Gynecology and Reproductive Health / IVF
Gynecology and Reproductive Health / In Vitro Fertilization
In Vitro Fertilization (IVF) Treatment
We share the excitement of being a mother with you. In order to perform your treatment completely and successfully, we, as the IVF Unit of Medistate Kavacık Hospital, will always accompany you. In this period, your doctor will always be in contact with you and answer your questions. The path to be followed by you may be difficult and stressful. For this reason, we have prepared this brochure explaining the possible situations, which may be experienced by you. We recommend that you read the brochure carefully.
The procedure of the in vitro fertilization consists of three stages:
- Ovarian stimulation
- Egg retrieval and fertilization
- Embryo transfer
The First Stage: Ovarian Stimulation
Women’s eggs develop in follicles, which are known as fluid-filled sacs, within their ovaries. In proportion to the growth of these follicles, estradiol hormone is secreted. The growth and number of the follicles are followed through vaginal ultrasound (USG). The estrogen hormone (E2) is controlled in combination wih an ultrasound scan, and the quality and maturity of the eggs are estimated. The protocol to be performed and the type and dosage of the medication to be used in the treatment are decided according to the patient’s clinical and laboratory results. After the ovarian stimulation is initiated, you can be called at particular intervals for ultrasound and hormone checks (3-4 times during your treatment).
You will be informed by your clinic about the result of serum E2 readings and the dosages of medications. The number of eggs may not be equivalent with the number of follicles seen through ultrasound. Mature eggs are usually derived from the follicles over 14mm in diameter. Another factor, which is evaluated in the ultrasound scan, is the structure and thickness of endometrium, which is the innermost layer of the womb. Endometrium has an important role in the growth of embryo and the conception.
Developmental period of the follicles are 9-10 days on average, and this period may be shorter or longer. After the size of follicles reached a certain level, the last injection (HCG), which is known as egg hatching injection, is applied in order to bring the eggs maturity. In fact, the aim is to collect the eggs at a certain level of maturity without hatching the follicles. The eggs are retrieved 26 hours, in average, after the injection. As anesthesia is administered during this procedure, the patient does not feel any pain.
As the procedure of egg retrieval will be performed under anesthesia, oral intake of food and fluid must be discontinued at least 6 hours before the procedure. This procedure takes 5-15 minutes in average. Through this procedure, the follicles that contain eggs are suctioned by inserting a thin needle into the ovaries under the guidance of vaginal ultrasound. You can leave the hospital 2 hours after the procedure is ended. Before leaving the hospital, our nurses will inform you about the points to be taken into consideration and the medications to be used.
Synchronously with the procedure of egg retrieval, your partner’s sperm specimen will be collected. If azoospermia (the condition in which there is no sperm in semen) is found in the male, the sperm is poor in quality, or any sample cannot be taken; sperm will be surgically picked up from the testes on or before the day of egg retrieval. If a surgical procedure is performed, the testicular tissue, which is surgically removed, is frozen, and it is thawed on the day of microinjection. All of the eggs may not be available for the procedure of microinjection. On the following day, our embryologists will inform you about the number of fertilized eggs. According to the number of the eggs fertilized and the quality of the embryos, the transfer day will be decided.
During the procedure of egg retrieval, your partner will give a semen sample. Necessary issues and points to be considered will be explained by our embryologists. It is necessary to give the semen sample at our room where has been specially prepared for this procedure. Our patients, who have a difficulty in giving the sample, should share their problem with our doctors before the procedure.
Uniting Eggs and Sperms
Standard In Vitro Fertilization Method: In this method, which is the first technique used in the IVF world, 50.000 – 100.000 sperms are added around each egg, and it is waited for the fertilization of the eggs with one of the sperm. For this method, the number and quality of the sperm should be at a good level.
Microinjection: It is a method commonly used in our day. It is the only choice especially for the male factors. A single sperm is injected into each mature egg through special pipettes under the microscope. It is known that the rate of fertilization is higher through this method.
After 16-18 hours on average (a day after the procedure of microinjection), it is checked whether the sperm fertilized the egg or not. Excluding the exceptions, the transfer is not made on the same day. The fertilized eggs are placed again into the culture medium and are expected to reach the subsequent stages.
The day of embryo transfer is decided according to the number of the fertilized eggs, the quality of the developing embryo, and if available, the information about the patient’s previous treatments. The developing embryos are transferred gently into the patient’s womb through a catheter. It is a simple procedure, which does not require any anesthesia. In order to observe the field in which the embryos will be left during the transfer of them into the womb on the ultrasound device, your bladder should be distended. From scientific perspective, a bed rest for 2 hours after the transfer at the hospital is sufficient for the success of pregnancy. The number of embryos to be transferred is decided according to the woman’s age and number of attempts. If there are sufficient embryos in number and quality after the transfer made, these embryos can be frozen based on the consent of the family. Freezing the embryos has two advantages: If pregnancy fails after the treatment, the remaining embryos can be transferred at a more affordable price without need to a surgery for egg retrieval and expensive needles in the next attempt. In addition, these embryos can be used in case that the couples want to have a second child though they have achieved the conception and the birth of their child.
After 12 days following the embryo transfer, it is possible to check through a blood test (Beta-hCG) if you are pregnant or not. If the result is positive, the test is repeated two days later. It is expected that the first value is doubled within two days. Menstruation does not mean that the pregnancy failed. After three weeks following the transfer, the gestational sac can be seen on the ultrasound.
Success of the Treatment
The IVF treatment is not a method which always provides you with a successful result. One of the most important factors bringing the success is the woman’s age. For this reason, after the decision is made, the treatment should be performed without delay. Smoking is a very important factor which decreases the success in women and the men. If there are chemical and toxic substances in the men’s workplace, and/or if they work in places such as factory or bakery, where the ambient temperature is high, the number and the quality of the sperm may be influenced negatively. On the other hand; in case that family history of the woman is notable for early menopause or personal history is notable for Hashimato’s thyroiditis, previous ovarian surgery or endometriosis, the number of eggs can be less than the number in her age group. If treatment results in a negative outcome, you should not be despondent. There is always a chance of pregnancy as long as there are eggs in the woman and sperms in the man.
Services Available in Our Center
Examination of the woman
- The first admission and examination (transvaginal ultrasonography)
- Hormone tests in addition to microbiological and serologic tests
- Hysterosalpingography (HSG), Hysteroscopy, and Laparoscopy (when needed)
- Chromosome analysis (when needed)
Examination of the man
- Examination to be made by an urologist (laboratory and radiological tests when needed)
- Sperm test (after irrigation of sperms)
- Structural defects of sperms (DNA damage)
- Chromosome analysis (when needed)
Check-up Program for Reproductive Health
It is a detailed program which provides the couples, who have not decided to give birth but are curious about their reproductive capacity, with both main tests and clinical evaluation.
Though this method was preferred commonly in case of unexplained (idiopathic) infertility in the past, it is usually used in the cases, which are diagnosed with mild male factor, in our day. Development of the follicle is provided through a pill to be taken orally or a needle. After the follicle reaches to a certain size, you will get the egg hatching injection. The sperms collected from the man are prepared and transferred to the womb through a catheter 36 hours after the injection. In this method, the average success rate is reported as 10-15% in the literature.
It is a filtration method used to find the best sperm, which has the most ideal DNA structure, for insemination and IVF.
It is a technique to thin the outer membrane of embryo through LASER in order to increase the chance of pregnancy in the necessary cases.
IVM (In Vitro Maturation)
IVM is an in vitro fertilization technique which involves the collection of eggs in the early period and the maturation of them at the laboratory settings without medication, or through the use of minimal egg-developing medication.
PGS/PGD (Pre-implantation genetic screening/diagnosis)
It is a method in which 1 or 2 cells will be taken from the embryo in the third day to make a genetic screening and transfer the healthy embryo into the womb at the stage of blastocyst in Day 5 in case of genetic disorder in one or both of couples, recurrent failure of IVF and recurrent miscarriage. The novel technological methods enable genetic analyses of the embryo in Day 5. However, the transfer is made in the following month, in this method.
If there are sufficient embryos in number and quality after the transfer, these embryos can be frozen. In addition, with the change made in the regulation of in vitro fertilization, eggs of women and sperm and testicular tissue of men can be frozen in necessary clinical conditions (chemotherapy before having planned children, decreased ovarian reserve, and the necessity of gonadectomy, which is a procedure related to testicle or ovarian) in married or single persons.
Sperm Retrieval through Surgical Methods
(TESE, TESA, PESA, MESA)
These methods are used in the patients who failed in the IVF treatment because of poor sperm quality, and in case that there is not any sperm in the sample given or the structure of sperm is irregular and damaged.
Especially in the microTESE method performed under the microscope, there is a chance for sperm retrieval even in very difficult cases.
Our hospital has an agreement with the Social Security Institution, and the report of in vitro fertilization is valid.