Assisted reproductive techniques cover all the treatment methods used to achieve pregnancy in couples who have failed traditional treatment methods, whose tubes are damaged or who have severe sperm problems. The simplest of these methods is intrauterine insemination, also known as "insemination", and the most complex is the microinjection method. In fact, there is no difference between classical in vitro fertilization and microinjection in terms of the treatments applied to the patient. The difference is due to the different laboratory procedures applied to the sperm and egg cells.
Assisted Reproduction Methods:
1. IMMUNIZATION (Intrauterine insemination = IUI)
2. IN Vitro Fertilization = IVF
3. MICROINJECTION (Intracytoplasmic Sperm Injection = ICSI)
4.Other (GIFT etc.)
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IMMUNIZATION (INTRAUTERINE INSEMINATION)
Vaccination or intrauterine insemination is performed by selecting the live and motile sperms of the man during the ovulation period with the help of a thin tube. It is administered directly into the uterus.
Reasons for vaccination:
1.Mild disorders in sperm count and motility
2.Unexplained infertility
3.Problems related to the cervix
4.Antisperm antibody positivity
/> 5.Other reasons
The woman's tubes must be open for insemination to take place. For this reason, women who will undergo this method should have a uterine x-ray. In this method, ovulation stimulating medication is generally used to adjust the timing and improve egg quality. When the egg reaches a certain size, an injection is made to crack the egg and the process is carried out 24-36 hours later.
The man's sperm are taken and the live and mobile ones are separated after certain procedures. These sperm are then injected into the uterus with the help of a thin tube. In this way, the number of sperm that have the chance to reach the egg is increased. Although the monthly chance of this method varies depending on the reason for doing it and the sperm results, it is generally around 15%. The chance of pregnancy is better in cases where the sperm count is over 10 million after preparation. The chance of pregnancy is low in cases where the sperm count is below 5 million.
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IN VITRO FERTILIZATION
( IN Vitro Fertilization )
One of the greatest areas of progress in medicine in recent years has undoubtedly been in assisted reproduction methods. With the in vitro fertilization method, which was first applied in 1978, it became possible for women who had little or impossible chance of getting pregnant due to problems with their tubes to become pregnant. This was followed by the application of the "microinjection" method, in which pregnancy could be achieved with a single sperm obtained from the testicles of men who had no sperm in their semen and were therefore told "you cannot have children" until that day. Over time, with the developments made in these methods, pregnancy rates reaching 50% have begun to be achieved in the appropriate patient group.
The classical in vitro fertilization method was initially a treatment method considered for women with problems with their tubes. Pregnancy was almost impossible with severely damaged tubes due to previous infections or other reasons.
There are several stages of the in vitro fertilization method called in vitro fertilization.
These are:
1.Suppression of the ovaries
2. Stimulation of the ovaries
3.Egg collection
4.Fertilization of the egg with sperm
5.Embryo transfer
Suppression of the ovaries: This process ensures that the egg development is under the doctor's control, the eggs develop equally in size and prevents premature ovulation. It is done in terms of For this purpose, depending on the woman's characteristics, medications are used 1 week before the expected menstrual day or from the first day of her menstrual period. These are in the form of nasal spray or subcutaneous injections. It is usually continued until 1 day before ovulation.
Stimulation of the Ovaries: Normally, an egg matures and is expelled in the ovaries every month. Pregnancy occurs with its fertilization. In assisted reproduction methods, the aim is to develop a large number of eggs in order to increase the chance of pregnancy. In this way, there is a chance to transfer the best embryos obtained from the collected eggs. The resulting excess embryos can be frozen and stored. There are various medications used to stimulate the ovaries. These medications are to be taken once or twice a day. It can be used between 2 and 8 ampoules. It usually starts on the 3rd day of menstruation. Egg development is monitored with frequent checks. During these checks, while egg development is monitored with ultrasonography, an idea about the quality of these eggs is obtained by checking the estradiol hormone in the blood. The formations containing eggs, called follicles, must be at least 3 and over 18 mm long. When this number and diameter is reached, the drugs that suppress and stimulate the ovaries are stopped and another injection is given to crack the egg. Egg collection is performed 34-36 hours after this last injection.
Egg Retrieval: Egg retrieval is performed under local or often general anesthesia. During this procedure, the ovaries are reached by entering the chamber with a needle under ultrasound guidance. Cysts containing egg cells, called follicles, in the ovaries are entered. With the help of vacuum, the egg cell is aspirated along with the fluid around it. The fluid taken is immediately checked by the embryologist in the laboratory and the doctor who performs the procedure is informed whether there are any egg cells in it. The number of eggs collected varies depending on the woman's age and ovarian capacity; on average, between 5 and 20 eggs are collected. All follicles in both ovaries are aspirated. The process takes 10-20 minutes. The collected eggs are kept in a nutritious environment and at body temperature.
Fertilization of the Egg by Sperm: While the woman's eggs are being collected, her husband gives a sperm sample in the laboratory. The collected sperm are subjected to certain processes and the sperm that are in good condition, motile and have a normal structure are separated. In the classical in vitro fertilization method, 100,000-150,000 sperm are deposited around each egg and one of them is expected to fertilize the egg. In microinjection, a single sperm is selected and dropped into the egg, thus ensuring fertilization. The difference between the two methods is at this stage. A single sperm in good condition is sufficient for microinjection. The next day, the eggs are checked to see if fertilization has occurred.
Embryo Transfer: If fertilization has occurred, embryo transfer is performed 72 hours after egg collection. Good quality embryos have 6-10 cells. The number of embryos to be transferred is decided according to the woman's age, cause of infertility and other factors. It is melted. This number is limited by law in some countries to reduce the rate of multiple pregnancy. In our country, 2-4 embryos are generally transferred. If excess embryos of good quality are obtained, the remaining embryos can be frozen with the permission of the family. A blood pregnancy test is performed 11 days after embryo transfer.
TO WHOM CAN IVF (In Vitro Fertilization) be performed?
1.Patients with problems with the tubes
2.Unexplained infertility cases that cannot be achieved with other treatment methods
3.Male infertility whose sperm problem is not very severe
4.Endometriosis
5.Other
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FACTORS IN IVF TREATMENT
1- WOMAN'S AGE
One of the most important factors affecting couples undergoing infertility treatment is the woman's age. The number and quality of eggs is generally better in younger women. When pregnancy occurs, the probability of miscarriage is less in younger women. Fertility reaches its peak around the age of 25 and then gradually decreases. The chance of pregnancy over the age of forty is low despite treatment and even methods such as babysitting.
2- OVARIAN CAPACITY
Although ovarian capacity decreases with advancing age, age is not the only factor. In other words, a young woman may have low ovarian capacity or a good ovarian capacity at an older age. There are some tests used to determine this. The ultrasonographic appearance of the ovary can give an idea about this. Many clinics use hormone tests performed on the 3rd day of menstruation to determine ovarian capacity. If the FSH measurement taken on the third day is below 10 mIU/ml, the ovarian capacity is considered good, and if this level is between 10-15, it is considered moderate. In women with FSH levels above 15, the chance of pregnancy is low, and when pregnancy occurs, the probability of miscarriage is quite high. Likewise, the low estradiol level on the 3rd day indicates that the ovarian capacity is good.
3- SEMEN QUALITY
The test that best determines a man's potential to have children is semen analysis. With the introduction of the microinjection method since 1994, the importance of the male factor in in vitro fertilization has decreased. In normal semen analysis values are as follows:
Normal semen analysis:
Amount: At least 2 ml
Number: At least 20 million per ml
Motility rate: At least 50%
Normally shaped: At least 50%
Leukocytes: Up to 1 million/ml
These figures are not absolute limits. Spontaneous pregnancies can occur even at values well below these values.
4- INFERTILITY DURATION
Infertility duration also has an impact. Although the chances decrease as this period increases, there is no reason to despair in cases that have not been treated before.
5- PREVIOUS PREGNANCIES
Previous pregnancies that resulted in live birth increase the chances of treatment.
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MICROINJECTION ( INTRACYTOPLASMIC SPERM INJECTION )
Microinjection is the process of injecting a single sperm into the egg cell. Thanks to this technique, men with very low sperm count or no sperm in their semen have been able to have children with a very small number of sperm obtained from their testicles. There is no difference between in vitro fertilization or microinjection methods in terms of treatment and other procedures applied to the woman. The difference is due to the different procedures performed in the laboratory after egg collection. In the in vitro fertilization process, around 100-150 thousand sperm are deposited around each egg and these sperm are expected to fertilize the egg, while in microinjection, fertilization is achieved with a single sperm.
Microinjection is applied in cases where classical in vitro fertilization procedures fail or in cases of severe male infertility. In some clinics, microinjection is applied to all eggs obtained in order not to leave egg fertilization to chance.
ASSISTED HATCHING )
It is the process of thinning an area of the membrane surrounding the embryo, called the zona, by mechanical or chemical methods. It is believed that this process makes it easier for the egg to attach to the inner lining of the uterus, which means it increases implantation rates. Although its benefits are not accepted by everyone, it can be used in patients who have previously had unsuccessful in vitro fertilization attempts or when the woman is 35 years old.
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