IVF Center

IVF treatment is the most commonly preferred assisted reproduction technique for the couples who cannot have children by natural means. The vast majority of the basic stages necessary for the formation of pregnancy in IVF treatment (In Vitro Fertilization), are performed outside the body in a laboratory environment, under controlled conditions.

In IVF treatment, hormone therapy is applied to obtain more than one egg from women, and maturing egg cells are harvested. Sperm and egg cells taken from the couple are brought together in a laboratory environment. The resulting embryos are transferred directly to the uterus or are frozen, to wait for the appropriate time for treatment. The fertilization, which under normal conditions occurs in the female body as a result of sexual intercourse, is thus transferred to the laboratory environment.

In IVF treatment, while the egg cells taken from the woman and the sperm cells taken from the men can combine and form the embryo without any intervention, in some cases, the best quality sperm must be injected into the egg by microinjection method for the formation of the embryo. This method, which is called intracytoplasmic sperm injection (ICSI), is often preferred for the couples with male induced infertility problems.

IVF treatment can be applied in many cases of infertility. One of the most important reasons why this treatment is preferred at such a high rates is that it can give results in cases of infertility caused by both men and women, or in the case of infertility whose cause cannot be determined.

The Process Before IVF Treatments

If pregnancy does not occur despite regular and unprotected sexual intercourse for 1 year, couples can resort to assisted reproductive techniques. Nowadays, successful results can be obtained in selected patients with Intrauterine insemination (IUI) and IVF treatment.

In order to increase the success rate of IVF treatment and to ensure that couples receive the happy news, it is important that treatment planning is made specifically for each couple. Before IVF treatment, with a series of tests performed on both women and men, both the underlying causes of infertility can be determined and information can be obtained about whether auxiliary methods should be used in the treatment process.

What Tests Are Performed Before IVF?

Different tests are performed over women and men in order to determine the treatment protocol before starting the IVF treatment.
Foamy Ultrasonography:
It is a special ultrasound examination performed for the purpose of integrated evaluation of the fallopian tubes, uterus and endometrial cavity. The procedure is completed in about 15 minutes.
AMH Test:
The AMH test, also known as the Anti Mullerian Hormone test, is performed to assess the ovarian reserve. AMH test results are extremely important in determining the treatment protocol to be applied during the treatment cycle. Blood tests are also among the tests performed.
Prolactin Test:
It is performed to determine the level of the hormone prolactin in the blood. Excessive levels of prolactin can prevent pregnancy from occurring.
Screening For Infectious Diseases:
A screening test for sexually transmitted diseases such as HIV, Chlamydia, Rubella can be performed before IVF treatment. These diseases can inhibit the growth of the fetus and lead to various complications.
Semen Analysis:
It is one of the tests that provides the most important data in the diagnosis of male-induced infertility and the determination of auxiliary methods in the pre-IVF process. Spermiogram results, which provide comprehensive information about the motility, number and morphology of sperms, may also lead to changes in the stages of IVF treatment.5 After semen analysis, it is possible to apply for further examinations such as Y chromosome microdeletion test, genetic tests, testosterone hormone tests and testicular ultrasonography in men who are diagnosed with having no sperm cells at all.
Trial Embryo Transfer:
Trial embryo transfer is optional. It is performed in order to evaluate the uterine response that may occur during the embryo transfer to be performed during IVF treatment. The results to be obtained can enable the customization of the procedure.

In addition to all these tests, for women, hysterosalpingography and additional ultrasound imaging may need to be performed. With the evaluation of the data obtained as a result of all these tests and imaging methods, IVF treatment planning can be carried out.

Reducing the pre-IVF treatment process to the test stages carried out only for men and women would be an incomplete approach. There are various factors that couples should pay attention to before IVF treatment. These factors, which can be attributed with lifestyle choices, can provide a positive effect on the treatment process.

Things to Consider Before IVF Treatment

Couples who are found to be suitable for IVF treatment as a result of physical examinations and tests performed need to make various changes in their lifestyle.

IVF treatment can become an exhausting process in which many physical and psychological restrictions may be required. A high level of awareness can result in couples being in the best mental and physical condition during the treatment process. Undoubtedly, these gains will have an impact over the treatment results.
Nutrition Before IVF Treatment:
Scientific research shows that Mediterranean-type nutrition can increase the success rate of IVF treatment for women under the age of 35, who are in the normal weight range. There is also a link between sperm quality and healthy nutrition in men.
Exercise Before IVF Treatment:
It is recommended that women who exercise regularly during the process before IVF treatment continue their routine. Being at the ideal weight range has a positive impact on the fertility of both men and women. Excess weight can lead to hormonal problems, and in men, it can affect the quality of sperm, and in women, the ovulation cycle.
Exposure to Chemicals IVF Treatment:
One of the reasons that leads to male and female infertility is exposure to chemicals. Endocrine disrupting chemicals can affect hormones, reproductive health, prenatal development. Avoiding chemicals such as parabens, triclosan, benzophenane can positively affect the success of IVF treatment.
Sleep Patterns Before IVF Treatment:
The duration and quality of sleep can positively affect the IVF cycle. In a study conducted in 2013, it was revealed that the fertility rates of the subjects who sleep 7-8 hours a day, was higher.

All these measures considered apply to both women and men. The role of men and women in the formation of pregnancy is equal. Another factor requires attention is overcoming the stress brought about by the process. Yes, IVF treatment does not promise an absolute result, but it offers a very important opportunity to couples who, over the years, wanted to finally receive that happy news. In the process, couples need to understand each other and manage stress successfully.

Stages of IVF Treatment

As an sssisted reproductive technique, In Vitro Fertilization or IVF treatment consist of certain stages. As I mentioned in my previous contents, the main goal of treatment is to perform the steps that normally occur naturally in the pregnancy process, but in a controlled manner and in a laboratory environment.

Before going into details about the question "What are the stages of IVF treatment?", I will provide some details in order explain the process more clearly.

The first stage of IVF treatment is the harvesting of egg cells from the woman. Before the realization of this stage, the expectant mother is started hormone therapy in order to harvest more egg cells. Since our main goal is to create as many healthy embryos as possible, we need to trigger the ovulation process for the women.

With hormone therapy, we can ensure that more eggs are formed in the monthly cycle and harvest them when they mature. At this step, the male factor comes into play. We take semen samples from men and separate the quality sperm from it. According to the results of semen analysis, we have different options to choose from.

If there is no problem in the sperm quality of the men, we do not make an additional intervention for the merging of egg cells and sperms and we expect fertilization to occur outside the body in a controlled laboratory environment. But men's sperm don't always make this possible. In other words, we also need to intervene in the fertilization process. In this case, we need to select the highest quality sperm and inject it in the egg using a special technique.

We follow up when fertilization occurs and our embryos are formed. We identify high-quality embryos and transfer them to the uterus of women with a simple procedure and expect them to hold. Of course, all these listed steps can be customized. We may need to support the basic stages with Auxiliary Methods in IVF Treatment. The couble-specific approach is extremely important. Although the stages of IVF treatment are generally standard, it should not be forgotten that intermediate treatments may be necessary.

Step-by-Step IVF Treatment

After all the necessary examinations have been performed as part of IVF treatment, if it is concluded that the couples is suitable for treatment, the ovaries of the woman are first over-stimulated.
Under normal conditions, one or two egg cells mature in the ovaries every month. During the stimulation of the ovaries, which is carried out at the initial stage of IVF treatment, women are given daily hormone supplements. These hormones mimic the body's natural hormones. During the cycle, it is possible to evaluate different protocols within the treatment carried out with the aim of developing a minimum of 3 eggs. After the examinations performed, the most ideal ovarian stimulation protocol for women can be selected. The ovarian stimulation phase covers a period of 10 – 12 days on average. Drug treatment begins on the second day of menstruation.

Since it is aimed to obtain both the ideal number and ideal quality oocytes with the stimulation of the ovaries, it is important to consider variables such as the age of women, her ovarian reserves, basal FSH and E2 levels, AMH levels, body mass index values, when determining the doses of the drugs to be administered.

At the stage of ovulation induction, both the use of hormonal drugs and the follow-up of the process are required. When the stimulation of the ovaries begin, ultrasound examination is needed at regular intervals to measure the size of the egg sacs and determine the response of the eggs to drugs. If, during the check-ups, data are obtained indicating that at least three eggs have matured and the follicles have reached over 17 mm, cracking injections are administered. The purpose of cracking injections in IVF treatment is to fully mature the eggs. Cracking injections are HCG hormone injections that mimic the hormone Luteinizing that is normally secreted by the pituitary gland and allows the eggs to crack in the natural cycle. These injections can be made intramuscularly or under the skin.

The timing of the cracking injections is extremely important. The most important thing to consider is that the egg harvesting process, which is the second stage of IVF treatment, should be done before the eggs are cracked. If the cracking injectiong is performed early or the egg harvesting stage is performed late, the matured eggs cannot be used for IVF treatment. For this reason, it is recommended that the egg harvesting process be performed 34 – 36 hours after the cracking injection.
The ovaries were stimulated, followed up with ultrasound, and when their size reached 16 – 20 mm, a cracking injection was applied. With the cracking injection, the eggs reached optimum maturity. It is at this stage that the maturing eggs need to be harvested before they crack and move into the abdominal cavity.

In the past years, techniques such as laparotomy and laparoscopy were used to harvest eggs. It was possible that these techniques were extremely complex and led to complications such as severe tubal disease and multiple adhesions. Today, egg harvesting is done by a highly developed and minimally invasive method.

The egg harvesting process, also called OPU, is an extremely comfortable procedure performed under sedation. It is performed via vaginal ultrasound. During the procedure, the follicles are viewed via ultrasound and with the help of a special syringe, the maturing follicles are reached from the vaginal canal and the fluid containing the oocyte is collected. Although it varies from patient to patient, usually, between 3 and 10 eggs are harvested. The duration of the procedure varies between 15 – 30 minutes depending on the number of eggs to be harvested. During egg harvesting, in order not to spoil the fluid aspirated from the maturing follicles, it is necessary to quickly send it to the embryology laboratory.
A semen sample should also be taken from men on the day the eggs are harvested. In order for the ideal number and quality of sperm to be collected, couples should abstain from sexual intercourse for 3 – 5 days before the procedure. The semen sample taken from the man is examined, and if the sperm quality is not considered sufficient, intracytoplasmic sperm injection (ICSI) may be recommended. The main difference between ICSI and traditional IVF has to do with how the egg is fertilized. In classical IVF treatment, the selected sperm and egg cells are brought together under special conditions and fertilization happens spontaneously. In the ICSI process, the highest quality sperm is selected and injected into the egg cell. Thus, it is ensured that the sperm can enter into the egg cell and the probability of fertilization is increased.

All these listed stages are valid if spermatozoa are present in the semen. However, for the men diagnosed with azoospermia, we need to resort to sperm collection techniques. The technique to be applied to get the sperm from a man varies according to the type of azoospermia. If sperm production is present in the testicles, but there is no sperm in the semen, there is azoospermia due to obstruction, and in this case, sperm can be collected from the testicles, epididymis or vas deferens.

In patients with non-obstructive azoospermia who do not have sperm production in their testicles, an advanced surgical technique called MicroTese becomes a necessity. During the MicroTESE surgery, which is performed under general anesthesia, all sections of the testicles where sperm are likely to be present are scanned and the testicular tissues that are likely to host sperm are collected. While the surgery is still going on, the embryology laboratory starts the sperm examination. The operation of patients with azoospermia, which is not due to obstruction, can be performed in a different time periods. Sperm can be frozen if the eggs have not yet been harvested, or if the eggs have been harvested before the operation, these eggs can be frozen.
It is the stage where the egg cells taken from the woman and the sperm collected from the man are brought together in the laboratory environment. As just elaborated, in the traditional method, egg cells and sperm are kept together under special conditions, waiting for fertilization to occur spontaneously. In case of poor sperm quality, a healthy single sperm cell is injected into the egg. After the performed procedures, it is followed whether fertilization has occurred, whether the embryo has formed.

If fertilization occurs, the embryos are monitored. If deemed necessary, Assisted Hatching (weakening of the embryo membrane) and preimplantation genetic testing methods can be applied.
After fertilization has occurred, the embryos formed are monitored for 3 to 5 days and then transferred to the uterus.7 During the procedure, the selected embryo is taken into the catheter. The catheter is released into the uterus after being passed through the vaginal canal and the cervix. It is an extremely simple and comfortable procedure. The number of embryos to be released into the uterus is determined by various factors. Transferring more than one embryo can increase the risk of multiple pregnancies. For this reason, no more than 2 embryos are transferred at a time.
5th day embryos are called blastocyst embryos. At this stage, the embryos have grown in size and are further developed. They resemble a ball of cells with a liquid inside. The most important indicators that give an idea about the quality of blastocyst embryos are their width and the appearance of the internal and external cell mass. It is understood that the wider the embryos, the better quality they are. They are classified by a number scale from 1 to 6. 6 represents the highest quality embryo. The inner and outer cell masses are also classified as a, b and c. A is the highest quality.

Embryo freezing can be performed in the presence of high-quality embryos that could not be transferred. Thus, if the IVF treatment fails, the second trial can be performed with just the embryo transfer. Embryo transfer is the final stage of IVF treatment. After this stage, the embryo is expected to attach the uterus (implantation).

In order to understand whether pregnancy has occurred after the transfer, about two weeks of waiting time is required. During this process, women may need to take the progesterone. Thanks to progesterone, the probability of implantation can be increased. Hormone therapy needs to be carefully planned.

A pregnancy test can be performed 12 days after embryo transfer. After IVF treatment, the formation of pregnancy and the healthy birth of the baby may vary according to the age of the mother, the quality of the embryo, past pregnancies, the cause of infertility and mother's lifestyle.

Risks of IVF Treatment

In Vitro Fertilization is an extremely safe and assisted reproductive treatment in which serious complications rarely occur. Planning the process specifically for couples and following each stage ensures that the risks that may be experienced are reduced. Nevertheless, IVF treatment is a medical treatment and is also known to have certain risks.

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It is known that ovarian hyperstimulation syndrome may occur in 10% of women due to the use of hormone drugs during the stimulation of the ovaries. However, many women experience it mildly and recover easily. OHSS is a complication characterized by dangerous enlargement of the ovaries due to fluid and the leakage of this fluid into the abdomen and into the chest area.

OHSS is not the only risk specific to the stage of ovarian stimulation. Side effects such as mild bruises at the injection site, nausea, vomiting, temporary allergic reactions, increase in vaginal discharge and fatigue may be encountered.
If more than one embryo is transferred to the uterus, it is possible to encounter multiple pregnancies. It is known that multiple pregnancies are more risky in terms of premature birth and low birth weight compared to single pregnancies.
At the stage of ovarian stimulation, drug therapy is used to ensure the maturation of more than just one egg. When the ovaries respond to these drugs and the eggs mature, they are collected via the method of transvaginal follicular aspiration. Although rare, there are some risks specific to the process. Infection, bleeding, damage to surrounding organs and reactions to the anesthetic agent are among the possible complications.
If the transferred embryo ends up in the fallopian tubes instead of the uterus, an ectopic pregnancy may occur. Therefore, if the pregnancy test performed after IVF treatment gave a positive result, it is important to make sure that the embryo is developing properly and the pregnancy is progressing normally.
A common belief about IVF treatment is that the risk of miscarriage is greater in IVF treatment. Although this is a correct opinion, it is necessary to carefully assess why the risk of miscarriage is higher after IVF. The risk of miscarriage in naturally occurring pregnancies is in the range of 15%-20%. In IVF treatment, the risk of miscarriage is about 22%. It is thought that variables such as the age of women and the cause of infertility are behind this increased risk. Although ovarian stimulation is considered a risk factor, it is accepted that advanced methods such as pre-implantation genetic diagnosis, which can be applied within IVF, can reduce the risk of miscarriage among women who are 40 years of age and older.

How To Increase the Success Rate of IVF Treatment?

The most commonly applied infertility treatment for couples who cannot have children naturally is IVF treatment. The first birth as a result of IVF treatment took place in 1978. Since then, many changes have taken place in the treatment process and a lot of progress has been made. Despite all these developments, it is not possible to talk about 100% success rate for IVF treatment. Multiple trials may be required for IVF treatment, and this requirement may become an experience that challenges couples in various ways. Therefore, evaluating the possibilities at the very beginning of the process can have a significant impact on the success rate of IVF treatment.

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Failure to take precautions against some factors that lead to the need for IVF treatment, may reduce the success rate of IVF treatment. Take fallopian tube problems, for example. In order for pregnancy to occur naturally, at least one of the tubes must be open and structurally sound.

Any obstruction in the tubes and the accumulation of fluid in the tubes is called hydrosalpinx. In the presence of hydrosalpinx, leakage of fluid accumulated in the tube into the uterus may interfere with embryo transfer. So, if the cause of infertility is hydrosalpinx, at first, this health problem should be addressed.
There is a linear correlation between the success rate of IVF treatment and the embryo quality. With the developing technology, the highest quality embryos can be selected and healthy birth rates can be increased for the couples with risk of genetic diseases. Preimplantation genetic testing can be briefly defined as a technique that allows the identification of genetic defects in embryos formed through IVF.2

If a genetic anomaly is present in one or both parents, this diagnostic method, which makes it possible to select the healthiest embryo among the embryos formed, has an important effect on increasing the success rate of IVF. PGT can also be recommended when there is no risk of genetic diseases. In recurrent IVF failures, severe male infertility, unexplained infertility, and late age of the expectant mothers, PGT can increase the success rate of IVF.
Although IVF treatment basically consists of the stages of stimulation of ovaries, collection of egg and sperm cells, fertilization and embryo transfer, it also includes many auxiliary methods performed to support these stages.

The main purpose of auxiliary methods is to increase the success rate of IVF treatment. Therefore, it is decided whether they will be applied in accordance with the couple in question. For more detailed information about Auxiliary Methods in IVF Treatment, you can access the relevant page via this link. To mention briefly, thanks to the auxiliary methods such as ICSI, which is included in the process in cases where sperm quality is low, PRP application to the ovaries to increase egg quality, and endometrial scratching to facilitate embryo transfer, solutions can be found to "couple-specific" problems that are likely to reduce the success rate of IVF treatment.
The advances in medical technologies, the development of treatment processes significantly increase the success rates of IVF. However, the fact that couples have important duties in this process should not be ignored. It is very important to abandon bad habits that harm sperm and egg quality months before IVF treatment begins.

It is known that habits such as smoking and alcohol consumption, being overweight, stress, an unhealthy diet and inactivity can have a negative effect on the success rate of IVF treatment. Therefore, couples who decide to resort to infertility treatments to have a baby need to take the necessary steps to live a healthier life.

Stress after infertility diagnosis is extremely common and there are many scientific studies showing that infertility leads to stress. The controversial and generally accepted fact, although not yet certain, is that stress can be a cause of infertility. Some studies conducted in recent years have shown that for women with high levels of the alpha-amylase enzyme in their saliva, which indicates stress, it take 29% longer to conceive compared to women who have low levels of this enzyme. We also know that cortisol, known as the stress hormone, affects the signaling between the brain and the ovaries.4 Therefore, success in stress management remains an important factor in the process of IVF treatment. In order to eliminate the stress and concerns experienced specifically during the period, couples may want to receive psychological support.
A common belief about IVF treatment is that the risk of miscarriage is greater in IVF treatment. Although this is a correct opinion, it is necessary to carefully assess why the risk of miscarriage is higher after IVF. The risk of miscarriage in naturally occurring pregnancies is in the range of 15%-20%. In IVF treatment, the risk of miscarriage is about 22%. It is thought that variables such as the age of women and the cause of infertility are behind this increased risk. Although ovarian stimulation is considered a risk factor, it is accepted that advanced methods such as pre-implantation genetic diagnosis, which can be applied within IVF, can reduce the risk of miscarriage among women who are 40 years of age and older.

Doctors

Assoc Prof.
Funda Göde

Gynecology and Obstetrics

+44 7480 8035 35


Assoc Prof.
Volkan Emirdar

Gynecology and Obstetrics

+44 7480 8035 35


Assoc Prof.
Gülin Okay

Gynecology and Obstetrics

+44 7480 8035 35


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