Turkey is a leader in advanced infertility treatments, which include egg cryopreservation (freezing), fertility preservation, and treatment of uterine fibroids.
The Magie Care team works to bring you the latest fertility treatments to give you the best options and minimize unnecessary exams.
Magie Care offers an integrated approach to the diagnosis and treatment of fertility-related disorders. In addition, our center provides you with the most advanced technologies.
Your visit to Turkey and exactly Magie Care Center can include an assessment of your condition by the most qualified doctors, a diagnostic examination of the cause of your infertility and help in finding the right treatment plan for you. Our team works with you so you can get pregnant through medication, surgery or in vitro fertilization (IVF).
Definition of in vitro fertilization
IVF is a complex series of procedures used to facilitate fertilization, prevent genetic problems and facilitate pregnancy.
During IVF, completed eggs are collected (retrieved) from the ovaries and fertilized by sperm in a laboratory. The fertilized egg (embryo) or eggs (embryos) are then transferred to the uterus. A full cycle of IVF takes about three weeks. Sometimes these steps are split into different parts and the process may take longer. IVF is the most effective process.
The chances of having a healthy baby through IVF depend on many factors, such as age and the cause of infertility. Additionally, IVF can be time-consuming and expensive. If more than one embryo is implanted in the uterus, IVF may result in more than one embryo in the same pregnancy (twin pregnancy).
Reasons for in vitro fertilization
In vitro fertilization is a treatment for infertility or genetic problems. Magie Care allows you to try less invasive treatment options before attempting IVF, including taking fertility drugs to increase egg production or intrauterine insemination, a procedure in which sperm are inserted directly into the uterus at the time of ovulation.
Sometimes IVF is suggested as the main treatment for infertility in women over 40. IVF can also be performed if you have certain health conditions. For example, IVF may be an appropriate option if you or your partner have:
- Poor sperm production or malfunction: Low sperm concentration, low motility, or abnormal size and shape can make it difficult for sperm to fertilize an egg.
- Unexplained infertility: Unexplained infertility means that there is no cause for infertility despite an evaluation.
- Genetic disorder: If either of you is at risk of passing on a genetic disorder to your child, you may be a candidate for preimplantation genetic testing, a procedure that involves in vitro fertilization. After the eggs are collected and fertilized, they are checked for certain genetic issues, although not all genetic issues can be found. Embryos without specific problems can be transferred to the uterus.
- Preserving fertility in people with cancer or other health problems: if you are about to start cancer treatment; such as radiation therapy or chemotherapy; Which can harm your fertility, in vitro fertilization may be an option to preserve fertility. A woman’s eggs can be taken from her ovaries and frozen in an unfertilized state for later use. Or the eggs can be fertilized and frozen as embryos for future use.
- Fallopian tube damage or blockage: Fallopian tube damage or blockage makes it difficult for an egg to fertilize and for the fetus to travel to the uterus.
- Ovulation Disorders: If ovulation is rare or does not occur, fewer eggs are available for fertilization.
- Endometriosis: Endometriosis occurs when tissues similar to the lining of the uterus implant and grow outside the uterus, often affecting the function of the ovaries, uterus, and fallopian tubes.
- Uterine fibroids: Fibroids are benign tumors that grow inside the uterus. It is common in women in their 30s and 40s. Fibroids can affect implantation of a fertilized egg.
- Tubal sterilization or excision: Tubal ligation is a type of sterilization technique in which the fallopian tubes are cut or blocked to permanently prevent pregnancy. If you want to get pregnant after tubal ligation, IVF may be an alternative to tubal ligation reversal surgery.
Preparation for in vitro fertilization
The success rate of in vitro fertilization depends on several factors, the most important of which are the age of the patients and the medical problems, in addition to the group of people involved in the treatment and the treatment methods.
Before starting an IVF cycle using eggs and sperm, you and your partner will likely need a variety of tests, including:
- Ovarian stock test: To determine the quantity and quality of your eggs, your doctor may test the concentration of follicle-stimulating hormone (FSH), estradiol (estrogen), and anti-Mullerian hormone in your blood during first days of your menstrual cycle. . The test results, often used with an ultrasound of the ovaries, can help predict how the ovaries will react to fertility drugs.
- Semen analysis: If not done as part of the initial fertility evaluation, your doctor will analyze your semen shortly before your IVF treatment cycle begins.
- Screening for infectious diseases: You and your spouse (or husband) will be screened for contagious diseases, including HIV.
- Embryo transfer trial (simulation): Your doctor may perform a sham embryo transfer to determine the depth of the uterine cavity and the most likely method for successfully placing the embryos in the uterus.
- Hysteroscopy: Your doctor will examine the inner lining of the uterus before starting the IVF process. This may involve sonohysterography; where fluid is injected through the cervix; and ultrasound to create images of the uterine cavity. or it may involve hysteroscopy; where a thin, flexible, lighted endoscope (hysteroscope) is inserted; Through the vagina and the cervix.
Before starting an IVF cycle, consider the following important questions:
- Number of embryos to transfer: The number of embryos transferred generally depends on their age and the number of eggs produced.
- Extra embryos: Extra embryos can be frozen and stored for future use for several years. Although some embryos die from the process of freezing and thawing, most will survive. Embryo freezing can make future IVF cycles less expensive and less invasive. You can also choose to dispose of unused embryos.
- Multiple pregnancy: If more than one embryo is transferred to the uterus, IVF can result in multiple pregnancy. This poses health risks to you and your unborn baby.
Stages of in vitro fertilization
In vitro fertilization involves several steps: ovarian stimulation, egg retrieval, sperm extraction, fertilization and embryo transfer. An IVF cycle can take about two to three weeks. More than one course may be required.
Ovulatory stimulation :
An in vitro fertilization cycle begins with the use of synthetic hormones to stimulate the ovaries to produce multiple eggs, rather than just one egg that normally forms each month. The production of these multiple eggs is necessary because some eggs will not be fertilized or develop normally after fertilization.
Several different drugs can be used, such as:
- Ovarian stimulation drugs: To stimulate the ovaries, you may be given an injection drug containing follicle-stimulating hormone (FSH), luteinizing hormone (LH), or a combination of the two. These drugs stimulate the production of more than one egg at the same time.
- Oocyte maturation drugs: when the follicles are ready to be extracted; It’s usually 8-14 days later; You will take human chorionic gonadotropin (HCG) or other medications to help the egg mature.
- Medicines for premature ovulation: These medicines prevent your body from releasing prematurely developing eggs.
- Medications for endometrial preparation: On the day of egg retrieval or at the time of embryo transfer, your doctor may recommend that you start taking progesterone supplements to make the endometrium more receptive to implantation.
Your doctor will work with you to decide which medications to use and when to use them. Typically, you will need a week or two of ovarian stimulation before the eggs are ready for retrieval. To determine when your eggs are ready for collection, you can go through the following steps:
- Transvaginal ultrasound: an imaging test of the ovaries to monitor the development of follicles (fluid-filled ovarian sacs where eggs mature).
- blood tests: to measure response to ovarian stimulation drugs; Estrogen levels generally increase as follicles grow, and progesterone levels remain low even after ovulation.
Sometimes IVF cycles before egg retrieval can be canceled for one of the following reasons:
- Insufficient number of developing follicles
- premature ovulation
- Too many follicles to grow, creating risk of ovarian hyperstimulation syndrome
- Other medical issues
If your cycle is canceled, your doctor may recommend changing the medications or their doses to improve response in future IVF cycles.
Egg retrieval :
- The egg retrieval procedure can be done 34 to 36 hours after the last injection and before ovulation.
- During egg retrieval, you will be given a sedative and painkiller.
- Transvaginal ultrasound aspiration is the usual recovery method.
- An ultrasound probe is inserted into the vagina to identify calcified follicles.
- A thin needle is then inserted through the ultrasound guide to pass through the vagina and into the calcified follicles to retrieve the eggs.
- If the ovaries cannot be reached with a transvaginal ultrasound, a transabdominal ultrasound can be used to guide the needle.
- The eggs are removed from the calcifying follicles using a needle attached to a suction device. Several eggs can be removed in about 20 minutes.
- After the eggs are retrieved, you may have painful cramps and feel full or pressured.
- Fertilized eggs are placed in a nutrient liquid (culture medium) and incubated. Eggs that look healthy and mature are mixed with sperm to try to make embryos. However, not all eggs can be successfully fertilized.
Sperm extraction :
A semen sample is usually taken by masturbation. But sometimes other methods, such as aspiration of the testicle, use of a needle, or surgery to remove sperm directly from the testicle.
Fertilization can be done using two popular methods:
- Conventional Insemination: During conventional insemination, healthy sperm and mature eggs are mixed together and incubated overnight.
- Intracytoplasmic sperm injection (ICSI): In intracytoplasmic sperm injection, a healthy sperm is injected directly into each mature egg. Intracytoplasmic sperm injection is often used when there is a problem with sperm quality or number or if fertilization attempts follow failed in vitro fertilization cycles.
In some cases, your doctor may recommend other procedures before the embryo transfer:
- Assisted hatching: About 5 to 6 days after fertilization, the embryo “hatch” from the surrounding membrane (zona pellucida), allowing it to implant in the uterine lining. If you are of advanced age or have had several unsuccessful IVF attempts, your doctor may suggest assisted hatching, a technique in which the zona pellucida is punctured just before the embryo transfer to help it hatch and establish themselves. Assisted hatching is also useful for previously frozen eggs or embryos because freezing can harden the transparent area.
- Pre-implantation genetic testing: embryos are allowed to grow in the incubator until they reach a stage where a small sample can be taken and tested for certain genetic conditions or the correct number of chromosomes, usually after five to six development days. Embryos without the affected genes or chromosomes can be transferred to your uterus. Although preimplantation genetic testing can reduce the risk of passing on a genetic problem to a parent, it cannot eliminate the risk. Therefore, prenatal screening is always recommended.
Embryo transfer :
- This is usually done two to five days after egg retrieval.
- You may be given a mild sedative. The procedure is generally painless, although you may experience some mild cramping.
- Your doctor will insert a long, thin, flexible tube called a catheter through your vagina, through your cervix, and into your uterus.
- A syringe containing one or more embryos is added to a small amount of liquid at the end of the catheter.
- Using a syringe, the doctor places the fetus or fetuses in your uterus.
- If successful, one of the embryos will be implanted into the uterine lining approximately 6-10 days after egg retrieval.
After operation :
After the embryo transfer, you can resume your usual daily activities. However, your ovaries may still be enlarged. Consider avoiding vigorous activities that can cause discomfort.
These side effects include:
- Passage of a small amount of clear or bloody fluid soon after
- the operation due to the Pap smear before the embryo transfer
- Increased breast tenderness due to high estrogen levels
- Slight bloating
- Mild cramp
If you experience moderate or severe pain after the embryo transfer, contact your doctor. He or she will evaluate you for complications such as infection, ovarian torsion (ovarian torsion), and SOS.
About 12 days to two weeks after egg retrieval, your doctor will test a blood sample to find out if you are pregnant.
- If you are pregnant: Your doctor will refer you to an obstetrician or other gynecologist for pregnancy care.
- If there is no pregnancy: The progesterone will be stopped and you will probably have your period within a week. If you miss your period or have unusual bleeding, contact your doctor. If you want to try another cycle of IVF, your doctor can suggest steps you can take to improve your chances of getting pregnant through IVF.
The chances of having a healthy baby after using IVF depend on a variety of factors, including:
- Mother’s age: The younger the mother, the more likely she is to conceive and deliver a healthy baby using her own eggs during IVF. Counseling is often offered to women 41 and older.
- Fetal status: Transfer of more developed embryos is associated with higher pregnancy rates than less developed embryos (day two or three). However, not all embryos survive the development process.
- Childbearing history: Women who have already had children are more likely to become pregnant through IVF than women who have not given birth. Success rates are lower in women who have used IVF multiple times but have not become pregnant.
- Cause of Infertility: The natural source of egg production increases the chances of getting pregnant through IVF. Women with severe endometriosis are less likely to get pregnant through IVF than women with unexplained infertility.
- Lifestyle factors: Women who smoke generally have fewer eggs retrieved during IVF and may miscarry more often. Smoking a woman can reduce the chances of IVF success by 50%. Obesity can reduce the risk of pregnancy and childbearing. Excessive consumption of alcohol, caffeine and certain medications can also have harmful effects.
The risks of in vitro fertilization include:
- Premature birth and low birth weight: Research suggests that IVF increases the risk of a baby being born prematurely or having a low birth weight.
- Ovarian hyperstimulation syndrome: Using injectable fertility drugs, such as human chorionic gonadotropin (HCG), to stimulate ovulation can cause ovarian hyperstimulation syndrome, in which your ovaries swell and cause you pain.
Symptoms usually last a week and include mild abdominal pain, bloating, nausea, vomiting, and diarrhea. Symptoms may persist for several weeks, even during pregnancy. In rare cases, a more severe case of ovarian hyperstimulation syndrome is possible, which can also cause rapid weight gain and shortness of breath.
- Spontaneous abortion: The rate of spontaneous abortion in women who deliver their first fetus through in vitro fertilization is equal to that of women who conceive naturally, and this rate varies from 15% to 25%, but increases with age from the mother.
- Complications of the egg retrieval process: Retrieving eggs using an aspiration needle can cause bleeding, infection, or damage to the intestines, bladder, or blood vessels. Risks are also associated with painkillers and general anesthesia, if needed.
- Ectopic Pregnancy: The incidence of ectopic pregnancy in women who conceive through in vitro fertilization ranges from 2% to 5%, when the fertilized egg implants outside of the uterus, usually in the fallopian tube. A fertilized egg cannot survive outside the uterus, making full-term pregnancy unlikely.
- Birth defects: The mother’s age is the main risk factor for birth defects, regardless of how the child is conceived.
- Stress: Using IVF can be financially, physically, and emotionally draining. So, the support of counselors, family, and friends can help you and your partner through the ups and downs of infertility treatment.