Çankaya / ANKARA
+90 552 441 89 66
My Areas of Expertise in Infertility and IVF
-
Fertility Counseling
-
Ovulation Tracking
-
Ovulation Induction and Intrauterine Insemination
(Egg Development and Insemination Treatments for Infertility)
-
Male Infertility
-
Low Ovarian Reserve, Premature Ovarian Insufficiency, Early Menopause
-
Endometriosis, Endometrioma (Chocolate Cyst), Adenomyosis
-
Polycystic Ovary Syndrome (PCOS)
-
Hypogonadotropic Hypogonadism
-
Unexplained Infertility
-
Oncofertility (Preservation of fertility in cancer patients)
-
HLA-Matched Sibling Directed In Vitro Fertilization (IVF) Procedures
-
PGT (Preimplantation Genetic Testing) - IVF Applications
-
Recurrent Pregnancy Loss
-
Tubal Reanastomosis
In vitro fertilization (IVF) treatment
In vitro fertilization (IVF) treatment, in its simplest terms, involves bringing together human sperm and egg cells in a laboratory setting, facilitating fertilization, and then transferring the resulting embryo into the mother's uterus. With rapidly advancing technology and treatment options, IVF has become a beacon of hope for couples who cannot conceive naturally or have not been successful with traditional infertility treatment methods."
When is IVF Performed?
• For couples unable to conceive due to severe sperm (male egg cell) abnormalities and male infertility.
• For couples unable to conceive due to both of the woman's tubes (egg-carrying channels) being blocked, leading to tubal factor infertility.
• For couples where the woman has significant adhesions or damage in the tubes and ovaries due to previous surgery.
• For couples unable to conceive due to a diagnosis of chocolate cyst or endometriosis in the woman.
• For couples with unexplained infertility, despite two rounds of advanced fertility treatments (gonadotropin hormone therapy) and failed intrauterine insemination.
• For women with diminished ovarian reserve, elevated FSH, or low AMH, or for couples seeking to conceive at an advanced age.
•For couples with serious ovulation problems such as PCOS, where hormones facilitating egg development (FSH, LH, estrogen) are very low (hypogonadotropic hypogonadism), and who require treatment to increase egg development.
Rarely, for certain medical conditions:
•In oncofertility applications, where eggs or embryos need to be frozen before cancer treatments such as cancer surgery or chemotherapy and radiotherapy that may negatively affect the ovaries.
•In cases where a suitable donor cannot be found for the treatment of an existing child's illness, necessitating HLA-matched sibling birth for stem cell or marrow transplantation.
•In cases where there is a known medical genetic problem in prospective parents (SMA, DMD, translocation...), IVF treatment is recommended after embryo biopsy and PGT (preimplantation genetic testing), confirming the genetic health of embryos obtained through IVF.
Stages of IVF Treatment
1. Preparation of Patients:
Firstly, couples desiring to have a child must undergo general health checks to ensure there are no additional obstacles to pregnancy. The following tests are conducted for IVF treatment:
•The male provides a semen sample after 3 days of sexual abstinence. If deemed necessary by a urology specialist, he may also need to undergo hormonal and genetic analyses through blood tests and other necessary examinations.
•On the 2nd or at the latest 3rd day of the woman's menstrual cycle, she should undergo hormonal tests and ultrasound. In special cases, hormonal and ultrasound tests may be performed independently of the menstrual cycle, based on the doctor's recommendation.
•A cervical smear (smear test) should be taken from the woman at the end of her menstrual cycle.
•If deemed necessary, observation of the uterine cavity with a camera (hysteroscopy) or uterine film imaging (HSG) can be performed.
For those affiliated with any social security institution to benefit from coverage in IVF treatment, they must meet the conditions specified in the current legislation (SUT regulations).
2. Treatment Monitoring:
IVF treatment should be individually planned according to each patient's medical characteristics. Patient compliance with the individually planned treatments and the accurate implementation of the treatment are crucial for treatment outcomes.
Control of egg development drugs should be done under supervision.
Treatment monitoring is carried out through serial blood tests and ultrasound. Dose adjustments are made according to the response to treatment. When the eggs reach a certain size, the use of ovulation-inducing drugs is planned.
Approximately 36 hours after the use of ovulation-inducing drugs, the egg retrieval procedure (OPU) is planned.
The correct timing and proper use of the ovulation-inducing drug, known as egg triggering, are crucial for the collection of good quality and sufficient eggs.
The egg retrieval procedure is performed under anesthesia and in operating room conditions. On the day of egg retrieval, the patient should be ready in the operating room after at least 8 hours of fasting and having consumed nothing.
3. Egg collection process (OPU):
The egg retrieval procedure is performed in surgical conditions and typically accompanied by vaginal ultrasound, lasting approximately 15-30 minutes. In patients without sexual activity, if egg freezing is planned for fertility preservation, the egg retrieval procedure can also be done abdominally (suprapubic). Each follicle is entered, and the contents are emptied using a special aspirator.
The fluid-containing tubes are taken to the embryology laboratory, where the presence of eggs is examined under a microscope. The egg retrieval process from both ovaries typically takes approximately 15-30 minutes.
4. Obtaining Sperm:
For in vitro fertilization in married couples, the male partner also gives a semen sample by masturbation in accordance with the sexual abstinence period at the center on the day of egg collection. If not enough sperm can be obtained in the semen sample, the man undergoes a procedure under operating room conditions to obtain sperm with biopsy methods (TESE, TESA, PESA). preparation is made.
5. Embryology Laboratory Procedures:
The eggs obtained from the follicular fluid during the egg retrieval process are examined under a specialized microscope, collected in a special culture medium, and stored in an incubator. Mature egg cells become ready for fertilization approximately 2-4 hours later.
The semen sample prepared in the laboratory is examined for sperm count, motility, and morphology, and it is prepared for the fertilization process.
In the conventional IVF method, the prepared sperm is placed in the same culture medium as the eggs, and fertilization is expected. If there is a severe sperm disorder or if sperm is obtained through surgical biopsy, fertilization is achieved using a microinjection method called ICSI, performed by an embryologist or biologist under a specialized microscope.
Fertilization monitoring and daily monitoring of embryo division are conducted, and the time for embryo transfer is determined based on the quality of the embryos.
For patients where embryo transfer is not planned, procedures such as egg freezing or embryo freezing are additionally planned.
6. Embryo transfer process:
Embryo transfer preparation is made on the planned day according to the embryo quality. Embryo transfer is performed in the operating room conditions with the guidance of transabdominal ultrasound. The patient is in a gynecological examination position with a filled bladder. Since embryo transfer is not a painful procedure, it does not require anesthesia. After cleaning the cervical mucus and secretions, the embryo, brought from the embryology laboratory in a special catheter, is placed into the uterus of the prospective mother in a way that the prospective mother can also observe.
After the procedure, treatments in the form of gel, injection, suppository, or tablet may be given to support the development of the uterine lining (endometrium) where pregnancy will occur. The patient is called for a pregnancy test 14 days after the transfer procedure. If pregnancy occurs, this treatment (luteal support) can be continued until the 8-10th week of pregnancy, depending on the doctor's recommendation.
In our country, with legal regulations, up to the age of 35, a single embryo can be transferred in the first and second attempts, and two embryos can be transferred in the third and subsequent attempts. For individuals aged 35 and above, a maximum of two embryos can be transferred in all attempts.
_edited.jpg)
Are there any risks associated with in vitro fertilization (IVF)?
In IVF treatment, risks can be related to the medications used or the procedure itself. One of the most significant risks is Ovarian Hyperstimulation Syndrome (OHSS), also known as excessive ovarian stimulation syndrome. This syndrome has various stages, and while mild forms can be managed on an outpatient basis, severe forms may require hospitalization and treatment. The likelihood of life-threatening severe forms is relatively low. In addition, there are minimal risks associated with surgical procedures, such as bleeding, infection, and anesthesia.
Another risk of IVF treatment is the occurrence of multiple pregnancies. Multiple pregnancies can lead to early labor, spontaneous miscarriage, low birth weight, abnormalities in the placenta, and congenital abnormalities in babies. These medical conditions can reduce the success of bringing a live baby home for couples undergoing IVF. Therefore, women who become pregnant through IVF should be closely monitored.