Frequently Asked Questions About In Vitro Fertilization

QUESTIONS ABOUT IN Vitro Fertilization

What are the methods used to reveal infertility problems in women?

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• Age
• Duration of wanting a child and results of previous evaluations and treatments
• Menstrual cycle (regularity of menstruation, ovulation pain, breast tenderness While mid-menstrual spotting may suggest ovulation, if accompanied by painful menstruation, it may suggest endometriosis)
• Medical, surgical and gynecological history (sexually transmitted disease, history of pelvic inflammatory disease, treatment of abnormal pap smear, previous abdominal surgery). At least while the systems are being reviewed, patients should be questioned about thyroid diseases, breast milk discharge, hirsutism, pelvic or lower abdominal pain, menstrual pain and pain during sexual intercourse.
• Pregnancy stories (pregnancy, birth, pregnancy outcomes and related complications).
• Sexual history (frequency of intercourse, sexual dysfunctions)
• Family history (whether there is an infertile individual in the family, family history of early menopause, birth defects, genetic disorders, mental retardation)
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• Lifestyle (work, exercise, stress factors, weight changes, smoking and alcohol use)

Examination

• 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 development of secondary sex characters is inadequate in hypogonadotropic hypogonadism, in Turner syndrome short stature, mane neck are seen)
• Thyroid gland diseases (nodule in the thyroid gland, tenderness, size of the gland), milk discharge from the breasts, hair growth, acne suggest an endocrine disorder, while adrenal gland diseases, polycystic ovary syndrome, high prolactin requires evaluation in terms of hyper-hypothyroidism.
• Tenderness on examination is significant in terms of chronic pelvic pain and endometriosis.
• Structural anomalies of the vagina and cervix, discharges, congenital anomalies of the uterus and tubes, infection and It requires evaluation in terms of cervical factor.
• On examination, the uterus is abnormal. Its size, irregular structure, lack of mobility may be significant in terms of uterine anomalies, endometriosis and adhesions in the pelvis.

Evaluation of the tubes

Hysterosalpingography (HSG): While it provides information about the distribution of the contrast material into the abdominal cavity after its passage through the tubes and exit from the tube ends, it also detects congenital anomalies and pathologies of the inner wall of the uterus (polyps, myomas, adhesions of the inner wall of the uterus). defines. If there is sufficient experience, hysterosalpingo-contrast-ultrasonography is another effective method for HSG. It should be done within 1-2 days following the end of menstruation. It is known that the sensitivity and specificity of HSG are approximately 65% ​​and 84%. It does not provide information about adhesions around the tube and endometriosis. Uterine films older than 2 years should be repeated. HSG may also have a therapeutic role. The tubes, which are closed with mucus plugs, can be opened with pressure while contrast material is administered during the shooting.

Chlamydia IgG antibodies: It is a painless, inexpensive and easy test that provides information about the presence of damage in the tubes. In many studies conducted in recent years, it is thought that Chlamydia infections cause infertility by causing damage to the tubes, even without pelvic inflammatory disease. In the world's leading infertility guidelines (RCOG guideline), it is recommended that all women be tested for chlamydia antibodies before HSG or any invasive procedure to be performed on the uterus.

Evaluation of the inner walls of the uterus

With ultrasonography examination performed with physiological saline, polyps, myomas on the inner wall of the uterus, adhesions on the inner wall of the uterus, and congenital disorders in the structure of the uterus can be diagnosed. In addition to the pathology in the tubes, subsequent or congenital disorders in the uterine structure can also be evaluated with HSG. Abnormal HSG findings require further examination such as hysteroscopy or laparoscopy.

The role of laparoscopy

The role of laparoscopy in the evaluation of infertility is controversial. It is an expensive and invasive examination. When endometriosis is suspected (painful menstruation, pelvic pain, deep pain during sexual intercourse) Laparoscopy may be performed in the presence of pelvic adhesions and a history of disease in the tubes (history of pelvic pain, complicated appendicitis, pelvic infection, pelvic surgery, previous ectopic pregnancy), abnormal physical examination and HSG. The prevailing opinion is that there is no need for laparoscopy in patients diagnosed with unexplained or male infertility as it does not change the treatment plan.

Tests that are not commonly used in the clinic

Poscoital Test:  Describes the relationship between menstrual cycle changes in cervical mucus and sperm. It should be done 2-12 hours after intercourse, just before the expected ovulation. It is not a routinely recommended test in the investigation of couples applying for children. It has no proven diagnostic value.

Endometrial Biopsy: It provides information about whether there is ovulation in the menstrual cycle and luteal phase defect. It is done 2-3 days before the expected menstruation. It is an expensive, invasive, unnecessary test that does not provide information about the inner wall of the uterus for the implantation of the embryo in the uterus and is unnecessary for the evaluation of ovulation.

Basal Body Temperature: It is a simple and useful test used in the evaluation of ovulation by taking advantage of the temperature-increasing effect of progesterone. It is a cheap test. During the entire menstrual cycle, body temperature is measured and noted in the morning without any activity. The increase in basal temperature correlates with the LH curve, starting to rise two days before the LH curve. Although it provides guidance about ovulation, it is a difficult test that can be affected by many factors and may vary depending on the observer.

Chromosome Analysis: Women diagnosed with early menopause (under 40 years of age) can be diagnosed with severe oligospermia. Chromosome analysis is recommended for both men and women in couples with a history of recurrent pregnancy loss.

What method is in vitro fertilization, when and in what cases is it recommended?

In women with blocked uterine ducts

In women with widespread adhesions in the abdomen due to endometriosis and in whom pregnancy cannot be achieved with treatment

In cases where sperm count and quality are severely impaired

In immunological infertility

In some hormonal disorders

In cases where pregnancy cannot be achieved with other treatment methods

Infertility of unexplained cause

In order to obtain a healthy baby by diagnosing some hereditary diseases at the embryo stage (preimplantation genetic diagnosis methods). (with)

Nowadays, the age of marriage is postponed, there is no time to waste. What is the effect of a woman's age on success?  How important is the egg in a woman?

If there is no age factor and the ovarian reserve is at an acceptable level, pregnancy can reach up to 70%. However, as you get older, the chance of getting pregnant decreases. While it is between 30-40% in those aged 40-43, it is less than 5% in those over the age of 43.

What is the personalized in vitro fertilization method?

In vitro fertilization treatments are available for every patient. Even though it is seen as a standard treatment from outside, every couple has a different problem of not being able to have children. A personalized treatment approach is adopted by using complementary diagnosis and treatment elements to find the source of the problem. For this reason, the treatment approach applied to each couple is different and personalized. One of the most important secrets underlying success is that each couple is considered individually and only the treatment system suitable for that couple can be put forward. Accurate diagnosis and personalized treatments bring high success. The medical world is moving towards a new concept that we have been applying for a long time. In order to increase the success of in vitro fertilization and reduce treatment costs, 'special treatment for couples' is now applied. Individualized treatment: Special treatment protocols are prepared for patients according to the patient's age, body mass index, ovarian reserve and hormone values. After questioning the duration of marriage, the treatments she has received before, the results of her previous attempts, the diseases she has undergone, surgeries, and gynecological surgeries, the uterus and ovaries are evaluated through examination. We can understand couples' responses to medications, which medications will be used for them, and in which fluids the development of eggs will yield better results through initial examinations. In vitro fertilization centers can now tell couples the success rate of the treatment through tests performed at the first meeting. Trial and error method e, evaluation must be done well. The pregnancy rate of a couple as a result of treatment can only be determined by the doctor after the embryo transfer.

Is in vitro fertilization treatment a long treatment, is hospitalization required? Is in vitro fertilization difficult for women? What awaits the woman, what stages does the treatment go through? How long does the treatment take? Are the treatments painful?

With the new treatment methods developed, we can now collect eggs in a shorter time. Treatment begins on the 2nd or 3rd day of menstrual bleeding and the approximate treatment duration lasts 7-10 days. 35-36 hours after the egg cracking injection is given, the eggs are collected under light anesthesia, under ultrasound guidance, and delivered to the laboratory to be fertilized with sperm. Developing embryos are 2-5 days old. The day is transferred to the uterus.

No stage of the treatment is painful, no hospitalization is required.

Can men with no sperm in their semen have children? What is the MicroTESE method?

Sperm can be obtained from the testicles with the Micro TESE method. Performing the procedure under a microscope increases the chance of finding sperm from 30 percent to 50-60 percent.

Testis is also a region that produces the testosterone hormone. Therefore, this method minimizes tissue loss by reducing the amount of tissue taken from the testicle. The patient's tissue loss is 70 times less in the microTESE method than in the multiple biopsy method.

Because it is performed under a microscope, it allows incisions to be made without damaging the vessels feeding the testicle.

Ovarian hyperstimulation syndrome ( What is OHSS? Can it be prevented?

Normally, in procedures such as in vitro fertilization or microinjection, controlled, mild stimulation of the ovaries is a desired condition. However, moderate or severe stimulation of the ovaries, or the condition known as ovarian hyperstimulation syndrome (OHSS), is an undesirable complication that can present in different ways. It becomes evident with overstimulation of the ovaries, fluid accumulation in the abdomen and enlargement of the ovaries. It needs to be recognized early. Therefore, in vitro fertilization patients need to be closely monitored with USG and estrogen. Enlargement of the ovaries, abdominal pain, abdominal swelling, fluid collection in the abdominal cavity

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