Sometimes, however, pregnancy may not occur. In this case, the evaluation of the woman and the man to determine the factors that may interfere with pregnancy and an approach according to the findings will be satisfactory.

IVF treatment is the most promising treatment with the highest chance of success in families who cannot conceive spontaneously.

In vitro fertilization is an assisted reproductive treatment for couples who cannot conceive spontaneously. In our center in Ankara, we evaluate our patients and carry out IVF and insemination treatments with the methods we plan according to their individual characteristics.

IVF treatment was first performed in the UK in 1976 and pregnancy was reported by Bob Edwards. Then the first live birth was achieved by the same team in 1978. Since then, approximately 7 million pregnancies have been achieved by in vitro fertilization all over the world.

In the early years, IVF treatment was only given to women with tubal problems, but the discovery of the microinjection (ICSI) method in the 1990s and the achievement of pregnancy gave hope to men with sperm count and motility problems.

WHAT IS IN VITRO FERTILIZATION?

In vitro fertilization (IVF) is the most effective treatment method to achieve pregnancy in spouses who have not been able to achieve pregnancy through spontaneous attempts or other assisted conception treatment methods. In IVF, the eggs obtained after ovarian stimulation are fertilized by combining them with sperm (microinjection).

The fertilized eggs are monitored and the embryos formed are evaluated and the best quality embryos are selected for transfer. In addition, the remaining quality embryos can be frozen for future use.

WHAT SHOULD BE CONSIDERED WHEN CHOOSING an IVF CENTER OR FERTILITY SPECIALIST IN ANKARA?

For success in IVF treatment, the experience of the practicing physician is as important as the individual characteristics of the spouses. When researching clinics and physicians, the number of years the physician has been working in this field, his/her experience, training, and the number of cycles of IVF treatment per month should be taken into consideration. In addition, comfortable dialog with the physician, one-to-one attention at every stage, laboratory conditions and the quality of the materials used are also important factors affecting success.

ANKARA IVF TREATMENT STEPS

IVF treatment mainly consists of 6 steps.

• Ovarian Stimulation:

The aim of IVF treatment is to ensure the development of as many eggs as possible by creating an appropriate drug and dose scheme according to the woman’s height-weight, menstrual cycle, ovarian reserve and treatment type. For this purpose, a personalized treatment scheme is created in the first control. Drug type, method of administration and dose are determined (8). Then, treatment is started in the desired month and the developing follicles are monitored by ultrasound control at certain intervals during the medication period. On average, the follicles reach the desired size in 8-10 days.

In patients with good reserve and planned fresh transfer, the general tendency is to perform a final shut injection in the presence of at least 3 follicles exceeding 17 mm. However, determining the time of the final shut injection according to the patient’s history, ovarian reserve and the type of treatment to be applied, in other words, individualization, will affect the number of eggs to be obtained, the rate of mature eggs and the quality of embryos. Some medications are used for ovarian stimulation.

The drug dose should be selected individually and ovarian stimulation should be individualized. Too low a dose may cause a decrease in the ovarian response, while too high a dose may cause an exaggerated response and increase the risk of overstimulation syndrome (OHSS). When determining the dose of egg enlargement medication to be used in treatment, it is useful to evaluate many issues together. Dose determination;

• Age of the patient,
• Response to a previous IVF attempt, if available,
• Body mass index,
• The number of antral follicles in both ovaries, i. in other words the ovarian reserve, should be taken into account

Stimulation with the lowest possible dose by paying attention to all these issues will help to achieve both patient safety and high success rates. It is very important to use the medication regularly as prescribed. Our nurse will explain this to you in detail. When the follicles reach the desired size, the eggs in the developing follicles are allowed to mature by giving a final shut injection.

•  Egg Collection:

As a general approach, the developing follicles are accessed with a needle inserted vaginally and the fluid in the follicles is aspirated with negative pressure and transferred into a tube. The embryologist evaluates the fluid under a microscope, collects the eggs and transfers them into a special container. Most egg retrieval is performed under anesthesia. The procedure takes about 15-20 minutes depending on the number of follicles present.

If the number of follicles is low, washing the inside of the follicle several times with a special culture fluid increases the possibility of retrieving the oocyte inside the follicle. Since egg retrieval will be performed under anesthesia, I recommend not to eat or drink anything after 12:00 at night before the procedure and not to use perfume or deodorant to avoid affecting the oocytes to be retrieved. The risk of complications after egg collection is very low.

In experienced hands, there is almost no risk of intra-abdominal bleeding or infection. After 45-60 minutes of rest after the collection process, you can leave the center and return home.

• Microinjection (ICSI):

After the cells around the eggs obtained after egg collection are removed, they are evaluated under a microscope and mature eggs are identified. There are 2 methods that provide fertilization in IVF treatment. Invitro fertilization (IVF) or microinjection (ICSI). In IVF, sperm are placed around each mature egg and the sperm itself is expected to fertilize the egg.

This method requires a certain number of sperm and fertilization rates are around 70%, which is slightly lower than with microinjection. With ICSI, each sperm is selected under a microscope and injected into an oocyte by an embryologist. Fertilization rates with this method are around 80%. Although this method was previously used especially in men with severe low sperm count, due to the higher fertilization rates, we now use the microinjection (ICSI) method as a fertilization method in all our patients, regardless of the reason for the inability to conceive.

After the ICSI procedure, the oocytes are placed in special nutrient liquids and placed in special devices called incubators, which are close to the in-body environment in terms of humidity, temperature and oxygen content. 16-18 hours after the procedure, the oocytes are evaluated for fertilization and fertilized oocytes are followed up.

• Embryo Culture:

Fertilized eggs are monitored for embryo development and quality. The embryos formed between days 2-4 after egg collection are called cleavage stage embryos and 3 days after egg collection, the embryos become 7-8 celled.

By the fifth day, the number of cells in the embryo reaches about 250-300 and cannot be counted individually. The parts of the embryo that will form the baby’s mate (trophoectoderm) and the baby (inner cell mass) begin to differentiate. The embryo at this stage is called a blastocyst stage embryo. I do not believe in the additional benefit of endometrial co-culture, so I do not use it.

• Embryo Transfer:

Depending on the number and quality of embryos available, we perform embryo transfer on day 3 or day 5. With embryos in the blastocyst stage, meaning embryos transferred 5 days after collection, the chances of pregnancy increase even more compared to day 3 transfer.

This is because some embryos cannot continue their development from day 3 to day 5 and are naturally eliminated. Thus, the embryo with the highest chance of implantation to the uterus can be selected with greater accuracy. Of course, it should not be forgotten that the embryo can be followed in the laboratory until day 5 only if there are appropriate laboratory conditions. In our clinic, we perform day 5 transfer in 70-75% of our fresh transfer patients.

Embryo transfer is performed with a full bladder. Because when the bladder is full, the curve of the uterus straightens and thus it is possible to visualize it clearly with abdominal ultrasonography and transfer can be done much more easily.

• Pregnancy test:

A pregnancy test can be performed on blood  11 days after the transfer in patients with day three embryo transfer and 9 days after the transfer in patients with blastocyst stage embryo transfer.

WHEN SHOULD IN VITRO FERTILIZATION BE CONSIDERED FOR THOSE WHO CANNOT HAVE CHILDREN?

In spouses who have difficulty in achieving pregnancy spontaneously, treatment options other than in vitro fertilization can be applied if the conditions are appropriate, but especially in the presence of the following conditions, in vitro fertilization treatment will be more appropriate.

• Those who cannot achieve pregnancy with options other than IVF (ovulation treatment, insemination, etc.)
• In patients with complete blockage of the tubes, in those whose tubes have been removed or tied,
• Severe sperm deficiency, i.e. oligospermia or low motility,
• Absence of sperm in semen (azoospermia),
• Those with low egg number (low reserve),
• Women aged 35 years, especially those over 38 years
• In the presence of advanced female age, genetic diseases in the family or chromosomal problems in the spouses, in vitro fertilization treatment for genetic diagnosis and screening (PGT) may be considered.

WHEN AND IN WHICH CASES IS IVF TREATMENT RECOMMENDED?

IVF treatment can be applied to achieve pregnancy in couples who cannot achieve pregnancy spontaneously. In particular;

• Those with unexplained infertility who cannot achieve pregnancy spontaneously or withother treatment options,
• Women over the age of 38, especially over the age of 40, who have a desire to become pregnant and who have tried spontaneously for some time without success,
• Women with low egg number (low reserve), ovulation problems (anovulation, hypogonadotropic hypogonadism, polycystic ovary syndrome, etc.),
• In men with low sperm count and motility, in men with azoospermia, the absence of sperm in semen,
• If the tubes are blocked or if the tubes have been surgically removed or tied,
• Genetic screening and obtaining healthy embryos is necessary due to genetic diseases or chromosomal abnormalities,
• IVF treatment can be performed in patients with sexual dysfunction (vaginismus, male erectile dysfunction or retrograde ejaculation).

Especially in spouses whose female age is above 36-38 years, if pregnancy could not be achieved despite 6 months of spontaneous attempts, control by a reproductive specialist and planning IVF rather than insemination will increase the chance of pregnancy. Because the woman’s age is a very important marker as it directly affects the quality of eggs produced.

WHO CAN UNDERGO IVF TREATMENT IN TURKEY?

In order to be able to undergo IVF treatment, the woman must be producing eggs, the man must have sperm cells and the woman’s age must be 45 years or younger. Because even if menstrual cycles continue at the age of 46 and after, even if eggs are seen, almost all of the eggs to be obtained are unhealthy, so the possibility of achieving pregnancy and birth with IVF is close to zero.

However, IVF can be performed even if the tubes are removed or tied in women. In addition, IVF can be performed even if the sperm count in the male is very low or even if there is no sperm in the semen (azoospermia), if sperm is found by biopsy (TESE/PESA).

In the presence of a genetic disease in the family, in vitro fertilization and genetic diagnosis-screening (Preimplantation genetic screening-PGT-M&A) by taking a cell sample from the embryo obtained can be performed in order to have a healthy baby or to ensure the birth of a tissue compatible (HLA) sibling in the presence of a disease that requires bone marrow transplantation in the child.

Preimplantation genetic screening (Preimplantation genetic screening-PGT&A, SR) can also be performed if a chromosomal abnormality is detected in a woman or a man, if the woman’s age is above 38 years, especially above 40 years, if there is an unexplained recurrent pregnancy loss or recurrent IVF failure.

WHO IS NOT ELIGIBLE FOR IVF TREATMENT?

In order to perform IVF treatment, an egg in a woman, sperm cells in a man and a uterus in a woman are required. In this context, IVF cannot be performed in women who have entered menopause and cannot menstruate without medication. In addition, IVF cannot be performed in a woman who does not have a uterus due to some congenital disorders. A woman’s age is one of the most important factors determining the possibility of pregnancy.

In this context, we do not recommend treatment at the age of 46 and older, even if the menstrual cycle continues, as there is no chance of success with IVF.

In men, if there are no sperm cells in the ejaculatory fluid, in other words semen, and no sperm can be obtained by biopsy, that is, TESE method, there is no chance of IVF treatment.

METHODS APPLIED IN IN VITRO FERTILIZATION TREATMENT

IVF treatment is a treatment method that requires significant experience and is performed using advanced technology. Individualized planning of each step of the treatment in IVF treatment will increase the number of oocytes obtained in IVF treatment, increase the quality of eggs and embryos, and ultimately increase the number of quality embryos, which will positively affect the chance of pregnancy.

For this reason, it is also the case all over the world that the experience of the physician who performs IVF treatment in Ankara, the education and training he/she has received in this field, and the laboratory conditions affect the chance of success, and IVF is not performed with the same pregnancy rate everywhere and under all conditions.

Pregnancy rates differ from physician to physician, from clinic to clinic.

First of all, during the ovarian stimulation phase, it is important to determine the drug usage scheme, drug type and dose, close follow-up and the right timing of the final shut injection according to the woman’s age, weight and height, ovarian reserve, menstrual cycles and previous treatment history, if any. In women over 35 years of age, the use of  combined (with LH activity) medications, a slightly later final shut injection in women with a low number of mature eggs, the use of dual final shut  injections, and a slightly earlier final shut injection in women with a previous problem of premature ovulation will increase the number and quality of oocytes to be obtained.

Careful and meticulous sperm selection in cases with very few sperm in semen, using the IMSI method for correct sperm selection, using Ca-ionophore method or piezoelectric application in families with sperm deformity, in families where it is thought that there may be problems in fertilization, or in families with a history of fertilization failure and low fertilization rate will increase fertilization rates.

In the embryo culture stage, embryo monitoring with time laps incubators in those with recurrent IVF failure will facilitate the accurate detection of embryos with division and developmental anomalies in the developmental stages and the correct embryo selection. Providing appropriate laboratory conditions, performing transfers at the blastocyst stage and freezing and storing the remaining quality embryos at the blastocyst stage will increase the chances of success of the spouses.

Genetic diagnosis and screening (PGT), if necessary due to medical conditions, will ensure the identification of chromosomally and genetically healthy embryos and increase the likelihood of a live and healthy birth.

WHAT TO CONSIDER BEFORE IN VITRO FERTILIZATION TREATMENT?

A detailed evaluation of the spouses before starting IVF treatment and planning the treatment according to their individual characteristics increases the chances of success. In addition, performing infection screening tests (toxoplasma, rubella, CMV infections, hepatitis screening tests), evaluating thyroid and sugar levels, reviewing some vitamin levels, determining the hemoglobin level by performing a complete blood count and taking precautions if any problems are encountered will ensure a safe start to pregnancy after treatment.

Careful evaluation of the uterus and ovaries in the examination of the woman allows the detection of some congenital anomalies in the uterus (intrauterine septum, unicornuat uterus, didelfis) and structures such as polyps, fibroids, etc. that occupy the inner surface of the uterus and reduce the chance of pregnancy. Ultrasonography can detect the presence of cysts in the ovaries and the number of eggs. In this way, a personalized treatment plan can be created and if a problem is detected, appropriate treatment can be performed before IVF.

At the same time, the evaluation of the uterus with 3D ultrasound is also helpful in detecting problems that may prevent intrauterine pregnancy. Chromosome analysis in women with low egg count at a young age and in spouses with sperm count below 5 million in men, evaluation of the tubes by hysterosalpingography in necessary cases in women, hereditary coagulation tests, which are additional evaluations in women with a history of recurrent pregnancy loss, will be useful.

WHICH IS THE BEST IVF METHOD?

The best IVF treatment Center of Turkey is a personalized planned IVF. Of course, the fact that the practicing physician is trained and experienced in this field, follows the scientific developments in the field of in vitro fertilization, has a good command of current practices and is competent will increase the chances of success.

Determining the appropriate treatment option according to the woman’s previous pregnancy or treatment history, taking appropriate precautions in the course of treatment in the use of medication, reviewing options such as in vitro fertilization with genetic screening (Preimplantation genetic screening-PGT) in the presence of advanced female age or recurrent miscarriages, and the additional use of methods such as Ca-ionophore or piezo electric in the presence of fertilization problems will increase the chance of success in fertility clinics. In other words, treatment efficiency and success are much higher with individualized planning rather than a fixed treatment scheme.

HOW IS ANKARA IVF TREATMENT PERFORMED?

For IVF treatment, the woman’s eggs must first be developed. For this purpose, drugs are used in the dose and scheme planned according to the woman’s age, number of eggs,  ovarian reserve, height and weight and previous treatment history, if any.

Generally, the follicles reach the desired size in 8-10 days. Then, after a final shut  injection, the eggs are collected with a procedure performed under mild anesthesia. The classical approach to egg collection is to enter the ovarian tissue with a needle inserted vaginally through the ultrasound probe and remove the fluid in the developing follicles.

The collected eggs are subjected to a special process to dissolve the cells around them and the mature ones are identified under a microscope and taken to the microinjection (ICSI) process. After microinjection, the eggs are transferred to a container containing a special nutrient liquid and placed in a device called an incubator.

These devices provide conditions very close to the temperature, humidity and oxygen levels of the human body. After ICSI, the eggs are evaluated for fertilization and those that are fertilized are monitored. The eggs then divide to form embryos. The embryos are removed from the incubator at certain intervals each day and evaluated in terms of cell number, arrangement, dead cell rate, diameter difference between cells, degree of expansion, quality of the inner and outer cell layer and the quality of the embryos is defined.

Depending on the number and quality of the embryos obtained after follow-up and the IVF treatment plan, embryos are selected at the cleavage (day 3) or blastocyst stage (day 5 or 6) and transferred or frozen.

After the transfer, a blood pregnancy test is performed 11 days after the day 3 transfer and 9 days after the blastocyst stage transfer to determine whether there is a pregnancy. In some special cases, we prefer not to transfer the embryos during the month of egg collection and freeze the embryos we obtain.

If a woman has a high number of follicles and more than 16 eggs are obtained after egg collection, in order to avoid the risk of overstimulation syndrome (OHSS), in the presence of polyps or fibroids in the uterus during ovarian stimulation, in case of vaginal bleeding during ovarian stimulation, in those with high progesterone levels on the blood on the day of the final shut injection, if embryo accumulation will be performed or if there is a plan for genetic diagnosis or screening (PGT), we do not transfer the embryos in the month of egg collection and freeze the embryos we obtain.

HOW TO EAT DURING ANKARA IVF TREATMENT AND AFTER THE TRANSFER FOR THE BABY TO IMPLANT IN THE UTERUS?

There is no special diet that increases the chance of the embryo attaching to the uterus after IVF treatment. However, it has been proven that a diet based on Mediterranean cuisine, i.e. limiting carbohydrates, eating a diet based on vegetables cooked with olive oil, and consuming foods rich in vitamins and proteins increase the chances of success to some extent.

As an fertility specialist, I  also recommend eating well-cooked meat, washing greens well and avoiding unvaccinated cats and dogs in case of infection. Consuming seasonal vegetables and fruits as much as possible, avoiding foods with long shelf life and additives, consuming less processed foods and eating more home-cooked foods will also positively affect the chances of success.

Unfortunately, smoking negatively affects the chances of success in Ankara IVF treatment because it negatively affects both the quality of the eggs to be formed and the development of the inner lining of the uterus.

Therefore, it is important to avoid smoking and alcohol. We consider a woman as pregnant from the moment treatment is started. For this reason, if you need to use any medication other than the medication we recommend, you should definitely use it with the approval of your IVF doctor. It is important to pay attention to whether any medication other than the scheme we have determined for you is compatible with the treatment period and pregnancy.

HOW MANY TIMES CAN IN VITRO FERTILIZATION TREATMENT ANKARA BE TRIED?

There is no number limit for IVF treatment. If the woman’s age and examination findings are appropriate and the man has sperm cells, IVF can be tried an unlimited number of times. Because the drugs used in IVF treatments, which have been performed worldwide for about 45 years, do not increase the risk of uterine, breast and ovarian cancer in women.

HOW LONG SHOULD THERE BE BETWEEN ATTEMPTS?

In IVF treatment, the treatment scheme differs according to the method chosen for the partners. In a woman with normal or low egg reserve, a fresh transfer can be performed if there is no obstacle related to blood hormone levels, the inner wall of the uterus or the tubes in the month of ovarian stimulation. In other words, embryo transfer can be performed in the same cycle as the egg retrieval.

In this case, if the treatment is unsuccessful and there are frozen embryos left behind, the preparation for frozen embryo transfer can be started even with the first menstruation after the necessary controls have been made. If there are no frozen embryos, it may be considered to take a one-month break and start a new treatment and fresh transfer plan.

When the number of eggs in the woman is high, especially if more than 16 eggs are obtained after collection, if there is a plan to perform genetic screening (PGT), if a problem was detected in the uterus during IVF treatment, an unexpected bleeding occurred, hydrosalpinx was detected in the tubes, or if the blood progesterone level was found to be high on the day of final shut injection, the embryos obtained can be frozen in different tubes instead of transferring that month.

In this case, even with the first menstrual bleeding after egg collection, if the examination and hormone evaluation are appropriate, the frozen embryo transfer preparation protocol can be started.

WHAT ARE THE REASONS FOR IN VITRO FERTILIZATION TREATMENT FAILURE?

The chance of success in IVF treatment varies according to the individual characteristics of the spouses. Factors that may affect the success of IVF treatment;

• One of the most important factors is the age of the woman. If the woman’s age is above 38 years, especially above 40 years, the possibility of the eggs being chromosomally problematic, that is, unhealthy, increases. Accordingly, the likelihood of conception decreases and the risk of miscarriage of the pregnancy increases and the likelihood of live birth decreases. At the same time, the risk of an unhealthy baby with chromosomal abnormalities also increases. In other words, as a woman gets older, the chance of pregnancy with embryo transfer of similar quality decreases compared to younger women. The upper age limit for IVF treatment is 45 years, as there is almost no chance of a live birth afterwards.
• Ovarian reserve; We call the number of eggs in the ovaries ovarian reserve. If the ovarian reserve is good, the number of embryos to be obtained during IVF treatment will increase and the possibility of obtaining embryos of good quality to be frozen in addition to the transferred embryos will increase. At the same time, the possibility of transferring embryos at the blastocyst stage, i.e. day 5, will increase, which will give us the chance to choose the best embryos among the embryos and increase pregnancy rates. For this reason, the chances of success in IVF are negatively affected by low ovarian reserve and the risk of not reaching the transfer in the treatment, that is, the risk of cancellation increases. However, the embryo implantation rate will be close to that of women with similar characteristics who have good ovarian reserve.
• Embryo transfer day; Embryo transfer at the blastocyst stage, in other words on the 5th day, increases the chance of pregnancy even more than the 3rd day, that is, the cleavage stage transfer. Because with embryo transfer at the blastocyst stage, we can select the embryo that is more likely to implant to the uterus with higher accuracy. However, of course, if there is no chance of selection, embryo transfer can also be performed on day 3 and we have many patients who have become pregnant in this way.
• Embryo quality; The quality of the embryo to be transferred is an important factor in terms of pregnancy rates. The chances of pregnancy will be higher with 3,4,5 and A or B quality embryos in blastocyst stage transfers and with clean embryos with 7 and 8 cells on day 3 in cleavage stage transfers.
• Hydrosalpenx: In the presence of tubal obstruction and a fluid-filled tube (hydrosalpenx), the fluid in the tube can flow into the uterus, reducing the chance of embryo attachment and increasing the risk of ectopic pregnancy and miscarriage. Therefore, in the presence of hydrosalpenx, embryo transfer after removal of the tube will increase the possibility of pregnancy.
• Recurrent IVF failure; As the number of previous unsuccessful attempts increases, especially after 3 unsuccessful attempts, the possibility of conception with a new attempt may decrease. In patients with recurrent IVF failure, it may be planned to make sure that there is no problem in the tubes, that there is no pathology related to the uterus and to perform chromosome analysis when necessary.
• Uterine factors; In the presence of uterine wall thickness problems, intrauterine adhesions, polyps or myoma uteri compressing the intrauterine cavity, pregnancy results will be negatively affected after IVF treatment.
• Smoking: In case of heavy smoking, in addition to the general health hazards of smoking, the number of eggs to be obtained as a result of IVF stimulation and the chance of pregnancy will decrease. For this reason, we advise our patients who will start IVF treatment to quit smoking.
• Obesity: In case of excess weight, the results can be negatively affected even with IVF treatment. In fact, in one study, when 500,000 IVF cycles were evaluated, it was found that the probability of pregnancy after Ankara IVF treatment decreased by 6% and the probability of live birth decreased by around 13% in women with excess weight on the obesity border.

We published our results in a multicenter study in which we were involved and we found that the woman’s age and the response to ovarian stimulation significantly affect the probability of conception . On this occasion, I should mention that the success of IVF treatment is significantly affected not only by the individual characteristics of the spouses, but also by the experience, knowledge and competence of the practicing physician in this field, the conditions of the laboratory where IVF treatment is performed and the quality of the materials used. As a female fertility specialist, I also personally take care of my patients during the entire treatment process.

WHAT SHOULD BE CONSIDERED IN ANKARA IVF TREATMENT?

During IVF treatment, it is important for men and women to pay attention to their lifestyle. Eating Mediterranean cuisine, that is, consuming meals rich in fruits and vegetables, rich in protein and olive oil, and avoiding carbohydrates, processed foods, packaged and ready-to-eat foods with additives positively affect the chances of pregnancy.

It is also important to avoid alcohol and smoking during the treatment period, to eat well-cooked meat against the risk of toxoplasma infection, and to wash greens well. Excessive physical activity should be avoided and heavy caffeine consumption should be avoided. Of course, it is also important to avoid stress during this period.

FREQUENTLY ASKED QUESTIONS :

WHAT ARE THE TESTS FOR MEN AND WOMEN IN IVF TREATMENT?

It is important to determine whether the woman is ready for pregnancy before IVF treatment. In this context, we recommend infection screening tests (hepatitis tests, TORCH group tests, complete blood count, measurement of sugar and thyroid hormone levels and control of some vitamin values). In addition, if the woman has a history of recurrent pregnancy loss, chromosome analysis and coagulation tests may be considered. Hysterosalpingography (HSG) is not absolutely necessary in all women.

It can be performed if there is a history of abdominal surgery, history of recurrent pregnancy loss, chocolate cyst, suspicion of obstructed, fluid-filled tube (hydrosalpenx) in ultrasound evaluation, previous uterine, tubal ovarian infection (pelvic inflammatory disease-PID). Otherwise it is not mandatory.

Thanks to the recently available 3D ultrasounds, we can evaluate the uterus in terms of formations, polyps, fibroids, congenital anomalies that may interfere with pregnancy.

If no problem is detected after this evaluation, hysteroscopy is not necessary. Studies have shown that interventions such as scratching the uterus do not increase the chance of pregnancy.

The first evaluation in the male is sperm analysis. In sperm analysis, evaluation of sperm count and motility, morphological evaluation and evaluation of sperms in terms of their external appearance (head, neck, tail structures) can be planned in men with a history of fertilization problems. In addition, chromosome analysis will be appropriate in men with a sperm count of less than 5 million or azoospermia and in men with a history of recurrent miscarriage. Hormonal evaluation and additional genetic tests may also be planned in the presence of azoospermia.

WHAT IS BLASTOCYST TRANSFER?

After egg collection, a sperm is injected into each mature oocyte. This method, which we call microinjection, ensures fertilization of the oocytes. The day after egg retrieval is considered day 1 and the embryos are then evaluated for their development and quality in the following days. Embryos reaching day 5 and 6 are considered blastocysts.

In appropriate cases, embryos can even be followed up to day 7. At the blastocyst stage, the embryo now has around 250-300 cells. The part that will form the baby, the inner cell mass, and the part that will form the trophoectoderm layer, have differentiated. Transferring the embryo that has reached the blastocyst stage is called blastocyst transfer.

On the third day, only 45-48% of good quality embryos can develop into good quality blastocysts and some of the embryos do not continue this development. Embryos in the good quality blast stage have a high chance of implanting to the uterus.

WHAT IS EMBRYO TRANSFER?

Embryo transfer is the process of transferring the embryos obtained with the Ankara IVF method into the uterus. For this purpose, the cervix is first visualized with a speculum inserted into the vagina. Then the cervix is gently wiped several times.

The cervix can be washed with a special washing liquid. The aim is to prevent contamination of the tip of the catheter containing the embryo during transfer. Then, firstly, the passage from the cervix into the uterus is checked with a trial catheter. Then the embryo-loaded catheter prepared by the embryologist is inserted into the uterus and the embryo is transferred to the targeted area in the uterus. It is helpful for our patient to have a full bladder during the transfer process to correct the uterine position.

The procedure takes 2-3 minutes and the chance of success is increased by seeing the catheter inserted into the uterus with an abdominal ultrasound during the transfer and transferring the embryo to the desired location.

Because the transfer process is the most important step where all efforts are finalized and the more gently the transfer is performed, the higher the chance of pregnancy. Scientific studies have shown that blood contamination in the catheter during transfer, forced transfer or contamination and infection of the catheter tip decrease the chance of pregnancy.

Apart from the transferred embryos, the remaining quality embryos can be cryopreserved for future use. We prefer to freeze embryos at the blastocyst stage (day 5 or 6) by vitrification method in patients with appropriate embryo quality, since the survival rate after thawing is higher and increases the chance of pregnancy.

WHO CAN UNDERGO EMBRYO FREEZING?

1. Those who have quality embryos other than the embryos transferred after embryo transfer,
2. To avoid the risk of overstimulation syndrome (OHSS) in the presence of polycystic ovary syndrome, i.e. in patients with many eggs,
3. In cases where an intrauterine or tubal problem is detected during ovarian stimulation (bleeding, myoma uteri, endometrial polyp, hydrosalpenx, etc.) and a decision is made not to perform a fresh transfer,
4. Those who have high levels of progesterone on the blood on the day of the final shut injection,
5. Those whose embryos are biopsied as part of preimplantation genetic diagnosis (PGT-M) or screening (PGT-A & SR),
6. In couples where embryo freezing is planned within the scope of fertility preservation approach and
7. It can be applied for those who are scheduled for dual stimulation in the same month.

WHAT IS MICROINJECTION (ICSI)?

Microinjection is one of the methods that ensures fertilization in IVF treatment. Although it was initially used especially in patients with very limited sperm count, today it is used in all patients, regardless of the reason for the inability to conceive. This is because the fertilization rate is higher than with invitro fertilization (IVF).

In microinjection (ICSI), each sperm is injected into a mature egg. It is the most effective fertilization method in assisted reproduction techniques. First, sperm is collected from the ejaculate fluid or from a tissue sample if sperm has been obtained surgically. Then the cells around the oocyte are separated and with the help of a micromanipulator device, 1 sperm is gently injected into each oocyte under a microscope.

WHAT IS THE ANTIMÜLLERIAN HORMONE (AMH) TEST?

Antimüllerien hormone (AMH) is a hormone secreted from the egg sacs called antral follicles, which are 2-9 mm in size, located in the ovaries and is an indicator of the number of eggs present in the ovary. It can be done on any day of the menstrual cycle and the variation in the level within the menstrual cycle or between cycles is very minimal compared to the FSH test, which is checked on the 3rd day of menstruation.

With age, the AMH level decreases as the number of eggs in the ovary decreases. A level of 2-4 ng/ml indicates a good reserve, while values below 1.5 ng/ml suggest a low reserve. In the presence of polycystic ovary, the level is usually above 4 ng/ml.

IVF and BHCG

After Ankara IVF treatment, the presence of pregnancy can be understood by performing a blood pregnancy test 9 days after embryo transfer at the blastocyst stage and 11 days after Day 3 embryo transfer. The name of the hormone tested in the blood pregnancy test is bhCG. Although a value above 5 mIU/ml on the first test day is considered positive, values above 30 are more reassuring.

HOW IS SPERM RETRIEVAL DONE?

The sperm to be used for fertilization of the oocyte in IVF treatment is selected and used after special preparation from the sample produced by the father-to-be through masturbation on the day of egg collection. A sexual abstinence of 1-2 days on the day of egg collection will give the best results in terms of sperm quality and motility.

If the father-to-be does not have enough sperm in the semen or if there is azoospermia, it may be necessary to use surgical methods to obtain sperm. For this purpose, TESE, TESA, MESA or PESA can be performed by taking a biopsy from the testicles under a microscope.

HOW IS THE EGG COLLECTED?

Egg collection in IVF treatment is performed by entering the ovary with the help of a needle advanced through a probe inserted into the vagina. The fluid in the follicles that have grown in the ovary is aspirated with the help of a needle, transferred into a tube and sent to the laboratory for examination.

The embryologist evaluates the fluid under a microscope to determine whether there is an oocyte in the fluid. The procedure takes about 10-15 minutes and is performed under light anesthesia. Thus, our patient does not feel any pain during the procedure.

After the egg retrieval procedure, our patient can leave our clinic after resting for 30-45 minutes. Since egg retrieval is performed under anesthesia, it will be safe not to drive a car, not to use sharp cutting tools such as knives, scissors and not to take a shower on the day of the procedure.

HOW MANY DAYS DOES ANKARA IVF TREATMENT TAKE?

In IVF treatment, there may be different procedures depending on the individual situation of the spouses. If embryo transfer is also planned in the month of ovarian stimulation, IVF treatment can be completed in about 2.5 weeks after menstruation.

However, if the embryos to be obtained that month will be frozen for purposes such as the risk of overstimulation syndrome (OHSS), embryo storage, genetic diagnosis-scanning (PGT), egg collection is performed approximately 12-13 days after menstruation and then laboratory processes can continue. If you have any questions about the IVF process, you can ask me, an English speaking IVF doctor.

AGE LIMIT FOR IN VITRO FERTILIZATION (IVF)

As a woman gets older, the number of oocytes decreases and the risk of unhealthy and problematic oocytes increases.

Therefore, a woman’s potential to conceive is greatly affected by her age. While the highest conception rates are in the 20s, the possibility of pregnancy gradually decreases from the 30s onwards, but the most significant effect occurs after the age of 40.

The risk of chromosomal abnormalities in the eggs produced, whether spontaneously or after treatment, ranges from 50-55% around the age of 38 to 90% at the age of 45. By the age of 46, it becomes almost 100%. For this reason, I do not recommend IVF at the age of 46 and later, even if the person has regular menstruation, even if eggs and embryos are obtained, since the possibility of pregnancy and, more importantly, childbirth is close to zero.

GENETIC SCREENING IN IN VITRO FERTILIZATION (PGT)

Preimplantation genetic screening (PGT) is a method that allows the embryos obtained through in vitro fertilization to be screened for chromosomes or genetic diseases by taking cell samples. Thus, information about the genetic structure of the embryo can be obtained before it is transferred to the uterus.

In which cases can PGT be performed?

• The building blocks of humans are chromosomes and each person has 46 chromosomes. As a woman gets older, especially after the age of 40, the risk of chromosomally problematic and unhealthy eggs produced increases. For this reason, the risk of many abnormalities, especially Down Syndrome, increases in the resulting embryo. Therefore, in the presence of advanced female age, PGT can be performed to screen the embryo in couples planning IVF. PGT performed for this purpose, which aims to screen for the presence of abnormal chromosomal structures called aneuploidy, is called PGT-A.
• If there is a chromosomal problem in the male or female, the embryos that are formed may have an excess or deficiency in the number of chromosomes. In this case, PGT can be performed to determine the chromosomal status of the embryo before it is transferred. PGT performed for this purpose is called PGT-SR.
• In the presence of a family history of genetic disease, in the presence of genetic disease in children born to the family before, or in the case of genetic disease carriage in the screening of spouses, the embryo obtained can be screened for disease and the healthy embryo can be identified and the birth of a sick baby can be prevented. PGT for this purpose is also called PGT-M. Preimplantation genetic diagnosis can also be performed for single gene disorders and HLA typing. Of course, a Reproductive Genetics Center is required for these treatments

SUCCESS RATE IN IN VITRO FERTILIZATION

The success rate in Türkiye (Turkey) IVF Clinics depends on several factors. These are;

• Female age,
• Ovarian reserve
• Day and quality of embryo transferred
• Whether there is an additional problem with the uterus or tubes that may interfere with pregnancy
• Sperm source (ejaculate or surgically obtained sperm)
• Doctor experience
• Laboratory conditions.

The most important factors determining the success rates in IVF treatment are the woman’s age and ovarian reserve. Because we know that as a woman’s age increases, the risk of unhealthy eggs produced increases. For this reason, pregnancy rates both in the natural process and in IVF treatment decrease with advancing age. In addition, the number of eggs also decreases with age and this affects the chances of conception at the level of low reserve.

Under the age of 30, the chance of pregnancy increases up to 58-60% with embryo transfer at the good quality blastocyst stage. In the 35-38 age range, the chance of pregnancy with embryo transfer at the 2 good quality blastocyst stage can be around 50-55%. After the age of 40, each additional age significantly decreases the chance of pregnancy, and while the pregnancy rate can be around 25-35% with embryo transfer at the stage of 2 quality blastocysts between the ages of 40-42, it decreases to almost non-existent levels after the age of 45.

However, if the chromosomal status of the embryo is screened with the preimplantation genetic screening (PGT-A) method and a healthy embryo is obtained, pregnancy rates increase to 70-74% even over the age of 40 with the transfer of a single healthy embryo.

THINGS TO CONSIDER DURING IVF TREATMENT AND AFTER EMBRYO TRANSFER

Daily life can be continued during IVF treatment. Daily activity and working do not have a negative effect on the treatment process. However, the first few days after embryo transfer are particularly important and we recommend staying at home and resting as much as possible during this period.

Continuous bed rest is not necessary. There is no harm in sitting, walking around the house and light movements. It is important that you take all the medications we recommend during the treatment and after the transfer.  If you need to use any medication other than the medication we have recommended, you should consult us whether it is safe or not.

CAN WOMEN CONCEIVED WITH ANKARA IN VITRO FERTILIZATION GIVE VAGINAL BIRTH?

Pregnancy achieved through in vitro fertilization does not require a different approach from spontaneous pregnancy in terms of pregnancy follow-up or mode of delivery. If there is no problem with the mother or the baby during pregnancy follow-up and if the examination findings are appropriate, vaginal delivery can be performed. Conception through in vitro fertilization does not require a cesarean section.

IS ANKARA IVF TREATMENT AN EXPENSIVE TREATMENT?

IVF treatment is a treatment method that requires advanced technology. The quality of the materials used during the treatment, laboratory conditions, temperature, humidity, gas values inside the laboratory and incubator, the quality of the equipment used affect the chance of success at least as much as the individual characteristics of the spouses and the experience of the physician.

As the quality of the materials used increases, treatment costs increase. For this reason, when deciding on a physician and center for IVF treatment in Ankara, the decision should not be based solely on pricing. However, I can easily say that IVF treatment is very successful in our country and is performed with success rates close to the reputable centers in Europe and America and is performed under much more economical conditions compared to those regions. For this reason, many patients from abroad prefer our country for treatment.

However, of course, the success rates of every physician and every clinic in our country are not the same as in the whole world. Success rates differ due to experience and technical equipment.

WHAT ARE THE LEGAL RESTRICTIONS ON IVF TREATMENT IN TURKEY

According to the Regulation on Assisted Reproductive Treatment Practices and Assisted Reproductive Treatment Centers in Turkey, sex determination methods, egg and sperm donation in vitro fertilization and surrogacy are prohibited.

In addition, couples applying for IVF treatment must have an official marriage certificate.

DOES IN VITRO FERTILIZATION WORK IN THE FIRST ATTEMPT?

The factors that most affect the chance of success in IVF treatment are the woman’s age and ovarian reserve. In women under 30 years of age, the chance of pregnancy is around 63-65% with embryo transfer at the blastocyst stage with good quality in the first attempt.

HOW MUCH IS IN VITRO FERTILIZATION in TURKEY?

The cost of IVF treatment varies according to the individual characteristics of the spouses, the type of treatment to be applied, the procedures to be performed and the city. Therefore, it is not possible to talk about a single price. However, if we talk about Ankara, we can say that the IVF price range is between 3500-3800 USD excluding medications.

I should remind you that the experience of the physician and laboratory conditions are as important as the individual characteristics of the spouses in IVF treatment, so it would be appropriate not to make a decision based only on the price.

İletişim Bilgileri

Yazar: Prof. Dr. Mehtap Polat
Telefon: +90 530 011 41 33
E-Posta: info@mehtappolat.com

Referanslar:

• Yaralı, M.Polat, G.Bozdağ, M.Günel, İ.Alpas, İ.Esinler, U.Doğan, B.Tıraş, ‘TESE-ICSI in patients with non-mosaic Klinefelter syndrome: a comparative study’, Reproductive Biomedicine Online, 2009;18(6): 756-760. DOI: 10.1016/S1472-6483(10)60023-5.
• Polat, G.Bozdağ, H.Yaralı, ‘Best Protocol for Controlled Ovarian Hyperstimulation in Assisted Reproductive Technologies: Fact or Opinion?’, Seminars in Reproductive Medicine, 2014; 32(4), 262-271. DOI: 10.1055/s-0034-1375178.
• Yaralı, M.Polat, S.Mümüşoğlu, İ.Yaralı, G.Bozdağ ‘Preparation of endometrium for frozen embryo replacement cycles: a systematic review and meta-analysis.’ J Assist Reprod Genet. 2016 Oct;33(10):1287-1304. Epub 2016 Aug 22.
• Mumusoglu, M. Polat, IY. Ozbek, G. Bozdag, E.G. Papanikolaou, S.C. Esteves, P. Humaidan, H. Yarali, ‘Preparation of the Endometrium for Frozen Embryo Transfer: A Systematic Review’ Front Endocrinol (Lausanne). 2021 Jul 9;12:688237. doi: 10.3389/fendo.2021.688237. eCollection 2021.
• Polat, S. Mumusoglu, G. Bozdag, I.Y. Ozbek, P. Humaidan, H. Yaralı, ‘Addition of Intramuscular Progesterone to Vaginal Progesterone in Hormone Replacement Theraphy in Vitrified-Warmed Blastocyst Transfer Cycles’
  Reproductive BioMedicine Online, 2020 Jun 40(6):812-818, https:// doi.org/10.1016/j.rbmo.2020.01.031 .

After transfer of the embryo, some supportive drugs that enhance the attachment of the embryo to the uterus should be used, and these drugs may vary according to the drug protocol we apply to the couple. Our nurses will tell you which drugs and for how long you should use these drugs.

Contact information :

Author : Prof. Dr. Mehtap Polat
Telephone : +90 530 011 41 33
E-mail : info@mehtappolat.com

What Causes Endometriosis?

Although the reason is not known exactly, the commonly accepted theory is that menstrual blood is poured into the abdominal cavity via tubes and endometrial cells settle and multiply there.

In endometriosis, cells that normally grow inside the uterus and are shed every month, which we call endometrial cells, settle in areas outside the uterus. Frequently, their localization is in the areas between the ovaries, tubes, uterus, intestines and peritoneum. When they settle in the ovary and cause a cyst, they are called endometrioma (chocolate cyst). They are almost always benign and can be easily diagnosed by ultrasonography.

Where Does Endometriosis Occur?

The places where endometriosis is often located are the areas between the ovaries, tubes, uterus, intestines and peritoneum. When they settle in the ovary and cause a cyst, they are called endometrioma (chocolate cyst). They are almost always benign and can be easily diagnosed by ultrasonography.

Less frequently, there may be involvement in the lungs, in the presence of severe disease, the intestines and urinary bladder.

What Are the Symptoms of Women with Endometriosis?

The most prominent complaints are abdominal pain, palpable abdominal mass and difficulty in getting pregnant.

Some patients with endometriosis may have no symptoms. However, the most common symptom is abdominal pain. Although pain is especially during menstruation, it can also occur during non-menstrual period, during sexual intercourse, or during urination or defecation if bowel and urinary tract involvement is present. Endometriosis is staged in 4 different classes, from Stage I to IV. Staging can only be done by laparoscopy. There is no relationship between the extent (stage) of the disease and the severity of symptoms. Although some patients have advanced endometriosis, they do not have any pain complaints, and sometimes they may have very intense pain in mild disease.

Why Can Endometriosis Prevent Conceiving?

Endometriosis can cause difficulty in conceiving by disrupting the anatomical relationship of the uterus, tube and ovaries, which are the abdominal organs, or by causing obstruction in the tubes and a fluid-filled tube, namely hydrosalpenx. However, endometriosis does not have a negative effect on pregnancy.

Endometriosis is staged in 4 different classes, from Stage I to IV. Staging can only be done by laparoscopy.

What are the Symptoms of Endometriosis in the Intestines?

Intestines can be affected due to adhesions between them and the surrounding organs, and in this case, the patient may complain of constipation. Or, if endometriosis foci invade the intestinal wall, it may cause bleeding during defecation.

Why Can Endometriosis Prevent Conceiving?

Endometriosis can disrupt the anatomical relationship of the uterus, tubes and ovaries, which are the abdominal organs. It can cause severe adhesions between all female reproductive organs and intestines, or it can cause obstruction in the tubes, causing a fluid-filled tube, namely hydrosalpenx. As a result of all these negativities, the relationship of the uterus, tube and ovary may be disrupted and may cause difficulty in conceiving.

In addition, the mere presence of chocolate cyst can have a negative effect on the surrounding healthy ovarian tissue, reducing the number of eggs, that is, the ovarian reserve.

However, endometriosis does not have a negative effect on pregnancy. It does not increase the risk of miscarriage or baby with anomalies.

What are the Endometriosis Treatment Options?

In patients who do not desire pregnancy, medical treatment may be considered. However, medical treatment options can be beneficial in terms of relieving the patient’s complaints. If the disease is completely permeable and there is a cyst, it does not have a destructive effect. The medical treatment options that can be used for this purpose are painkillers in the non-steroidal anti-inflammatory group, combined birth control pills, preparations containing progesterone, and the use of GnRH agonists.

Removal of the cyst in the ovarian tissue or burning of the endometriosis foci in the abdomen by laparoscopy, and in the presence of severe disease, the adhesions between the intra-abdominal structures can be opened and the organ functions (bowels, urinary tracts, etc.) can be corrected.

However, we stay away from surgical treatment as much as possible, except in patients with suspected cancer, severe pain complaints but no response to medical treatment, very large cysts, or rupture of the cyst wall and leakage of the cyst contents into the abdominal cavity. Because even the best hands on the ovarian tissue carry the risk of loss of healthy ovarian tissue and decrease in ovarian reserve. In addition, endometriosis is a recurrent condition and surgery may not always contribute to pain relief.

How Is Endometriosis Treated?

Treatment should be planned according to the woman’s symptoms and whether she wants to conceive or not.

In patients who do not want to be pregnant;

Depending on the woman’s complaints, medical treatment may be considered. However, medical treatment options can be beneficial in terms of relieving the patient’s complaints. If the disease is completely permeable and there is a cyst, it does not have a destructive effect. Medical treatment options that can be used for this purpose are painkillers in the non-steroidal anti-inflammatory group, combined birth control pills, preparations containing progesterone and drugs containing GnRH agonists.

Laparoscopy may also be an option for patients who do not respond to medical treatment, have severe pain, and have difficulty in maintaining their daily life. By performing laparoscopy, removal of the cyst in the ovarian tissue or burning of the endometriosis foci in the abdomen, and in the presence of severe disease, the adhesions between the intra-abdominal structures can be opened and the organ functions (bowels, urinary tracts, etc.) can be corrected.

However, we stay away from surgical treatment as much as possible, except in patients with suspected cancer, severe pain complaints but no response to medical treatment, very large cysts, or rupture of the cyst wall and leakage of the cyst contents into the abdominal cavity. Because even the best hands on the ovarian tissue carry the risk of loss of healthy ovarian tissue and decrease in ovarian reserve. In addition, endometriosis is a recurrent condition and surgery may not always contribute to pain relief.

In patients who want pregnancy;

It is not true that every patient with endometriosis can become pregnant with treatment. Spontaneous pregnancy can also be achieved in couples whose tubes are open, who ovulate regularly and who do not have sperm problems belonging to the spouse. For this reason, in a couple who applied with the complaint of inability to conceive, it is important to first investigate whether there is an additional factor on the side of the woman or man that may cause the inability to become pregnant.

In couples who are young, do not have a problem that may affect the permeability of the tubes, have a short period of not being able to conceive and have no male problems, it may be an option to wait for spontaneous pregnancy for a while, or ovulation vaccination can be applied in patients with suitable conditions. You can find detailed information about vaccination treatment in our vaccination treatment article.

If the woman’s age is 38 years or older, the period of not being able to conceive has exceeded 2-3 years, if a male problem is detected (lack or absence of sperm (azoospermia), sexual dysfunction, etc.) and severe adhesions in the abdomen with a previous operation If there is a history of tuberculosis and tuberculosis, IVF treatment may be considered.

In patients with an IVF plan, we would like to avoid surgery unless there is a suspicion of cancer or other medical necessity. It is accepted that in vitro fertilization in the presence of endometrioma cysts does not have a negative effect on egg or embryo quality or pregnancy rates. In our study, in which we presented our own data, which was accepted in an international journal, we reported that pregnancy rates were similar in women with and without endometrioma with the same characteristics. For this reason, we prefer to apply IVF treatment without surgical treatment in couples for whom we have decided to undergo IVF treatment.

What are the Treatment Options for Infertile Couples?

First of all, it is important to investigate whether there is an additional factor on the side of the woman or man that may cause concomitant inability to conceive. Especially in the presence of women aged 38 and above, if the period of not being able to conceive exceeds 2-3 years, if a male problem is detected (lack or absence of sperm (azoospermia), sexual dysfunction, etc.) and severe adhesions in the abdomen with a previous operation If there is a history of tuberculosis and tuberculosis, IVF treatment may be considered.

In patients with an IVF plan, we would like to avoid surgery unless there is a suspicion of cancer or other medical necessity. It is accepted that in vitro fertilization in the presence of endometrioma cysts does not have a negative effect on egg or embryo quality or pregnancy rates. In our study, in which we presented our own data, which was accepted in an international journal, we reported that pregnancy rates were similar in women with and without endometrioma with the same characteristics. For this reason, we prefer to apply IVF treatment without surgical treatment in couples for whom we have decided to undergo IVF treatment.

In couples who are young, do not have a problem that may affect the permeability of the tubes, have a short period of not being able to conceive and have no male problems, it may be an option to wait for spontaneous pregnancy for a while, or ovulation vaccination can be applied in patients with suitable conditions.

Frequently Asked Questions About Endometriosis

Does endometriosis cause trouble getting pregnant?

If it causes adhesions in the abdomen, obstruction in the tubes and a disorder in the anatomical relationship of the uterus, tube and ovary, endometriosis may cause problems in conceiving on its own. Otherwise, only the presence of isolated foci of endometriosis in the abdomen or the presence of endometrioma cysts in the ovary is not necessarily a contraindication to pregnancy.

How can you tell you have endometriosis?

The most common complaint in patients with endometriosis is severe inguinal pain during menstruation. In addition, some of the patients may have abdominal pain during non-menstrual period or pain during sexual intercourse. In addition, trouble getting pregnant can be added to the picture in most patients.

Finding an endometrioma cyst on ultrasonography in the pelvic examination is sufficient to make the diagnosis. However, ovarian cyst formation is not seen in every patient with endometriosis. In some parts, there may be involvement only in the membrane called the peritoneum, which covers the inner wall of the abdomen. In this case, that is, in the presence of early-stage endometriosis, the only way to make a diagnosis is to see the foci laparoscopically, as endometriosis foci cannot be seen by ultrasonography. However, nowadays we almost always do not perform laparoscopy for diagnosis purposes only.

How should the treatment be in the presence of hydrosalpenx?

If the end of the tubes opening into the abdominal cavity is blocked and there is fluid accumulation in the tube, we call this situation hydrosalpenx. The presence of hyrosalpenx is a condition that significantly reduces the chance of conception, increases the risk of ectopic pregnancy and increases the risk of miscarriage. For this reason, removing the hydrosalpenx tube before attempting pregnancy or, if there is a very severe adhesion, at least disconnecting it from the uterus will increase the chance of success after the treatment.

Ankara Endometriosis Surgery

As I mentioned above, we stay away from surgery in the presence of endometriosis unless it is absolutely necessary. Because even after laparoscopic surgeries performed in the best hands, there may be loss of healthy ovarian tissue, decrease in the number of eggs, and adhesions in the abdomen.

However, in patients with severe abdominal pain, unresponsive to medical treatment, rupture of the cyst wall, or in the presence of hydrosalpenx, surgery with the laparoscopy technique can be considered.

Contact information :

Author : Prof. Dr. Mehtap Polat
Telephone : +90 530 011 41 33
E-mail : info@mehtappolat.com

The Egg is the female reproductive cell, and it is the largest cell in the body. Egg freezing means when a woman’s eggs, which are obtained after ovarian stimulation, are stored for future use by in vitro fertilization method.

WHO CAN UNDERGO EGG FREEZING?

Egg freezing is allowed under certain conditions to preserve fertility with the regulation on Assisted Reproductive Therapy and Assisted Reproductive Treatment Centers published on September 30, 2014.
In situations where;

• There is a family history of early menopause, such as mother, aunt, and sister of the woman,
• Presence of a disease that required the removal of ovaries,
• In case of need for chemotherapy or radiotherapy for any reason,
• If the ovarian reserve is determined to be low and there is no plan to have a baby at the moment,
•  
  A woman’s eggs can be frozen and stored.

HOW THE EGG FREEZING PROCESS IS PERFORMED?

In order for egg freezing to be performed, first of all, the development of multiple eggs in the ovaries of the woman must be ensured. Because under normal conditions, every woman ovulates only one egg every month and loses a number of egg cells that vary from person to person before they can develop.

With the help of drugs to be given from outside, it is essential to enlarge the eggs that will be lost and to ensure the development of multiple eggs. For this reason, first of all, after the examination of the woman, the appropriate stimulation protocol for ovarian stimulation is selected. The choice of this protocol is made according to the age of the woman, her menstrual pattern, ovarian reserve and whether there is an additional health problem.

Then, in the desired month, appropriate drugs are started within the scope of this selected protocol, and egg-enhancing drugs are started with the woman’s menstruation. Until the egg sacs, namely the follicles, reach the desired size, in general, we want the leading ones to reach 17 mm in size, followed by ultrasonography at intervals of a few days. Generally, 8-10 days of ovarian stimulation is required for the follicles to reach the desired size. You can read our Stimulation of the Ovaries article to get details about stimulating the ovaries.

When the follicles reach the desired size, a final shut injection is applied to ensure the maturation of the oocytes, and then oocyte pickup is performed under light anesthesia. Since we almost always perform the oocyte pickup procedure under anesthesia in our center, no pain is felt throughout the procedure and the process takes approximately 10-15 minutes.

On the day of oocyte pickup, the oocytes are evaluated for their maturity under the microscope after the cells around them are removed, and the mature eggs are frozen in groups of two or three with the vitrification technique. In the vitrification technique, the liquid inside the cell is released out of the cell with the special solutions, and replaced with the liquid called cryoprotectant. Then the oocytes are stored in tanks containing liquid nitrogen at -196 °C. After collection, only mature oocytes can be frozen and stored. Approximately 80% of the oocytes collected are mature.

WHAT ARE THE IMPORTANT POINTS IN EGG FREEZING?

Stimulation of the ovaries in a proper way will increase the number of eggs to be obtained at the end of a single stimulation cycle. For this reason, choosing the most appropriate ovarian stimulation protocol according to the individual characteristics of the woman and reserve of the ovaries and using the appropriate drug doses will affect the number of eggs to be obtained. In addition, the timing of the final shut injection also affects the chances of success. Early or late trigger may reduce the number of mature eggs or cause problems such as early triggering.

HOW MANY EGGS SHOULD BE FROZEN TO PROTECT FERTILITY?

Age of the woman is an important factor that influences both egg count and egg quality. Every girl is born with a fixed number of egg cells from birth, and from puberty, one egg is laid every month and she lose a certain number of eggs too. However, no woman has a chance to produce new eggs either spontaneously or with medication.

Therefore, as age progresses, the number of eggs remaining in the ovaries decreases. In addition, as the age of the woman progresses, the risk of getting chromosomally problematic and unhealthy eggs increases, and therefore, getting pregnant becomes more difficult compared to younger ages, the risk of miscarriage and loss of the pregnancy increases, and the risk of anomaly, especially Down Syndrome, increases in the baby.

Because of those, the number of eggs to be frozen varies according to the age of the woman. While freezing 8-10 mature eggs under the age of 35 may be sufficient, more mature eggs will be needed over the age of 40. Therefore, freezing only a few eggs does not mean that fertility is preserved. To better understand the impact of female age on fertility, you can read my Preimplantation Genetic Testing (PGT-A) article.

Contact information :

Author : Prof. Dr. Mehtap Polat
Telephone : +90 530 011 41 33
E-mail : info@mehtappolat.com

The protocols we use in IVF treatment; 

• Long Protocol (GnRH agonist protocol, luteal estrogen priming protocol)
• Short Protocol (GnRH Antagonist protocol, progesterone primed protocol)
• Microdose Protocol (OC-Mikrodose flare up protocol)
• Ovarian Sensitizing Protocol ( Letrozole (Femara) protocol)
• Minimal Stimulation Protocol
• Dual Stimulation Protocol (Double ovarian stimulation in the same cycle)
  
  

While determining the dose of egg enlargement drug to be used in the treatment, dose adjustment should be made by taking into account the patient’s age, the response to previous IVF trials, body mass index, the number of antral follicles in both ovaries, that is, the ovarian reserve. By paying attention to all these issues, stimulation with the lowest possible dose will help to achieve both patient safety and high success rates. 

After the treatment is started, the daily dose of medication is started. It is important that the drugs to be used are used as described on a regular basis every day. 

How many days does ovarian stimulation last?

The use of ovarian stimulating drugs takes 8-10 days on average. During this period, it is necessary to measure the size of the egg sacs, namely the follicles, by measuring estradiol in the blood and ultrasonography from time to time. During ovarian stimulation, determining the individualized drug use protocol and dose according to the individual characteristics of the woman and the ovarian stimulation response, if any, is of vital importance in terms of the response to be received and thus the success of IVF. Inadequate use of the drug dose may decrease the response, while overuse of the dose may increase the risk of developing overstimulation syndrome (OHSS). 

In the presence of polycystic ovary syndrome (PCOS) or in cases with a high ovarian response and more than 18 egg sacs with a size larger than 11 mm on the day of the cracking injection, it is preferable to freeze all embryos obtained that month and not to make fresh transfers in order to avoid the risk of OHSS. we are doing. 

After the follow-up, when the egg sacs reach the desired size, we plan the egg collection process 34-36 hours after the cracking needle. In general, we prefer to make cracking needles when the size of at least 3 egg sacs exceeds 17 mm in our applications. The purpose of applying the cracking needle is not to crack the eggs, but to ensure their final maturation. 

Treatment can be canceled during ovarian stimulation in 10-15% of patients. 

During ovarian stimulation, no special diet is required in terms of nutrition. We recommend that you consume vegetables and fruits as normal of the season, and not to use alcohol and cigarettes. If you need to use a medicine due to another ailment, you should consult us and make sure that it is appropriate. During this period, there will be no harm in working, doing light exercises and having sexual intercourse until the last days of stimulation. 

Contact information :

Author : Prof. Dr. Mehtap Polat
Telephone : +90 530 011 41 33
E-mail : info@mehtappolat.com

What are the Symptoms of Polycystic Ovarian Syndrome (PCOS)?

The most common symptom is menstrual irregularity that continues from the age when patients first start menstruating. Every patient does not need to have this symptom but most of the patients mentions about menstrual irregularity. It is considered normal for the menstrual cycle to be every 21-35 days from the first day to the first day of the next period. In patients with menstrual irregularity, menstrual intervals may be every 45-60 days, or in some patients, it may be on the verge of not having a menstrual period without medication.

An increase in hair growth in the male-pattern areas of the body is another indication that is observed in most of the patients. In other words, hair growth is frequently seen on the face, nipples, waist, arms and thighs where hair growth is not normally seen especially in women. More than normal hair loss, thinning hair, oily skin and acne complaints increase in most women too.

In addition, some patients have increased insulin resistance, hyperinsulinism, increased blood sugar levels, high blood lipid levels, and a tendency to gain male-type weight gain, that is, fat in the abdomen and belly.

Clinical Findings: 

If 2 of the 3 findings below are present in our patient, we diagnose her as having PCOS. 

• Menstrual irregularity (usually 6-8 or fewer periods per year) that is often seen from adolescence may be in the form of infrequent menstruation in the majority of patients, while in some, it may be in the form of absence of menstruation without medication. However, this is not the rule, regular periods may be seen in some patients.
• Androgen hormone elevation causing male pattern hair growth (above the lips, chin, nipples, thighs, arms and waist) increase, intense hair loss and acnes as a clinical reflection or only high androgen hormone (testosterone, DHEAS, androstenedione) levels in the blood can be detected.
• In the past, the presence of more than 12 egg sacs (antral follicles) of 2-9 mm in size in both ovaries in the ultrasonographic evaluation was considered as a polycystic ovary image. However, today, thanks to highly sensitive ultrasonography devices, this number has been updated as more than 20 antral follicles for each 2 ovaries.
  
  

How is PCOS diagnosed?

For the diagnosis of PCOS, The Androgen Excess and PCOS Society criteria, National Institute of Health (NIH) criteria or Rotterdam criteria can be used. Rotterdam criteria are the frequently used one today.

In accordance with the Rotterdam diagnostic criteria, we diagnose the patient as having PCOS, if 2 of the 3 findings below are present.

• Menstrual irregularity (usually 6-8 or fewer periods per year) that is often seen from adolescence may be in the form of infrequent menstruation in the majority of patients, while in some, it may be in the form of absence of menstruation without medication. However, this is not the rule, regular periods may be seen in some patients.
• Androgen hormone elevation causing male pattern hair growth (above the lips, chin, nipples, thighs and arms and waist) increase, intense hair loss and acnes as a clinical reflection, or only high androgen hormone (testosterone, DHEAS, androstenedione) levels in the blood can be detected.
• In the past, the presence of more than 12 egg sacs (antral follicles) of 2-9 mm in size in both ovaries in the ultrasonographic evaluation was considered as a polycystic ovary image. However, today, thanks to highly sensitive ultrasonography devices, this number has been updated as more than 20 egg sacs for each 2 ovaries.
  
  

Parameters to Consider in Polycystic Ovarian Syndrome

Approximately half of the patients are overweight. Insulin resistance and hyperinsulinism are observed in most of the patients, regardless of excess weight. Those with insulin resistance may also need to lose weight and use medication when necessary. At the same time, the risk of developing type 2 diabetes increases throughout life in the presence of PCOS.

There is also an increased risk of developing coronary heart disease in those with insulin resistance or diabetes, in addition to high blood lipid levels in PCOS patients.

In the presence of PCOS, besides the increase in the frequency of depression and anxiety, the possibility of eating disorders also increases.

The risk of thickening (hyperplasia) or cancer in the inner wall of the uterus may increase in patients with menstrual irregularity who have 3-4 months between periods or less frequent menstrual periods and whose regularity cannot be achieved with medical treatment.

Treatment of Polycystic Ovarian Syndrome

The treatment is planned according to whether the woman have a desire of pregnancy.

Can Women with Polycystic Ovarian Syndrome get Pregnant?

Women with polycystic ovary syndrome can achieve pregnancy effectively after they are evaluated as a couple and the appropriate treatment method is determined. In fact, the possibility of pregnancy without the need for IVF may be quite high in couples who do not have any additional problems related to either the woman or the man, and where the woman’s age is young.

In this scope;

Treatment in the period where there is not a planning for pregnancy;

Regulation of the life style should be the primary aim here. Thereby, providing weight loss with regular nutrition, a diet low in carbohydrates and increasing exercise will help initiation of ovulation function in some patients and may ensure regular menstruation. Even loss of 5-10% of body weight can be beneficial to regulate menstruation. So, losing 4-8 kg for a woman whose weighs 80 kg can ensure regular menstruation without any need for the treatment. Meanwhile, weight loss will contribute to the improvement of insulin resistance and blood lipid values to be in the normal range.

Androgen deprivation drugs can also be used in order to prevent excess hair growth in patients who cannot benefit from using birth control pills for 6 months or who do not want to use birth control pills. However, in cases where this treatment is applied, it should be reminded that pregnancy should be avoided absolutely.

The treatment methods applied prevent the growth of new hairs. Thus, epilation methods should be applied in order to destroy the existing hairs.

Menstrual Irregularity Treatment in PCOS

Having regular menstruation periods is important in PCOS patients. Because menstruation at intervals infrequent than 2 months causes the inner wall of the uterus to remain under the influence of estrogen solely and if regular bleeding is not provided with drugs, problems such as hyperplasia that can turn into malignant diseases in neglected patients and cause an increase in the risk of cancer of the inner wall of the uterus in the following years. Therefore, as a recommendation to be followed, it is important to follow the menstrual cycle of the person and to use medication when necessary.

The most commonly used drugs in this context will be combined birth control pills. This type of treatment can be considered especially in patients with increased body hair growth, to prevent the development of new hairs, to reduce the complaints of oily skin and acne, to regulate menstruation and to prevent pregnancy in cases with regular menstruation.

Use of cyclic progesterone can also be considered to protect the inner wall of the uterus in cases with irregular menstruation and for people who do not want to use birth control pills. In the absence of menstruation, the use of progesterone-containing drugs for 10-14 days every 2 months may be recommended in this regard. However, this treatment will not provide a solution to the problem of excess hair growth and acne.

What are the risks that can be encountered in polycystic ovary syndrome?

Approximately half of the patients have overweight problem. Most of the patients have insulin resistance and hyperinsulinism, regardless of excess weight. Weight loss may be beneficial for those with insulin resistance, and the use of metformin-derived drugs can be considered if necessary. Meanwhile, the risk of developing type 2 diabetes during life increases in the presence of PCOS.

In addition to high blood lipid levels in PCOS patients, insulin resistance or diabetes will pose an increased risk of developing coronary heart disease.

Again, an increase in the frequency of depression and anxiety and an increase in the possibility of eating disorders have also been reported in the presence of PCOS.

Having menstrual irregularity may pose a risk for the thickening (hyperplasia) or cancer in the inner wall of the uterus in those whose intervals between periods are 3-4 months or less frequent and are not regulated by medical treatment.

Treatment in the presence of polycystic ovarian syndrome

In the period where there is not a planning for pregnancy;

We recommend to implement a diet and exercise program that will provide weight loss for those who have menstrual irregularity due to overweight and lack of ovulation. In many patients, 5-10% weight loss can improve ovarian function and also contributes positively to insulin resistance and blood lipid levels. If the patient is also willing and diligent, establishing a low-calorie nutrition program and making exercise a lifestyle will enable ovulation without treatment and pregnancy if there is no additional problem.

In patients with menstrual irregularity, it is important to determine whether spontaneous ovulation occurs, especially if the intervals are longer than 35 days. In this context, from the 21st day of menstruation until get the next menstruation, weekly progesterone hormone measurement can be made in the blood. If the progesterone level in the blood is above 3ng/ml, it is considered as the presence of ovulation.

In the period where there is a planning for pregnancy;

Determining whether spontaneous ovulation occurs is important in patients with menstrual irregularity, especially if the intervals are less than 35 days. In this context, from the 21st day of menstruation until next menstruation, weekly progesterone hormone measurement can be performed in the blood. The progesterone level above 3ng/ml in the blood is considered as the presence of ovulation.

If there is no ovulation in the patient and there is no situation that will cause an additional pregnancy problem for the woman or the man, the first-line treatment is the pill treatments that provide ovulation. Pill treatments are easy to use and inexpensive. Ultrasonography follow-up is not required during the use of these drugs. Approximately 30-40% of patients can achieve pregnancy after 6 months of use at the dose at which ovulation is achieved.

Especially in couples who are young, who do not have obesity, which means that not overweight to the point of disease, the probability of ovulation is higher with these pills. If ovulation cannot be obtained when measured with a blood test, the dose of the drug is increased and another attempt will be done. If ovulation cannot be achieved with the highest recommended dose of the drug or if pregnancy is not achieved despite ovulation, second-line treatment can be started.

The second-line treatment option is low-dose daily injection therapy. In order to stimulate ovulation, drugs called gonadotropins will be used in very low daily doses to enlarge 1 or 2 egg sacs, namely follicles. When the follicles reach the desired size, a final shut injection is applied. With this method, ovulation can be achieved in 95% of patients. Pregnancy rates are around 23-25% when intrauterine insemination when added. IVF treatment should be started in patients who cannot achieve pregnancy despite 2 or 3 attempts.

However, ovarian stimulation with daily injection requires experience and precision. Use of the drug in excessive doses and an unproper follow-up will cause an uncontrolled number of excess follicle development and the risk of multiple pregnancy such as triplets, quadruplets and quintuplets and the risk of developing overstimulation syndrome (OHSS) will arise. Therefore, performance of this treatment by an experienced reproductive specialist is important here.

Ovarian drilling was commonly performed to reduce androgenic hormone production by laparoscopically making holes in the ovary with the effect of heat in patients who did not respond to ovulation treatment with pills in the past. Thus, spontaneous ovulation could be achieved in some patients with the reduction of the androgenic hormone produced. Today, however, this procedure has been avoided due to the fact that this procedure is a surgical procedure, adhesions can develop in the abdomen after the operation, unresponsiveness to the new generation pill treatment is almost non-existent, and there are effective daily injection treatments options.

In vitro fertilization, which is the third treatment option, is the treatment method with the highest chance of pregnancy and the chance of pregnancy is much higher in patients with polycystic ovary syndrome than in patients without.

Since more oocytes can be obtained than the rest and the possibility of blastocyst transfer at the 5^th day after oocyte pickup increases, and choosing the best embryos on the day of transfer becomes possible. In addition, since a large number of embryos of good quality can be obtained, it is also possible to store the embryos other than the transferred embryos by freezing with the rapid freezing technique, namely, the vitrification method. In young age and patients who do not have an additional reason for not being able to get pregnant, up to 60%  pregnancy can be achieved with in vitro fertilization treatment.

However, ovarian stimulation during in vitro fertilization in the presence of PCOS requires experience. Because the weight gain is also included in the calculation, making it difficult to adjust the dose of the drug to which a response can be obtained. Giving more drugs than necessary may cause an exaggerated response and an increase in the risk of developing overstimulation syndrome (OHSS), and using drugs in low doses may cause the target number of oocytes not to be reached.

Evaluating the response obtained after ovarian stimulation and making a treatment plan accordingly, especially in the presence of PCOS, is also important. It is important for patient safety that all embryos obtained are frozen and fresh transfer is not made in order to avoid the risk of OHSS in cases with more than 18 follicles with a size greater than 11 mm on the day of the day of final shut injection after ovarian stimulation in IVF.

Since the ovaries are much more viable than their peers in this group of patients, choosing the appropriate drug protocol, adjusting the drug doses used according to the patient, choosing the final shut injection type appropriately, and transferring with thawing application after freezing and storing all embryos instead of fresh transfer when required is very important in terms of patient safety and minimizing the risk of ovarian hyperstimulation syndrome (OHSS).

Contact information :

Author : Prof. Dr. Mehtap Polat
Telephone : +90 530 011 41 33
E-mail : info@mehtappolat.com

In vitro fertilization is one of the assisted reproductive techniques applied to couples who cannot conceive spontaneously and other treatment methods have not been successful. In IVF treatment, 1 or 2 of the best quality embryos obtained in the laboratory environment are transferred to the uterus of the expectant mother and pregnancy is achieved.

IVF Treatment Steps: Evaluation of the Couple and Creation of the Treatment Plan

The first step in couples who want to have a baby but cannot conceive spontaneously is to evaluate the couple in detail. For this purpose, a detailed history of the man is taken and sperm analysis is planned. Then, the detailed history of the mother-to-be is taken, and an examination is performed to evaluate the uterus and ovaries.

In couples whose in vitro fertilization decision is made after the first evaluation, individualization of IVF treatment and the creation of a couple-specific treatment scheme increase the chance of success. In addition, treatment can be started after routine screenings of the woman or man and, if necessary, other tests are performed and evaluated.

Yumurtalıkların Uyarılması

When in vitro fertilization treatment is started, the first step is to stimulate the ovaries within the specific drug use schedule and dose determined according to the age, ovarian reserve, previous trial history, if any, and weight of the expectant mother. The aim of IVF treatment is to obtain as many eggs as possible in a controlled manner. However, ovarian stimulation with the lowest required dose and with close follow-up will both increase the number of eggs to be obtained and prevent the risk of dangerous situations such as overstimulation syndrome (OHSS).

The ovarian stimulation phase lasts approximately 8-10 days. In this process, we want the expectant mother to come to our center for blood follow-up and ultrasound control at regular intervals. Then, when the egg sacs, namely follicles, reach the desired size, we ensure that they become mature and ready for collection with the application of cracking needles.

Egg Collection (OPU)

The eggs inside the follicles developed by ovarian stimulation are collected by the egg collection process. We almost always perform the egg collection procedure under light anesthesia to increase patient comfort. Egg retrieval is performed by entering the ovarian tissue with a needle guided by a vaginal ultrasonography probe and takes approximately 10-15 minutes. After 1 hour of rest after the procedure, the expectant mother can return to her home.

Microinjection (ICSI)

On the day of egg collection, the sperm produced by the father-to-be by masturbation is prepared and microinjection (ICSI) is performed to ensure fertilization from the mother-to-be’s eggs to the mature ones. In the micronejection process, a single sperm is transferred into each mature egg. The next day, the fertilization status of the eggs is evaluated. With this method, the fertilization rate is around 80%. However, this rate may decrease in case of sperm or egg abnormalities.

Embryo Culture and Follow-up

After micronejection, the egg is removed in a special medium, in a special device called an incubator. Incubators are devices that we place the embryos until the transfer process, imitating the mother’s body and the uterus in terms of heat, humidity and gas ratios. Embryos are removed only once each day until the day of transfer and evaluated for cell number, dead part ratio, cell lineup, level of expansion, inner cell mass and outer cell (trophectoderm) layer quality. If a continuous embryo monitoring system (time lapse) incubator is used, the embryo is not taken out of the incubator. Embryo quality is understood by evaluating the images taken with the cameras in the device in the computer environment.

As well as the cell qualities of the mother and father-to-be, the quality of the devices and mediums used in the laboratory, the quality of the materials used, and the ideal level of the laboratory environment in terms of heat, humidity and gas ratios also affect the embryo quality and therefore the chance of pregnancy.

According to the number and quality of the embryos of the couple, the transfer process is 3. or 5. day is decided. 5. With embryo transfer, the chance of pregnancy is higher.

Embriyo Transferi

The day of transfer is determined according to the number and quality of embryos the couple has. In our center, 75-80% of our patients with whom we have applied freshly are 5. We are transferring embryos at the blastocyst stage. With embryo transfer at the blastocyst stage, the embryo with a higher probability of attachment to the uterus can be selected, and thus the pregnancy rates are 3. day is higher compared to embryo transfer.

While the ideal number of cells in terms of embryo quality is 7 to 8 cells in the 3rd day transfer, in the blastocyst stage, that is, in the 5th day. The ideal quality in day embryos is 3-4-5- expansion level and inner and outer cell quality is A or B.

Embryo transfer is performed with urine constricted and under observation by ultrasonography from the abdomen. Our embryologist loads the embryo to be transferred into the transfer catheter and we, the physicians, gently and duly transfer the embryo into the uterus. This process takes about 2-3 minutes, and at that time, the urethra makes it easier to enter the uterus by flattening the angle of the uterus.

After the transfer, it is sufficient for the expectant mother to rest for 1 hour in our center. Then he can return home.

Pregnancy test

After embryo transfer, 3. 11 days from day transfers, 5. We can understand the presence of pregnancy with the blood pregnancy test performed 9 days after the day transfers. We accept that the initial value is above 30 muu/ml as a positive result.

Why Are Quality Indicators Important in IVF Laboratory?

The equipment of the IVF laboratory, the quality of the tools and materials used, the ambient temperature, humidity and gas ratios affect the quality of the embryo that will develop and thus the chance of success after the treatment.

For this reason, it is also important for success to meticulously select the materials used, to carefully measure and record the temperature, humidity and gas ratios in the laboratory every day, to meticulously record and monitor quality indicators such as fertilization rates, embryo division rates, embryo development rates at the blastocyst stage.

In addition, it is important for success to follow the statistics of the operations performed by the personnel working in the laboratory, and to keep the records carefully and carefully.

We also attach importance to quality in our center in Ankara. In this context, after a rigorous audit, our center was awarded the ISO 15189 accreditation certificate by the Turkish Accreditation Agency (TÜRKAK). In addition, our center has ISO-9001/2015 certificate, which is an indicator of international service quality.

At the same time, our IVF Laboratory; It has successfully completed the UK-based UK NEQAS International Quality Expertise (UK NEQAS International Quality Expert) Program and has certified its compliance with international standards in vitro fertilization laboratory conditions.

Contact information :

Author : Prof. Dr. Mehtap Polat
Telephone : +90 530 011 41 33
E-mail : info@mehtappolat.com

How is the Application of Hysteroscopy Procedure?

A device called a hysteroscope having a camera at the end enters the uterus in Hysteroscopy procedure. This device is large enough to pass through the natural opening in the cervix through which menstrual blood flows.

Thus, there is no requirement to make an incision to the uterus and the inside of the uterus can be viewed with the help of the camera at the tip, and if an observation of pathology is made in the uterus in the same session, corrective operations can be performed into the uterus with tips such as scissors and resectoscope, which can be integrated into the device.

In Which Situations Is Hysteroscopy Applied? 

Office Hysteroscopy is a kind of general screening that takes approximately 10-15 minutes. A clear view of the inside of the uterus is provided and the pathologies can be noticed if there is any. The intrauterine problem that the patient may have can be treated in this way or by operative hysteroscopy. Conditions that can be treated with hysteroscopy include the following;

• Endometrial polyp,
• Submucous fibroids originating from the uterus or fibroids pressing on the inner lining of the uterus,
• Adhesions formed on the intrauterine wall,
• Uterine septum,
• If the intrauterine device (spiral) thread could not be seen in the vaginal examination  
  

  What aspects should the patient pay attention to after the hysteroscopy procedure?

Resting for a short time to return home will be enough for patients who have undergone hysteroscopy. In the first few days, mild groin pain may be seen that can be controlled with painkillers, and a small amount of vaginal bleeding may be experienced, similar to the one on the last days of menstruation. In order to avoid infection and pain, it is recommended not to have sexual intercourse and not to enter the sea or pool for 7-10 days. It is sufficient to rest on the day of the procedure. You can return to daily life or work the next day.

What kind of risks can be observed in the hysteroscopy procedure?

A risk of perforation may be possible in the uterus in inexperienced hands, especially during operative hysteroscopy for removal of uterine septum, adhesions or fibroids. However, there is not any risk in experienced hands. Heavy bleeding or infection may develop very rarely.
Thus, consulting specialist doctors and getting their opinion, and evaluating the necessity of the procedure and the risks in detail will be important before performing hysteroscopy.

What are the Advantages of Hysteroscopy Method?

• Treatment of the problems related to the inside of the uterus can be done by entering the uterus through the vaginal route without making an incision to the abdomen and uterus.
• Very little pain is felt after the operation. Recovery time is very short.
• The patient can return to her daily life after resting for 1-2 hours.
• Spontaneous pregnancy or IVF treatment can be started 1-2 months after the procedure.

Contact information :

Author : Prof. Dr. Mehtap Polat
Telephone : +90 530 011 41 33
E-mail : info@mehtappolat.com

Some of the eggs that exist in the ovaries regularly start to mature every month by being stimulated by the hormones FSH and LH secreted from the pituitary gland in the brain. One of the developing eggs is released from the ovary by rupture of the follicle that is known as the sac in which it is located, and so, the developed egg is caught by the fallopian tube. Tubes located on the right and left sides of the female body, one end opening to the uterus and the other end to the abdominal cavity, are approximately 8-10 centimeters long.

Pregnancy occurs when the mature egg in the fallopian tubes meets the sperm, which is the reproductive cell of the man. While existence of a problem in both tubes may prevent pregnancy from occurring, if only one of them is healthy, pregnancy may occur as a result of fertilization by combining the egg and sperm. This is why it is very important for the fallopian tubes, one of the female reproductive organs, to be healthy and functional. As a result of the obstruction of the end of the tubes opening into the abdominal cavity, they may fill with fluid and cause the development of hydrosalpinx.

What Does Hydrosalpinx Mean?

The fallopian tubes, which extend from the ovaries that are the reproductive organs of the female body to the uterus, are the places where the egg and sperm come together to be fertilized and the zygote formed spends its first days. In response to the hormone released from the pituitary gland in the brain for the development of the egg, the cells in the fallopian tubes produce fluid. This liquid is preparation for possible pregnancy.

Thanks to this fluid in the fallopian tubes, the embryo is fed and moves towards the uterus. However, due to previous infections, surgery or the presence of endometriosis, the end of the tubes opening into the abdominal cavity may be blocked and the existing fluid may remain there without being drained. This fluid, which is toxic with a lethal nature to the formed embryo, both makes it difficult to get pregnant and increases the risk of losing the resulting pregnancy by ectopic pregnancy or miscarriage. Therefore, it is very important for reproduction.

What are the Symptoms of Hydrosalpinx? 

There may be a problem with the woman or the man in terms of reproduction systems, in case couples who want to have children cannot get pregnant despite not being protected during having regular sexual intercourse. If hydrosalpinx is present in both tubes, it may be difficult to get pregnant spontaneously. Even it is on one side, a decrease in the possibility of pregnancy, an increase in the risk of ectopic pregnancy, and an increase in the possibility of miscarriage and loss of pregnancy can be observed after spontaneous pregnancy or IVF treatment.

No symptoms are observed with the disease known as hydrosalpinx. However, in some cases, complaints such as pain and burning in the abdomen and groin area at intervals can be experienced. Sometimes it can also cause groin pain during sexual intercourse. In addition, the fluid accumulated in the tube may flow into the uterus and may cause brown colored discharge in the intermenstrual period. Or, during the ultrasonography examination, it can be seen that fluid is collected in the uterus.

In the presence of hydrosalpinx, it is not possible for women to get pregnant naturally if both tubes are affected. But in some cases, a person can become pregnant naturally, with only one fallopian tube functional. Hydrosalpinx is not a condition that can be easily noticed by people who do not plan pregnancy.

How is Hydrosalpinx Diagnosed? 

In situations, where pregnancy does not occur despite regular sexual intercourse for 1 (one) year when the woman is under 35 years old, and for 6 months when she is over 35 years old, we recommend that couples consult a specialist doctor. The doctor takes a detailed history of the couple and then conducts a gynecological examination. After the gynecological examination, the person is examined by ultrasonography. The diagnosis of hydrosalpinx may not always be made by ultrasonography, but if suspected, a definitive diagnosis can be made with hysterosalpingography (HSG).  

What are the Treatment Methods for Hydrosalpinx? 

The only treatment for hydrosalpinx is surgical removal of the tube. For the women who are not planning pregnancy treatment is not necessary. Surgical removal is recommended to be made before the pregnancy plan for people who are considering pregnancy. Laparoscopic surgery is a very effective method in the treatment of hydrosalpinx.

In the laparoscopic surgery method, the person is operated under general anesthesia. Diagnosis and treatment of Hydrosalpinx can be done at the same time by placing imaging device and other laparoscopic hand tools through small incisions in the abdomen.

Contact information :

Author : Prof. Dr. Mehtap Polat
Telephone : +90 530 011 41 33
E-mail : info@mehtappolat.com