IVF Treatment

What is IVF treatment?

IVF treatment is an assisted reproductive treatment method used to solve these problems of couples who cannot conceive naturally. This treatment has been performed with many different techniques for many years. The first live birth with IVF treatment occurred in 1982.

In IVF treatment, the egg taken from the woman's ovary is fertilized in the laboratory with the man's sperm. The fertilized egg cell is then implanted into the uterus. The fertilized egg placed in the uterus divides and multiply and attaches to the endometrium.

IVF treatment is applied to couples who have not been able to conceive naturally for more than 1 year. In IVF treatment, pregnancy rates are between agerage 20 and 40% and live birth rates are between 15-25%.

Who is IVF treatment for?

85 percent of female can get pegnant within 1 year and 93 percent of their can conceive within 2 years, if couples not using birth control methods have sex regularly. In 7-15% of pregnant women, course of getting pregnant lasts very long time due to unexplained reasons. Couples who cannot conceive after this period can be treated with IVF after the reasons are investigated and evaluated.

IVF treatment is mostly done for couples with infertility problems. However, IVF treatment can be performed to people who have a known genetic disease or have a child with single gene disease so that they can have a healthy child.

IVF treatment is done when:

• Advanced woman age: If the woman's age is over 40, IVF treatment can be decided more easily.
• Obstruction in the tubes: Pregnancy starts after egg fertilizing in the tube reachs the uterine cavity. Tubes can be blocked because of infection, previous surgery or anomalies. Sometimes it is obstructed and blocked by the doctor for sterilization.
• Defects in ovarian functions: Ovulation problems, low number of eggs and ovarian failure make pregnancy difficult.
• Endometriosis: Endometriosis is the condition that the inner tissue of the uterus( endometrium) exists inside the ovaries, tubes and abdomen. This can prevent pregnancy by causing adhesions and bleeding.
• Removed tubes: In cases such as ectopic pregnancy, hydrosalpenx and sterilization, the tubes can be removed surgically. Therefore, it is possible to have a child only with IVF treatment.
• Sperm problems: Sperm number, speed and dysfunction are the reasons for not being able to conceive.
• Removal of the ovaries: The ovaries may have been removed due to various diseases. However, the ovaries removed are frozen and stored. Sometimes ovarian failure may develop at an early age. Ovarian freezing or egg freezing can be done. These stored ovarian tissue and eggs are then used in IVF treatment.
• Single gene disease transmitter in both spouses: If a woman or man has a genetically transmitted disease such as cystic fibrosis, thalassemia, sickle cell anemia or neuromuscular muscle diseases, preimplantation genetic diagnosis and IVF treatment can be performed for healthy baby.

Sperm number, velocity and morphological disorders may make it hard to conceive. In this case, advanced IVF treatment methods are used.

The first step in IVF treatment is to stimulate egg development with various drugs and hormones. Then the developing eggs are collected and taken out of the body. Eggs are fertilized with sperm in a laboratory environment. Fertilized eggs are transfered into the uterus and their development is observed.

The stages performed in IVF treatment are:

1. Egg development
2. Injection of the trigger drug
3. Egg collection
4. Obtaining sperm
5. Fertilization of the Eggs
6. Development and storage of the embryo
7. Transfer of embryo to uterus

1. Egg Development (Ovulation Induction)

Ovulation induction is the first phase of IVF treatment. Egg development in the ovaries is provided with drugs given externally. The aim is to obtain numerous and high quality eggs.

2. Using Of The Trigger Shot

The egg develops in a fluid-filled sac called a follicle in the ovary. The follicle formed with the onset of egg development is followed by ultrasound. When the follicles diameter reaches 17-18 mm, a hormone called trigger shot is given to the woman. This injection is administered under the skin as a single dose. The aim is to ensure that eggs are matured for collection. Trigger shot is mostly injected 35-36 hours before egg collection.

3. Egg Collection

Egg collection is done under ultrasound. Because the ovaries are adjacent to the intestines, bladder and pelvic vessels. In the egg collection process, the eggs are taken out by entering the fluid-filled sacs called follicles. This process lasts about 15 minutes. The obtained follicle fluids are examined under the microscope by the embryologist. The embryologist looks for eggs in this fluid.

Egg retrieval is done under anesthesia. Therefore, it is necessary to fast for 6-8 hours before the procedure. The bladder should be empty before the procedure. During the IVF treatment, the woman should have a healthy diet and should not smoke or use alcohol. Tea and coffee consumption should not exceed 1-2 glasses per day.

4. Obtaining Sperm

Before giving sperm, the man should abstain from sexual intercourse for 2-3 days. The sperm fluid taken by masturbation is washed and cleaned of dead cells, leukocytes and other wastes.

Sperm can be stored by freezing. If the man will not be able to give sperm on the day of the procedure, these frozen sperm are used in IVF treatment.

In men with a significant decrease in sperm count, sperm can be obtained directly from the testis and epididymis by microsurgical methods. The epididymis is a gland located on the testicle.

Different microsurgical techniques called MESA, PESA, TESA and TESE are used to obtain sperm from the epididymis and testis.

5. Fertilization of the Eggs

After the eggs are collected, they are selected by embryologists and fertilized with sperm within 6 hours. Three methods can be used to fertilize the egg. These:

• Invitro Fertilization (IVF, Classical Insemination),
• Intracytoplasmic Sperm Injection (ICSI, Microinjection Technique),
• Morphologically Selected Intracytoplasmic Sperm Injection (IMSI).

In vitro Fertilization (IVF, Classical Insemination): In IVF method, sperm and egg are left in the same environment in the laboratory. Fertilization of the egg with the sperm occurs naturally. The quality of an embryo obtained in this way is high. However, spontaneous fertilization may not occur. Therefore, this method is not used much nowadays.

Intracytoplasmic Sperm Injection (ICSI, Microinjection Technique): In this method, sperms are examined under the microscope and the best ones are selected morphologically. The sperm selected by the embryologist is injected into the egg with a very thin special cannula under the microscope. This method is very useful in case of sperm number, motility and morphological disorders. Therefore, ICSI is a widely used method today.

Morphologically Selected Intracytoplasmic Sperm Injection (IMSI): The method is similar to ICSI. However, sperms are examined in detail by magnifying them 6000 times under the microscope. In this way, the morphologically best sperms are selected. The IMSI method has become important in eliminating the problem of male infertility.

6. Development and Storage of the Embryo

The day after fertilization, the eggs are checked. How many eggs have been fertilized? Embryos are stored in special devices called incubators in the laboratory. The development of the embryo is followed by microscopes with cameras called embryoscopes. Storing and following the embryos in this way increases the quality rates.

7. Transfer of Embryo to the Womb

After the necessary preparation and cleaning steps, the embryo is placed in the uterus with a special thin cannula. The procedure is done by seeing under ultrasound. The bladder should be slightly full before embryo transfer.

In our country, a single embryo transfer can be performed until 35 years old. 2 embryo transfers are allowed for women 35 aged and over. Embryo transfer is done in between 2 and 6 days after egg collection. In order to increase the chance of pregnancy, different transfer days are preferred for each woman.

Success Rates in IVF treatment

The most important factor affecting the success rates in IVF treatment is the age of the woman.

• If the age of the woman is under 35, the success rate is 35-45%,
• If the age of the woman is between 35-37, the success rate is 35%,
• If the age of the woman is between 38-40, the success rate is 25%,
• If the woman is over the age of 40, the success rate is around 15%,
• If the woman is over the age of 42, the success rate drops to 5-10%.

Success rates in IVF treatment increase up to 45-60% after 3 attempts. If the woman is young, the success rate goes up to 80%.

What Are the Risks of IVF Treatment?

IVF treatment has some risks. These:

• Ovarian Hyperstimulation Syndrome (OHSS): OHSS is a disorder that occurs as a result of overstimulation of the ovaries by the drugs given in the treatment. The size of ovaries increase. Fluid accumulates in the lung, heart and intra-abdominal cavities. Symptoms such as nausea, vomiting, swelling in the abdomen, abdominal pain and shortness of breath are seen. The progress of the clinic puts the mother's life in danger. Women with polycystic ovary syndrome are at higher risk of developing OHSS.
• Bleeding, vascular injury, bowel and bladder injuries may occur during egg collection.
• Ovarian torsion: The ovaries may rotate around themselves during treatment. In this case, vascularization of the ovary is disturbed. There is intermittent, severe pelvic pain.
• Ectopic pregnancy: There is a 2-5% risk of ectopic pregnancy after treatment.
• Multiple pregnancy: There may be twin or triplet pregnancies.
• Risk of preterm birth
• If the maternal age is over 35, the risk of miscarriage, birth defects and anomalies increases with age.