IVF treatment is the dream of many families who want to have a child. The instinct to become a mother and father is one of the most important instincts that ensure the continuation of humanity. If there is no obstacle to pregnancy in the spouses who want to have a baby, mostly spouses can achieve pregnancy spontaneously when they want a baby.

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.

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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 .