IN VITRO FERTILIZATION

IN VITRO FERTILIZATION

IVF: What is it, What are the Applications and Procedures, Frequently Asked Questions

IVF: What is it ?

In vitro fertilization treatment, which is one of the reproductive treatment methods, begins with the collection of eggs from the expectant mother and the collection of sperm cells from the expectant father. After fertilization in the laboratory environment, the resulting embryo is placed in the uterus of the expectant mother. After this point, the pregnancy continues as a naturally pregnancy. IVF treatment is performed in two different methods. One of them is defined as classical IVF treatment and in this method, egg and sperm are left in the same environment and natural fertilization is expected. The second method is microinjection application. In this form of treatment, the sperm is injected directly into the egg cell. Although both treatment methods are applied successfully, the physician decides which method will be applied according to the health status and reproductive abilities of the spouses. The aim of IVF treatment is to be possibility of a healthy pregnancy.

1.When should infertile couples seek IVF treatment?

If a woman who is under the age of 35 and does not have any disease that can prevent her from becoming pregnant, cannot conceive despite having unprotected and regular sexual intercourse for 1 year, she should definitely be under examination and seek treatment if necessary. Women who are over the age of 35 or have had any problems affecting conception before, should try for 6 months. If pregnancy has not occurred at the end of this period, the necessary treatment procedure should be started as soon as possible so that the age does not progress further and time is not lost.

  • Stage 1: Stimulation of the Eggs, Normally, one egg per month in women grows, matures and hatches. If a single egg is taken in IVF procedures, the egg may not be fertilized or a healthy embryo may not develop after fertilization. For this reason, many eggs are tried to be obtained by using ovarian stimulating drugs in IVF. Treatment is started according to the results of vaginal ultrasonography and blood hormone results on the 2nd day of menstruation. At the beginning of the treatment, the dosage of drug are determined according to the body mass index (kg/m2) of the person, the ovarian reserve, the drug doses used in the previous treatments if IVF has been performed before, and the number of eggs collected. Drug doses and treatment protocols are determined specifically for each patient and individualized treatment protocols are applied.
  • Stage 2: Egg Retriaval: A mild sedative or anesthetic is given to the expectant mother so that she does not feel pain or other discomfort during egg retrieval. The doctor aspirates eggs from the woman's ovaries using an ultrasound vaginal probe with a thin hollow needle attached to it. This process takes about 12-30 minutes. These samples are sent to the laboratory without losing time. If the ovaries are not accessible by transvaginal ultrasound, an abdominal ultrasound can be used to guide the needle. The eggs are removed from the follicles with a needle attached to a suction device. Expectant mothers may experience cramping and a feeling of fullness or pressure after egg retrieval.
  • Stage 3: Sperm Retrieval Expectant Father: Samples of semen are collected through masturbation in the sampling room. The sample taken is given to the laboratory. For men who do not have the semen, sperm can be obrained surgically from the ovaries.
  • Stage 4: Fertilization: In the IVF procedure, which is the classical in vitro fertilization method, the egg and semens taken are brough together in the culture in the laboratory and they are expected to be fertilized. In ICSI, also known as the microinjection technique, the sperm is injected into the egg. As a result of both methods, an embryo is formed by fertilization of the egg.
  • Stage 5: Embryo Transfer: in embryo transfer, which is the last stage of IVF treatment, the previously egg retrieval is transferred to the uterus of the expectant mother. Without anesthesia, the embryo is left into the uterus with the help of a catheter in the transfer process performed with ultrasonography.
  • Fallopian tube damage or obstruction: Damage or obstruction of the fallopian tube makes it difficult for an egg to fertilize or for an embryo to reach the uterus.
  • Previous tube sterilizaiton or removal: If you've had tubal ligation (a type of sterilization in which the fallopian tubes are cut or blocked to permanently prevent pregnancy) and you want to get pregnant, IVF tubal ligation may be an alternative to reversing the situation.
  • Ovulation Disorders: Anovulation, which is low ovarian reserve, is for 5-25% of infertility causes. Whether a woman is ovulating or not can be determined by following ovulation with ultrasonography (USG) or by looking at the progesterone hormone levels in the serum (on the 19th, 21st and 23rd days of menstruation). In the USG, the egg does not grow or the repetitive progesterone measurements are below 3 mg/ml, which indicates the absence of ovulation.
  • Unexplained infertility: It means that no cause of infertility has been detected despite evaluation for common causes.
  • Endometriosis: Endometriosis occurs when uterine tissue settles and grows outside the uterus - usually affecting the function of the ovaries, uterus, and fallopian tubes.
  • Uterine fibroids: Fibroids are benign tumors on the uterine wall and are common in women in their 30s and 40s. Fibroids can interfere with the implantation of a fertilized egg.
  • Impaired sperm production or function: Sperm concentration below average, poor movement of sperm (poor mobility), inability to penetrate the cervical mucus, inability to survive, or abnormalities in sperm size and shape.
  • A genetic disorder: A genetic disorder: If there is a risk of passing the genetic disorder to their children, mothers and fathers can apply for preimplantation genetic tests. In IVF treatment, after the eggs are collected and fertilized, they are screened for some genetic problems; but not all genetic problems can be detected. Embryos that do not contain identified genetic disorders can be transferred to the uterus. Preimplantation genetic diagnosis (PGD) is a recommended diagnostic method for couples who are at risk of passing on a serious genetic disease to their children. Thanks to PGD in the embryos of couples carrying certain genetic diseases such as cystic fibrosis, thalassemia, the disease can be diagnosed and that embryo can be eliminated in this way without pregnancy occurring, without the need to terminate the pregnancy. Preimplantation genetic diagnosis offers an alternative way not only for couples with such genetic disease risks, but also for couples who are unable to form a healthy pregnancy due to recurrent miscarriages caused by structural chromosome disorders (eg translocation, inversion, etc.).
  • Fertility preservation for cancer or other health conditions: If it is about to be started cancer treatment, such as radiotherapy or chemotherapy that can harm fertility, in vitro fertilization (IVF) for fertility preservation may be good option in this situation. Thanks to in vitro fertilization method, retrieval eggs can be done from woman's ovaries and freeze them in an unfertilized state for later use. Alternatively, eggs can be fertilized and frozen as embryos for future.

Factors such as the mother's age and embryo quality are of great importance in the success of IVF. Therefore, the chances of success also vary according to these factors. While the success of IVF is 55-60% in women under the age of 30, this rate drops to 15-20% in women over the age of 40.