When it is decided to undergo in vitro fertilization treatment, first the patient's ultrasound evaluation and ovaries and uterus examination are performed. In this examination, it is decided which drug protocol will be applied to the patient. In patients with cysts in their ovaries, a detailed evaluation of the cyst should be made before in vitro fertilization treatment begins. Because in cysts that develop due to ovulation disorders, in vitro fertilization medications may cause the cyst sizes to grow further.
Patients who are evaluated with ultrasound and are suitable for ovulation medications should consult the physician again when they menstruate. Drug treatment should be started when menstruation occurs. In vitro fertilization treatment consists of five main stages:
First stage: Egg Development (ovulation induction)
Different stimulating hormone drugs can be used for the development of women's eggs. These are drugs mostly applied through the skin of the abdomen. The development of eggs is ensured within 10-14 days with stimulant medications that are started when the patient menstruates. If ovaries need to be suppressed before menstruation, the duration of drug use may be extended. It is possible to obtain 5-10 eggs from women who normally produce one egg per month, with these ovulation enhancing drugs.
While the eggs are developing, patients should be evaluated with ultrasound and blood tests at regular intervals. In these examinations, the development of the eggs is ensured in a controlled manner and the timing of additional medications is decided to prevent premature cracking. When the eggs reach a certain size, the maturation of the eggs is ensured with drugs popularly called "cracking needles".
Second stage: Egg Collection (oocyte pick up)
Once the eggs reach a certain size. It should be collected approximately 36 hours after the "cracking injection" applied. All eggs are collected with the method called “OPU (oocyte pick-up)”. Egg retrieval is performed with the help of a special cannula added to the vaginal ultrasound probe. When the ultrasound probe is applied to the vagina, the eggs are entered one by one with a cannula advanced through a special tunnel and their contents are aspirated. The procedure time varies between 15-20 minutes on average.
Egg collection process It can be performed under general or local anesthesia, depending on the patient. In local anesthesia, the feeling of pain is reduced by injections applied to the cervix. Patients who will undergo general anesthesia must stop oral feeding six hours before the procedure.
The collected eggs are given to the embryology laboratory in the operating room. Embryologists examine the collected eggs under a microscope and preserve them in special liquids.
Egg collection is a low-risk surgery. Patients may experience a small amount of pain and bleeding after the procedure. While the pain can usually be completely stopped with painkillers, the bleeding disappears completely in a few days.
Third stage: In Vitro Fertilization and Microinjection
Laboratory procedures to be applied to the collected eggs include the age of the expectant mother, the number and quality of eggs, The decision is made by evaluating the sperm status (number, movement and shape), whether there has been an in vitro fertilization attempt before, and whether genetic screening will be performed. In the classical in vitro fertilization method, prepared eggs and washed sperm are compared in special media. This process is done by calculating the number of sperm per egg, and in this process, the sperm itself carries out the job of fertilizing the egg. After a total of 18-20 hours, it is checked whether fertilization has occurred.
When sperm parameters are below normal limits, the fertilization ability of the sperm will be very low. In such cases, the "microinjection" technique should be preferred. However, today, the classical in vitro fertilization method has been completely replaced by the microinjection technique, with the idea that the chance of pregnancy is higher.
In the microinjection technique, the collected eggs are first subjected to mechanical and enzymatic processes and cleaned from neighboring cells around them. Then, the eggs are observed to move into the metaphase-II stage, which is suitable for fertilization. Sperm is injected into mature eggs that have reached this stage, under the guidance of a special microscope, which we call a micromanipulator. When the microinjection is completed, the eggs are transferred to a new medium and stored. Fertilization control should be done after approximately 18-20 hours. In embryos where fertilization takes place, cells begin to divide and multiply. The transfer day is determined according to the durability of the embryos.
Four Third stage: Embryo Transfer
In embryos where fertilization is checked, embryologists evaluate the embryo quality by looking at some parameters. Embryo transfer can be done on any day from the second day to the fifth day.
During the embryo transfer process, the patient is placed in the examination position. Vaginal and cervical secretions are cleaned with sterile culture fluids that nourish the embryos. Then, using special soft catheters, the embryos are placed in the mother's uterus under ultrasound guidance. This procedure is very short and painless. After a short-term bed rest, the expectant mother is informed about the medications she will use and the patient is discharged.
Fifth stage: Pregnancy test
After the embryo transfer, the expectant mother can return to her normal life. Studies have shown that it is useless to constantly monitor the patient on bed rest after transfer. For this reason, the expectant mother can return to her normal social life without straining herself.
After the embryo transfer, some hormone medications are given to increase the chance of pregnancy. It is very important that the patient takes these medications regularly. Approximately 12-14 days after the transfer, the expectant mother should have a blood pregnancy (B-HCG) test. The most difficult part of the entire treatment is the waiting period after embryo transfer. It is not recommended to be impatient and have the test done early as it may be confusing.
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