IN VITRO FERTILIZATION

In Vitro Fertilization (IVF) is an assisted reproduction technique applied to couples who want to have a child but cannot achieve pregnancy naturally.

It is usually applied to individuals who do not get results in infertility treatments.

This method, in its simplest form, includes fertilization of eggs and sperm taken from couples in a laboratory environment, transfer of the resulting embryo to the mother’s uterus, and all supportive applications for the baby to grow healthily in the mother’s body in case of pregnancy.

Who Needs IVF Treatment?

All couples who cannot achieve a natural pregnancy despite regular unprotected sexual intercourse for one year until the age of 35 and for 6 months after the age of 35 should definitely consult a gynecologist to check their reproductive health with the suspicion of infertility. First of all, the hormone levels of the woman, whether there is an obstruction in the tubes, ovulation function, and the sperm quality of the man should be examined to determine whether it is possible to conceive normally. After these examinations, the process can begin if the physician deems it appropriate and necessary, and then if the couple accepts IVF treatment.

In which cases is IVF treatment applied?
Women with blocked or damaged fallopian tubes.
Hormone irregularities.
Impaired ovulation function.
Women with endometriosis (chocolate cyst).
Men with low sperm count or problems with sperm movement.
Polycystic ovary syndrome (PCOS) or other ovarian problems.
Uterine fibroids.
Couples with a genetic disease or disorder.
Unexplained causes of infertility.

Stages of IVF Treatment

1- First Interview

During the first interview, the patient’s history is taken carefully and comprehensively. If the couple’s previous attempts to have a baby have been unsuccessful, they are asked to explain their experiences in this regard. Important experiences such as past treatments, pregnancy and miscarriage are learned and previous test results are examined by the doctor. Accordingly, the doctor asks for a comprehensive investigation of the reasons for the couple’s inability to have a child.

2- Normal Pregnancy Assessment
The couple’s blood tests, chromosome analysis and reports on other diseases, if any, are requested. A gynecological examination and ultrasound are then performed. The examination of the woman is of great importance in determining the chances of conception with IVF treatment. During the examination, the capacity of the ovaries, the presence of any cysts in the ovaries, the structure of the uterus, the presence of fibroids (myoma) or congenital (anomalies) and the presence of space-occupying formations such as fibroids or polyps in the inner layer of the uterus (uterus) are evaluated. The condition of the woman’s egg reserves is assessed. During the examination, a PAP Smear test (cervical cancer) can be performed if it has not been done recently, and a culture test can be performed if there is discharge. If the semen analysis is normal and there is no sexual dysfunction, the man does not need to be examined. Any surgical report or related notes are examined. All this data helps to organize and determine the IVF treatment process and when the treatment will start.

3- Compatibility Test for Couples

IVF treatment is decided if the patients have all the necessary tests in the following 6 sections.

The first tests for the woman include FSH, LH, Estradiol, Prolactin, TSH, and AMH hormone tests to monitor ovulation levels and hormone balance in general. These tests are done between days 2 and 4 of menstruation.
Ultrasound scan and initial consultation (approval from other doctors).
HIV, Anti HCV, HBsAg profile is requested for both men and women (Hepatitis B Hepatitis C and HIV test).
Sperm count is checked.
A blood incompatibility test is performed.
Embryo genetic testing is performed.

4- Egg Enlargement Treatment

First, some medicines are taken to mature a few of the eggs and make them ready for fertilization. How to take these medicines is determined by the doctor. They are given as a daily injection or as a nasal spray and continued for about two weeks. This is called ovulation induction. After the natural menstrual cycle has been suppressed, the person is given a fertility hormone called follicle-stimulating hormone (FSH). This hormone increases the number of eggs produced by the ovaries. This means that more eggs can be collected and fertilized. With more fertilized eggs, the patient has more embryo options to use in clinical treatment.

5- Egg Collection and Sperm Collection

Eggs and sperm from the woman and the man are brought together in the laboratory. Egg retrieval is done in the operating room under general anesthesia using transvaginal ultrasound, accessing the ovaries through the vagina. This tube is immediately taken to an embryologist who is ready to find and analyze the eggs. The collected eggs are then placed in a special incubator. In the first few hours after the operation, patients may complain of insomnia, sickness and vomiting, but afterwards they usually feel better and can go home. Pain in the abdomen, similar to menstrual pain, may be felt for a few days after the operation. Some minor vaginal bleeding and spotting may also occur.

On the morning of the egg retrieval day, the male partner also comes to the clinic for sperm collection. The couple is advised to abstain from sexual intercourse for three days before the sperm collection. Semen is collected through masturbation in a special room prepared for the male partner and the healthiest sperm are selected. No saliva, soap or other lubricant such as Vaseline should be used during masturbation/sperm collection. Semen sample should be given in a sterile container.

6- Fertilization in Laboratory Environment

After the sperm and egg have been collected, the sperm is injected into the egg using ICSI. The eggs and sperm are stored together in a special container and fertilization takes place. As the cells in the fertilized eggs divide and develop into embryos, staff in the laboratory monitor the progress. The fertilization process takes 3 to 5 days, and patients are frequently informed about embryo development.

7- Embryo Monitoring

At this stage, the doctor determines the number of embryos to be transferred before the treatment begins. This depends on the age of the patient.

In the 1st IVF cycle, women under 37 years of age should have only a single embryo transfer, in the 2nd IVF cycle, a single embryo transfer if 1 or more high quality embryos are available. If the best quality embryos are not available, the doctor will consider using only 2 embryos and will transfer a maximum of 2 embryos in the 3rd IVF cycle.
Women aged 37 to 39 years in the 1st and 2nd full IVF cycle should have a single embryo transferred if 1 or more high quality embryos are available. Embryo transfer for the couple should only be considered if there are no embryos of the highest quality, and in cycle 3, a maximum of 2 embryos should be transferred.
Women between 40 and 42 years of age can have a double embryo transfer.

If any suitable embryos remain, they can be frozen for future IVF attempts.

8- Embryo Transfer
About three to five days after the egg retrieval, one or more embryos are placed in the uterus (this is called embryo transfer). The doctor slides a thin tube through the cervix into the uterus and places the embryo directly into the uterus through the tube. The procedure takes about ten minutes. The couple is then informed in detail about the number and quality of the transferred embryos, in addition to the risk of multiple pregnancy and possible precautions. After about half an hour of rest, the patient is allowed to go home.

9- Post Transfer Process
During this time, sexual intercourse is not allowed until the pregnancy test. Pregnancy occurs when any of the embryos attach to the lining of the uterus. This is done in the IVF clinic with a laboratory development system and a team of professional embryologists. After the embryo transfer, the woman is told to rest for the rest of the day. Full bed rest is not necessary unless there is a risk. Most women return to normal activities the next day. For 8 to 10 weeks after the embryo transfer, the patient should take daily pills of the hormone progesterone. Progesterone is a hormone produced naturally by the ovaries that prepares the lining of the uterus (womb) so that an embryo can attach more firmly to the uterus. Progesterone also helps an implanted embryo to grow and implant in the uterus.

10- Pregnancy Test
About 12 to 14 days after the embryo transfer, the woman returns to the clinic and is tested for pregnancy. The definitive result is obtained through beta-hCG hormone tests. The test is repeated two days later. After 2 weeks, the gestational sac or sacs are monitored by transvaginal ultrasound scan.
Remember; all couples who cannot achieve a natural pregnancy despite regular unprotected sexual intercourse for one year until the age of 35 and for 6 months after the age of 35 should consult a gynecologist to check their reproductive health with the suspicion of infertility.