Although the first thing that comes to people's mind when talking about in vitro fertilization (IVF) is a baby in a test tube, what is actually mentioned here is the realization of fertilization by combining the reproductive cells taken from the expectant mother and father in a laboratory environment. The world's first successful in vitro baby was born in England in 1978. Thus, a breakthrough was made in reproductive medicine and many people, who seemed impossible to have children 30-40 years ago, were able to become pregnant thanks to this method. Today, this method is used not only for pregnancy, but also to obtain embryos that do not carry the disease in couples with some genetic diseases, and to ensure the pregnancy of genetically similar siblings in cases where transplantation is required. It is estimated that approximately 6 million babies have been born with IVF technology to date.
WHAT IS IN Vitro Fertilization (IVF), WHAT IS ICSI (MICROINJECTION)?
From the expectant mother Healthy eggs, developed with the help of drugs, are collected under ultrasonography and combined with sperm taken from the father in a laboratory environment to ensure fertilization. For each egg, 50,000-100,000 sperm are taken and placed in the same container. It is expected that one of the sperm in the same container will enter the egg and perform fertilization. The fertilized egg cells then divide and develop the embryo. Embryos are checked every day and allowed to grow under laboratory conditions for 2-5 days. The developing embryos are then placed in the uterus.
In microinjection (ICSI) treatment, unlike standard in vitro fertilization treatment, a sperm is injected into each egg under a special microscope and the embryos are waited for their development. ICSI is usually performed in severe male infertility. In such men, the number of healthy sperm is very low or although there is no sperm in the semen, sperm is obtained from the testicles surgically. It is also applied to couples where the expectant mother is over 38 years of age, where a small number of eggs are obtained, and where fertilization or pregnancy cannot be achieved with standard in vitro fertilization treatment.
IN WHICH CASES IS IVF PERFORMED?
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If there is blockage or damage in the tubes
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If the ovarian reserve is low
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In ovulation if there is a problem
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If there is endometriosis or chocolate cyst
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In patients whose tubes have been tied or removed before
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If there is a problem in sperm production, structure and/or function
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If pregnancy cannot be achieved despite trying other methods
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If there is a genetic problem and you want to have a pregnancy that is not affected by this problem
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In diseases that require tissue transplantation, obtaining a sibling with a similar genetic structure can be used in transplantation.
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Freezing embryos in patients who will be treated for cancer and storing them for future pregnancy
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Freezing embryos for future pregnancy in women who postpone having children for career or other reasons. storage
ARE THERE RISKS AND COMPLICATIONS OF IN Vitro Fertilization Treatment?
As with every treatment, there are some risks in in vitro fertilization treatment. . These are:
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Multiple pregnancy
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Miscarriage
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Premature birth, miscarriage birth weight
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Ectopic pregnancy
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Bleeding due to egg retrieval, infection, bowel-bladder-vascular injury
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OHSS: It is a generally mild condition that develops due to the cracking of many eggs at the same time, causing enlargement and swelling in the ovaries, abdominal blistering, abdominal pain, nausea, vomiting, and weight gain, but sometimes requires hospitalization and treatment.
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Increased risks of some cancers due to long-term and high-dose drug use resulting from the condition that causes infertility
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Due to treatment stress, some psychological problems
IS IVF BABY RELIGIOUSLY OBJECTIVE?
Islam encourages marriage and having children.
“Marriage is from my sunnah. Whoever does not act according to my sunnah is not from me. Get married! Because I will be proud of your multitude against other nations. Whoever has the financial means should get married immediately. Hz. Muhammad (PBUH)”
He also commands to be treated for diseases.
“Be treated, O servants of Allah. Because God creates everything he creates. He has definitely created a cure (cure) for the disease. However, one disease is an exception. It is old age. Hz. Muhammad (PBUH)”
The members of the Presidency of Religious Affairs and the Supreme Council of Religious Affairs have taken the following decision on this issue:
Date: 05/01/2002
Women or women If pregnancy is not possible through natural intercourse due to a defect in the man;
The egg and sperm to be fertilized must both belong to the married spouses, that is, neither of them belongs to a foreigner;
The fertilized one The egg develops in one's own womb (in the womb of the partner who owns the egg), not in another woman's womb;
This process requires both parents; It is medically proven that it will not have a negative impact on the material, spiritual and mental health of the child to be born; There is no harm, in terms of Islamic provisions, in ensuring the pregnancy of married women who are unable to become pregnant and become mothers in a normal way, through various medical means.
Achieving a woman's pregnancy with another woman's egg or sperm taken from a foreign man other than her husband. It is not permissible because it offends human feelings and carries elements of adultery.
HOW DOES THE PROCESS WORK?
A treatment session in in vitro fertilization. It takes about 15-17 days. Several sessions of treatment may be required.
First Interview
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Candidates for mother and father are evaluated separately
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Lifestyle changes, weight control, nutrition recommendations are given
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Information is obtained and recommendations are made about the use of cigarettes, alcohol, medication, substances, etc.
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The woman is evaluated by examination, ultrasound, uterine film and some blood tests
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The man is evaluated by sperm test
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In vitro fertilization is really The answer to the question "Does it need to be done?" is determined.
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Information is given about alternative treatments (vaccination, etc.) Precautions are taken for these problems by performing some tests before getting pregnant
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Pre-pregnancy counseling is given (nutrition, folic acid, vaccines, etc.)
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The patient is informed about the treatments and success rates
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The treatment plan is determined
Tests to be done for women
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Blood group, complete blood count, some bleeding-coagulation tests
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Hormone tests such as FSH, LH, Estradiol, Prolactin, Progesterone, TSH.
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HBsAg, antiHBs, antiHCV, Rubella IgM-IgG, Toxoplasma IgM-IgG tests for the preliminary identification of current infections or immunity.
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If deemed necessary, examinations for other systemic diseases, microbiological and genetic tests may be added.
Ovarian Stimulation
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Usually, egg enhancing injections are started on the 2nd or 3rd day of menstruation (if ultrasonography and tests are normal)
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During in vitro fertilization treatment, the woman's ultrasonography and hormone tests are performed at certain times. Close follow-up is important both to increase the success and to ensure the safety of the treatment. Egg development is monitored by ultrasound and/or blood tests at 2-3 day intervals.
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When the eggs reach a certain size and maturity, an egg cracking shot is given. In order to obtain good quality eggs, it is extremely important for the patient to have the cracking shot at the specified time and to be at the center for egg collection at the specified time.
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Egg collection takes place approximately 36-37 hours after the cracking needle. process is done. Sometimes, even though the number of eggs is high, no egg cells come out of them. One of the most important reasons for this situation is that the patient had the cracking shot at the wrong time.
Egg Collection Procedure
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This is a painful procedure. It is performed under anesthesia. For this reason, the patient must be hungry for 6-8 hours
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Egg collection is performed vaginally under ultrasound guidance. A thin needle is inserted into the follicles seen on ultrasound and the fluid in the follicles is withdrawn. The collected liquid is sent to the laboratory. The liquid is examined under a microscope and the eggs in it are found and collected. Sometimes no egg is found in this collected liquid. In this case, the follicles are It is washed several times with a liquid to try to find eggs. And this process is done one by one for each follicle.
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The process takes approximately 20-30 minutes
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After the procedure, the patient takes a few minutes. After staying in the hospital for about an hour, some medications are started and discharged.
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In the next 3 days, patients are called and informed about how many mature eggs were taken and how many were fertilized and developed.
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If a sufficient number of eggs do not develop, if the eggs hatch early, if an excessive number of eggs develop and there is a risk of OHSS, the egg collection process is canceled in some special cases. Treatment is interrupted.
Fertilization
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The eggs arriving at the laboratory are subjected to some special processes, and mature ones are selected
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During egg collection, the expectant father also gives sperm. For this, 3-5 days of sexual abstinence are required before the egg collection process. Sperms are given by the father-to-be through masturbation in a special container in the sperm donation room prepared for the male patient. Then, the highest quality sperm are selected for in vitro fertilization by going through various processes in the laboratory and the egg is fertilized with sperm in the laboratory environment. In men who do not have sperm in their semen, sperm obtained surgically from the testicle is used.
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Not every egg collected may be fertilized. The average fertilization rate is 70-75%. So, if 10 eggs are taken, an average of 7-8 of them will be fertilized. While some couples have a higher rate of fertilization, in some couples there may be no fertilization due to abnormalities in the egg or sperm.
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Embryos developing from fertilized eggs are followed by embryologists
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Quality embryos are selected and generally transferred to the uterus on the 3rd day or 5th day (blastocyst) (between 2-6 days).
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What day will the transfer be made? It depends on the number of embryos, their quality and patient characteristics. It is determined by looking at criteria such as the woman's age, the reason for in vitro fertilization treatment, the results of previous attempts, the number of developing embryos, embryo development characteristics and daily development rate, whether preimplantation genetic diagnosis will be performed or not.
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