo culture helps to distinguish between developing embryos and arrested embryos and allow us to identify healthy embryos to be transferred.
Our team of experts observe the development process until the day 5 to identify the embryos that do not have normal chromosome structure. Preimplantation genetic diagnosis is recommended to better manage this process.
Considering the advantages and disadvantages of these options, parents are asked about their opinion on whether to continue with day 3 embryos or day 5 blastocysts and the healthiest decision is implemented.
Embryo Biopsy
Embryo biopsy which is defined as removing one cell or a small group of representative cells by embryologists from developing embryos is used in the IVF treatment process. These cells that are sent to a genetic/molecular laboratory are examined to test for genetic disorders in embryos. With this technique healthy embryos can be selected before they are transferred to the mother's uterus. With this technique unhealthy, unsuitable embryos (genetic or chromosomal problems) are identified and eliminated.
ICSI - Intracytoplasmic Sperm Injection
Intracytoplasmic sperm injection(ICSI) is a procedure in which a single sperm cell is injected directly into an egg. This is a revolutionary technique in reproductive medicine and makes it possible for infertile men with severely low sperm counts (oligospermia) to be a father.
The ICSI technique can be used to fertilize eggs and develop embryos in all patients who have problems related with sperm count, sperm motility or sperm morphology. And in azoospermia cases in which no sperm cell is seen, with a small incision on the scrotum (a sac of skin that contains testes) under general anesthesia the testes are examined under microscope and the areas where the possibility of finding sperm is high is determined and live sperm is found in small pieces of tissue removed using the ICIS technique and later injected into the egg. This technique is called micro TESE.
Embryo Transfer
Embryo is generally transferred between the days 2 and 5 after fertilization. The goal here is to transfer/plant the embryo from the laboratory into the mother's uterus which is the last place of development.
Ultrasound guidance is used during the transfer to monitor the passage of embryo transfer catheter to ensure that embryos are planted in the right place. Embryo Transfer is a painless and mostly a simple procedure but the patient must have a full bladder to view the uterus with ultrasound and facilitate the transfer therefore the only problem the patient can have is to have a full bladder and associated psychological distress.
This procedure which is similar to a standard gynecological examination is painless unlike a surgical operation and is done without any sedatives/anesthetic agents.
This procedure is done at average 36oC in a dimly lit, sterile and calm room next to the laboratory.
Not all healthy developed embryos are planted in the uterus at the same during the process; there are some certain legal and medical limitations. Embryos that are not transferred can be frozen and stored with the approval of the couple. The price for embryo freezing procedure includes freezing and storage for 1 year and if patients want to keep their embryos longer than 1 year, they can be stored at very reasonable prices which would be set annually.
The patient needs to rest 30-60 minutes in our clinic after the transfer. It is very important that you relax and rest well physically in the first night. You can return to your normal daily routine on the next day; our team will give you a "to do and not to do" list which you should observe at all times.
If the results observed are not satisfactory during the preparation stage (high progesterone level or uterine lining not thick enough) no procedure is done and embryos are frozen and stored until a new cycle.
Positive Pregnancy Test Result
It is possible to determine whether the treatment is successful with a blood test 10-12 days after the embryo transfer. Urine test is not considered to be reliable for physicians since it may not give an accurate answer. The physician can ask to repeat the test 48 hours after the initial test if deemed necessary.
If the test result is positive and increasing values are found:
The patient should continue to take medications in the first trimester as instructed by the physician who give the IVF treatment. Because when progesterone supplements are discontinued early, miscarriage can happen; maintaining pregnancy in the first 8-10 weeks depends on the woman having sufficient level of progesterone hormone in her body. If this is not the case, miscarriage becomes inevitable. Approximately 2 weeks after a positive blood test result, pregnancy and even baby's heart beat can be viewed with vaginal ultrasonography.
First the women eggs are harvested and kept in a laboratory environment and then outer layers of eggs are removed and mature cells are separated. The purpose here is to identify mature eggs to be used for microinjection. Then sperm from the husband is prepared using several methods and one sperm is injected into each mature egg using a special micro-manipulation equipment. Then they are kept in special incubators with regulated conditions and checked every 24 hours. Eggs that are injected with sperms are stored in special liquids called media. For this procedure to be successful the couple need to be well prepared, and good embryology laboratory conditions and teamwork of a embryologist and nurses are needed.
Egg Freezing (Oocyte Cryopreservation)
Thanks to technological investments and our highly educated and experienced team, Ve have clinic offers egg freezing and storage services in the clinic for a future pregnancy possibility.
Who Can Use Egg Freezing Option?
Patients who have a recurring ovarian surgery risk like endometriosis Women who want to get pregnant later in life due to social reasons Patients who will receive chemotherapy.
To create a pool for patients with low ovarian reserves.
Who Are the Candidates for Frozen Embryo Transfer?
For patients who want to use their frozen embryos from the last treatment (the last treatment can be either successful or unsuccessful)
For patients whose embryos are all frozen and no fresh transfer is made due to the hyperstimulation risk or due to the reason that the uterus is not suitable for transfer,
Clinical preference,
For patients for whom embryos are collected (embryo pool) due to various reasons including low egg reserve etc. after embryos are exposed to genetic testing
Preparation of the Uterus for Frozen Embryo Transfer
Developing eggs and egg retrieval procedure during fresh embryo transfer and hormones released by the ovaries prepare the uterus for embryo transfer. The patient can be prepared with ovulation treatment during frozen embryo transfer despite being not very practical however a better option is to suppress ovulation with medications and to prepare the uterus with oestrogen and progesterone hormone supplements so that the ages of uterus and embryos are the same. Embryos that are thawed on the same day are planted in the uterus prepared as described above.
How is Frozen Embryo Transfer done?
In vitro fertilization treatment can result in transfer of embryos both fresh and frozen. Some clinics do not have fresh embryo transfer option and they only offer frozen embryo transfer. In our clinic both fresh and frozen embryo transfers are done successfully depending on the patient's condition. The goal in frozen embryo transfer is to prepare the uterus to accommodate pregnancy and to equalize the age of embryos that are thawed and ready to be transferred and the age of uterus. Because theoretically an embryo that is frozen on day 5 can only be accepted by an uterus that is exposed to progesterone for the same number of days to achieve successful pregnancy. Embryos are frozen with a technique called vitrification with very high post-thaw survival rates and then stored in numbered compartments at -196 C in liquid nitrogen containers. These numbers are called embryo addresses and each embryo address is kept in files. In theory there is no upper time limit for storage. We achieved successful pregnancies followed by successful births with embryos that were frozen 11 years ago.
