What is IVF Treatment (In Vitro Fertilization)?
The first IVF baby was born in England in 1978. With the development of experience and technology, infertility and IVF treatments have made a breakthrough; There have been advances in many aspects such as the selection of the best egg and sperm, the division and follow-up of the fertilized egg in the environment closest to the mother's environment in the most ideal conditions, and embryo transfer under ideal conditions. Elimination of genetic diseases and obtaining tissue compatible siblings have made it possible to treat sick and surviving children.
In vitro fertilization is the process of fertilization of the mother-to-be with the egg cell (oocyte) and the father-to-be's sperm in the laboratory environment and then placing it in the mother's womb.
Fertilized eggs continue their development in the laboratory in special media that mimic the mother's womb, and the developing embryos are graded for their quality. It is placed in the mother's uterus under ultrasonographic control in the multicellular stage (Day 3 after fertilization) or the stage called blastocyst (5 or 6 days after fertilization).
All procedures, including stimulation and monitoring of the ovaries, egg collection and embryo transfer, are performed in experienced and certified IVF outpatient clinics and laboratories.
What are the Treatment Steps in IVF?
First Inspection
In this interview, your medical history and previous tests, if any, are evaluated. After the examination, a special treatment plan is made for you. If there are conditions for a treatment with a committee report, that is, financially supported by the health insurance, information is given about the list of relevant documents.
Preparation
The first step tests in preparation for IVF treatment are ultrasound examination of the expectant mother, measurement of antral follicle count (also known as egg number) and egg reserve, evaluation of the structure of the uterus, TSH, prolactin and if necessary AMH measurement independent of the menstrual day, sperm test in men (spermiogram). ).
In addition, tests for viral diseases that may pose a risk for the baby or prospective parents are requested for both men and women (Hepatitis B and C, HIV).
For these initial evaluations, you do not have to come to the examination at the beginning of your period or have a blood test at the beginning of your period. Blood tests and examination can be done on any day of the menstrual and cycle of expectant mothers.
Then, during the active treatment process, you will usually have to come on the 2nd or 3rd day of the menstrual period.
Stimulation Therapy (Egg Cell Development)
An IVF treatment begins with ultrasonography and ovarian stimulation (ovarian stimulation). On the 2nd or 3rd day of menstruation, the ovaries are evaluated by ultrasound of the treatment. If the ovaries are in normal condition, HMG, FSH, LH hormones that support egg cell development and increase their number are started with a subcutaneous injection.
These needles are mostly applied daily. They are simple drugs that the patient can administer himself. The drug administration determined for you is taught by our nurses. Ovulation is followed up first after 4-5 days, then at 2-day intervals, and the drug dose and treatment duration are adjusted.
When the follicles (egg sac) reach a certain size, anti-cracking needles can be added to the treatment so that the developing eggs do not crack early.
Egg Cracking
Follicle maturation takes between 8-11 days during ovulation follow-up. When the follicles reach 17 -19 mm in size, a cracking needle (hCG, rec. HCG) is applied. Egg collection is done 34-36 hours after that.
Egg Collection and Fertilization in the Laboratory
This procedure is performed in the in vitro fertilization operating room under sedation (light general anesthesia) and is painlessly collected by pulling the follicle fluid through the needle under the control of ultrasonography. Each follicle (ovary sac) contains an egg. Egg collection may take 5-10 minutes. The expectant mother can be discharged after 2-3 hours of rest after the procedure. It is a procedure with a very low probability of complications. Moderate vaginal bleeding after the procedure is normal.
The eggs obtained are cleaned from the cells and wastes around them and kept in the incubator, and on the same day they are combined with the sperms or the sperm selected by special methods are injected into the egg and fertilized by microinjection (ICSI) method.
In the observation made approximately 16 hours after the microinjection, the nuclei structures from the male and female should be seen. In a normal fertilization, two nuclei are seen.
Embryo Transfer
Embryos are grown and developed in special media and special devices that imitate the mother's uterus in terms of criteria such as temperature, nutrients, and carbon dioxide ratio. A fertilized egg begins the first division approximately 20 hours later, forming a 2-cell embryo. Evaluation is made by considering parameters such as the shape and size of the cells (Blastomers) in the embryo, the degree of fragmentation between them, the number of nuclei, and the intracellular appearance. On the 3rd day, the embryo reaches the 8-cell stage (Cleavage), and on the 5th day, it reaches a stage called the developed blastocyst, which has too many cells to count. Embryo transfer into the uterus is usually done on the 3rd or 5th day. This is decided by evaluating the embryo quality and the patient. Conditions are different for each patient.
In general, it is preferred that your bladder is full under the best conditions and for the easy transfer of embryos into the uterus. In this way, the uterus behind the bladder can be better visualized by ultrasonography and the embryo transfer process is facilitated. There is no need for anesthesia in this procedure. When embryo transfer is performed in experienced hands, the chance of pregnancy increases.
The number of embryos to be transferred is also determined by the medical regulations of the Ministry of Health. It is medically reasonable and possible to transfer only one embryo in the first two attempts to expectant mothers under the age of 35. The patient's history, whether there is a previous pregnancy, previous treatments, embryo quality may vary depending on the criteria. In special cases or in accordance with the age limit, 2 embryos can be transferred. The purpose of single embryo transfer is to prevent multiple pregnancy. Multiple pregnancy is a condition that should be avoided medically as it brings risks such as miscarriage, premature birth, and disabled child. The aim of the treatment is not only to get pregnant, but also to have a healthy pregnancy and have a healthy child.
Embryo Trimming (Assisted Hatching)
One of the reasons for failure in IVF is that the membrane surrounding the embryo does not rupture and the embryo cannot attach to the uterus. Thinning or completely opening the embryo membrane before transfer is done using mechanical, acid solution and laser. Its contribution to pregnancy rates has been proven.
Freezing Embryos (Vitrification)
After embryo development, in some cases, it is possible to freeze all embryos and sometimes the embryos left over from embryo transfer, and to transfer embryos after the treatment and preparation of the uterus or later in natural conditions. There are patient groups in which it has been proven that the chance of pregnancy is increased by freezing all embryos and transferring them later. In addition, with the subsequent transfer of the increased embryos, the opportunity to try a single IVF treatment several times arises and the success rate increases gradually.
Pregnancy test
The pregnancy test is ideally performed from blood (beta hCG) 10 to 15 days after embryo transfer, depending on the clinic's preference. If the pregnancy test is positive, the test may be repeated two or three days later, if necessary. An appointment is made two weeks later to see the pregnancy and evaluate your baby's condition.