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IVF (in vitro fertilization) is one of the techniques to help people with fertility issues have a baby. It is often preferred because the eggs and sperm of the couples can be used and the success rate is relatively high.
Reyap Hospital Corlu IVF Unit
It is an assisted reproductive treatment unit, which was established to serve couples who want children, and has all the new technical equipment brought by modern technology and a team with experience and knowledge in a way that can provide all kinds of services on this subject.
Many factors prevent an egg from being fertilized by sperm. In vitro fertilization is the name given to the procedures based on the logic of taking the egg cells produced in the female body out of the body with special needles and fertilizing the male sperm in the laboratory environment and transferring the obtained embryos or embryos into the female uterus.
One or more eggs are taken from the ovaries by a needle under ultrasonography and anesthesia and fertilized in the laboratory with the sperm taken from the father candidate.
Fertilized eggs (embryos) are placed in the womb of the expectant mother within 2-5 days with the help of a catheter. In vitro fertilization is a process that starts with a pre-interview and ends in pregnancy.
Vaccination treatment (intrauterine insemination)
Vaccination is a treatment method in which sperms are enriched in number and motility using special methods and are injected directly into the uterus with the help of a catheter.
It is frequently used in the treatment of infertility due to its cost and having fewer side effects than advanced auxiliary treatment methods and its ease of application.
Sperm count and lack of movement in men, cervical factors in women, ovulation disorders, sexual dysfunction, and unexplained infertility are the main conditions where vaccination is applied.
Egg development is ensured with the use of stimulant drugs in the ovaries before the vaccination process, which increases pregnancy rates.
To perform vaccination treatment, sperm values must be appropriate and at least one of the tubes in the uterus must be open. Therefore, sperm parameters are evaluated with semen analysis in men before treatment, and whether the tubes are open with uterine film (hsg) or laparoscopy in women.
Besides, hormone tests are performed to evaluate the ovarian reserve of the woman before treatment.
After the procedure, the patient should rest on the examination table for 20-30 minutes, and then bed rest is required.
Natural in vitro fertilization (natural cycle)
In natural IVF treatment, the patient is followed up in the natural process of the egg without any external hormone treatment, it is the process of collecting it just before the cracking stage and inseminating it with the IVF method outside the body. The single egg obtained here can be developed and a good embryo can be obtained and pregnancy can be achieved by transfer.
The natural cycle is applied to patients who do not respond to the classical IVF method.
If possible, the couple is asked to come together for the first appointment. It will be beneficial for your planned treatment to bring with you all your previous examinations (hormone tests, uterine film, sperm analysis results), any surgery you have undergone, and documents belonging to your previous treatments.
After the preliminary interview and evaluation, when it is decided to start in vitro fertilization, your missing examinations will be completed and your ovaries will be evaluated with vaginal ultrasonography and the appropriate treatment protocol will be selected for you.
The basic steps applied in an IVF treatment cycle:
stimulation of the ovaries
egg collection (OPU) and sperm delivery
fertilization, embryo culture
embryo transfer (ET)
Stimulation of the ovaries
It is aimed to provide more than one egg development in the ovaries with the drugs used in the process of stimulating the ovaries, also known as ovulation induction. The reason why more than one egg development is desired is that some of the eggs obtained are not high-quality and some will not be fertilized with sperm. Besides, pregnancy rates are higher when more than one egg is fertilized and transferred to the uterus.
Timing is very important in IVF treatments.
During the treatment, the ovaries are monitored with the help of vaginal ultrasound and the development of fluid-filled sacs called follicles, which are supposed to contain eggs, are monitored. Blood samples are also taken to monitor egg development.
The purpose of IVF treatments is to stimulate the ovaries in a controlled manner. Self-hatching of eggs is undesirable and drugs are used to prevent this.
Treatment with a GnRH agonist reduces the risk of premature ovulation by preventing LH and FSH release from the pituitary gland.
Subcutaneous or intramuscular daily injections of drugs suitable for the preferred treatment protocol for stimulation of the ovaries It is applied in directions.
Egg retrieval process
Egg retrieval is a simple surgical procedure performed by vaginal ultrasound-guided aspiration. It is usually done under anesthesia. Mature follicles are entered through the vagina with an ultrasound probe. Eggs are aspirated from the follicles with a needle attached to a pump unit.
Egg collection is usually completed within 10-20 minutes. Some patients may experience cramping pain on the day of the procedure, but this situation usually subsides the next day. Feelings such as bloating and/or compression may last a few weeks after the procedure.
On the day of egg collection, the male will also be asked to give a sperm sample. The sperm sample given by masturbation in a special room directly connected to the andrology laboratory will be processed through several procedures and the most qualified ones will be selected and prepared for in vitro fertilization. It may be necessary to obtain sperm by surgical methods (TESA / TESE / MicroTESE) in cases such as the absence of sperm in the sample or the inability to give a sample.
Azoospermia (absence of sperm in the semen)
Azoospermia, which means that there is no sperm in the semen, is seen in 1% of all men and 10-15% of men with infertility problems.
The problem in most azoospermic men is that although the sperm carrier ducts are open, mature sperm production in the testicles is not sufficient. In this case, which can be called testicular failure, the problem is either in the testicles or in the production of the hormone involved in sperm production. In approximately 40% of patients, the cause of azoospermia is not the production defect in the testicles, but the process of expelling the mature sperm produced through the ejaculatory ducts.
In men diagnosed with azoospermia, a detailed history is taken and a physical examination is performed and the cause of azoospermia is found with the necessary laboratory tests. The basic tests performed when evaluating azoospermic men are the determination of the levels of FSH and testosterone hormones.
In the case of azoospermia, sperm examination is performed from testicular tissues obtained from the patient’s testicles using surgical methods. These surgical procedures are TESA, TESE, PESA, MESA. Micro Tese procedure is a more beneficial method in terms of sperm finding success compared to other procedures because it is performed under a large microscope. The procedure can be performed under local anesthesia or general anesthesia.
The patient can be discharged on the same day. If sperms are found, sperms can be frozen for use in the next treatments. Thus, there is no need for a second surgical procedure.
Microinjection and embryo culture
A frequently asked question is the difference between in vitro fertilization (IVF) and microinjection. In the IVF method, fertilization is expected to occur by placing 50-100,000 sperm around each egg. In the microinjection method, the selected sperm is injected directly into the egg prepared by many procedures.
After the egg collection process, the eggs stored (culture medium) in the laboratory are cleaned from other cells around them by peeling them with the egg peeling process just before the microinjection process, and mature eggs are determined. Only mature eggs can be used in the microinjection process.
Sperm obtained by ejaculation or surgical methods from the testis is prepared by sperm preparation techniques.
With the microinjection method, a living sperm is placed in an egg using special devices and stored in special environments called incubators. If two pronuclei (nuclei) are observed in the egg the day after the microinjection process, it means that the egg is fertilized.
One of these nuclei is inherited from the mother and the other from the father. Fertilization is observed in approximately 70% of mature eggs. These rates may decrease due to impaired sperm and/or egg quality. Sometimes there may be no fertilization at all.
Two days after egg retrieval, fertilized eggs divide to form 2-4 cell embryos. On the third day, the embryo divides into approximately 8-10 cells. It reaches the blastocyst stage on the fifth day.
Nesting with assistance (thinning of the embryo membrane)
It is a technique that enables thinning of the embryo membrane just before embryo transfer when it is thick. This method can be applied in elderly patients or couples with recurrent implantation failures.
Preimplantation genetic diagnosis (PGD)
It is a method used to determine the chromosomal structure of the embryo. With this method, one or two cells (blastomere) are taken from the developing embryo and the genetic structure of the embryo is investigated. Embryos determined to be genetically normal are selected for transfer.
Embryos can be transferred 2-6 days after egg collection. The number of embryos transferred depends on the quality of embryos depend on the age of the woman and whether there has been a previous IVF trial and similar factors. The transfer process is not different from the examination procedure and is generally painless. However, some patients may experience mild cramping pain.
Before the transfer, the urinary bladder of the expectant mother is requested to be partially filled. In this way, the transfer process can be done with ultrasound. Embryos loaded into the transfer catheter by the embryologist are transferred to the uterus by the obstetrician.
It is a procedure that does not require anesthesia, but some patients may prefer mild sedation.
Taking progesterone after embryo transfer
Progesterone support is initiated after the egg cracking injection continues until the pregnancy test is performed. Then, the doctor determines how long progesterone will continue to be used.
Embryo freezing (Cryopreservation)
Embryos remaining after embryo transfer can be frozen and stored for later reuse if the number and quality are appropriate. In the next cycle, the treatment is easier, cheaper, and less painful since ovarian stimulation and egg retrieval are not performed on the patient. After freezing, embryos can be stored for up to 5 years.
Sperm and egg cells can be frozen before cancer treatment to protect their fertility in patients who will undergo chemotherapy and radiotherapy.
It is a method that can be applied in young patients with a large number of good quality embryos. In this method, embryos are transferred at the “blastocyst” stage 5-6 days after egg collection, thus allowing selection of the best quality embryos and transfer of a small number of embryos.
12 days after the embryo transfer, it will be understood whether pregnancy has been achieved by checking the Beta hCG hormone in the blood. This test is important even if the woman is bleeding.
The success rate of IVF treatment
The success rate of IVF treatment depends on the age of the woman being treated and the cause of infertility.
Younger women are more likely to have a successful pregnancy. IVF is generally not recommended for women over the age of 42 because the chances of a successful pregnancy are thought to be very low. Success rate;
29% for women under 35 years old
23% for women aged 35-37 years old
15% for women aged 38-39 years old
9% for women aged 40-42 years old
3% for women aged 43 to 44 years old
2% for women over 44 years old
Maintaining a healthy weight and avoiding alcohol, cigarettes, and caffeine during treatment increases the chances of success of IVF.
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