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%.
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:
Before treatment, the causes of infertility in men and women should be investigated detailly. A woman can become pregnant without IVF treatment when many causes like uterine septum, subendometrial fibroids, obstruction in the tubes, endometrioma and hormonal problems are treated.
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:
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.
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.
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.
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.
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:
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.
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.
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.
The most important factor affecting the success rates in IVF treatment is the age of the woman.
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%.
IVF treatment has some risks. These: