In vitro fertilization and embryo transfer (IVF-ET)

In vitro fertilization is the removal of one or more mature egg cells from the woman’s ovaries and their fertilization in a special environment outside the body with the sperm taken from the woman’s partner. Embryo transfer is the placement of these fertilized eggs in the uterus. This method is applied to women whose tubes are blocked or damaged for any reason, in cases where there are low sperm count or structural defects in sperm, in cases of male or female immune problems, in some cases of endometriosis, and in infertile couples with an unexplained cause. It is not applied to women who do not have a uterus for any reason (congenital or surgically removed), women who do not have ovaries and who are unable to ovulate.

IVF-ET process includes different steps. It does not require hospitalization during these procedures. It should be kept in mind that each patient will have a unique response to the treatment they receive and each IVF treatment period may result in different results. This means that you will respond differently to treatment than other patients, and also that your response during one treatment period may differ from your next treatment. For this reason, you will see that the treatment and tests that are suitable for you will be different from other patients from time to time. Please do not compare your test results and treatment plan with those of other patients. Although you may have many problems in common with other patients, remember that IVF is a very private matter and some patients may not feel comfortable discussing it. IVT-ET steps are listed below in general.

 

Suppression of Hormones

In the normal period of one month, in the ovaries of the woman, only one egg matures and becomes ready for ovulation. However, our aim is to increase the chance of fertilization by forming more than one (at least 3) mature egg cells. Therefore, the normal process is inhibited by suppressing it.

 

Stimulation of the ovaries (ovulation induction)

The ovaries are stimulated to ensure that at least 3 egg cells develop and mature, thus increasing the chance of fertilization. The drugs used for this purpose are used for 7-20 days. While using the drug, the development of the egg cell is monitored by ultrasonography (blood tests if necessary).

 

Monitoring the development of the egg cell (folliculometry)

The development of the egg cell must be closely monitored in order to control the ovulation time and thus collect the eggs before they are spontaneously ejected. The development of the egg cell is monitored by ultrasonography (blood tests if necessary). After five days of ovarian stimulation treatment, transvaginal ultrasonography will be performed. This procedure is not inconvenient. You may have some vaginal discharge after the procedure, due to the gel we apply on the vaginal probe to make it easier for us to take an image. 

Follicles are fluid-filled round sacs inside the ovaries. Therefore, they appear as black circles on the ultrasound screen. Usually there is one egg in each follicle. Eggs are invisible. The number of follicles may not be the same as the number of eggs. During the follow-up, from the sixth day of treatment, your daily blood sample will be taken to determine your blood estradiol level. Depending on your estradiol level, the treatment you will receive that afternoon and the morning of the next day will be planned.

 
It is extremely important that you do not compare your own values with those of other patients. Such a situation may cause unwarranted concerns. Each person will respond differently to medication. We do not specifically look for value when performing ultrasound and evaluating your blood sample. Your doctor will evaluate your results and will let you know first if there are any problems.

 

Egg cell retrieval (OPU)

There are several methods used to collect eggs. Direct needle aspiration is used via ultrasound. During this procedure, the vagina is locally anesthetized and women do not feel pain. Before egg collection, an attendant will accompany you to prepare. Before preparing, please make sure to empty your bladder completely. If anesthesia is planned, the anesthesiologist will answer all your questions about anesthesia. After all the preparations are completed and the serum is inserted, you will be taken to the operating room and you will be asked to lie down on the operating table.

Egg collection by vaginal ultrasonography is a minor surgical method. Before starting the procedure, the woman is administered a sedative medication. The procedure is performed under local anesthesia. The vaginal ultrasonography probe is placed in the chamber. With the help of ultrasonographic image, the ovaries are reached and mature eggs are collected. It takes an average of 20-30 minutes to collect the eggs. Although the number of eggs collected varies from woman to woman, the average is 3-15. After the eggs are collected, there may be a small amount of bleeding in the form of spotting and groin pain.

 

Fertilization of the egg cell

After the egg cells are collected, they are placed in a culture medium in a special cabinet (incubator) in the laboratory. Meanwhile, the sperm of the spouse is prepared with a special washing technique and the healthy sperms are separated. In the IVF method, 4-6 hours after the egg cells are collected, the sperms taken from the spouse are left next to the egg cell and the sperms are expected to fertilize the egg. Microinjection method is used in cases where spontaneous fertilization is not expected due to insufficient number of sperm or poor quality of existing sperm. In the microinjection method; A healthy sperm is injected into the egg cell. 

The day after egg collection, fertilization occurs in most cases. However, embryo transfer can be done after the fertilized egg has started to divide normally, which usually takes place one day after fertilization. Although rare, one of the risks of fertilization is that fertilization does not occur. Sometimes the reason is obvious, but often no cause can be found.

 

Placing the fertilized egg cell in the uterus (Embryo Transfer)

It is learned whether there is fertilization 24 hours after the egg cells are taken, and whether there is healthy embryo development after 48-72 hours. The number of embryos to be implanted in the uterus varies according to the age of the woman and the number of fertilized embryos. While multiple embryo transfer increases the chance of success, it can also cause some undesirable situations such as multiple pregnancy. Embryos that have not been transferred for any reason can be frozen and stored for later use. In our center, this storage process can be carried out successfully at high standards. The recommended average longest storage period is 5 years.
The method is simple and does not require anesthesia, it is like vaccination. The implantation of the fertilized embryo into the uterus is often painless. The embryo is placed in the uterus through a catheter. The processing time is on average 5-10 minutes. A speculum is inserted into the vagina. Sometimes, evaluation is made with abdominal ultrasonography. A catheter is then inserted into the cervical canal and pushed into the uterus. You may feel very little cramping pain when the catheter is inserted into the uterus. Embryos are then released into the uterus. The embryologist then examines the catheter under a microscope to ensure that all embryos have been transferred.

 

Pregnancy test and monitoring

A blood pregnancy test is performed 12-14 days after embryo transfer. A blood pregnancy test will be done 12 days after embryo transfer. You will be notified of the results as soon as possible.
Usually the test results are either positive or negative. But sometimes the test result can be suspiciously positive. questionable positivity; It is seen in late but normal implantation of the embryo, in non-continuing pregnancies, in the presence of ectopic pregnancy, in cases such as laboratory errors. In the presence of any of these conditions, it is extremely important to follow up with hCG. If the result of the first test is positive or suspiciously positive, the second test should be done 2 days later.

If the Pregnancy Test is positive (+):
Ectopic pregnancy, number of pregnancies, etc. In order to determine the conditions, it is checked whether the pregnancy is in the uterus and in its normal course with ultrasonography.
In couples who have not conceived spontaneously or despite treatment for a long time, the miscarriage rate is slightly higher than normal in pregnancies provided by assisted reproductive techniques. Therefore, it is necessary not to be alarmed when faced with such a situation. It is not abnormal to have very little vaginal spotting or bleeding before the pregnancy test.

If the Pregnancy Test is negative (-):
If your pregnancy test is negative, you can stop using the drug. If your bleeding has not started, it will start within 3-5 days. This may be different from your normal period (lighter or heavier, shorter or longer). If you haven’t seen your period after a week, call us. A new trial can be started at the appropriate time. Many women find IVF or microinjection very stressful. For this reason, it is beneficial to rest for 2-4 months between treatment periods.

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