Infertility, defined as the inability to conceive despite unprotected intercourse, is both a medical and social problem. Diagnosis of infertility resulting from problems related to women or men is often possible with today's technology. Liv Hospital IVF unit understands the concerns of couples with a patient-centered approach in the solution process of this problem and directs them to the necessary treatment method. The high level of technological infrastructure of our hospital makes the job of experienced doctors working in the IVF laboratory easier and increases thepregnancy success of infertile couples. Liv Hospital IVF unit aims to provide the highest level of service to infertile couples in the light of scientific developments with its highly equipped embryology and genetics laboratory and experienced physician staff.
I tried to give information about the stages of IVF in the video below.
Preliminary Interview Stage
The first stage of IVF treatment begins with a preliminary interview. When the infertile couple comes for the first interview, the history of both the woman and the man is listened to and recorded. Previously performed tests, hysterosalpingography, and surgical epicrisis are evaluated. In light of these, the treatment protocol to be applied to the couple is decided as a result of gynecological and urological examinations. After the woman's examination, it is evaluated whether there is a need for an operation before the treatment. Sometimes, an operation called Hysteroscopy is needed due to congenital anatomical problems of the uterus or myomas, polyps, and synechiae (adherence). Sometimes, a Laparoscopy operation is required due to infection and fluid accumulation in the tubes (Hydrosalpnex) or myomas growing outside the uterus.
The woman's age, egg reserve, previous surgeries, presence of endometriosis, hormone levels and previous treatment protocols will be effective in deciding on the protocol to be applied.
Egg Development Period (Ovulation Induction)
IVF treatment begins on the second or third day of the menstrual period. During this period, the patient who comes to our clinic undergoes a gynecological examination and the egg reserve is re-evaluated. The presence of a functional cyst in the ovary or a mass occupying space in the uterus is checked. If there is no negative situation, it is decided to start the treatment. In order to develop eggs, drugs called Follicle Developing Hormone (FSH) are started to be administered in the form of an injection. The dose of the drug to be administered is calculated according to the woman's body mass index (BMI), egg reserve, age and the doses applied in previous treatments, if any. The injections to be administered are small needles called insulin syringes and are taught how to do them by the IVF nurse. They are usually applied around the navel or on the arm.
The patient who has started the injections is called for a check-up 3-4 days later to assess the development of the eggs. The patient is followed up several more times over a period of 5-8 days by administering the medications applied. The end of the injection treatment is reached when at least three of the eggs reach 17 mm. The last injection (cracking injection) is administered at a certain time for the eggs to mature. This time is very important because the egg collection process is performed 35-36 hours after the injection is administered. If the injection is administered at the wrong time, the eggs may crack or be collected before maturation. Therefore, it is vital for the treatment that the injection is administered at the time you are told.
The egg development period ends with this last injection. This period, which is usually completed within 10-12 days from the beginning of the period, is an important period for producing quality eggs. Do not use medication or have an X-ray taken without your doctor's knowledge during this period. Stay away from alcohol and cigarettes. Stress can make treatment physiologically and psychologically difficult. Stay away from factors that will stress you. If you have difficulty coping with this, get help from your clinical psychologist.
Egg Collection Procedure
The third stage of the IVF stage is the collection of eggs. The collection of eggs matured with a maturation needle is called “Oocyte Pick Up” or OPU. This procedure is performed under general anesthesia and takes approximately 15 minutes. After the procedure, the patient is sent home after resting for two hours in the hospital.
The procedure is performed with transvaginal ultrasound guidance. The ovaries are reached with the help of a long needle attached to the vaginal ultrasound probe. All eggs are entered one by one and the fluid inside is removed. The collected egg fluid is immediately examined by the embryologist under a microscope and the egg cell is separated from this fluid. The collected eggs are placed in special cabinets called incubators and kept for a certain period of time. While the OPU procedure is performed on the woman, a sperm sample is taken from the man by masturbation. If the man is azoospermic, i.e. has no sperm, sperm is searched for with an operation called MICRO TESE. If sperm is found, the woman is given an egg collection procedure. If sperm is not found in the Micro TESE operation, egg collection procedure will be meaningless.
Microinjection (ICSI) Procedure
This process is the placement of sperm into the egg under a special microscope using a needle as thin as a hair. If the eggs collected with the OPU process are at the maturity level called M2, they turn into an embryo after microinjection . In other words, the fertilized egg is called an embryo. The microscope used can have different configurations to facilitate sperm selection and to select higher quality sperm. The quality of the selected sperm can be better understood by zooming in with the method called IMSI.
If the eggs used in the microinjection process are of high quality and mature, fertilization occurs at an average rate of 80%. A check is made 17 hours after the microinjection process to understand whether fertilization has occurred. In this check, the appearance of a structure called 2PN indicates fertilization. Fertilized embryos are monitored in a special system called an incubator, where many variables such as carbon dioxide, oxygen, nitrogen, temperature and humidity are constantly controlled. In embryo development, the number of cells after division and the equality of cells are evaluated. The shape of the embryo, which is clean and has no particles, indicates the highest quality embryo. The transfer day is decided between the second and fifth days of embryo development according to the number of embryos obtained.
Embryo Transfer
The process of placing embryos created in the laboratory through treatment into their natural environment, namely the uterus, is called “embryo transfer”. If the number of developing embryos is low, the third day transfer is usually performed, while if the number of existing embryos is sufficient, the fifth day transfer is preferred to detect embryos that have reached the fifth day. Embryos on the fifth day are called blastocysts and have a higher pregnancy potential. The procedure is performed with abdominal ultrasound. In order for the uterus to be visible on the ultrasound screen and to be traced in a straight line, the bladder, or the urinary bladder, must be full. For this, the patient is made to drink water before the procedure and urination is ensured.
The mother-to-be is placed on a gynecological examination table and a speculum is placed in the vagina to see her cervix. Then, the embryos are transferred into the uterus with the help of a catheter through the cervix and the procedure is completed. The embryo transfer procedure is generally considered a painless procedure. The vast majority of patients describe the procedure as painless. However, the feeling of urgency to urinate is uncomfortable and only occurs under anesthesia.
Luteal Phase (Contraceptive Support Treatment Period)
During this period, drugs are given to help the transferred embryos adhere. The most important of these drugs are those containing the hormone progesterone. Progesterone hormone is usually applied as a vaginal gel. In addition to progesterone, estrogen hormone, aspirin-derived drugs and in some special cases, blood thinner injections can be used. This process lasts 12 days. At the end of the process, a pregnancy test is performed on the blood to determine the result.
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