In Vitro Fertilization (IVF)

If the mother-to-be's fallopian tubes are blocked or she has a low egg count, if the father-to-be has moderate to severe sperm abnormalities, or if pregnancy cannot be achieved despite everything being normal, IVF may be recommended. IVF is a method of creating pregnancy by fertilizing the mother-to-be's egg and the father-to-be's prepared sperm outside the body and then transferring the resulting embryo to the uterus.

Who needs IVF?

If you have been trying to conceive for a year without using contraception, you should consult a fertility clinic for infertility treatment and assisted reproductive techniques.

You should contact your doctor if:

If you are considering pregnancy and are over 30 years old, especially if you have not had a menstrual period in the past six months,

If your menstrual periods are irregular or painful, or if you experience pelvic pain, endometriosis (such as chocolate cysts), or recurrent miscarriages (two or more),

If you have a low sperm count, a history of testicular or prostate diseases, or sexual problems.

In vitro fertilization (IVF) is an assisted reproductive technique used for couples who are unable to conceive and has been in use for many years. Today, IVF is one of the most preferred infertility treatments.

In cases of unexplained infertility, infection, blocked fallopian tubes, low sperm quality in men, or conditions caused by weight or advanced age, couples can have a baby through IVF.

IVF involves collecting the female reproductive cells (eggs) and male reproductive cells (sperm) and combining them outside the body in a laboratory environment to achieve fertilization.

The fertilized eggs begin to divide and undergo the initial stages of development, known as the embryo stage, in the laboratory environment, after which they are transferred to the uterus of the prospective mother. From this point onward, the pregnancy is indistinguishable from a naturally occurring pregnancy.

The difference from natural pregnancy lies in the fact that fertilization takes place in a laboratory setting and the fertilized eggs are transferred back into the mother's uterus.

The process of implanting eggs in IVF is performed in two ways:

The fertilization process in the laboratory involves placing sperm next to the eggs and waiting for the sperm to enter the eggs on their own and perform fertilization (classic IVF).

Or, sperm is directly injected into the egg using a pipette under a microscope to achieve fertilization (intracytoplasmic sperm injection, or ICSI). IVF specialists determine the preferred method based on the characteristics of the couple.

The goal is to achieve the highest possible success rate for the couple.

What Does the IVF Treatment Process Involve?

Women with regular menstrual cycles produce a single egg each month. In IVF treatment, hormone medications are administered externally to increase this number.

Although each treatment protocol may vary, two parallel hormone treatments are generally administered to promote egg development and prevent early ovulation.

During the use of these hormone medications, ultrasound and blood tests are performed to monitor the ovaries' response, i.e., egg development, and to adjust the dosage as needed.

The mature eggs are then collected using a simple aspiration method with a needle known as the “trigger shot” and fertilized with sperm obtained from the male in a laboratory setting.

Egg retrieval can be performed under general anesthesia or under sedation and local anesthesia.

This fertilization process can be achieved by placing the sperm and eggs side by side in the classic IVF method, or by injecting each sperm into a single egg under a high-powered microscope, a process known as microinjection. Your doctor will explain which method is most suitable for you.

The fertilized eggs are left to develop in a temperature- and atmosphere-controlled culture environment in the laboratory for 2 to 3 days, or in some cases 5 to 6 days, and at the end of this period, the best-developed embryos are selected and transferred back into the uterus.

The number of embryos to be transferred directly affects the chances of pregnancy and the risk of multiple pregnancies. Therefore, this number will be discussed in detail with you prior to transfer, following the determination of embryo quality. The embryo transfer procedure does not require anesthesia or sedation in most cases.

Other conditions for which IVF treatment is used include:

For a pregnancy to occur naturally, both of the woman's fallopian tubes must be open and functioning normally.

IVF treatment should be applied if the fallopian tubes, also known as the ovaries, are blocked, severely damaged, or surgically removed.

IVF treatment may also be necessary if there are adhesions around the female reproductive organs that prevent the fallopian tubes from capturing the eggs that develop in the ovaries.

These intra-abdominal adhesions may be related to previous surgeries performed in these areas (e.g., ovarian cyst surgery, myomectomy, ectopic pregnancy surgery, etc.) or to inflammatory conditions of the female internal genital system that have been detected or undetected.

In such cases, the first stage of treatment may involve laparoscopic (minimally invasive) surgery to remove these adhesions and restore normal fallopian tube-ovary function. If this is not possible or if pregnancy does not occur spontaneously within a certain period after surgery, IVF should be considered.

In women with ovulation problems, if ovulation is achieved with medication but pregnancy still does not occur, IVF should be considered. A significant portion of this group consists of women with polycystic ovary syndrome.

If the woman has endometriosis, IVF treatment may be necessary. Endometriosis is a condition in which the endometrium, which normally lines the uterus and is shed during menstruation, is found outside the uterus, around the fallopian tubes, on the ovaries, and on the intestines.

Endometriosis can prevent a woman from becoming pregnant. If pregnancy is not achieved within a certain period of time following surgical removal of the disease, IVF treatment is initiated.

If there are abnormalities or deficiencies in sperm count, sperm motility, or sperm morphology (shape) in men, IVF treatment may be necessary.

Today, IVF/ICSI is the treatment method with the highest success and pregnancy rates in male-factor infertility. Early referral of couples with male-factor infertility to IVF treatment increases the chances of success.

If no sperm cells are found in the male sperm analysis, IVF treatment may be the only option. In this case, sperm cells must be obtained surgically from the epididymis or testicles, making IVF/IUI the sole treatment method.

IVF may be necessary in cases of unexplained infertility. IVF is also a suitable option for couples who have attempted to conceive naturally, undergone examinations and tests without any problems being detected, and are facing unexplained infertility.

Although these couples always have a chance of conceiving naturally, this chance decreases significantly over time and as the woman's age increases. IVF treatment yields good results in these couples and eliminates stress and tension in the shortest possible time.

If immunological infertility is present, IVF/IUI treatment can be used to achieve results. If antibodies develop against sperm cells in the semen or female reproductive system and other treatments are unsuccessful, IVF treatment should be considered.

IVF treatment should be considered in cases of advanced female age. Fertility declines with advancing age. This decrease accelerates after the age of 35. Therefore, starting IVF treatment without delay is an effective and successful approach, especially for women aged 38 and over who want to have children.

A loss of time that cannot be replaced by other infertility treatments is a high price to pay for women of this age. IVF treatment may be the best choice during this race against time.

IVF treatment should be performed in cases where preimplantation genetic testing is required.

In conclusion

The increase in the success rates of IVF treatment has moved it from being a last resort treatment option to one of the most effective treatments for infertility.

The advancement of IVF treatment has saved many couples from the distress and tension of remaining childless for many years.

What Are Your Chances with IVF?

The success of IVF treatment is defined by your ability to return home with a healthy baby nine months after the completion of treatment.

In our country, approximately one in three couples conceives a child during their first IVF attempt.

Experts predict that by 2027, the success rate of IVF worldwide could reach 100%. Turkey ranks 5th among European countries and 7th globally in terms of IVF success rates. The country with the highest success rate in IVF is the United States.

To achieve high success rates in IVF treatment, the following factors are important. Your obstetrician will use appropriate treatments and up-to-date IVF methods based on risk factors to increase your chances of success.

Factors affecting success rates in IVF treatment include:

The woman's age (the chance of pregnancy decreases after age 35)

High body mass index (BMI over 30)

Decreased ovarian reserve

Sperm quality

Decreased sperm count, sperm motility issues

Immune system issues affecting the ovaries and sperm

Unexplained infertility

Issues with the uterus and fallopian tubes

The presence of myoma, polyps, adhesions, or endometriosis in the uterus that prevent implantation

Smoking in both partners

Avoiding stress, maintaining a balanced diet, and avoiding alcohol

When discussing your chances with IVF treatment, it is important to consider that not every treatment attempt will result in a live birth.

Sometimes, success rates are mentioned based on the high level of the pregnancy test (beta HCG value) measured in the blood after treatment. However, a rise in the pregnancy test in the blood does not always indicate that the pregnancy will progress to the delivery stage.

In some cases, despite a positive pregnancy test in the blood, the pregnancy may be lost without being detected by ultrasound. This is called a biochemical pregnancy. Or, even if the gestational sac is visible, a baby with a heartbeat may not develop.

For these reasons, when evaluating the chances of success with IVF treatment and reading publications on the subject, it is more accurate and realistic to consider that not every treatment attempt will result in a live birth.