In Vitro Fertilization (IVF)
In vitro fertilization (IVF) is an assisted reproductive technique applied to couples who want to have children.
What is IVF?
IVF begins with the extraction of egg cells produced in a woman's body using special needles after they have matured with medication. These eggs are then fertilized with male sperm in a laboratory environment, and the resulting embryo or embryos are placed into the uterus.
Who is a candidate for IVF?
IVF is a treatment method applied to couples who cannot have children due to reasons related to the woman, the man, or sometimes both. The situations in which IVF treatment is applied can be listed as follows;
- If the fallopian tubes are blocked during the hysterosalpingography (HSG) or if both tubes have been surgically removed
- In men with azoospermia (absence of sperm in the semen) or oligospermia (low sperm count)
- In women with reduced ovarian reserve
- If there is an endometrioma (chocolate cyst)
- In cancer patients, in vitro fertilization (IVF) can be used to preserve reproductive function before chemotherapy/radiotherapy.
IVF Stages
IVF treatment is a process consisting of specific stages. First, the prospective mother is given hormone medication to increase egg production. Then, the mature eggs are collected and fertilized in a laboratory environment with sperm taken from the prospective father. After fertilization, the healthiest embryo is selected from among the developing embryos and transferred to the mother's uterus. After the transfer, a pregnancy test is performed and the pregnancy process is monitored. The success rate of IVF stages depends on the age of the couple and the quality of their reproductive cells.
In Vitro Fertilization (IVF) Treatment
In vitro fertilization (IVF) is one of the assisted reproductive methods applied to couples who cannot have children naturally. An egg taken from the woman and sperm taken from the man are fertilized in a laboratory environment to create an embryo. This embryo is transferred to the woman's uterus. The treatment process generally consists of hormone therapy, egg retrieval, fertilization, and embryo transfer stages. The success rate depends on factors such as age, egg and sperm quality. IVF treatment provides a solution to infertility problems and enables many couples to have children.
IVF Prices
IVF prices vary depending on the center, the techniques used, and additional services. The cost of IVF treatment can vary depending on the techniques used, the equipment of the center, and additional services. Hormone tests, genetic screenings, and additional procedures performed during the treatment process can affect the cost. You can contact Medipol Healthcare Group for detailed information about pricing.
IVF Center
IVF centers are healthcare facilities specifically equipped for infertility treatment. In these centers, treatment processes are carried out with advanced reproductive technologies, expert doctors, and embryologists. When choosing a center, success rates, expert staff, laboratory infrastructure, and patient reviews should be considered. With its expert medical staff and state-of-the-art laboratories, Medipol Healthcare Group is a reliable choice for your IVF treatment.
What is Infertility?
Infertility is the inability of a couple to conceive naturally after at least one year of regular, unprotected sexual intercourse. It can be caused by either male or female factors. Hormonal imbalances, genetic factors, structural problems in the reproductive organs, infections, lifestyle factors, and advanced age can all contribute to infertility. Treatment varies depending on the cause.
Infertility Symptoms
Infertility can often occur without showing any noticeable symptoms. In women, infertility symptoms may include menstrual irregularities, painful periods, hormonal imbalances, and ovulation problems. In men, infertility symptoms may include factors such as low sperm count, erectile dysfunction, and pain or shrinkage in the testicles.
So, what causes infertility? In women, ovulation disorders, blocked fallopian tubes, and hormonal imbalances; in men, problems with sperm production or motility can lead to infertility. Environmental factors, genetic diseases, stress, and lifestyle can also negatively affect fertility.
If pregnancy does not occur after a year of unprotected intercourse, it is important to consult a specialist doctor for early diagnosis and treatment.
What is Unexplained Infertility?
Unexplained infertility is a condition where the cause of infertility cannot be determined despite all tests and examinations. Couples are unable to conceive naturally, and no medical reason can be found. Pregnancy does not occur even though basic factors such as ovulation, sperm quality, and fallopian tube patency are normal. In this case, assisted reproductive techniques such as artificial insemination and in-vitro fertilization (IVF) may be recommended. Lifestyle changes and supportive treatments can also contribute to the process.
Why Choose Us?
Our IVF center provides services with a team of expert and experienced gynecologists specializing in infertility, an experienced laboratory team closely following developments in the field of IVF, a state-of-the-art embryology laboratory, and a patient-focused approach. We frequently update our medical equipment and treatment protocols in line with global developments, performing IVF procedures with a high success rate.
What is Endometriosis (Chocolate Cyst)?
Endometriosis is a chronic disease in which endometrial tissue, the lining of the uterus, grows outside the uterus, usually in the ovaries, fallopian tubes, and abdominal cavity. This condition can lead to symptoms such as severe menstrual cramps, chronic pelvic pain, pain during intercourse, and bowel and bladder problems.
Endometriosis can reduce ovarian reserve by causing inflammation and adhesions, and can impair fallopian tube function, leading to infertility. As the disease progresses, chocolate cysts (endometriomas) may develop. Diagnosis is usually made with ultrasound and laparoscopy. Treatment may include hormone therapy, pain management, or surgery, depending on the patient's age, symptoms, and desire to have children.
Endometriosis treatment is tailored to the individual patient based on their age, symptoms, and desire to have children. In mild cases, symptoms can be controlled with pain relievers and hormonal medications. However, in advanced cases, surgical options are considered for more effective treatment.
Endometriosis surgery may be necessary, especially in cases of severe pain, large chocolate cysts, or infertility. Laparoscopic surgery can remove endometriosis lesions, alleviating the patient's symptoms and preserving reproductive health. Following surgery, additional hormone therapy is usually recommended to prevent recurrence.
With early diagnosis and appropriate treatment methods, endometriosis can be controlled, thus significantly improving the quality of life for patients.
Endometriosis Symptoms
Endometriosis manifests itself particularly with severe pain during menstruation. Pain during sexual intercourse, chronic pelvic and lower back pain, and bowel and bladder problems are among the common symptoms. Menstrual irregularities, excessive bleeding, constipation, diarrhea, and bloating may also be related to endometriosis.
As the disease progresses, adhesions can form in the uterus and fallopian tubes, increasing the risk of infertility. Symptoms can vary from person to person, sometimes being mild, while other times they can severely impact quality of life.
What is an Isthmocele? Can it Cause Infertility?
An isthmocele is a pocket or scar that forms in the uterus after a cesarean section. This condition can lead to irregular periods, spotting, and fluid buildup in the uterus. An isthmocele can cause chronic inflammation in the uterus, making it difficult for an embryo to implant and, in some cases, can be a cause of infertility. Diagnosis is usually made with ultrasound or hysteroscopy. Treatment options may include surgical repair and hysteroscopic procedures.
What is Male Infertility?
Male infertility stems from factors such as low sperm count, motility, and morphological abnormalities. Varicocele, hormonal imbalances, genetic factors, infections, and immune system problems can all cause male infertility. Additionally, environmental factors such as smoking, alcohol, stress, unhealthy diet, and radiation exposure can negatively affect sperm quality. A semen analysis is performed for diagnosis, and treatment is determined based on the underlying cause.
Varicocele in Male Infertility
Varicocele occurs when the veins in the testicles become abnormally enlarged, disrupting blood flow. This can increase testicular temperature, negatively affecting sperm production, motility, and quality, thus leading to infertility. Varicocele is usually painless, but some men may experience discomfort in the testicles. Diagnosis is made through physical examination and ultrasound. Surgical treatment, especially in advanced cases, can improve sperm quality and increase the chances of natural pregnancy.
What is Azoospermia?
Azoospermia is the complete absence of sperm cells in the semen and is a significant cause of male infertility. What causes azoospermia? This condition usually arises from insufficient sperm production (non-obstructive azoospermia) or blockages in the sperm ducts (obstructive azoospermia). Hormonal imbalances, genetic disorders, infections, testicular trauma, and environmental factors such as radiation can also lead to azoospermia.
The symptoms of azoospermia are often not immediately noticeable because the amount and appearance of semen may be normal. However, it is detected through tests performed on men experiencing infertility problems. Additional symptoms such as hormonal imbalances, testicular shrinkage, or decreased libido may also be present alongside azoospermia.
Diagnosis is made through semen analysis and hormone tests. Treatment for azoospermia is planned using different methods depending on the underlying cause. Hormone therapies can support sperm production, while surgical interventions may be necessary if there is an obstruction. Surgical sperm retrieval methods such as micro-TESE are used to increase the chances of reproduction in men who have no sperm in their semen. In addition, assisted reproductive techniques such as in-vitro fertilization (IVF) can help azoospermic men have children.
SGK-Covered IVF Treatment
SGK covers the costs of up to three IVF treatment attempts for insured individuals who do not have children in their current marriage. Adoption is not an obstacle to benefiting from this support.
Conditions:
- The treatment center must have an agreement with the Social Security Institution (SGK).
- A medical board report must prove that it is not possible to conceive naturally.
- The woman must be between 23 and 40 years old.
- One of the spouses must have been insured for at least 5 years and have paid premiums for 900 days.
- Except for premature ovarian failure or azoospermia, other treatments must have failed within the last 3 years.
- If a woman is over 40 years old at the time of embryo transfer, the Social Security Institution (SGK) will not cover the costs. However, if the embryo transfer is performed within 30 days with a valid medical report obtained before the age of 40, the expenses will be covered.
Frequently Asked Questions About IVF Treatment
How Long Does IVF Treatment Take?
Generally, the period for stimulating the eggs with hormone injections lasts between 8 and 14 days, but the average is 10-12 days.
How many times can IVF treatment be attempted?
There is no limit to the number of attempts in IVF treatment.
Is IVF Treatment Painful?
IVF treatment is not a painful procedure. The egg retrieval process is performed under anesthesia and takes approximately 10-15 minutes.
What happens in the laboratory during IVF treatment?
- Stimulating egg development using hormone medications
- Collecting eggs under anesthesia
- Fertilizing the eggs with sperm, embryo development, and implantation of the embryos into the uterus
What Should Be Done Before IVF Treatment?
In the initial consultation for couples seeking treatment for infertility, a detailed medical history is taken. Following this, the prospective mother undergoes a gynecological examination and ultrasound. This examination assesses the mother's ovarian reserve, uterus, and cervix. Information is provided regarding the necessary tests to determine the causes of infertility. A hysterosalpingogram (HSG) is requested for the mother, and a spermogram (semen analysis) is requested from the father. The aim of all these tests is to identify the causes of infertility.
In vitro fertilization (IVF) treatment is recommended for couples in the following situations:
- Fallopian tube blockage (if the fallopian tubes are blocked due to previous surgeries, ovarian inflammation, or if the tubes have been removed or treated with medication due to a previous ectopic pregnancy)
- If egg reserve is depleted
- If there is endometriosis
- If pregnancy has not been achieved with previous standard treatments
- In men, azoospermia (absence of sperm) or severe oligoasthenoteratazoospermia (total motile sperm count below 5 million)
- If either spouse has a genetically inherited disease such as thalassemia (Mediterranean anemia), cystic fibrosis, or hemophilia.
- To protect your spouse from infectious diseases such as hepatitis and HIV.
- Before cancer treatment
Tests Required from Couples Starting IVF Treatment
Female
- HbsAg
- Anti-HCV
- Anti-HIV
- TSH
- Prolactin
- Serum AMH level
- Rubella IgG
- Complete blood count and blood group
Male
- HbsAg
- Anti-HCV
- Anti-HIV
- Spermiogram
How is IVF Treatment Performed? How Many Days Does Treatment Last? How Many Eggs Are Collected? What Are the Stages?
IVF treatment consists of 5 stages.
- Ovarian stimulation
- Egg retrieval (OPU)
- Fertilization in a laboratory setting
- Embryo culture
- Embryo transfer (ET)
Ovarian Stimulation
On the 2nd or 3rd day of menstruation, after an ultrasound, hormone tests are requested. If the ultrasound and blood tests are satisfactory, hormone injections are started to obtain a large number of eggs from the ovaries. The stimulation of the ovaries with hormone injections usually lasts between 8 and 14 days, but averages 10-12 days. During this time, the patient is called to the hospital 2-3 times for check-ups, ultrasounds are performed, and hormone levels are checked in the blood if necessary. When the follicle size (the small sacs containing eggs) reaches 18-20 mm and a sufficient number is obtained, an ovulation induction injection is necessary to mature the eggs.
Egg Retrieval
Egg retrieval (OPU) is performed 35-36 hours after the trigger injection. Anesthesia is administered during the retrieval procedure. It is generally an easy procedure that does not cause significant pain. Using an OPU needle attached to a vaginal ultrasound probe, follicles located within the ovaries are collected through the vaginal wall and sent to the embryology laboratory in a sterile tube. This procedure takes approximately 15-20 minutes, depending on the number of eggs to be collected. Mild abdominal pain and tenderness may occur on the day of the procedure. If a large number of eggs are collected, a feeling of fullness and pain in the abdomen may persist for a few days.
Fertilization in a Laboratory Environment
Approximately 2 to 3 hours after egg retrieval, the mature eggs are evaluated under a microscope. On the same day, fertilization is performed using sperm obtained from a semen sample taken from the male through masturbation, using special washing and preparation techniques. In some cases where sperm cannot be obtained (from the testes or epididymis), sperm can be obtained through surgical procedures.
Microinjection (ICSI = intracytoplasmic sperm injection) is a procedure in which sperm is injected into an egg under 200 to 400x magnification. After the procedure, fertilization of the eggs is checked 18 to 20 hours later. Because microinjection provides a high fertilization rate, it is routinely performed by many centers today.
Embryo Culture
One of the most important steps in IVF procedures is ensuring embryo development under laboratory conditions. After fertilization, embryo development is monitored, and the transfer is performed on the appropriate day. Transfer days vary depending on the number of eggs obtained from the woman and the quality of the developing embryos. While day 5 (blastocyst) transfer is frequently performed, day 3 or day 4 transfers can also be done depending on embryo development.
Embryo Transfer
Embryo transfer is a crucial procedure, the final step in the IVF process. It is a painless procedure and does not require anesthesia. Before embryo transfer, couples are informed about the quality and current condition of the embryo to be transferred. The transfer is performed with a full bladder and under ultrasound guidance to ensure the embryo is placed in the most suitable location in the uterus. The embryo, brought in a catheter by the embryologist, is placed approximately 1 cm below the top of the uterus by the doctor performing the transfer, and the catheter is removed. Half an hour of rest after the transfer is sufficient. Longer periods of bed rest have been found not to increase the chances of pregnancy.
Embryo Freezing
In in vitro fertilization (IVF) laboratories, the process of freezing and storing embryos obtained from the fertilization of sperm and egg cells for later use is called "Embryo Freezing". Embryos can be frozen at all developmental stages from day 1 to day 6. The freezing process involves mixing the embryos with a preservative fluid using a technique specific to their developmental stage, placing them in tubes, and freezing them in liquid nitrogen (-196 degrees Celsius) before storing them in tanks.
Frozen embryos are removed from liquid nitrogen and thawed at room temperature when they are ready to be thawed. One of the most important criteria indicating the success of the freezing method is a 98-99% viability rate in the embryos after thawing. At our center, we freeze and thaw our embryos using the "vitrification" method. With this thawing method, we achieve pregnancy rates that are at least close to, or even slightly higher than, those achieved with fresh embryos.
Embryo freezing (vitrification) procedure at the IVF Center.
- It is applied in the following cases:
- In the presence of remaining healthy embryos after transfer
- In cases with a risk of Ovarian Hyperstimulation Syndrome (OHSS)
- Due to Preimplantation Genetic Diagnosis (PGT)
- In cases requiring intrauterine surgery (endometrial polyp,
What is Egg Freezing? In Which Cases Is It Applied?
Egg freezing (oocyte freezing) is the process of freezing and storing egg cells obtained from a woman's ovaries for the purpose of having children in the future. Egg freezing is performed similarly to the classic IVF procedure, and mature eggs obtained after egg retrieval are frozen and stored using a rapid freezing method called vitrification. According to the IVF regulation published in our country in 2014, women can freeze their eggs in the following cases:
- Before treatments that may damage the ovaries, such as chemotherapy and radiotherapy;
- Before surgeries that may lead to loss of reproductive function (such as removal of the ovaries);
- In cases where ovarian reserve is reduced or there is a family history of early menopause, as documented by a health board report consisting of three specialist physicians.
In women undergoing chemotherapy/radiotherapy for cancer treatment, ovarian stimulation for IVF can begin immediately, regardless of their menstrual cycle. Hormone injections are administered to stimulate the ovaries, and this process usually lasts 10-11 days. In cases where we do not want elevated estrogen levels in the blood, such as in breast cancer, medication deemed appropriate by the doctor is used to obtain a sufficient number of eggs without raising estrogen levels. In cases with reduced ovarian reserve, treatment begins on the 2nd-3rd day of menstruation, and follicle development is stimulated using hormone injections, usually lasting 10-12 days.
When the eggs reach a certain size, an ovulation trigger injection is administered, and egg retrieval takes place 34 to 36 hours later. Mature eggs are frozen in the laboratory by embryologists. In non-virgin women, egg retrieval is performed vaginally, while in virgin women it can be done abdominally. Women with low ovarian reserve may require more than one treatment cycle. The storage period for eggs is 5 years. This period can be extended if desired. Clinical pregnancy rates range from 4-12% per egg retrieved. Two important factors determining pregnancy rates after egg freezing are the woman's age at the time of egg freezing and the number of eggs frozen.
What is a Continuous Embryo Monitoring System (Embryoscope)?
A continuous embryo monitoring system is a system that allows the development of embryos formed after fertilization to be monitored 24 hours a day until they are transferred to the expectant mother's uterus. Embryos obtained during IVF treatment are monitored in special devices called incubators. During this process, in order to both evaluate embryo development and select the embryo with the highest chance of implantation in the uterus, the embryos are removed from the incubators every day and evaluated under a microscope by an embryologist.
EmbryoScope is a state-of-the-art incubator equipped with special cameras that periodically image the embryos. This allows for close monitoring of the embryo's fertilization and division stages, enabling the selection of the embryo with the highest chance of implantation in the uterus.
Advantages
- It allows us to evaluate all developmental stages of embryos while they are in the laboratory environment.
- Since they are not removed from the device for evaluation, they are not exposed to stress that may occur due to external conditions.
- In some cases where the embryo shows abnormal division, the probability of pregnancy is very low. It is not possible to determine these division abnormalities with evaluations made only once a day. Thanks to the Embryoscope, it is possible to detect these embryos with a low probability of pregnancy.
What is Embryo Glue?
Embryo transfer is the most critical and delicate stage in the IVF treatment process. Embryo glue is a hyaluronan and human albumin-rich fluid used during embryo transfer to support the implantation of the embryo in the uterus. Its application is actually quite simple. The embryo(s) to be transferred are kept in embryo glue for approximately 30 minutes, and the transfer is performed within this fluid. Hyaluronan is also found in high amounts in the uterus during natural fertilization. By using embryo glue, the hyaluronan in the uterus can be increased, thus improving the chances of success in IVF. It has been shown to increase pregnancy rates, especially in women over 35 who have experienced repeated IVF failures.
Who is PGT Recommended For?
- Advanced maternal age (38 years and older)
- Recurrent early pregnancy losses
- Recurrent IVF failures
- Severe male factor infertility cases (less than 5 million sperm per ml of semen sample or no sperm at all - Azoospermia)
- Embryo selection to shorten the time to achieve pregnancy in couples with no risk factors
- Known translocation carrier status
- Presence of a child with a single gene defect and/or requiring HLA-compatible transplantation
How is PGT Performed?
Following a classic IVF procedure, cell samples are taken from embryos suitable for biopsy on day 5 and frozen. After genetic analysis of the biopsy cells, embryos with a normal chromosomal structure are implanted into the mother's uterus. Next-generation sequencing (NGS) is one of the genetic analysis technologies that allows us to perform comprehensive chromosomal screening in embryos.
This test screens all 24 chromosomes, providing more detailed and sensitive results and better determining the rate of mosaicism in embryos. It has begun to be used as an advanced technique for PGT. With NGS, embryos are screened quickly and effectively, and genetic problems at the chromosomal level are detected before pregnancy.
What are Recurrent IVF Failures? How are they Investigated?
Successful implantation is a complex process involving two main players (mother and embryo). IVF failure can stem from anatomical reasons, factors related to the endometrium layer, and factors originating from the embryo.
What tests should be performed on couples experiencing recurrent IVF failure?
Investigation of Anatomical Causes
These cases should be treated with 3D ultrasonography and hysterosalpingography (HSG; uterine x-ray). Myomas, endometrial polyps, and intrauterine adhesions that disrupt uterine integrity should be investigated. Furthermore, it is known that hydrosalpinx, where the end of the fallopian tube closes and swells with fluid, causes a 20-50% decrease in live birth rates.
Evaluation of the Endometrium
A receptive endometrium is important for embryo implantation. Assessment of the endometrium's thickness and appearance via ultrasound examination is necessary for successful implantation. The endometrial thickness should be at least 6–8 mm. Thin, unresponsive endometrium is difficult to treat. Difficulties in embryo transfer can also reduce implantation rates. In all assisted reproductive treatment cycles, embryo transfer should be performed as easily as possible and without stimulating the uterus.
Assessment of Embryo Quality
Sperm and egg quality can affect embryo quality, reducing the chances of implantation.
Investigation of Genetic Causes
In cases of recurrent IVF failures, an increase in chromosomal abnormalities has been observed. Therefore, to investigate chromosomal abnormalities in the mother and father, chromosomal analysis should be performed from peripheral blood.
Sperm Factor
During the investigation of the causes of recurrent IVF failure, some advanced morphological analyses of sperm can be performed, and special sperm selection methods can be tried, because the contribution of sperm cells to the production of normal and healthy embryos is very important. It has been reported that the T helper 1/T helper 2 (helper immune system cells) ratio is higher in cases of recurrent miscarriage and recurrent implantation failure compared to fertile couples.
While some studies have found an increase in natural killer cells, this finding has not been fully proven. The idea that immunological factors may play a role in implantation failure has led to the testing of treatments mentioned in scientific studies, such as steroid use, intravenous immunoglobulin (IVIG) administration, intravenous lipid infusion, fertility vaccines, and allogeneic lymphocyte therapy. However, the benefits of these treatments have not yet been proven.
What do blood hormone levels tell us?
AMH (Anti-Müllerian Hormone)
Anti-Müllerian hormone (AMH) is a hormone secreted from follicles in the ovaries that range in size from 2 to 6 mm. There is no specific time of year for the test; it can be performed on a blood sample taken on any day of the menstrual cycle. AMH is currently the most important blood test for providing information about ovarian reserve. An AMH value below 1.1 ng/ml indicates decreased ovarian reserve.
FSH (Follicle-Stimulating Hormone)
FSH levels, measured on the 2nd or 3rd day of the menstrual cycle, are used as a measure of ovarian reserve. High values (> 12 IU/L) indicate decreased ovarian reserve. However, this does not necessarily mean that the chances of getting pregnant are severely reduced. Basal FSH values can vary from month to month. An FSH value > 20 IU/L is considered an indicator of decreased chances of pregnancy.
E2 (Estradiol)
E2 levels are often below 50 pg/mL on days 2-3 of the menstrual cycle. In women with reduced ovarian reserve, high E2 values (above 60-80 pg/mL) in the early follicular phase indicate accelerated egg development.
LH (Luteinizing Hormone)
The LH hormone, which increases in the middle of the menstrual cycle and enables ovulation, is also the main hormone that triggers the release of the egg. Its ratio (FSH/LH) is normally greater than one at the beginning of the menstrual cycle. An LH/FSH ratio greater than 2.5 may raise suspicion of polycystic ovary syndrome. In addition, LH hormone levels are measured as high during menopause and the onset of menopause.
Prolactin
This hormone, secreted by the pituitary gland, is responsible for milk production in women. It is responsible not only for milk secretion but also for functions such as reproduction and the menstrual cycle; in women, it should be at a level of approximately 15 to 25 µg/L. High levels of prolactin hormone prevent ovulation. For this reason, getting pregnant becomes more difficult than under normal circumstances.
TSH (Thyroid Stimulating Hormone)
A thyroid hormone test is a measurement of triiodothyronine (T3) and thyroxine (T4) hormones produced by the thyroid gland, and TSH (thyroid hormone) originating from the pituitary gland, which is responsible for stimulating the thyroid gland, in order to evaluate the functions of the thyroid gland. When the thyroid gland is overactive, it is considered hyperthyroidism, and when it is underactive, it is considered hypothyroidism.
DHEAS (Dehydroepiandrosterone Sulfate)
DHEA-S is primarily secreted from the adrenal glands in both men and women. Its levels can increase in polycystic ovary syndrome, in women with increased hair growth, and when there are problems with the adrenal glands.
What is Ovulation Treatment?
Ovulation medications can be used to treat some women who have been unable to conceive naturally. Ovulation medications are a primary treatment method, especially for women with ovulation disorders. The most commonly used ovulation medications are:
Gonadotropins
In women who cannot ovulate with medication or who do not become pregnant despite ovulation, ovulation stimulation is performed with injections. Injection treatment is started with low doses (37.5-75 IU) on the 2nd or 3rd day of menstruation. After 5 days of injections, follicle development is monitored with ultrasound. Monitoring continues at 2-3 day intervals depending on follicle size. Although insemination is not necessary in women with polycystic ovary syndrome who have undergone injection treatment, insemination treatment may be added to slightly increase the chances of pregnancy.
How to Take a Pregnancy Test?
A pregnancy test measures the amount of the hormone Beta-HCG in the blood or urine, which increases in the body at the onset of pregnancy, to detect pregnancy. Although this hormone is generally associated with pregnancy, it can also increase due to some other illnesses. The test, which is done with a single tube of blood taken from the arm, usually yields results the same day.
Blood pregnancy tests are more reliable because they directly measure the level of Beta-HCG in the blood. Normally, in healthy women who are not pregnant, the level of the Beta-HCG hormone is between 0-10 mIU/mL. With the onset of pregnancy, the level of this hormone begins to increase rapidly. Urine pregnancy tests, which are the first choice for many people who suspect they are pregnant, are performed by dropping a small amount of urine onto a kit.
The test kit measures the level of Beta-HCG in urine and gives a result as a single line (negative) or a double line (positive). Although urine tests have a high reliability rate, test kits can sometimes give false results, so it is advisable to use blood tests for a definitive result.
Sperm Selection Techniques
DGS (Density Gradient Centrifugation)
The success rate of in vitro fertilization (IVF) is increased by selecting high-quality sperm. Routine sperm preparation techniques such as density testing, gradient centrifugation (DGS), and swim-up methods are already fundamental components of assisted reproductive procedures. Using these methods, sperm are separated, selected under a special microscope, and injected into the egg using the ICSI method. To obtain the highest quality embryos from these selected sperm, sperm shape is examined; that is, the regular shape of the sperm's tail, head, and neck is crucial. While classical methods are still used for selecting high-quality sperm, improved and even newly developed methods also exist.
HOST-EOSIN Y (Sperm Selection Based on Sperm Membrane Integrity)
The normal structure of the sperm membrane is important in evaluating sperm viability. For this purpose, Eosin Y and HOST tests are routinely performed in cases where immobile sperm are observed in diagnostic semen analysis. Additionally, the HOST test is also used to select motile sperm in cases of necrozoospermia and totally immotile sperm samples.
PICSI (Sperm Selection Based on Membrane Maturity)
The outer layer of a woman's egg contains a protein called hyaluronic acid (HA), and during normal fertilization, there are regions where mature sperm bind to this protein. The PICSI Dish is a specially designed dish with a HA-bound region on its surface. The washed sperm sample is placed on the edge of this region, and after 15 minutes, HA-bound sperm are collected. It is used for ICSI (Intrauterine Insemination).
MICROCHIP (Sperm Selection via Microfluidic Channel System)
Sperm chip, the closest sperm selection method to natural sperm, is a system of small channels filled with buffered fluid that allows sperm to move through the cervical canals in a way similar to their natural path. In this system, called a microfluidic channel system (Micro Chip = Sperm Chip), a sperm sample placed at one point is expected to move through the channels to the other end by their own movement. Sperm that show this progression are considered to have normal morphological structure, and the sperm collected in the pool are used in IUI/ART procedures.
PICSI and MICROCHIP methods, still considered experimental, can be applied as an alternative method in cases of male infertility without severe morphological abnormalities and with adequate sperm motility. These methods cannot be used in cases where sperm count is very low and sperm motility is very poor. Furthermore, they are not suitable for use in cases where sperm is obtained from the testicles using TESA/TESE methods.
What is Ultrasound?
An ultrasound is a type of sound vibration with a high frequency that is imperceptible to the human ear. Because ultrasound does not use the harmful rays found in X-ray imaging, it can be easily used to visualize almost all disorders. As an indispensable imaging method in modern medicine, ultrasonography evaluates the structure of the reproductive organs, uterus, and ovaries. Any anomalies in the appearance of the uterus (such as double uterus, polyps, intrauterine adhesions, fibroids, or intrauterine septa), the structure of the ovaries (including the presence of cysts), and any dilation in the fallopian tubes (hydrosalpinx) are assessed to investigate their relationship with infertility.
Ovarian reserve is assessed using ultrasonography on days 3-5 of the menstrual cycle. The purpose of this ultrasonography is to evaluate the ovarian capacity, which decreases in women, especially with age. By evaluating the number of follicles (antral follicle count, follicles with diameters between 2-5 mm) and serum AMH levels together with the ultrasound, the likelihood of a response to treatment is estimated. The treatment protocol and drug dosages are planned based on this information. This assessment plays a crucial role in choosing the appropriate treatment and determining its success rate.
Fertility-Preserving Approach in Cancer Patients
Advances in cancer treatments have allowed many people to overcome cancer. However, cancer and its treatments do have negative effects on fertility. Preserving fertility before cancer treatment protects these individuals' dreams of starting a family in the future.
Cancer treatments such as chemotherapy, radiation, and surgery can cause early menopause or ovarian damage in women, while in men they impair sperm production.
Women are born with approximately 1-2 million eggs (which is their maximum capacity). These eggs are continuously lost over time, and by puberty, they have around 400,000 eggs remaining. Chemotherapy drugs cause these remaining eggs to deplete even faster, leading to early menopause.
Fertility-preserving approaches in cancer patients
Fertility-preserving approaches in women include:
- Egg freezing
- Embryo freezing
Both methods are in-vitro fertilization (IVF) techniques and are recommended before cancer treatment begins. In cases where the patient needs to start chemotherapy immediately, fertility-preserving approaches can be used during breaks in chemotherapy.
Embryo Freezing
This method is only applied to married couples. In women who will undergo chemotherapy/radiotherapy due to cancer treatment, ovarian stimulation for IVF can begin immediately, regardless of their menstrual cycle. Hormone injections are started to stimulate the ovaries, and this process usually lasts 10-11 days. As in classic IVF treatment, when the eggs reach a certain size, an ovulation trigger injection is given, and egg retrieval is performed 34 to 36 hours after this injection. High-quality sperm selected by embryologists are placed into the mature eggs under a microscope. After fertilization, the embryos are frozen and stored on the 5th day. Your cancer treatment can begin 1-2 days after egg retrieval. These processes take an average of two weeks. After cancer treatment is completed and your hematologist-oncologist gives permission, and if you are ready to become a mother, the uterus is prepared and the embryo is placed inside the uterus.
Egg Freezing
This is a preferred treatment method for single patients. The egg freezing process is similar to classic IVF, and mature eggs obtained after egg retrieval are frozen and stored using a rapid freezing method called vitrification. Hormone injections are started regardless of the menstrual cycle, and this process usually lasts 10-11 days. When the eggs reach a certain size, an ovulation trigger injection is given, and egg retrieval is performed 34-36 hours after this injection. The obtained mature eggs are frozen and stored using the vitrification method. Your cancer treatment can begin 1-2 days after the egg retrieval procedure.
Newer treatments such as ovarian tissue freezing are fertility-preserving approaches to consider, particularly in children who have not yet reached puberty, and in cancer patients who do not have time to wait for procedures such as oocyte/embryo freezing and need to start chemotherapy immediately.
To preserve your chances of having children in the future, it is recommended that you consult with an IVF specialist before starting cancer treatment.
