In cases where the woman's age is less than 40, if clinical pregnancy cannot be achieved despite giving at least 4 good quality embryos in at least 3 in vitro fertilization applications, we call this situation recurrent implantation failure. In this case, action is taken according to the embryos obtained. The methods are different if a good quality embryo has been obtained or not.
If a good quality embryo has been obtained but pregnancy has not occurred:
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Office Hysteroscopy: It is important to carefully examine the inside of the uterus. There may be conditions that may be overlooked, such as polyps or myomas, that may prevent adherence.
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Opening or Removing Diseased Tubes by Laparoscopy Method: If there is adhesion, obstruction in the tubes or obstruction at the mouth of the tubes, If fluid accumulation (hydrosalpinx) occurs; It is known that when an embryo is placed in the uterus, it becomes difficult for the embryos to attach to the uterine wall due to this obstruction, adhesion or hydrosalpinx. The negative effects of the current situation on the embryo can be prevented by opening and removing the tubes of these patients using the laparoscopic (closed) method or by closing the area where the tubes exit the uterus.
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Mother-Father Genetic examination: Couples' chromosomes Their structures are examined.
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Thrombophilia, that is, genetic conditions that tend to blood clotting: Conditions that are prone to blood clotting are detected and necessary precautions are taken.
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Examination of Sperm DNA Damage: This subject, which has become very current in recent years, is based on measuring the damage rate in the DNA of sperm cells and treating the results according to the results. If the DNA damage rate in sperm cells is over 35%, the ejaculate, that is, the sperm obtained through normal ejaculation, is not used and sperm is withdrawn from the testicles with a special method and those sperm are used (TESA method).
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PGD (Preimplantation Genetic Diagnosis) (Genetic Examination of Embryos): One blastomere, that is, the round cell, of the 8-cell 3rd day embryo is taken out with a special pipette and sent for genetic analysis. As a result, information is obtained whether that embryo is genetically normal or defective. Preimplantation genetic diagnosis method is also successfully applied in our center. Especially in women over the age of 38 who have formed more than three embryos, when embryo transfers are made after genetic diagnosis, pregnancy rates similar to the younger age group are achieved. It is beneficial for couples who have had more than two unsuccessful in vitro fertilization attempts. In addition, since genetically problematic embryos may occur as a result of fertilization in men with impaired sperm count, it may be recommended to be used in the selection of healthy embryos.
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CGH-ARRAY: 13., 18., 21 with the PGT method. ., X and Y chromosome structures are examined. However, the structure of 22 chromosomes and sex chromosomes is examined with the CGH method.
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I.M.S.I (Selected Sperm Microinjection with Microscopic Magnification): Under approximately 3000 times magnification. It is the logic of better fertilization by selecting the most correct and ideal sperm in terms of morphology, that is, appearance. It is applied.
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HLA-G5: Detecting the HLA G5 protein produced by embryos with the highest retention ability and using it in embryo selection will increase the pregnancy rate. This method is also used in our clinic. It is a method used especially to increase the success of in vitro fertilization.
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P.I.C.S.I: It is a method used to select mature sperm during microinjection and to separate those with genetic defects. In genetically normal sperm, a special protein found in the cell membrane allows these sperm to adhere to plates prepared in the laboratory. Sperms that do not have this protein cannot overcome the plate barrier.
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Assisted Hatching (AHA): In this technique, the sheath (zona pellucida) surrounding the embryo is used. ) is thinned by laser, acid or mechanical methods, that is, shaving is done. These methods do not have any superiority over each other, and any of them can be used depending on the experience of the center. On the day of transfer, the embryos are evaluated together with the patient's age and history to decide whether this procedure will be performed or not. This process can also be used to transfer cryopreserved embryos. The pregnancy rate can be increased with this method in fertilized cells. However, this issue has not been fully clarified.
Bad Embryo E Methods to Increase Success in Obtained Cases:
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I.V.M. (In Vitro Maturation): It is the process of collecting eggs at earlier developmental stages and developing them under laboratory conditions. In this way, the risk of overstimulation called OHSS is eliminated and medication is not used.
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Defragmentation (Cleaning of Harmful Particles in the Embryo): While some embryos develop, normal cell division occurs. In addition, some unwanted particles are formed. Trailers can be watched at varying rates. These particles, called fragments, reduce the quality of the embryo and also reduce the success of the treatment. Therefore, very experienced teams clean these particles with special techniques under the microscope and special micro pipettes, called defragmentation, and increase pregnancy rates with the fragmentless embryo given.
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Endometrial Co-Culture (Artificial Womb): It is a method used in patients with repeated unsuccessful in vitro fertilization experiences and in those with poor quality embryos. A new environment is prepared by combining a small piece of the intrauterine tissue (endometrium) of these patients with maternal serum and some special substances. The retrieved eggs are grown in this environment after the microinjection process (fertilization by injecting the sperm into the egg) and higher quality embryos are obtained.
To Achieve Success Differentiation of Drug Treatment: Some patients have low ovarian responses and reserves, while others have more. In this case, some protocols based especially on the AMH hormone are applied. In some cases, the doses and types of cracking injections are changed.
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