In Vitro Fertilization (IVF)

What Is A In-Vitro Fertilization Baby?

In vitro fertilization is the most commonly known method of assisted reproduction treatment techniques. Different methods of IVF, developed to achieve the best success rates, are in use today.

In IVF treatment, the female egg cell (oocyte) and the male germ cell (sperm) are fertilized outside the body under carefully prepared laboratory conditions. Then, a certain number of these fertilized egg cells (embryos) are selected and placed into the uterus.

Who are suitable to undergo IVF?

Women; who have both tubes blocked:

IVF treatment is used in these cases because the sperm cell will not have a chance to reach the egg cell and fertilize it.

Low sperm count, abnormal motility, or low ratio of normal sperms (morphology):

These problems of low sperm count, abnormal sperm motility, or low ratio of normal sperms can be found individually or they may coexist. If the sperm count and motility of sperms are normal but the ratio of sperms with normal appearance is below the limits, the couple will need assisted reproduction treatment.

Failure of becoming pregnant despite intrauterine insemination:

If intrauterine insemination fails to succeed during 3-4 cycles, the couple may prefer to undergo IVF.

Cases of infertility due to unspecified causes:

Of all infertility cases, 20% may not have an explicable cause despite all investigations. IVF is considered in such cases, especially in female patients, who are 36 years old or older.

Severe cases of endometriosis:

In endometriosis; the internal lining of the uterus called the endometrium, which is involved in the occurrence of regular menstrual cycles in women, migrates outside the uterus implanting on the ovaries, intra-abdominal membrane, or tubes. Menstrual bleeding from extrauterine areas may cause the formation of ovarian cysts and adhesions in the tubes and the intra-abdominal membranes. IVF may be required in advanced cases of endometriosis. Also, IVF may be the first option for treatment especially for our patients, who are older than 35 years old and who have not had any children yet.

How is IVF performed?

1. Stimulation of the Ovaries

On the 3rd day of the menstrual period, injection of hormonal medications are started in order to stimulate the ovaries. The aim of using such medications is to increase the chance of becoming pregnant by inducing the growth of more than one egg cell. The process of ovarian stimulation takes approximately 12 - 14 days. However, the length of the process may vary from person to person because it will be determined by the response of the ovaries to the medications. During this process, the growth of eggs is monitored closely via ultrasonography, which will be performed every 2-3 days.

In this treatment protocol, gonadotropin-releasing hormone antagonists are administered as a protective measure to avoid premature follicular rupture on the 6th day of medication use. This medication is injected into the umbilical area.

2. Egg Retrieval

When the eggs become mature enough and achieve a certain size, another medication is injected to induce follicular rupture so that eggs can be retrieved. Approximately 34-36 hours after this injection, the eggs are collected. Because this procedure requires meticulous care, the timing of the injection is critical.

Egg Retrieval: The patient is admitted to the clinic after an overnight fasting. Then, the egg retrieval is performed; which will take approximately 15-20  minutes. The procedure is painless because the patient will be anesthetized. In the IVF procedure, the eggs are retrieved via the vaginal route. For this process, a catheter (needle) is used under ultrasonography guidance. One end of the needle is attached to a suction device to remove eggs out of the ovary. The number of mature eggs may be around 10-12 per patient but this number may vary ranging from 1 to 40. In some patients, no eggs are retrieved although such cases occur rarely. Because patients will not need to stay at the hospital after the procedure, they can return home a few hours later.

3. Fertilization of Eggs

The retrieved egg cells are fertilized under laboratory conditions via the classical IVF method or microinjection (ICSI) method depending on the sperm cell quality. The fertilization results in the development of the embryo, which is the cornerstone of the growth of the baby in the uterus. Fertilization is confirmed via a microscopic examination. The fertilization process takes approximately 12 to 15 hours. The patient is informed about the results of the procedure and a day will be scheduled for embryo transfer.

4. Embryo Transfer

Transfer is performed in the following 48-72 hours or even 120 hours after the retrieval of fertilized embryos (called pre-embryos or zygotes). Because the timing of the transfer will be determined based on the quality of the embryo, timing of the embryo transfer may vary. Embryos are transferred into the uterus by gently passing them through the cervix by means of a catheter, which is a thin plastic tube. The number of embryos to be transferred is 1 for the first two treatment cycles in patients under the age of 35 years and at most 2 in all other patients. Because the procedure is simple and painless, the patient will be discharged from the clinic soon. A hormone that we call progesterone is administered vaginally or as an injection to the patient until the pregnancy test that will be performed approximately two weeks later. When the pregnancy test is positive, ultrasonography is performed to see the gestational sac 10 days after the pregnancy test.