In Vitro Fertilization (IVF) Treatment

The first pregnancy was provided by the IVF method in 1976 and resulted in ectopic pregnancy. Then, the first healthy baby through IVF treatment was born in 1978 with IVF. With the development of technology, in vitro fertilization treatments have also blazed a trail. Along with the great advances in genetic science, advanced technologies and scientific studies have brought about many methods such as selection of healthy embryos, differentiation of single gene diseases.

In vitro fertilization is the procedure where a woman's egg is successfully combined with male sperm and placed into the mother's uterus until fertilization. The development of fertilized eggs is provided on special media in our laboratories and embryos are developed. The developing embryos are graded for their quality and placed in the mother's uterus under ultrasound guidance at the multicellular stage or the so-called blastocyst. All IVF procedures, including stimulation and monitoring of the ovaries, ovo collection and embryo transfer, are performed in advanced IVF clinics and laboratories.

What are the steps of IVF treatment?

First Examination

At the first visit, you will meet one of our physicians and have your first meeting. Your medical history and any previous tests, if any, are evaluated, the examination is performed for diagnosis and a special IVF Treatment plan is made for you. At this stage, you will get in touch with the finance department and find out about the most suitable options for you. You can also provide the necessary requirements and documents list for SSI.

Pre-Treatment Preparation

Antral follicle count (egg age, number of eggs) is measured for females by ultrasonography and uterine structure is evaluated by egg reserve, hormone tests (TSH, PRL and AMH if needed) are performed independently of menstrual period and sperm test (semen analysis) is performed in males. Hepatitis B and C (HbsAg, Anti HCV) and HIV tests, which we call serology are also requested in both females and males. Treatment protocol appropriate for you is determined accordingly. 

It is not mandatory to come to the examination for the first evaluation or to perform the tests when you are in your menstrual period. Nowadays, there are evaluation and testing facilities such as ultrasound and AHM which can be performed in non-menstrual period. Since almost all treatments start on the 2nd or 3rd day of menstruation, you should contact us as soon as your menstruation period starts and make an appointment to start treatment. When you reach our nurses and assistants in the beginning of your menstruation period, the appropriate day and time will be created.

Starting the Birth Control Pills

In some cases, especially in out-of-town or overseas patients, such as ovarian cyst may prevent the treatment of conditions that may prevent the occurrence of conditions for the use of 2-5 weeks before the IVF contraceptive pill can be used. If this option is appropriate for you after the first interview or online evaluation, our assistants will advise you on the use of medication.

Ovulation Treatment 

A IVF treatment begins with ultrasonography and ovarian stimulation. First USG examination is performed usually on 3rd or 2nd day of the menstruation. Ideally, ultrasonographic examination should be performed vaginally. Vaginal ultrasonography always gives a clearer and more accurate result about the ovaries and uterus. Uterus and ovaries may not be seen clearly in abdominal ultrasonography. In the first examination, the ovaries are evaluated, and ovarian cysts, ovo cysts, uncracked ovos, rest follicles are checked for any residual ovo from the previous month. If you have one of them in your ovaries, your treatment may be postponed to the next month, because the number of ovos that develop from that ovary may be reduced, which may result in inefficient treatment. 

Ovulation Tracking

If the ovaries are clean, ovo multiplier and ovo growth FSH (Gonal F) or HMG (Merional) injections are used. Your specialist will choose the most appropriate dosage and the most appropriate kind of medicine for you. The medication designated for you is described to you in detail by our nurses. All drugs used in IVF treatment are patient-friendly and can be self-medicated. Therefore, it has quite simple uses. Our expert nurses will give you detailed information about how to use the drugs and will give you the necessary training patiently to make the injections yourself. After the first examination, you will have a 4-5 day treatment plan and then you will have your second appointment for ovulation follow-up. In your second appointment, vaginal ultrasonography is performed again to determine how many eggs (follicles) are developed and how large they are by looking at your egg development, which we call follicle (yolk sac). When the eggs reach a certain size, suitable cracking needles (Cetrotide) are started to prevent the eggs from cracking early. After that you will now have two injections per day. One is to enlarge the ovo and the other is to prevent the growing ovo from cracking. After the second ultrasound examination, a third examination appointment is usually established (each patient may not meet this standard) to determine the day of ovo collection.

Ovo Ripening (Cracking)

In the third ovulation follow-up ultrasonography, the ovos (follicles) are now maturing. The process of these injections varies from person to person, but usually lasts between 8-10 days. In this final ovo measurement, hCG (Ovitrelle, Choriomon), which is a fracture injection, is planned if there are 3 ovos (follicles) that have reached an average size of 17 mm in total. This injection is one of the most important stages of treatment. Ovo collection must be planned 34-36 hours after this injection is given, otherwise the developing ovos will crack and disappear before being collected and all the labor may be wasted. For this reason, your doctor and nurse will repeatedly tell you that the time of these injections are very, very sensitive. All precautions will be taken to prevent this injection from being done incorrectly. How to use the injection will be taught to you by our trained nurses.

Ovo Collection and IVF Laboratory

36 hours after cracking injection is performed vaginally in the IVF operating room with sedation (mild general anesthesia), the ovos are collected by means of a ninjection while the patient sleeps. There is only one ovo in each follicle (yolk sac). Therefore, the collection process is done with great care to ensure that none of them is wasted. Each tube collected is immediately examined under a microscope, if the ovo is not taken, washed again and ensured that the ovo is obtained. Ovo collection usually takes 15-20 minutes. After all the ovos are collected, the patient is taken to the ward for rest. After 2-3 hours of rest, the anesthesia effect is lost and the patient is discharged after the food is fed. Occasionally, bowel, bladder and vascular injuries may occur during ovo collection. Infection is very rare. Very little vaginal bleeding may occur.

Collected ovos are cleaned and incubated in incubators on the same day with the sperm from the male spouse is brought together and fertilized. Fertilization is performed either by the sperm sample placed around an ovo as in the traditional in vitro fertilization process and the sperm is expected to fertilize the ovo by itself or by the ICSI (microinjection) method.

Impregnation 

At the 16th hour following microinjection application, the core structures from male and female should be observed. For a healthy fertilization, there should be two core structures. The absence of the nucleus structure indicates that there is no fertilization and that 1 or 3 fertilization occurs abnormally.

Embryo or Day 5th Day Blastocyst Transfer

After this stage, embryos are grown and developed in special media and special devices. A fertilized ovo begins the first division after approximately 20 hours to form a 2-cell embryo. From this period on, we evaluate embryos according to certain criteria. The shape and size of blastomeres (cells within the embryo) are made by taking into account parameters such as degree of fragmentation between blastomers, number of nuclei in blastomers, cytoplasmic appearance and early compacting. On the third day, the embryo turns into an eight-cell stage, and on 8th day it becomes an embryo called an advanced blastocyst with too many cells to count.  Transfer is usually performed on 3rd or 5th day. This is determined by evaluating the embryo quality and the patient. The appropriate conditions for each patient are different. Your doctor and embryologist will make the right decision for you. 

During all these laboratory development stages, you will be called by our embryologists and you will be informed about your embryos. When the date of transfer is decided, you will be given the appropriate day and time to come to the transfer.

When you come to embryo transfer you will be asked to have your bladder full so drink plenty of water and do not urinate. The purpose of this is to monitor the uterus well with bladder-filled ultrasonography and the ultrasound-guided embryo transfer process is much better. Embryo placement (transfer) is performed without anesthesia. It is a painless procedure and should be performed with precision, it is very important to place the embryo into the uterus without damaging it. When this stage is performed in experienced hands, the chance of pregnancy increases. 

The number of embryos transferred is the most curious issue for our patients. The number of embryos transferred was determined primarily by laws and regulations. In addition, it depends on many criteria such as  the patient's history, whether she has had a previous pregnancy, previous treatment results, and embryo quality. According to the regulation, only one embryo transfer is required in the first two attempts for women under 35 years of age. For women over 35 years of age or those who have failed in vitro fertilization twice before, two embryo transfers can be made. This is to prevent multiple pregnancies. Complications of multiple pregnancies have many risks such as miscarriage, preterm birth and multiple pregnancy so it is undesirable. The purpose of IVF treatment is not only to get pregnant but to have healthy children.

Assisted Hatching

Pregnancy may not occur even though good quality embryos are obtained and transferred in IVF treatments. One of the reasons is that the membrane surrounding the embryo does not tear and the embryo cannot hold onto the uterus. For this purpose, we apply membrane thinning or completely opening method to embryos on the 2, 3 and 4 days before transfer. The process can be carried out in 3 different ways: mechanical, acid solution and laser. We prefer laser method because it is easy to apply and takes less time.

Freezing of Remaining Embryos (Vitrification)

After embryo transfer, the growing embryos are frozen with a successful technique called vitrification. The aim of this is to achieve the chance of pregnancy easily by simply transferring the embryo without going through all these long efforts and troubles if pregnancy cannot be obtained in the first treatment or if a second pregnancy is desired.

Pregnancy test

On average 12 days after embryo transfer, blood pregnancy test (beta hCG) is used to determine whether pregnancy occured. If the pregnancy test is positive, it is repeated after 48 hours. If the blood value of the pregnancy test shows a 2-fold increase in 48 hours, your appointment is scheduled for the first ultrasound after 2 weeks.