What is in vitro fertilization?
In vitro fertilization, which is a treatment method applied for the purpose of treatment in infertile couples, is actually a definition used in our language. In Latin, the word “In Vitro” means “inside a container”. In vitro fertilization, called “In Vitro Fertilization” in medical language, refers to the fertilization of the egg and sperm outside their natural environment, that is, outside the body. This concept is currently used as an expression that will cover both the classical method of in vitro fertilization treatments and the treatments using microinjection.
The first IVF attempts began in the 1970s, but the first successful IVF attempt was made with the birth of baby Louis Brown in 1978. The evolution of the treatment has been achieved through intensive studies to adapt it to physiological pregnancy and increase success in the process up to the present day.
One of the cornerstones that has increased the success of treatment is the development of drugs used to develop eggs and the introduction of drugs that prevent these developing eggs from cracking. With the successful application of the microinjection method, great progress has been made in male infertility. Embryo freezing methods and technological innovations in laboratory equipment help to increase the success of pregnancy and live birth every day.
Who can undergo in vitro fertilization?
IVF treatment is applied to married couples who cannot have children naturally or with other treatment methods. If there are any previous treatment methods applied to couples applying for treatment, the results are examined. The length of the couple's marriage and the woman's age can facilitate the direct transition to treatment. For example, trying treatment with methods with low pregnancy success for a 40-year-old woman who applies with a desire for a child may be a waste of time. Or, there is no other method other than performing IVF treatment with microinjection on the spouse of a man with a very low sperm count.
Is it right to proceed with in vitro fertilization without trying simpler treatments such as insemination?
In IUI treatment, the normal pregnancy formation mechanisms are valid. In other words, in women, the tubes must be open, the ovulation function must be working or it must be activated with drugs. In men, the number of motile sperm must be at a certain level. If these conditions are not present, it is inevitable to apply IVF treatment. It is not possible for a woman with blocked tubes to get pregnant with IUI. Or a man who does not have motile sperm in a sperm test has no chance of having a child with methods other than IVF. Therefore, in some cases, IVF treatment can be directly selected and applied as a first-stage method.
How is in vitro fertilization done?
IVF treatment is performed by placing sperm taken from the man into eggs obtained from the woman under appropriate laboratory conditions. The process of placing sperm into the egg is called fertilization. The fertilized egg is now called an embryo. The embryos that are formed are transferred to the mother's uterus and pregnancy is expected to occur. IVF treatment is completed with hormone support treatments.
Does the expectant mother feel any pain during the transfer process?
The process of placing embryos created in the laboratory through treatment into their natural environment, namely the uterus, is called “embryo transfer”. This process usually takes place between the third and fifth days of embryo formation. 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 bladder, must be full. For this, the patient is made to drink water before the procedure and is made to urinate. A speculum is placed in the vagina so that the cervix of the expectant mother, who is taken to the gynecological examination table, can be seen. Then, the embryos are placed into the uterus with the help of a catheter through the cervix and the procedure is completed. The vast majority of patients describe the procedure as painless. However, the feeling of urgency to urinate can be disturbing. Anesthesia is rarely needed, but the procedure is only performed under anesthesia in patients with a history of vaginismus.
How many embryos are transferred to the expectant mother?
The number of embryos transferred to the mother affects the number of possible pregnancies that can occur. In other words, if you transfer 3 embryos, triplet twins or singleton pregnancies can occur. For this reason, multiple embryo transfers were applied in the early years of in vitro fertilization treatments in order to increase pregnancy success. However, it has been seen that multiple embryo transfer increases the risk of multiple pregnancies but does not increase the live birth rate. Because multiple pregnancies are more dangerous than singleton pregnancies in terms of premature birth and miscarriage. In multiple pregnancies, the complication rates that both the baby and the mother may experience are higher. Scientific research has shown that it is possible to achieve the same success rate with a single embryo transfer as with two or three embryos.
Considering all of this, the Ministry of Health restricted the number of embryos to be transferred with the IVF regulation published in 2010. Accordingly, women under the age of 35 can transfer one embryo in the first two attempts, and two embryos in the third attempt. Women over the age of 35 can transfer two embryos in the first attempt. Thus, the number of embryos transferred has been reduced, reducing the possibility of multiple pregnancies.
When is pregnancy detected?
The period after the embryo transfer is the waiting period. During this period, medication support is applied to increase the embryo's adhesion. These medications, which contain the progesterone hormone, provide the hormonal support the embryo needs and ensure that implantation, or adhesion, occurs. This period is a total of 12 days. At the end of this period, a midwife test is performed and the result is evaluated. The level of the hormone called Beta HCG shows us the presence of pregnancy. In other words, the 12th day after the embryo transfer is the day when pregnancy can be understood. Sometimes, if the result is not at the desired level or if it is at a level that leaves room for hesitation, the blood test is requested to be repeated two days later. The aim here is to ensure that Beta HCG levels are regularly increasing.
Who cannot undergo IVF treatment?
In order for IVF treatment to be performed, eggs, sperm and a normal structured uterus are required for a healthy mother candidate. In addition to these, the couple who wants a child must be legally married. If the man has no sperm and sperm cannot be obtained by surgical means, IVF cannot be performed. Treatment cannot be performed on women who are in menopause or those who have entered early menopause and have no egg cells. It is forbidden for unmarried couples to receive treatment for legal reasons. In addition, IVF treatment is not applied to those with chronic diseases that make pregnancy dangerous for the mother candidate.
What are the chances of success of IVF?
There are many evaluation criteria that can be mentioned when evaluating the success rate of IVF treatments. The first of these is called the “clinical pregnancy rate” and it gives the rate of patients whose baby’s heartbeat is seen after the procedure. This is not very healthy data. Because some of these pregnancies end in miscarriage. The data called the “implantation rate” gives us the ratio of the number of embryos transferred to the number of babies whose heartbeats are seen. However, this data is a bit complicated for patients to understand the evaluation. Another evaluation data is the “ongoing pregnancy rate”. This data gives the rate of pregnancies that have completed their first trimester. Since it is not possible to comment on the number of babies who go home here, it is not considered valuable data. The most important data in IVF treatments is the “live birth rate”. Since it is the evaluation criterion that shows that the treatment has reached its final point, it is considered the most important statistical data. However, most IVF centers cannot follow up all the patients they have impregnated until birth. There are patients who come from out of town or from abroad, such as those whose follow-ups are done in other places. However, centers are responsible for obtaining information about the outcome of these patients.
Clinical pregnancy rates fluctuated in 2010 with the introduction of the single embryo transfer regulation, but combined with good embryo freezing methods, this rate is around 50% in good centers as it was before. The live birth rate is around 40% in good centers.
What are the risks?
In general, IVF treatment is considered to be a low-risk treatment method. However, as with every procedure and surgical method, complications may occur. These are vascular injuries that may occur during the egg collection process or complications related to anesthesia. Such complications are very rare. The biggest assumed risk in IVF treatments is “ovarian hyperstimulation syndrome - OHSS for short”, which occurs due to excessive stimulation of the ovaries. In patients who develop OHSS, the permeability of the vascular wall increases and fluid accumulates around the abdominal cavity, lung cavity and sometimes the pericardium. This condition can be life-threatening in severe cases. Therefore, ways to avoid OHSS have been investigated. With modern treatment techniques, OHSS is now very rarely seen in good clinics. Because embryo transfer is not performed in risky cases, embryos are frozen. In this way, OHSS is prevented either before it occurs or in the early stages.
How long does the treatment take?
The duration of IVF treatments varies depending on the protocol used. In the most commonly used methods today, this period lasts 17-18 days from the start of menstruation. Although there are individual variations, this period usually does not exceed 20 days. The period mentioned is the period from the injections that begin at the beginning of menstruation to the day the embryo is transferred.
How many times can IVF be repeated?
There is no such limitation. As long as couples have sperm and eggs and are not affected financially or psychologically, they can try treatment.
How long do I have to wait for the second application if the attempt is unsuccessful?
Although there is no specific time between treatments, two-month breaks are generally recommended rest periods.
Do the drugs used in treatment cause any harm?
Drugs are hormones that have been in use for a long time and are actually found in the female body. Therefore, the demonstrated and proven harms of these drugs are at a level that can be ignored.
Does a woman feel pain during the egg collection process?
Egg collection is a painful process. For this reason, it is usually done using anesthesia. The anesthesia applied is a type of anesthesia used in short-term surgical procedures, where only the anesthesia process is done and the muscles are not relaxed.
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