Almost every married couple's dream is to have another member of their family and have a baby. Couples who cannot have a baby naturally resort to in vitro fertilization treatment. With the progress and developments in this application process (treatment stages, medication use), the success rate in in vitro fertilization treatment is increasing day by day. However, despite all these developments in the treatment process, a 100% success rate has not yet been achieved. This situation also explains why some couples who cannot have a baby naturally cannot get results with in vitro fertilization. In such couples, in order to achieve a successful result, medication and some methods are applied in addition to the treatment.
Some of the treatments used;
● Some drugs that reduce blood clotting (aspirin, heparin, etc.)
● Embryo glue
● Magnetic sperm selector
● Co-Culture (artificial womb)
● Viagra
● Antioxidant use
● Timing of supportive therapy after embryo transfer
● Lymphocyte vaccine
● DHEA (Parent hormone produced by a gland near the kidney.)
As a result of long-term studies, it has been understood that one of the most important reasons for failure in IVF treatment is "anti-phospholipid syndrome". This syndrome is a situation where microscopic residues are formed as a result of the increased clotting property of the blood in the capillaries and the blood flow to the growing fetus is slowed down, leading to the death of the fetus, and therefore, this situation prevents pregnancy. Since drugs such as aspirin and heparin keep the blood clotting at the required level, they have also started to be used in IVF treatment. However, while there are studies showing that the drugs work, there have also been unsuccessful studies. The use of low-dose drugs in treatment does not have positive effects on live birth.
Embryo Glue
Embryo Glue is a culture medium created during embryo transfer. It contains a substance called Hyaluronan. It is thought that this substance increases the possibility of the embryo settling in the uterine wall. However, it is not known exactly how Hyaluronan affects the intrauterine tissue and the embryo, but since it plays an active role in the adhesion of cells to each other, its use during embryo transfer has been deemed appropriate. Although it is widely used in treatment, there is not enough scientific evidence to show that it increases pregnancy. The common opinion of all experts is that the only condition for increasing the embryo settling rate is to obtain quality embryos . However, it has been observed that embryo glue allows the embryo to settling in the uterine wall despite the low embryo quality in women over the age of 35.
Antioxidant use
Embryo development occurs slower than normal in laboratory conditions. Although no definitive case has been determined as a result of the research, it is assumed that the cause of this situation may be oxidative stress sources. These sources are high oxygen pressure, light and substances used in the culture medium. Therefore, it was thought that the problem would be solved by using antioxidants. Although no definitive conclusion has been reached at the end of many studies, this method is applied in most in vitro fertilization centers.
Viagra
One of the most important factors in treatment is the endometrium. The thickening of the tissue depends on the blood flow to the uterus. If the embryo is created in the laboratory and placed in the uterus and does not attach to the uterine wall, pregnancy will not occur. Viagra comes into play when the intrauterine channels are insufficient and prolongs the effect time of nitric oxide on the dilation of the veins. Therefore, it is thought that Viagra may increase the possibility of pregnancy if the intrauterine thickening is not sufficient. On the other hand, it is also known that the most important reason for preventing intrauterine thickening is intrauterine adhesions that occur due to interventions performed in the uterus or other reasons. Therefore, it should be made sure that there is no adhesion in the uterus before using Viagra.
Magnetic sperm selector (Sperm magnet)
The biggest factors that cause infertility in men are not having enough sperm in number, the sperms that do exist not moving fast enough and morphological disorders. In recent important studies, it has been proven that there are reasons that cannot be found when sperms are examined normally. It has been found that the probability of pregnancy decreases for these reasons. It has been stated that the rate of apoptosis (programmed death of the cell) has increased in the sperms that have been studied. The biggest factors that cause cell death are: radiation, chemicals and similar situations.
Co-culture (Artificial womb)
Another technique used in in vitro fertilization is the use of “feeder cells” (different cell types from different animal species) in order for the human embryo to grow and develop in a culture medium. Theoretically, these nutrient layers support the culture medium by adding nutrient cells. Although nothing can be said for these components, they may have an important effect on embryo development. These nutrient cells used are not allowed to increase at their normal rate because such a situation would cause the cells to consume the nutrients of the environment they are in or to acidify the environment. In this case, when the appropriate number of cells is reached, their reproduction is controlled with certain techniques.
The types of cells used vary from laboratory to laboratory. Different tissue cells from different types of animals are used with great success in the field of artificial wombs. In addition to using cells from different types, some IVF centers have resorted to using cells that belong only to one of the biological parents of the embryo because they think that other cells may transmit poison or viruses to the environment.
In addition to the view that success is achieved by using feeder cells, there is also information that contradicts this. Although some publications have reported that embryo quality increases this way, there is also information indicating that it does not show any increase in pregnancy rates. For this reason, although the technique has been known for many years, it is applied by a small number of centers. In our country, the artificial womb technique, which is used more for commercial purposes, is shown as a miraculous source of hope for couples who have previously failed.
Lymphocyte vaccine
In this method, lymphocyte cells separated from the blood of the father, the biological parent of the embryo, are placed under the skin of the mother. It is a method that has been tried in unsuccessful couples, but its effectiveness has not been proven.
DHEA (Dehydroepiandrosterone)
DHEA is known as a hormone secreted from the adrenal gland. This hormone is converted into testosterone and estrogen in the body. Although its effect on the ovaries is not fully known, there are studies indicating that the method increases the success rate of IVF treatment in expectant mothers with weak ovarian response. However, we still do not have enough studies to express an opinion in this area.
Timing of supportive care after embryo transfer
In IVF treatments, due to the damage caused to the ovaries by the removal of eggs from the body or the disruption of the connection between the brain and the ovary by the medications that need to be used, the progesterone hormone (a sex and steroid hormone secreted from the anterior pituitary gland in women, which plays an important role in the menstrual cycle, pregnancy and embryogenesis in humans and other animals) necessary for pregnancy cannot be secreted sufficiently and therefore this hormone is given by other means (injection, vaginal or oral). There is no common opinion on the start and end time of the treatment, the purpose of the treatment, how long the treatment will continue or the dose of the hormone to be given. However, many IVF treatment centers continue progesterone treatment until the formation of the placenta, i.e. until the 12th week.
Studies have shown that the most effective and safe method for administering hormones to the body is through injection treatments. However, due to the difficulty of injectable treatments, many IVF treatment centers prefer vaginal applications.
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