Description

Fertility Center – IVF

Overview

Infertility is manifested by absence of conception in
obstetric history or inability to conceive despite successful previous
conception. Almost 25% of all women will face infertility at any time of their
lives.

Women achieve maximum reproductive efficiency around
25 years of age, followed by significant reduction in reproduction especially
at age of 35 years. Chance of conception for a couple is 57.6% on average in a
3-month period, 72.1% in 6-month period, 85.2% at the end of a year and 93% at
the end of 2 years. In other words, especially young couples should not hurry.

For young couples under the age of 25, infertility
workup can be postponed up to 2 years. For couples above the age of 30, it is
recommended to wait for 6 to 12 months before infertility tests are started.

Influence of age on fertility is contradictive for
men. Men achieve maximum fertility level around the age of 35, followed by a
remarkable reduction after the age of 45. However, it is known that there are
men who can be father even at 80 and accordingly, “age” of male person is not
as important as for women.

Reasons of Infertility

Male factors account for 25-40% of all cases, while
female factors account for 40-55%; combined male and female factors are
responsible for 10 to 15% of cases and 10 to% are idiopathic cases. In other
words, both men and women are almost equally responsible for the infertility.

WHAT IS IN VITRO FERTILIZATION?

In vitro fertilization implies a complex procedure,
where eggs produced by ovaries are collected using special needles and those
eggs are fertilized with sperms of the male subject at laboratory conditions
and the resultant embryo(s) is/are transferred to the uterus. One or more than
egg is harvested using a special needle under anesthesia with ultrasound
guidance and they are fertilized by sperms of the father at the laboratory
settings. The fertilized eggs (embryos) are placed into the womb of the mother
using a catheter in 2 to 5 days.

Who are good candidates of the procedure?

• Patients with occluded or surgically removed
  Fallopian Tubes,
• Patients with endometriosis or who cannot
  conceive with surgical treatment,
• Patients with ovarian problem who do not respond
  to medical treatment,
• Patients diagnosed with idiopathic infertility,
• Patients with low sperm count or no sperm in the
  semen.

What are the stages of the in vitro fertilization?

• Maturation of follicles
• Oocyte pick-up (collecting the eggs)
• Preparation of sperms and fertilization of eggs
• Thinning the embroyal membrane
• Embryo transfer
• Pregnancy test

The age, ovarian reserve, blood hormone levels and
height/weight ratio are considered to determine an appropriate treatment
protocol and the dose of medication for patients who will receive in vitro
fertilization therapy.

For long-term protocol, the medications that suppress ovarian functions are administered in the form of nasal spray or subcutaneous injection approximately for 10 to 12 days. When the patient menstruates, the second part of the treatment is started and the
hormone therapy is maintained for 8 to 10 days in average, which will ensure
maturation of eggs. Next, oocytes are picked up.

For short-term therapy protocols, egg maturation hormones are started as of second to third day of menses, and ovarian suppression hormones are added to the treatment in subsequent days in order to suppress spontaneous hormone secretion of ovaries.

Patients are monitored with blood hormone analyses and
vaginal ultrasound, and when the follicles reach the appropriate size, human
chorionic gonadotropin, colloquially known as egg hatching injection, is
administered and oocytes are picked up 33 to 26 hours later. This procedure is
carried out under anesthesia to suppress pain and it takes about 10 to 15
minutes.

Embryos are selected 2 to 5 days after oocytes are
picked up and a thin catheter is inserted through the cervix and embryos are
transferred. Embryo transfer is a pain-free procedure and patients can watch the
procedure as it is performed with ultrasound guidance. Patients are discharged
to home after resting in bed for 30-45 minutes following the embryo transfer.

ARE SPERMS AND OOCYTES HARVESTED FROM THE COUPLE?

Absolutely yes. Submission of marriage documents is
one of the prerequisites of the procedure. Irrespective of the underlying
factor, a man who cannot produce sperms or a woman who cannot produce egg is
not admitted to the treatment. Own germ cells of the officially married couples
are used for the treatment.

WHAT IS THE SUCCESS RATE OF THESE TECHNIQUES?

The success rate of the in vitro fertilization therapy
should be determined according to health-related characteristics of the couple.
The success rate of the in vitro fertilization is influenced by many factors,
including but not limited to ovarian reserve, age and serious male factor. For
couples who are transferred embryo, the success rate is around 55-60% if women
is ≤35 years old and has good ovarian reserve, while the figure is around 30%
for women older than 40. Considering the high rate of genetic anomaly in this
age group, preimplantation genetic diagnosis should be considered and thus,
genetically normal embryo is transferred to increase the chance of conception.

IS IN VITRO FERTILIZATION THE ONLY TREATMENT OPTION FOR COUPLES WHO CANNOT ACHIEVE
CONCEPTION?

Four couples with difficulty in conception, the
underlying problem should be identified with a detailed examination and the
best treatment method that would most possible achieve the conception should be
determined and the couple should be informed.

Treatment methods broadly include surgical treatment
of problems in Fallopian tubes, ovulation induction and monitoring,
insemination and in vitro fertilization. For couples who meet particular requirements,
conception can be achieved with intrauterine insemination that implies
instilling the specifically processed sperms into uterus after ovulation is
induced by medications.

WHAT IS INSEMINATION?

Insemination is, in fact, a procedure that is performed
to increase chance of sperm to fertilize the egg.

The woman is given pills or injections to have two or
three oocytes mature in the period, while sperms of the man is irrigated and
prepped with special methods. Thus, sperms with good motility are harvested.
 The timing of hatching is manipulated with egg hatching injections and
sperms are placed into the uterus through a special plastic tube, and sperms
can easily reach the egg(s), as the route they follow is shortened.

Certainly, minimum a canal or tube should be patent in
order to perform the procedure. Therefore, the uterine cavity should be imaged
before the insemination.

As it is known that the chance of conception does not
increase after three or maximum 4 attempts, it is not necessary to repeat more
than four times. Although the insemination appears like a simple procedure, it
should necessarily be performed by an experienced gynecologist &
obstetrician.

It should be clearly known that not all infertile
couples are good candidates for the insemination.

HOW IS OOCYTE PICK-UP PERFORMED?

Oocyte Pick-Up (OPU) implies harvesting oocytes using
a special thin needle that is inserted through the vaginal canal with the
ultrasound guidance. The procedure is usually carried out under general
anesthesia. Therefore, oocyte pick up does not cause pain.

As anesthesia will be administered, the patient should
stop eating and drinking after the mid-night one day before the procedure.

The picked up oocytes are evaluated by expert
embryologists in the laboratory located in the adjoining room and they are
prepped for conventional in vitro fertilization or microinjection.

Patients can be given paracetamol or similar pain
killers, as inguinal and abdominal pain can sometimes be felt after the
procedure. Patients are allowed to eat and discharged to home several hours
later. The risk of inflammation and bleeding is rare after the oocyte pick-up.
For such condition, necessary treatments are immediately started, but the risk
is lower than 1 percent.

The picked up oocytes are fertilized by sperms of the
man in the same day. The procedure can be conventional in vitro fertilization
or microinjection.

If serious difficulty is faced in taking specimen for
spermiogram, sperms can be taken from testes under local anesthesia.