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What You Need to Know About In Vitro Fertilization (IVF)

In vitro fertilization (IVF) is a collaborative process involving prospective parents, doctors, laboratory staff, and auxiliary healthcare teams. Let’s explore the fundamental information about IVF, success rates, and the treatment process together:

What is IVF?

In vitro fertilization (IVF) is an assisted reproductive technique used to help couples diagnosed with infertility achieve pregnancy. Also known as IVF, it stands for "in vitro fertilization," meaning fertilization of the egg and sperm takes place outside the body in a laboratory setting. This process results in the formation of embryos.

These embryos are monitored for development in the laboratory before being transferred to the uterus of the woman. Approximately 12 days after embryo transfer, a pregnancy test is conducted to determine the outcome.

IVF is a collaborative process involving prospective parents, doctors, laboratory staff, and auxiliary healthcare teams. It requires teamwork from a team comprising a gynecologist (obstetrician-gynecologist), andrologist (urology specialist), embryologist, nurse, and support staff.

When is IVF Recommended?

IVF may be recommended under various circumstances:

For Women

Under 35 Years Old

If a couple, despite having unprotected and regular sexual intercourse for one year, cannot conceive naturally, IVF may be suggested.

For Women

Over 35 Years Old:

If a couple, despite having unprotected and regular sexual intercourse for six months, cannot conceive naturally, IVF may be recommended.

During this period of unsuccessful attempts at pregnancy, it is essential for couples to undergo health checks to determine their reproductive capacities.

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Smart Sperm Selection with Artificial Intelligence, Enhancing IVF Success - First Introduced in Turkey, Exclusively at Bahçeci!

Recently implemented in some of the world's renowned fertility centers, Smart Sperm Selection with Artificial Intelligence is now available in Turkey, exclusively at Bahçeci laboratories! This system, utilizing artificial intelligence to choose the sperm with the highest potential for creating a quality embryo, contributes to increased success rates in IVF. The artificial intelligence technology compares millions of sperm, recording their movements that even the human eye might overlook, and instantly marks the highest quality sperm, notifying the embryologist. The real-time and millisecond-level assessment detects the sperm with the best morphology, motility, and speed, surpassing the capabilities of the human eye, ensuring the selection of the highest quality sperm.

Pre-IVF Conception Possibility:

It is possible for couples to achieve pregnancy before starting IVF treatment. Prior to commencing treatment, a thorough analysis of the patients is conducted. The first rule for a successful IVF treatment is to accurately identify the factor preventing childbirth.

For couples experiencing difficulty conceiving naturally, various reasons may exist. It is crucial to make the correct diagnosis to decide on the appropriate treatment.

For instance, if there are uterine cystic findings such as fibroids or polyps that could prevent pregnancy, treatments targeting these issues can be applied, allowing for pregnancy without the need for IVF.

The goal is to enable couples to become parents without financial and emotional strain if their medical history permits.

Intrauterine Insemination (IUI) Treatment

If existing issues have been addressed with treatments but pregnancy hasn't occurred, intrauterine insemination (IUI) can be considered. For IUI to be applicable, it is necessary for the male partner to have sperm and the female partner to produce eggs.

In the case that IUI is deemed suitable, the prospective mother undergoes an examination with her doctor on the 3rd day of her menstrual cycle. During this examination, the condition of the ovaries is checked, and if deemed necessary, the ovaries are stimulated with hormonal medications to promote egg development. When the eggs reach the desired maturity, a trigger shot is administered. The highest-quality sperm, providing the highest probability of achieving pregnancy, are selected and transferred into the uterus with the assistance of a catheter.

Methods for Achieving Pregnancy Before Starting IVF:

Egg Tracking for the Woman

If necessary, the woman's egg development is monitored with or without the use of medications. The couple engages in intercourse on designated days based on this tracking, increasing the chances of pregnancy. If hormonal factors such as diabetes or thyroid issues are present, treatment and lifestyle changes can lead to pregnan-cy without resorting to IVF.

Medication for the Man

Medications and vitamins are used to increase the sperm count or motility in the man. Lifestyle changes may also be requested from the man. In many of our pa-tients, we have obtained pregnancy using medication treatments to reach quality sperm, without the need for a Micro-TESE procedure.

Success Rates in IVF

The success rate in treatment varies depending on age and the cause of infertility. The most crucial factor determining success is having a sufficient number and quality of eggs. In other words, the condition of the egg reserve directly influences treatment success.

The number of eggs in women decreases with age, especially starting from the mid-30s. Besides the decrease in quantity, a decline in quality becomes more pronounced after this age. Therefore, the younger the prospective mother, the higher the number and quality of eggs.

For couples wishing to have children, starting treatment without delay is important to increase the chances of success.

During this period, couples who have not achieved pregnancy should undergo health checks, and they should consult a doctor to determine their reproductive capacities.

What Can Be Done to Increase Success?

One of the most critical factors influencing success in IVF applications is the quality of the embryology laboratory and the experience of embryologists. All processes for embryo development take place in the embryology laboratory after the egg retrieval process.

A successful laboratory is equipped with the latest technological infrastructure, uses high-quality materials and equipment, and is capable of producing and selecting the highest quality embryos with minimal loss from the retrieved eggs and sperm cells.

IVF treatment is a team effort. The doctor, embryologist, genetic specialist, nurse, in short, everyone involved in the treatment, must be specialized in their field, and a harmonious working system is one of the essential factors affecting success. The doctor's experience is crucial, and creating a personalized treatment plan by evaluating the diagnosis and treatment protocols within the framework of the couple's specific conditions and needs is important.

Couples also have some responsibilities to increase the chances of success in treatment. It is recommended that couples adopt a healthy lifestyle approximately three months before starting treatment. Following certain recommendations provides significant support during the treatment process. Managing stress, maintaining a healthy diet along with regular exercise, can positively impact treatment results.

Preliminary Consultation

The first step is the preliminary consultation, where we listen to your medical history and review any previous treatment and test results you may have. This stage is, in fact, the most crucial step for planning the treatment process correctly.

There is no requirement for the preliminary consultation to be on a specific day of the menstrual cycle. This consultation can be conducted on any day.

Schedule a Preliminary Consultation

Examination and Tests

The prospective mother comes for an examination on the second or third day of her menstrual cycle. The doctor examines the prospective mother to gather information about her ovarian capacity and uterus. The Anti-Müllerian Hormone (AMH) test, indicating the state of the egg reserve, is requested. When necessary, a uterine X-ray (HSG) or hysteroscopy may be recommended.

Additionally, thyroid function tests, prolactin hormone levels, blood count, blood type, and serological tests (Hepatitis and HIV tests) may be requested.

Tests for Women Starting IVF Treatment for the First Time:

Anti HCV

Anti-HIV 1-2

HBsAg

Prolactin

Rubella IGG

Free T3

Free T4

Complete Blood Count

Anti-Müllerian Hormone (AMH)

Estradiol (E2)

Progesterone (P4)

Tests for Men Starting IVF Treatment for the First Time:

HBsAg

Anti HCV

Anti-HIV 1-2

Semen Analysis

Increasing Egg Production and Egg Development Monitoring

Based on the examination results, the doctor prescribes hormone medications to stimulate the ovaries and achieve the development of numerous eggs. The patient is informed about the use of medications. The process of using hormone medications lasts approximately 8-14 days. The purpose of administering injections is to obtain mature eggs. The dosage of hormone injections is determined based on the woman's age, weight, and, if any, previous treatments.

Follow-Up Examinations

The prospective mother administers the injections regularly and visits the doctor at intervals determined according to egg development.

Follicle development monitoring is conducted by measuring the estrogen level in the blood and observing the number and sizes of follicles in ultrasonography. We determine the dosage of injections containing FSH and HMG by evaluating these data together during the process.

As the follicles grow, estrogen levels in the blood increase. In some special cases, LH and progesterone hormones may also be measured to gain insight.

HCG/Trigger Shot

Follow-up examinations may be daily or every other day depending on the response of the ovaries. When the largest follicle reaches a size of 18-20 mm after approximately 8-10 days, the HCG shot (trigger shot) is administered, and the egg retrieval process begins about 34-36 hours later.

Egg Retrieval (OPU)

Egg retrieval, also known as oocyte pick-up (OPU), refers to the extraction of the eggs developed during the treatment to the external environment. The procedure, which lasts for about 10 minutes, is performed under anesthesia.

The patient lies in a vaginal examination position and does not feel any pain during the collection of eggs. After resting in the clinic for a maximum of 1 hour after the procedure, the patient can return home.

Sperm Collection

On the same day, the male patient provides a sperm sample through masturbation in a designated sperm collection room. Lubricants, soap, and similar substances with lethal components should not be used during masturbation. The collected sperm is transferred to the laboratory, and after necessary procedures, the fertilization process begins.

In some special cases, such as the absence of fresh sperm, previously frozen sperm stored can be thawed and used.

Embryo Formation (Fertilization)

The fertilization process is carried out through two main methods:

Classic IVF: Fertilization is achieved by placing sperm and egg cells in the same environment, allowing motile sperm to reach the egg in their natural environment.

Intracytoplasmic Sperm Injection (ICSI): A selected sperm cell is injected into the egg using micro-pipettes.

After the fertilization process, the eggs are preserved in devices called incubators, which mimic the uterine environment in the best possible way.

Embryo Development and Selection

We monitor the development of embryos on a daily basis to select the highest quality embryos with the highest chance of implantation.

Using devices known as embryoscopes, which allow 24/7 live observation of the embryos without disrupting their environment, we can make a more accurate and safer selection of embryos with the highest potential.

Embryo Transfer

The embryo transfer stage is the shortest but most critical stage in IVF treatment. Incorrectly performing the transfer of a developed embryo to the uterus, the culmination of the entire treatment, can jeopardize the success of the entire treatment.

The transfer is performed between the 2nd and 6th days after OPU (egg retrieval) based on the number and development of embryos, age, previous trial numbers, and various other parameters. The embryo, reaching a certain maturity, is placed inside the uterus with the help of special catheters.

After the transfer, it is recommended to perform a pregnancy test on the 12th day in fresh cycles and on the 15th day in frozen cycles using Beta HCG.

Therefore, in IVF treatments, the experience and success of the doctor performing the transfer are also crucial, as important as embryo quality and selection.