The stages of in vitro fertilization treatment consist of taking the egg cells produced in the woman's body out of the body and combining them with the man's sperm in the laboratory environment, and returning the resulting fertilized egg embryo into the woman's uterus (embryo transfer).
What are the Stages?
First Interview in In Vitro Fertilization
Detailed history and examination of the woman is of great importance in determining the chance of getting pregnant with in vitro fertilization. If the semen analysis is normal and there is no sexual dysfunction, there is no need to examine the man.
The woman's age, the period of wanting a child and the results of previous evaluations and treatments, menstrual cycle, medical, surgical and gynecological history (sexually transmitted disease, pelvic inflammatory disease). Disease history, treatment of abnormal PAP smear, previous abdominal surgery), thyroid diseases, breast milk discharge, hirsutism, pelvic or lower abdominal pain, menstrual pain and pain during sexual intercourse are questioned.
Pregnancy history (pregnancy, birth). , pregnancy outcomes and related complications), sexual history (frequency of intercourse, sexual dysfunctions), family history (whether there is an infertile member in the family, family history of early menopause, birth defects, genetic disorders, mental retardation), lifestyle (work, exercise, A careful and comprehensive history is taken regarding stress factors, weight changes, smoking and alcohol use.
Weight and body mass index (while increased body mass index is associated with decreased fertility, abdominal circumference obesity is associated with insulin resistance) , development of secondary sex characters, body type (while the development of secondary sex characters is insufficient in hypogonadotropic hypogonadism, short stature and mane neck are seen in Turner syndrome) are determined.
On examination, structural anomalies of the vaginal and cervix, discharges, congenital anomalies of the uterus and tubes are determined. Make an evaluation in terms of anomalies, infection and cervical factor.
On examination, the abnormal size of the uterus, the irregularity of its structure, and its lack of mobility may be significant in terms of uterine anomalies, endometriosis and adhesions in the pelvis. Sensitivity during the examination is significant in terms of chronic pelvic pain and endometriosis.
With the ultrasound performed, the capacity of the ovaries, whether there are any cysts in the ovaries, the structure of the uterus, the presence of myomas or congenital abnormalities, and the presence of myomas or polyps in the inner layer of the uterus. The presence of covering formations is evaluated. During the examination, if it has not been done recently, a PAP Smear test and if there is discharge, a culture is performed.
If the semen analysis is normal and there is no sexual dysfunction, there is no need for the man to be examined.
History taking, examination, ultrasound. After the tests are evaluated, the stages of the in vitro fertilization process are explained in detail and the most accurate information is given about the couple's chances of achieving pregnancy with treatment. Information about the potential side effects and long-term risks of the application (for mother and baby, multiple pregnancy) is also shared and their consent is obtained.
Investigations in In Vitro Fertilization
Laboratory studies to be performed before in vitro fertilization treatment. tests are completed (such as Hormones, Hepatitis B and C screening, HIV, Rubella IgG, blood count, blood group determination)
Preparation for In Vitro Fertilization
- Such as smoking, alcohol It is necessary to get away from all toxic substances as soon as possible.
- A multivitamin containing folic acid is started.
- Care should be taken to lead a regular and stress-free life before and during in vitro fertilization treatment. >
- You should have a healthy, versatile and balanced diet. A diet rich in proteins may be beneficial.
- Losing weight in obese patients increases the chance of pregnancy and helps a healthier and more trouble-free pregnancy.
Stimulation of the Ovaries in In Vitro Fertilization
The common purpose of ovulation treatments is to hormonally stimulate the ovaries to produce more than one egg. The type and dose of medication may vary depending on the patient and the treatment protocol applied.
Results of ultrasound examination and blood hormone tests on the second or third day of menstrual bleeding. The dose of medication to be used is decided according to the After stimulation therapy begins, the patient is called for control at regular intervals. During these checks, vaginal ultrasonography is performed to check the number and size of developing follicles (small fluid-filled cystic structures containing eggs).
Another factor evaluated during ultrasound follow-ups is the structure and thickness of the layer called endometrium that lines the inside of the uterus. Its structure is extremely important as it will settle in the endometrium when pregnancy occurs.
The aim of the treatment is to obtain as many 16-20 mm diameter follicles as possible. Although the duration of treatment varies, the average is 10-17 days. If it is determined by ultrasound and blood tests that the follicles have reached a sufficient size, human chorionic gonadotropin (hCG) injection is made to ensure final maturation.
Suppression of Hormones in In Vitro Fertilization
The target in in vitro fertilization treatments is to obtain a sufficient number of follicles. is to obtain an egg cell capable of fertilization. In order to achieve this goal and gain control, the untimely and irregular effects of the hormones produced by the body must be eliminated. For this purpose, hormone suppressing drugs are used. These injections are started when the eggs reach a certain size during follow-up.
Egg Collection (Opu) in In Vitro Fertilization Treatment
In order for the eggs to be collected, it must first be decided that they are mature. The eggs are collected approximately 35-36 hours after the injection of mature eggs (hCG). For this procedure, the woman and the man go to the in vitro fertilization center together. Since egg retrieval is performed under mild anesthesia, the expectant mother must be hungry and should not consume food or liquid for the last 6 hours.
OPU is performed very easily and comfortably with vaginal ultrasonography. The patient lies in the gynecological examination position and after being covered with sterile sheets and cleaning the vagina, vaginal ultrasonography begins.
Egg retrieval is the process of emptying the fluid-filled structures called follicles, which contain eggs, by entering the ovary with a needle under the guidance of vaginal ultrasound. The collected liquid is immediately given to the laboratory and examined under a microscope to see if it contains eggs. If there are egg cells, they are removed. If no egg can be obtained from the follicle, a special liquid is given through the same needle to wash the follicle cavity and an attempt is made to remove any egg that may be left inside.
In this way, the process continues until all follicles are aspirated. It takes approximately 20-30 minutes to aspirate both eggs. The egg contained in the follicle fluid, which is examined with a special microscope, is placed in the culture fluid and placed in the incubator. After the egg collection process, the patient can be taken to the rest room and go home after resting for 1-2 hours.
Fertilization in In Vitro Fertilization (Icsi-Microinjection)
A few hours after the eggs are collected, the cells around them are cleaned and matured. It is evaluated that they are not. The fertilization process is applied to mature eggs.
While the eggs are collected from the woman, the man also gives sperm. The most ideal method for collecting sperm is masturbation. In people who do not have live sperm in their semen, sperm is removed surgically. The resulting semen is placed in a special container and allowed to liquefy. The liquefied semen is examined in terms of sperm count, motility and shape.
Fertilized eggs are placed back into the culture medium and expected to reach advanced stages. When the appropriate stage is reached, a certain number of high-quality embryos are taken and transferred into the woman's uterus.
Approximately 2-4 hours after the eggs are collected, a single sperm is injected into each egg with the help of a special device called a micromanipulator (microinjection (ICSI). ) method).
On average, around 70% of the collected eggs are mature and suitable for fertilization. Approximately 70% of these will be fertilized. For example, a woman with 10 eggs will develop an average of 5 embryos. This is an average and the number may be above or below it.
Preimplantation Genetic Diagnosis (Pgd) in IVF Treatment
Preimplantation genetic diagnosis for a known disease (such as cystic fibrosis) during in vitro fertilization treatment. It is the genetic examination of a cell taken from the embryo. In preimplantation genetic screening, a specific disease is not investigated; All chromosomes are scanned for a possible genetic problem as much as possible.
The purpose of these procedures is to identify the problematic embryo in advance. By providing , the aim is to both reduce the possibility of miscarriage and increase the chance of success of in vitro fertilization. These procedures require special laboratory conditions and experienced personnel.
To whom it is performed
-
Patients whose maternal age is 38 and over
-
Patients with recurrent pregnancy loss,
-
Patients with recurrent in vitro fertilization failures (3 or more)
-
More Patients with previous genetic problems or a history of carrying a baby with Down syndrome
-
Patients with a genetic problem in their own genetic screening (karyotype)
-
Patients with single gene disorders (autosomal dominant, X-linked diseases or autosomal recessive diseases)
- Patients requiring HLA typing
Embryo Transfer in IVF Treatment
Embryos can be transferred any day between Days 2 and 5, from the two-cell stage to the blastocyst stage. According to the regulations of the Ministry of Health, one embryo should be transferred in patients younger than 35 years of age and in the first two treatment attempts.
During the embryo transfer, the patient is placed on the table in the gynecological position. After the speculum is inserted into the vagina, it is cleaned with sterile physiological saline. Then, the cervix is cleaned with special culture fluids. The embryologist brings the embryos to be transferred from the laboratory in a catheter. The physician performing the procedure deposits the embryos into the uterus under the guidance of abdominal ultrasound.
Embryo transfer is a painless procedure and does not require anesthesia. After the procedure, the patient is given progesterone hormone in the form of injection, suppository or cream to support the endometrium. This treatment, called luteal phase support, continues until the 10th week of pregnancy if pregnancy occurs.
Pregnancy Test in IVF Treatment
A blood pregnancy test is performed on the 12th day after embryo transfer.
p>Read: 0
