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Treatment of infertility & in vitro-fertilization methods

Treatment of infertility & in vitro-fertilization methods

If a couple can not achieve conception in one-year period despite no use of any birth control method and sexual intercourse at regular intervals (twice to four times a week), infertility is considered for the couple. Today, infertility that may be caused one or both of the partners affects 20% of women at reproductive age. While the cause of infertility can be detected for some couples, the reason remains unexplained in 10% of cases. If the under lying cause can not be detected, the couple falls into group of idiopathic in fertility.

Causes of Infertility

  • Obstruction of Fallopian tubes due to past history of infection, congenital deformities in uterus, myomas, and disorders in sperm-producing canals of male subject

  • Ovulatory disorders such as polycystic ovary, chocolate cysts, and disorders like endometriosis

  • Poorly regulated metabolic diseases such as goiter and diabetes

  • Decrease in sperm count, deformed sperm, poorly motile sperms and total absence of sperm in semen

  • Genetic disorders

  • Improper sexual intercourse due to certain reasons, such as premature ejaculation, erectile dysfunction and vaginismus

Treatment of Infertility

Irrespective of the method actually used to manage infertility, the chance of pregnancy is 25-60% in average even for couples with no fertility disorder. Success of the treatment depends on the actual reproductive problem of the patient and the treatment method. For the treatment of infertility, success rate of invitro-fertilization ranges from 50% to 60% in women younger than 35. Under lying factor of the infertility is taken into consideration, when the treatment modality is selected for the couple.

Methods used for Treatment of Infertility

  • Ovulation induction

  • Insemination

  • Treatment of under lying causes of infertility

  • Invitro-fertilization methods and micro-injection


Age of the individual, ovarian capacity, body mass index, genetic variations and ovarian response to previous treatments as well as history of problems in embryological development are taken into consideration  InVitro-Fertilization therapy methods that consists of 5 steps:

1. Stage (Pre-Interview): IVF treatment is a 5-step process. These steps are completed in 4 weeks. In the initial discussion with the couples who want to achieve pregnancy, candidate mother and father are informed about causes of infertility and tests that are done to establish the diagnosis. Previous spermiograms, reports of X-ray examination of uterus and Fallopian tubes (hysterosalpingography – X-ray examination of uterus and Fallopian tubes- should be scanned, if not already available), and tests and reports of previous infertility treatments are reviewed and all necessary blood tests are made. Thusly, patient's history is obtained. If the candidate mother did not have a smear test within the previous year, the test is made. In the light of allexisting data, cause of infertility is detected and relevant treatment is started.

2. Stage (Induction of Ovaries): At the second stage of IVF, the candidate mother visits the doctor on second or third day of the menstrual cycle in order to have ovariese valuated. The doctor examines ovaries of the candidate mother with ultrasound and hormone analyses can be considered, if a relevant pathology is identified. Physician reviews all results and prescribes a medicine to induce ovaries and grow eggs and the patient is informed by the nurse about how the medication is taken. 

3.Stage (Egg Collection or Retrieval): Egg retrieval is one of the most important stages in the inVitro-fertilization process. After eggs are grown to the target size and maturation with hormone medications, they are retrieved from uterus using a specialized syringe under general anesthesia. Eggs are retrieved from uterine cavity through vaginal route and fertilized with classic IVF or micro injection methods. Inclassic IVF, a certain number of sperms are added  where the eggs are present, and it is expected that egg is fertilized by one of these sperms. In micro injection method, the healthiest sperm with best quality is selected and injected into an egg with a specialized method.

4.Stage (Embryo Transfer): Eggs and sperms that are collected for fertilization and embryo transfer are checked in the laboratory and embryo development is supervised. Embryos with highest quality are selected by the embryologist. The governing law allows transfer of one embryo for women younger than 35 and two embryos for women older than 35. Embryo(s) that meet quality criteria are implanted in the uterus by a physician with a special catheter that is inserted into uterine cervix. Although no anesthesia is administered, no pain or ache is felt during embryo transfer and the mother candidate is allowed to rest for 45 minutes to 1 hour after the procedure. She can engage in routine activities of daily life after it .

5. Stage (Supportive Treatment): Supportive medications are prescribed for the candidate mother in order to help the embryo implant better in the uterus following embryo transfer. Beta HCG level is analyzed 12 to 15 days later.

The most crucial factor influencing women's fertility is their age. As women get older, their chances of getting pregnant drop. There are almost no chances of conception in women over the age of 44. Past history of sexually transmitted illnesses, as well as infections of the ovaries and Fallopian tubes, all have a negative impact on the chances of conception.

All women who have an active sex life should have a gynecological exam once a year. In these exams, a PAPP-A test, often known as a smear test, should be performed to screen for cervical cancer.

If uterine leiomyomas compress the endometrium, where the fetus grows, the chances of conception may be reduced. Leiomyomas that are not present in the uterine wall, on the other hand, do not pose a concern for pregnancy unless they expand and block the Fallopian tubes, which prevent the conception.

If conception fails in women who are younger than 35 and have no disease that hinders conception, examinations and treatment should be started. Regular attempts should be maintained for 6 months, for women who are older than 35 and have any problem that hinders the conception. Treatment should be started, if pregnancy fails at the end of this period.

Up to the age of 45, in vitro fertilization is an option, although women over 40 should be aware that their chances of conception decline.

The sperm is placed in the medium and anticipated to fertilize the egg in conventional in vitro fertilization. The best sperms with the highest quality are selected from all sperms and injected into the egg using the microinjection procedure.

In vitro fertilization refers to the creation of an embryo by fertilizing an egg with a sperm after the mother's eggs have been met with the father's sperm in the same medium.

In microinjection, the sperms are carefully selected and injected into an egg using a special device called a micromanipulator.

İt are used for women who cannot get pregnant with conventional treatment methods.

In the first phase, drugs are used to induce ovulation. The next step involves picking up eggs with a small size under anesthesia. In the third phase, The embryo then forms when the spermfertilizes it, and the last phase is the embryo transfer.The embryos are transferred into the womb.

Microinjection can be considered for in vitro fertilization therapy. İt can be performed if the sperm count is less than expected. Sperm can be surgically extracted from the testicles if it is not found in the semen.

A needle is then inserted into the ovaries using the guidance of a vaginal ultrasound and a fluid-filled structure, called follicle The fluid that collects in the ovaries is drained and the egg is found within the tube cells that can be seen only under microscope This procedure is not painful and can be performed under mild or even general anesthesia. to make patients feel comfortable.

Picking up oocytes is a simple procedure. There is no discomfort or ache. After the surgery, the patient can be discharged to their home and continue thier daily life activities.

The ovarian reserve is unaffected by in vitro fertilization medicines or techniques.

Fertilization is not possible with all mature eggs. The quality of the eggs has a significant impact on fertilization. After fertilization, some eggs may not grow into viable embryos. 

The transfer of an embryo into the womb is a simple and quick operation. . A physician inserts a thin, plastic catheter into the cervical os. This catheter is used to transfer the embryo into the womb. 

Medicines used to promote ovulation may produce greater embryo development than is necessary. Embryos of good quality that aren't transplanted can be frozen and stored.

Embryos are chosen based on the age of the mother, the quality of the embryos, the number of attempts, and the quantity of embryos to be froze. The restriction for embryo transfer is one embryo for women under the age of 35 and two embryos for women above the age of 35, according to a regulation issued on March 6, 2010.

After the embryo is transferred, future mothers should rest  for 45 minutes. The patient does not need to rest once she is allowed to leave the hospital after the time period recommended.

Following the transfer, future moms may resume all normal activities with the exception of sports activities such as hard exercises, jogging, and sexual intercourse.

Sexual activity is not advised for future mothers, particularly after the stage of transfer This practice, however, has not been scientifically proven yet.

In vitro fertilization uses medications to induce ovulation. Here, the major problem faced in administration of these medications that do not increase risk of cancer is intraabdominal effusion, also called hyper-stimulation syndrome.

Ectopic pregnancy occurs in 1-3 % of in vitro fertilization cases. Heteropic pregnancy, which includes both intrauterine and extrauterine pregnancy, is estimated to be around  0.5 %of all pregnancies.

The success rate of frozen embryo pregnancies is determined by the laboratory's quality at the in vitro fertilization center. In our clinic, 45 to 50 percent of frozen embryos result in pregnancy.

There is no distinction.

Both future mothers and fathers should have a detailed genetic test if in vitro fertilization therapy does not result in pregnancy. If there is an issue that prevents pregnancy, treatment should be started right away. In the majority of cases, however, no substantial cause is discovered.

From the initial day of medicated treatment until the pregnancy test, it takes about 30 days.

When it comes to the chance of miscarriage, there is no difference between an IVF pregnancy and a regular pregnancy.

Three IVF attempts are usually indicated. Attempts for pregnancy can be successful, but the chances are extremely low.

In IVF, the spouses' own sperm and eggs are used. In our country, sperm or egg donation is prohibited.

IVF can identify the gender of the baby, but it is both ethically and legally illegal in our country.

Genetic testing on embryos is performed if there is a recurrent miscarriage or a genetic disorder, and actions can be taken to prevent genetic problems.

Embryos of future mothers and fathers with single-gene illnesses such Mediterranean anemia and sickle cell anemia genetic testing may be recommanded. Following pregnancy, amniocentesis or chorionic villus biopsy can be used to diagnose genetic disorders.

The age of the future mother and the quality of the embryo are critical factors in IVF success. Although IVF is successful in 55-60% of women under the age of 30, the percentage drops to 15-20% in women over the age of 40.

The age of the future mother, the quality of the transferred embryo, and the health of the uterus all have an impact on the success o

Obstruction of Fallopian tubes and intrauterine problems, such as myoma and polyp, hinders implantation of the embryo into the endometrium (the innermost lining of the womb).

The most important risk of IVF include multiple pregnancies and edema caused by ovaries that have been overstimulated.

Hospitalization is not needed at any stage of in vitro fertilization.

There are no distinctions between babies born through natural means and those born through IVF. Only fertilizations with medically removed sperms may raise the risk of some abnormalities.

From drug doses used in IVF through embryo freezing (cryopreservation) techniques, the IVF center plays an important role at each stage.

Considerations while choosing an IVF center:


  • Operation history of in vitro fertilization center, number of cases and experience of IVF specialist and embryologist working in the center,
  • Pregnancy rates and rate of leaving the center with a living baby after the procedures,
  • Presence and quality of embryo freezing laboratory, ratio of living embryos after thawing procedure,
  • Truly and honestly informing applicants

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