What is IVF?
Treatment for test-tube babies or IVF (in vitro fertilization) is the most commonly used assisted reproduction treatment (ART) technique today. Technically speaking; IVF treatment is the fertilization of the female egg cells (oocyte) by the male germ cells (sperms) (cells found in semen) outside the body under carefully prepared laboratory conditions followed by the selection of a certain number of these fertilized egg cells (embryos) and their placement into the uterus.
All IVF practices performed since 1971 formed the basis of today's IVF technique. The modern founder of IVF treatment is Robert G. Edwards. The first "test-tube baby" is Louise Brown, who was born in England in 1978. Following this revolution in reproductive health, studies in the field of IVF have accelerated and become widespread. The first IVF birth was accomplished at Ege University in Turkey in 1989.
Several modes of treatment have been established.
We are ready to accompany you on this path to a healthy and happy future for both you and your baby.
IVF / Microinjection Technique
Although the length of treatment may vary across the types of assisted reproduction techniques, the long protocol is the one most commonly applied. The treatment steps in the long protocol are as follows:
1. Stimulation of the Ovaries
On the2-3rd day of the menstrual cycle, injection of hormonal medications are started in order to stimulate the ovaries. The aim of using such medications is to increase the chance of becoming pregnant by inducing the growth of more than one egg cell. The process of ovarian stimulation takes approximately 10 - 12 days. However, the length of the process may vary from person to person because it will be determined by the response of the ovaries to the medications. During this process, the growth of eggs is monitored closely via ultrasonography, which will be performed every 2-3 days.
In this treatment protocol, gonadotropin-releasing hormone antagonists are administered as a protective measure to avoid premature follicular rupture on the 6th day of medication use. This medication is injected into the umbilical area.
2. Egg Retrieval
When the eggs become mature enough and achieve a certain size, another medication is injected to induce follicular rupture so that eggs can be retrieved. Approximately 34-36 hours after this injection, the eggs are collected. Because this procedure requires meticulous care, the timing of the injection is critical.
The Egg Retrieval Procedure: The patient is admitted to the clinic after an overnight fasting. Then, the egg retrieval is performed; which will take approximately 15-20 minutes. The procedure is painless because the patient will be anesthetized. In the IVF procedure, the eggs are retrieved via the vaginal route. Under ultrasonography guidance; a catheter (needle) with a suction device on one end is used to remove eggs out of the ovary for the egg retrieval purpose. The number of mature eggs may be around 10-12 per patient but this number may vary ranging from 1 to 40. In some patients, no eggs are retrieved although such cases occur rarely. Because patients will not need to stay at the hospital after the procedure, they can return home a few hours later.
3. Fertilization of Eggs
The retrieved egg cells are fertilized under laboratory conditions via the classical IVF method or microinjection (ICSI) method depending on the sperm cell quality. The fertilization results in the development of the embryo, which is the cornerstone of the growth of the baby in the uterus. Fertilization is confirmed via a microscopic examination. The fertilization process takes approximately 12 to 15 hours. The patient is informed about the results of the procedure and a day will be scheduled for embryo transfer.
4. Embryo Transfer
The transfer is performed in the following 48-72 hours or even 120 hours depending on circumstances after the retrieval of fertilized embryos (called pre-embryos or zygotes). Because the timing of the transfer will be determined based on the quality of the embryo, timing of the embryo transfer may vary. Embryos are transferred into the uterus by gently passing them through the cervix by means of a catheter, which is a thin plastic tube. The number of embryos to be transferred is 1 for the first two treatment cycles in patients under the age of 35 years and at most 2 in all other patients. Because the procedure is simple and painless, the patient will be discharged from the clinic soon. A hormone that we call progesterone is administered vaginally or as an injection to the patient until the pregnancy test that will be performed approximately two weeks later. When the pregnancy test is positive, ultrasonography is performed to see the gestational sac 10 days after the pregnancy test.
5. Pregnancy Test
A pregnancy test is performed 12 days after the transfer procedure. Pregnancy test results inform about whether a pregnancy is established. The pregnancy test is the assessment of beta HCG test levels; which does not require overnight fasting.
An ultrasound examination is performed 10 days after the pregnancy test yields a positive result indicating the establishment of the pregnancy. Our patients coming out of town or abroad can undergo necessary examinations; where they reside, provided that they inform us.
How is infertility diagnosed?
If the couple cannot have a child despite 1 year of regular intercourse, the possibility of infertility is considered. For women over the age of 35, this period is 6 months. Sperm analysis for men; ultrasonography, hormone analysis and HSG (hysterosalpinography - medicated uterine film) for women are performed.
How is male infertility diagnosed?
A sperm analysis after 2-7 days of sexual abstinence is the most important test to determine male infertility. Sperm count, motility, and deformity are evaluated. According to the result, tests such as hormone analysis, chromosome tests, ultrasound can be added.
How is female infertility detected?
The diagnosis is made by hormone tests to be performed on 2nd-3rd days of menstruation, ultrasonography examination and medicated uterine film to be performed at the end of menstruation. Women with reduced egg reserve, ovulation disorder, structural defect in the uterus and/or fallopian tube obstruction should apply to assisted reproductive techniques centers.
Which couples undergo IVF treatment?
- Women with both tubes blocked
- Men with sperm count less than 5 million and low sperm motility
- Women with reduced ovarian reserve
- Patients with ovulation disorder who do not respond to ovulation treatments
- Endometriosis patients
- Women with unexplained infertility who cannot conceive with two vaccinations.
- Women over the age of 38 IVF treatment is recommended.
Which drugs are used in IVF treatment?
In vitro fertilization treatment begins with egg enlarging injections, and after the eggs reach a certain size, injections are made to prevent premature cracking. When the eggs reach a sufficient size, the cracking injection is made. After the egg is collected, additional drugs are used to support the lining of the uterus.
In intrauterine insemination, the eggs are stimulated to grow and an ovulation trigger shot is administered. Then, sperm is collected from the male and prepared in the laboratory before being injected into the uterus, where fertilization takes place within the woman's body.
In IVF, eggs are retrieved and fertilized with sperm in the laboratory. Embryo development is monitored, and a suitable embryo is transferred into the uterus.
Does SSI cover IVF treatment?
- If the female age is between 23-39,
- If the tubes are blocked,
- If the sperm count is <5 million,
- If the ovarian reserve is decreased,
- If married for >3 years,
- If sufficient premium days and insurance period have been completed,
- If pregnancy could not be achieved with 2 vaccination treatments
these married couples can have in vitro fertilization treatment covered by SSI for 3 times, provided that they issue a report.
What should be considered during IVF treatment?
IVF is an outpatient treatment that does not require hospitalization. The patient can continue her normal daily life. Injections are administered under the skin, the patient can do it herself. Injection times are important. Smoking, alcohol use, excessive consumption of tea and coffee and packaged unhealthy foods are not recommended.
How many times can IVF be tried?
Theoretically, as long as the woman does not go through menopause and produces eggs, she can try IVF. The trial can be performed as long as there are sperms and eggs.
Until what age can IVF treatment be tried?
As long as menopause is not reached, IVF treatment can be performed. However, after the age of 35, the chance of pregnancy with IVF decreases with each passing year. After the age of 44-45, it drops below 10%.
What is the success rate of IVF?
The chance of success in IVF is different for each patient. It would be correct to evaluate the patient and give a rate. The success rate is 50% on average, and it can go up to 70%.
What affects the success rate of IVF treatment?
Factors affecting the chance of success in IVF are female age and ovarian reserve. The quality of the obtained embryo also affects the chance of pregnancy.
Is there risk of multiple gestation in in vitro fertilization therapy?
In our country, single embryo transfer is legally obligatory in the 1st and 2nd IVF treatment in patients under the age of 35. In the third and over IVF treatments in patients under 35 years of age and in patients over 35 years of age, 2 embryo transfers can be made. If 2 of the 2 embryos attach, twin pregnancy can occur. Transfer of more than 2 embryos is prohibited.
How long does the in vitro fertilization treatment take?
IVF treatment starts on the second or third day of the menstrual cycle, egg growth treatment continues for about ten or twelve days. The time until transfer is approximately 15-20 days. There are also new treatment protocols that are applied without waiting for the menstrual period or with more than one egg enlargement treatment in one cycle, when deemed necessary. However, in this case, the transfer is not performed, and the embryos are frozen.
Does body weight affect IVF treatment?
It is appropriate for patients with BMI (Body Mass Index ) >/30 to start treatment after they lose weight.
The dose of medication used in overweight patients is increased.
The risks of gestational diabetes, premature birth, and gestational blood pressure increase during pregnancy.
What are the risks of in vitro fertilization treatment?
The most important side effect of IVF treatment is OHSS (OVARIAN HYPERSTIMULATION SYNDROME), which occurs as a result of overstimulation of the ovaries. The ovaries are enlarged, fluid accumulates in the abdomen, and adrenal and liver functions are affected. Severe cases of OHSS require hospitalization. However, today, there are methods that minimize the risk of OHSS, in expert hands, the risk of OHSS is considerably reduced.
Egg retrieval is a surgical operation, although very rarely, the risk of bleeding, bladder-intestinal injury and anesthesia-related risks have been reported. Multiple pregnancy is also a risk, but limiting the number of embryos transferred has greatly reduced this risk.
Why is laboratory important in IVF treatment?
One of the most important factors affecting the chance of pregnancy is the quality of the embryo. Embryo quality depends on the quality of the egg and sperm, but the laboratory conditions in which the embryo develops also affect the quality. Therefore, the chance of pregnancy increases with correctly selected embryos produced in laboratories where experienced embryologists work following technological developments.
Can IVF treatment be tried again in women who have miscarried?
After about 3 months of rest, IVF treatment can be started again.
Can couples with chromosomal disorders have children with IVF?
Chromosomal damage transferred to the embryo reduces the chance of embryo attachment or may cause miscarriage. Embryos can be genetically scanned. Thus, it is possible for couples with chromosomal disorders to have children with in vitro fertilization by selecting and placing an embryo with a normal chromosome structure.
After the egg is collected and combined with the sperm, embryo development is evaluated in the laboratory and quality evaluation is made with criteria such as cell number, symmetry, and fragmentation rates. While the 3rd day embryo has 6-10 cells, the 5th day embryo, which we call blastocyst, becomes a compacted cell collection. The blastocyst is an embryo whose durability has been tested for a long time in the laboratory. Which patient will be transferred the 3rd day and which will be transferred the 5th day is decided according to the patient's condition, number of eggs, fertilization rate, embryo course and previous treatment responses.
Day 3 embryo and day 5 embryo
What is the difference between fresh embryo transfer and frozen embryo transfer?
If there is a risk of OHSS, if hormone levels are not at the desired level, if the intrauterine membrane is not at the desired thickness, if formations such as fluid, polyps and fibroids are detected in the uterus, or if the quality embryos increase after the appropriate embryo is selected and transferred, it is recommended to freeze the embryos. Eggs are not grown or collected for frozen embryo transfer. The uterine lining is prepared. There is no difference in terms of chance of pregnancy.
Is endometriosis an obstacle to IVF treatment?
It is not an obstacle, on the contrary, if there is a desire to have children in patients with endometriosis, IVF treatment is recommended before surgery. Pregnancy is achieved in patients with endometriosis with appropriate in vitro fertilization protocols.
Can polycystic ovary patients have children with IVF?
Polycystic ovary patients are the most advantageous patient group for IVF. A large number of eggs can be developed using less medication. However, it is a group that should be followed closely due to the risk of OHSS. Chances of pregnancy are high.
How to measure egg reserve in women?
The precursor egg, antral follicle count and blood AMH (antimullerian hormone test) test) are the most common methods we use to determine ovarian reserve in ultrasound.
How is the quality of eggs determined?
Hormone tests or ultrasound examination do not give information about the quality of the egg. There is no test to determine egg quality. Only after the egg is collected and evaluated under the microscope in the laboratory, its quality is determined.
Can the number of eggs be increased?
Every month, a certain number of eggs come out of the woman's reserve, and one of them grows and cracks, the others undergo atresia. This happens in each menstrual cycle. In IVF treatment, we aim to stimulate and grow all the eggs that come out of the pool that month with drugs, so we get more eggs. However, there is no proven treatment method that will increase the woman's reserve. Stem cell, PRP, vitamin supplements are experimental treatment methods.
Why is IVF treatment important in women with low AMH levels?
A low AMH does not mean that there can be no normal pregnancy. However, in vitro fertilization is recommended so that there is no loss of time. Young patients with low AMH levels can have the chance of pregnancy of their peers with a quality embryo transfer.
How is IVF treatment done in women with blocked tubes?
One of the tubes being blocked does not prevent pregnancy if there is no other reason. However, if both tubes are blocked, there is no chance of pregnancy through the normal way and inoculation treatment since sperm and egg cannot meet and fertilize. IVF treatment should be planned in this case. If there is fluid accumulation in the tubes in patients with blocked tubes, transfer should be planned after tubes are removed or tied to prevent fluid from flowing into the uterus.
How is IVF treatment done in men with low sperm count?
In vitro fertilization is a treatment for women, regardless of who has the problem. As long as the sperm count is not 0 (zero) in the man, low number does not prevent IVF. Sperms suitable in terms of shape and movement are selected and placed into the egg by microinjection. Even 1-2 motile sperms are enough. Smoking-alcohol use and excessive caffeine consumption are not recommended for men. Weight control, vitamin supplements may be recommended if necessary.
After the necessary hormone tests and blood tests, in patients who are scheduled for Micro-TESE, appropriate tissue particles are taken from the testicles under light anesthesia under a microscope, and sperm cells are searched for in these tissues. The sperm found fresh or after thawing are used in the microinjection process.
Why is sperm motility important in male patients?
For a normal pregnancy to occur, the sperm must reach and fertilize the egg with forward mobility. Sperm motility is also important for vaccination and classical IVF treatment.In microinjection treatment, the sperm is injected into the egg with the help of a thin glass needle. Slow or in situ motile sperm can also be used.
A Mediterranean diet is recommended. A diet rich in protein and low in carbohydrates should be followed. Fresh fruits and vegetables in season should be consumed. Processed foods and acidic beverages should be avoided. It is not recommended to consume more than 2-3 cups of tea or coffee. Male and female patients with BMI (Body Mass Index)≥30 should seek help from a dietitian and lose weight.
How do smoking and alcohol consumption affect the treatment?
Smoking and chronic alcohol consumption adversely affect both sperm and egg qualities and reduce the chance of pregnancy during IVF.
What is the IVF success rate in relatively older patients?
If the woman's age is over 38, the chance of pregnancy decreases with each passing year.
20-25% between the ages of 40-42,
10-15% between the ages of 43-44,
If ≥45 years of age, the chance of pregnancy is less than 10%.
How can the chance of pregnancy be increased in IVF treatment?
Patients should apply medication times and doses carefully, eat healthy, avoid harmful habits, and additional metabolic diseases (thyroid, sugar, etc.) should be treated, if any. After the doctor evaluates the patient, a high chance of pregnancy should be ensured with personalized treatment methods and laboratory applications.
EmbryoGlue (embryo glue that allows the embryo to attach to the uterus), and Tractosil (a serum that prevents the uterus from contracting during transfer) are some of the treatment methods that increase the chance of pregnancy.
In recurrent IVF failures, in addition to the above methods, the chance of pregnancy can be increased by other methods such as antibiotic therapy, immunoregulatory serum, and drug therapy to eliminate infections in the uterus.