In Vitro Fertilization (IVF) is defined as a reproductive technique. IVF is performed by retrieving a woman's eggs from her ovaries and fertilizing them with sperm in a laboratory. Following the fertilization, embryos are developed in 3-5 days. Embryos with the highest pregnancy potential are selected and transferred to the expectant mother's uterus via a catheter.

In What Cases is IVF Recommended?

• Both fallopian tubes are obstructed
• Ovulation disorders due to advanced age
• Impaired sperm production or function, or low sperm quality or low sperm motility
• When pregnancy can't be achieved in women despite fertility treatment due to either chocolate cysts (Endometrioma-Endometriosis) or unexplained infertility
• Patients scheduled to have a healthy baby by diagnosing some hereditary diseases at the embryo stage via the preimplantation genetic test

Procedures Carried out throughout IVF Cycle

1. Ovulation Induction (Stimulation of the Ovaries): Fertility for women relies on the ovaries releasing healthy eggs. As a result of the examinations and analyzes, the appropriate treatment is tailored for the person. On day 2 or 3 of the woman's menstrual cycle, hormone therapy is started to stimulate the development of follicles of the ovaries resulting in the production of multiple eggs in one cycle. By taking into account the woman's age, weight, ovarian reserve test results, and her response to previous treatments, patient-specific drug doses may need to be adjusted for successful ovulation induction. Hormonal therapy involves taking oral or injectable medication to stimulate multiple egg production. Some vitamins and elements are also supplemented. The body's response is monitored through the cycle using ultrasound. The main goal in controlled ovarian stimulation is to optimize egg quantity for embryo development and increase the chance of pregnancy.The ovarian stimulation phase lasts about 7-11 days. When the desired egg number and size as well as the thickness of the uterine inner wall are ensured, an injection is administrated to trigger the oocytes to go through the last stage of maturation, before they are retrieved. About 34 to 36 hours after the injection, the egg retrieval or ovum pick-up takes place.
2. Ovum Pick up (OPU)
   Ovum pick-up (egg retrieval) is a procedure carried out under vaginal short general anesthesia about 34 to 36 hours after administrating the injection to trigger the oocytes to go through the last stage of maturation. During the procedure, a transvaginal ultrasound probe is used to guide a needle through the back wall of the vagina up to the ovaries. With the help of USG, the needle is used to aspirate the follicle and suck the fluid and oocyte from each follicle. The egg retrieval procedure lasts about 10-30 minutes. There is no harm to take painkillers in case of lower abdominal cramping or groin pain after the procedure. Light spotting or infection is rare.

   The aspirated follicular fluid is transferred into sterile tubes. The follicular fluid is examined under a microscope in the embryology lab and searched for oocytes. Not every follicle contains an oocyte. Once the oocytes are found, they are evaluated for fertilization by the embryologist. On the same day of the egg retrieval, the male partner is required to provide a semen sample by masturbating in a special room in the IVF center.

   From the moment the egg and sperm cells are retrieved, they are transferred to a special solution and then are kept in a special incubator designed to ensure environmental conditions similar to the body environment. Thus, the environmental conditions surrounding the gametes can be tightly controlled in terms of light, gas ratios, as well as temperature.4 hours after the OPU procedure, fertilization can be ensured either by placing the mature oocytes and selected sperm cells in a culture dish for spontaneous fertilization or by (ICSI); injecting the sperm, which is immobilized by removing its tail, into the egg under a microscope.Following these procedures, the fertilization rate of the eggs is around 70 – 80% on average. This rate may vary depending on the reasons for infertility of the couples, the age of the patients, and the quality of the egg and sperm cells used.

3. Embryo Transfer: Embryos formed after fertilization are stored in special media and are checked daily. Good quality embryos and poor quality embryos are grown in separate media at the end of the first day. Some embryos may stop developing during this growth and follow-up phase. As a result, suitable embryos are transferred into the uterus on the 2nd or 3rd day, when they have 4-8 cells, or on the 5th day, when they reach an average of 100 cells, called a blastocyst.A single embryo transfer is recommended for women younger than before the age of 35, and two embryos transfer is recommended to those, who are older than 35 or for those, who have 3 previous transfer failures. If the number of good quality embryos than the number to be transferred, the unused embryos are frozen and stored for later use with the consent of the patient.