Infertility and IVF
What is Infertility?
Failure to achieve pregnancy despite regular and continuous sexual intercourse without any prevention method of pregnancy for one year is called infertility.
The incidence of infertility does not vary greatly between societies, approximately 15% of couples all over the world have to consult a specialist because they do not have a baby. When any of the following conditions occur, it is necessary to suspect infertility and consult a physician without waiting for the passage of one year to clarify the situation.
- Under the age of 35 and have not been able to conceive for more than 12 months,
- If you are over 35 years old and have not been able to conceive for 6 months
- If you are over 40 years old and have not been able to conceive for 3 months
- If you have recurrent miscarriages
- If couples have mental or physical problems that prevent them from having healthy sexual intercourse
- If, despite having previously undergone treatment to have a child, the result is unsuccessful
Causes of Infertility
The main causes of infertility are:
- Failure to have healthy sexual intercourse between spouses
- Despite healthy and regular coexistence, it becomes difficult or inhibited for reproductive cells (egg and sperm) to unite,
- Fertilization cannot occur despite the fact that reproductive cells can unite,
- The semen sample taken from the man does not have enough sperm in number and morphology to ensure pregnancy by normal means
- Although the woman’s age is not advanced, it is determined that the ovarian reserve is reduced as a result of the examinations performed
- Advanced female age (38 years and older) and 6 months of unprotected continuous sexual intercourse despite pregnancy
- Endometriosis causes the deterioration of the ovary-tube relationship
- Impaired ovulation function
- Obstruction of the fallopian tubes in women
- Although the results of all examinations are normal, the cause of unexplained infertility is seen
- The inability of the embryo to develop despite the fact that fertilization has occurred,
- The development of the embryo but its inability to hold on in the womb,
- Although there is no problem in the development of the embryo, the pregnancy that occurs ends prematurely with miscarriage or premature birth.
The main reason for the disruption of attachment and fetal development in the uterus and the difficulty or inhibition of the union of reproductive cells is the inability to carry out the production of these cells in men and women in a healthy way. Although the union has occurred, the obstruction of attachment in the womb may be of immune or genetic origin. The main causes of infertility mentioned above manifest themselves in men and women with different results. For example;
- As a result of hormonal dysfunctions, it may occur in the form of menstrual irregularities in the woman, while it may occur in the form of sexual dysfunctions (erectile dysfunction, premature ejaculation, etc.) in the man.
- The causes due to anatomical (organic) structure disorders manifest themselves in the form of obstruction in the tubes, myoma, polyp in the woman, while in the male varicocele can show in the form of undescended testicles.
- Causes related to psychophysiological (mental and physical) dysfunctions may manifest themselves as vaginismus in women and erectile dysfunction in men.
- Tuberculosis from infectious factors (microbial diseases) can cause infertility by causing mumps anatomical and pathological problems.
- Toxic (environmental) factors are, pesticides, various chemicals can cause infertility by creating anatomical or pathological problems.
- As a result of causes related to immunological (immune system) and hemophilic (bleeding-clotting) dysfunctions, infertility may occur due to problems in the attachment of embryos to the uterus or in ensuring the continuity of this even if they do hold.
- Causes due to genetic (hereditary) dysfunctions can manifest themselves as recurrent miscarriages in couples.
What are the Causes Requiring IVF Treatment?
- Ovulation disorders (Polycystic ovary syndrome, Chocolate cysts)
- Obstruction of tubes
- Antisperm antibodies
- Pathologies located in the uterus
- Thyroid hormone disorders (goiter, hypothyroidism, hyperthyroidism)
- Previous infections related to the genital organs
- Previous surgeries related to the uterus and ovaries
- High milk hormone
- Decreased ovarian reserve due to advanced age
- Cervical causes, cervical factor
- Being overweight
- Closed cervix
- Not having regular sexual intercourse
- Adhesion in the uterus
- Luteal phase insufficiency
- Have undergone chemotherapy and radiotherapy treatment
- Go through the menopause in the early period
- Back ejaculation
- Undescended testicle
- Problem with sexual intercourse
- Impaired orgasmic function
- Medications that are used for a long time
- Causes that prevent sperm formation
Tests and examinations for the cause of infertility can be grouped into 2 groups.
Basic examinations of the mother-to-be:
If you are going to have IVF treatment for the first time, the following way is followed for you at Centrum IVF Center;
First of all, your hormones in egg production are examined by blood analysis, then the condition of your ovaries is evaluated with ultrasonography. These tests and examinations applied to you take approximately 30 minutes, the results are available in the afternoon of the same day.
If you are a mother who has previously undergone infertility treatment but has not received results, or if you have recurrent miscarriages; At the Centrum IVF Center, your doctor will want to examine you in more detail. These are further tests for the immune system, blood clotting factors and gene mutations. When your diagnosis is made correctly through these tests, the likelihood that your treatment will result in pregnancy will increase.
Basic examinations of the father-to-be:
The main examination that should be done to you is sperm analysis. In order for the sperm analysis to give the most accurate result, it is useful to come to our center with a sexual abstinence of 3 or 6 days. The sperm cells you give are examined under a microscope in the laboratory. As a result of the sperm analysis, the number, motility and structural / shape characteristics of your sperms are determined. You can get the result of this test about 3 hours after the sample is given.
Detailed examinations of the mother-to-be
When there is a suspicion of infertility caused by the mother-to-be, more detailed applications and examinations can be performed if our doctors deem it necessary.
- Hormonal panel: It is a set of examinations for the measurement of hormones that directly or indirectly affect the work of the ovary. These tests are; AMH, FSH, LH, E2, Prolactin, T3, T4, TSH. The decrease or increase in the values of this hormone has negative effects on female ovulation.
- L/S (laparoscopy): At the diagnostic stage (Diagnostic Laparoscopy), it can be examined whether the tubes are open, whether there are masses and adhesions occupying space in the ovaries, the general condition of the structure of the uterus or it can be applied for therapeutic purposes such as myoma and mass removal (Operative Laparoscopy).
- H/S (hysteroscopy): It is the examination of the uterus with a very thin optical instrument. Thanks to hysteroscopy, it can be seen directly and intervened whether there are conditions that may prevent the development of pregnancy, deformities in the uterus, adhesions, formations such as myomas.
- HSG (hysterosalpingography): In this radiological method, also known as uterine film, by administering drugs from the reservoir, irregularity in the appearance of the uterus structure, whether there is obstruction in the mass tubes that occupy space, can be easily observed.
- Sonohysterography: It is a simple intrauterine examination method. Physiological saline solution is given into the uterus with the help of an injection by passing through the reservoir. At the same time, the uterus is filled by following up with ultrasonography and if there are formations (myoma, polyp) that take up space in the uterus, it is tried to be observed. In addition to the examination, it is an easy test performed when a suspicious condition is detected on ultrasonography and its contribution to the diagnosis is quite high.
Detailed examinations of the father-to-be
When there is a suspicion of infertility caused by the father-to-be and if our doctors deem it necessary, more detailed practices and examinations can be performed.
- Scrotal color doppler ultrasonography
- High-centrifugal semen analysis
- Testicular Biopsy
- Hormone Tests
- IVF Treatment Methods
We can group Classical Treatment Methods into 4 main groups.
- Ovulation Treatment (ovulation induction)
- Azoospremia Treatment
- Insemination therapy (IUI-intrauterine insemination)
- IVF / Microinjection (ICSI)
- Ovulation Treatment (Ovulation Induction)
The mother-to-be is given medications that will stimulate ovulation, pills to be taken orally or in the form of injections. Thus, stimulation of the ovaries and ovulation is ensured.
To Whom Is Ovulation Treatment Applied?
It is applied in the treatment of infertility due to irregular ovulation of the mother-to-be. This treatment is applied in mild ovulation disorders and when the sperms are of the desired quality.
First of all, the cause that leads to azoospermia is investigated. If there is a duct obstruction or hormone deficiency, know that these can be successfully treated, sperm can be released in the semen and pregnancy can be seen naturally. For this, it is enough to look at your FSH, LH and Testosterone hormones. In most of the cases with canal obstruction, sperm came out in the normal way without the need for IVF.
If one of these is absent, what remains is a disorder in the sperm production of the testicles, that is, Nonobstructive Azoospermia. In this case, you still continue to be able to get sperm out with treatment. When sperm analysis is performed after a short-term medication, a small number of sperm come out of the semen. After the sperm samples taken several times in succession are collected in a pool, the in vitro fertilization stage can be started.
If that doesn’t work, don’t worry. With MicroTESE surgery, a high rate of live mature sperm can be found in the testicles.
Insemination therapy (IUI-intrauterine insemination)
The sperms given by the father-to-be are separated with some special serums in the laboratory. Then, it is purified from dead cell residues and low quality (disshaped, immobile) sperms and made healthy and concentrated. Ovulation-enhancing treatment is also applied to the mother-to-be. After ovulation, the sperm of the father-to-be is given to the inner cavity of the uterus with a thin and soft special injector. After repeated insemination three times, if no results are obtained, further treatment methods are started. The chance of pregnancy is 10-15%.
To whom is the insemination treatment performed?
Insemination is mostly performed in cases of unexplained infertility where there are cervical problems, mild disturbances in sperm count and motility or no problems of the parents-to-be.
IVF treatment consists of assisted reproductive methods together with many techniques that offer solutions to highly complicated problems such as infertility, which prevent having children in normal ways. Approximately 3 million babies in our country have been born with IVF treatment method. The majority of these babies were born after a successful pregnancy process with the microinjection technique. Microinjection technique is the injection of a single healthy sperm cell obtained from the father-to-be directly into the egg cell obtained from the mother candidate with a thin injection under the microscope and subjected to fertilization.
Microinjection method provides the opportunity to have a child with a single quality sperm obtained from fathers with insufficient sperm count and motility. For this reason, it is the most preferred method today because a healthy fertilization process is performed with only one motile sperm and sufficient morphological characteristics among the sperms that are not capable of fertilizing the egg. The stages after it is brought together with the egg proceed as in IVF treatment.
What is the Difference Between IVF Treatment and Microinjection?
With classical in vitro fertilization, that is, IVF, a large number of reproductive cells obtained from the mother-to-be and father are brought together in a laboratory environment, selecting the best quality embryos and transferring them to the uterus of the mother-to-be. In the microinjection technique, only one of the sperms obtained from the father-to-be is injected into the egg cell with a special medical injection under the microscope.
In short, as a result of bringing together more than one reproductive cell in the laboratory environment with IVF, the sperm is expected to fertilize the egg cell on its own. However, in the ICSI technique, a single sperm is injected directly into the egg and subjected to fertilization. Apart from this, there is no difference between IVF and microinjection technique. Other procedures are performed as in classical IVF stages.
Stimulation of the ovaries and follow-up of egg development; The success of IVF treatment depends on the production of a large number of high quality eggs in the ovaries of the mother-to-be. For this purpose, with the treatment determined specifically for the person, the ovaries are stimulated with medications that stimulate the development of the egg. These medications are injections made under the skin or into the muscle. Stimulation of the ovaries with these medications takes about 10 days. During this process, the mother-to-be is checked several times under the guidance of ultrasonography to monitor the development of the egg. If necessary, hormone levels (E2) are examined from the blood and the dose of the drugs is adjusted.
Ovum pick up (OPU); During the follow-up of egg development, on the day when it is determined that a sufficient number of eggs have matured, HCG injection (cracking injection) is given to complete the last developmental step of the eggs. The collection of eggs is scheduled for the 36th hour after this last injection of medicine. During the collection of eggs, sedative, sleep-inducing drugs can be given, or the procedure can be performed completely under anesthesia. The procedure is similar to vaginal ultrasonography performed in your egg development follow-ups. The only difference is that an injection connected to the transvaginal ultrasonography device is passed through the vagina and the fluid in the ovaries of the mother is collected and the eggs in this fluid are taken. If no egg can be reached in the follicle fluid, it is tried several times with a special solution washing method to reach the eggs that are thought to be left inside. The egg collection process takes approximately 20-30 minutes. With the sperm cells taken from the father-to-be, the fertilization process of the eggs taken from the mother-to-be is carried out on the day the eggs are collected. Following the egg collection process, the couple is discharged from the clinic after 2-3 hours of rest. After this stage, the parents-to-be are informed by the doctor and nurse about the medications to be used.
Laboratory procedures; A day after the eggs are collected, the couple is informed about how many of the eggs are fertilized normally. After this stage, the normally fertilized Embryo is monitored in the laboratory for 2 to 5 days. At the appropriate time, the highest quality ones among them are selected in a certain number of times and placed in the mother’s womb as determined by the legal framework.
After determining when this placement (transfer) process will be carried out, the parents are called by our laboratory and informed.
Embryo Transfer; Before the transfer process, the couple is informed about the number and quality of embryos to be transferred. The transfer process is no different from a very simple inspection process. No anesthesia is required. All that is required before the transfer is for the mother to drink water and fill the bladder a little. Because the transfer process is performed under ultrasonographic observation and for this, the bladder must be somewhat full. During the transfer process, an injection loaded with embryos is inserted into the uterus by passing through the vagina and cervix and the embryos are released into the uterus. If there are good quality embryos left behind after the placement process, these embryos are frozen and stored for future use with the consent of the couple.
Pregnancy test: It is desirable to take a pregnancy test 12 days after the transfer date. According to the results of the pregnancy test, the process is managed by the doctor and nurse.
What are the In Vitro Fertilization Treatment Prices?
IVF treatment is seen as a silver lining for couples who want to have a baby today. Today, it is possible for couples who cannot achieve pregnancy by natural means to have children with IVF treatment method. Both IVF centers and the state offer price policies and supports to help couples who want to have children. Couples whose conditions are suitable for this procedure can benefit from a discount on both IVF and medications at a certain rate.
IVF costs are a subject that is generally wondered and researched. Personalized treatment plans are determined by the evaluation of the patient by the doctor at the first examination. For this reason, it is not possible to make an exact pricing before the program.
You can contact the number below to reach our clinic in Ankara and get detailed information about the treatment fees.