In Vitro Fertilization (IVF) Treatment

Who needs fertility treatment: Symptoms & Causes

Doctors use to say that the main symptom of infertility is not getting pregnant while having regular sexual intercourse for at least 12 months. In most cases, there would be no other visible symptoms. It is recommended to see a doctor when a couple has been regularly trying to conceive a baby for at least one year, in case that the female partner is below 35 years of age; after 6 months if the woman is aged 35 or older, and immediately after 40.

According to general numbers, nearly 40% of all infertility causes are women related, 40% are men related and 20% are the so called ‘unexplained infertility’. What stays behind those numbers is vitally important, as the primary cause defines the treatment and determines its successful outcomes. An extensive testing and evaluation process is applied in ACIBADEM to accurately identify reproductive problems and to devise appropriate solutions. Blocked fallopian tubes, ovulation problem, endometriosis, advanced maternal age, low number of sperm count or motility or sperm, immunology factors can all cause fertility issues, and each of them requires a different treatment modality.

It is estimated that nearly 15% of all couples are affected by infertility. Fortunately, we have many tools today to aid conception, and they are evolving with time to help us achieve better outcomes.

Fertility treatments: IUI vs. IVF

Intrauterine insemination (IUI) and In Vitro Fertilization (IVF) are the two major fertility treatments used to achieve pregnancy. IUI is closer to the natural conception: sperm from the male partner is processed in our lab and inserted directly into the woman’s uterus during ovulation. This type of assisted reproduction technology (ART) ensures high concentrations of good quality sperm deposited close to the egg. It is supposed to increase the chance of conception in couples that are younger in age, with mild male factor or some cases of unexplained infertility.

IVF, on the other hand, is the process of fertilization outside of the body, in embryology laboratory. Depending on the primary cause for infertility, some additional techniques may be used with the IVF procedure. They may include but are not limited to:

• Microinjection (ICSI) – a sperm cell is injected directly into the egg, using a special microscope;
• Piezo ICSI – a new method for insemination of fragile oocytes;
• Micro-chip – allows selection of sperms with the highest fertilization potential;
• PESA/MESA/TESE/ Micro-TESE – surgical retrieval of sperm from the testicles;
• Round Spermatid Injection (ROSI) – activates sperm cells with electrical stimulation, used for azoospermia patients;
• Micromanipulation methods (assisted hatching, watching embryos through fragments);
• Endometrial co-culture – used to improve the quality and implantation of embryos;
• Endometrial Receptivity Array (ERA) – diagnoses the state of endometrial receptivity in the window of implantation;
• Pre-implantation genetic diagnosis (PGD) – allows to check the chromosomes(genetic material) of the embryos for abnormalities;
• Cryopreservation (freezing) of sperm, oocytes and embryos – allows their safe storage for future use;
• Ovarian rejuvenation with PRP – applied toincrease the ovarian capacity and reserve to help the IVF treatment, etc.

Fertility innovations: We contribute to research and science

Along with all effective fertility treatments available worldwide, ACIBADEM Reproductive Medicine & Infertility Centers apply some pioneering methods with promising results. Just to name a few of them:

• Stem cell therapies and PRP (Platelet rich plasma): While the age of becoming a mother advances, the fertility potential of a woman begins to decrease very rapidly after the age of 35. Though it is not possible to turn the clock back for the mother, stem cell therapies and PRP practices can be used to regenerate and reactivate body functions. PRP application can be used in IVF treatment for two purposes: to improve the endometrium (the inner surface of the womb) and increase the chance of a successful implantation, or to increase the ovarian capacity in women with low ovarian reserve or even early menopause. At ACIBADEM, PRP therapy is applied according to specially designed protocols, ensuring promising results that are already reported internationally as scientific research. Increasing success in spontaneous conception and better quality of oocytes ate observed in a majority of patients.
• Immunological infertility treatment: Recurrent implantation failures or miscarriages in couples with good quality embryos can sometimes be referred to the immune response of the woman’s body. Human body is naturally designed to act against foreign antigens, and in rare cases it could wrongly recognize the embryo as an enemy and reject it. At ACIBADEM, trials on immune suppression are being conducted with positive outcomes.

Infertility surgery: Who is a candidate?

For some infertility patients, surgery can help to correct abnormalities that impede the conception. Blocked fallopian tubes, endometriosis, adhesions, myomas and abnormalities of the uterus are a few examples of conditions that might require surgical treatment. Nowadays, laparoscopic techniques and robot-assisted surgeries make operations safer than ever. With proper treatment, affected patients might even be able to conceive naturally, without assisted reproduction and IVF procedures. At ACIBADEM, infertility surgery is performed with minimally invasive techniques to ensure fast recovery.

Q: What tests should I do before the IVF procedure?

A: Before your first consultation with our IVF specialist, you may be asked to provide results of some general blood tests. You will receive a detailed list and explanation prior to your first appointment. Specific tests may be required by your doctor after taking your medical records, depending on your case.

Q: What should I expect at my first appointment?

A: Each experience is unique. However, a typical first appointment at Acıbadem might look something like this: First, you will be greeted at the front desk, then escorted to the physician’s office where you will speak with the physician for about an hour. Next, you will meet a nurse who will help you implement the doctor’s orders. Acıbadem International Patient Center will plan your every step, elaborately. You will receive a lot of information. Feel free to take notes and ask questions during your consult. We welcome you to call or email us if you have any questions or concerns at any time.

Q: How long time does the IVF process take?

A: An average IVF cycle usually takes 15-25 days:

Stage 1. Cycle Begins: 1 Day;

Stage 2. Ovarian or Follicle Stimulation: 8-12 Days;

Stage 3. Egg Retrieval: 1 Day;

Stage 4. Embryo Development: 3-5 Days;

Stage 5. Embryo transfer.

Q: How is IVF done?

A: An IVF procedure involves five main stages. First, we boost your egg supply. Women undergo injection which stimulates the ovaries to produce more eggs than the usual natural cycle. The second stage is to monitor your progress and mature the oocytes. An ultrasound scan is carried out to check the development of eggs and medication is used to help them mature. Once the follicles reach a mature size of 17 or 18 mm, an HCG injection is administered which leads to final development and maturation of the eggs. The third stage is to collect the eggs from the ovaries. This procedure is done by ultrasound guidance, where the doctor utilizes a narrow needle to retrieve eggs from the ovary through the vaginal wall. The procedure is painless, performed under mild anaesthesia. The fourth step is fertilizing the eggs in the lab. The sperm can either be mixed with eggs to fertilize (that is named conventional insemination – standard IVF procedure), or one selected sperm cell can be injected directly into each mature egg (this is called Intracytoplasmic Sperm Injection or ICSI). The fertilized eggs, now called embryos, are allowed to grow and develop in culture media for typically 3 or 5 days. When they reach 5 days, they are called blastocyst stage embryo. Then generally 1 or 2 embryos, which have demonstrated the best quality and development, are carefully transferred to the uterus. A small, sterile, flexible catheter for embryo transfer is used for this purpose. That is the most important stage of an IVF procedure. Once the embryos have been transferred into your womb, you need to wait for 2 weeks before taking a pregnancy test to see if the treatment has worked or not.

Q: After the embryo transfer, can I walk, exercise, travel or go back to work immediately?

A: Moderate activities are not forbidden after the embryo transfer, and yet you would better rest and take it easy for a couple of days. During the weeks to come, you’d better walk than run, and you should avoid anything related to heavy lifting or jumping. Travel and work are allowed, as long as you don’t climb Mount Everest.

Q: Is there anything else I can do to increase my chances of success?

A: Your physical and emotional health is crucial during an IVF procedure. A healthy and comfortable lifestyle will certainly contribute to successful outcomes. Smoking is strictly forbidden. In addition, balanced food diet with reduced intake of carbohydrates is recommended. Eating foods rich in antioxidants is useful. Antioxidants are found in most of the plant foods but some of the richest sources are blackberries, blueberries, strawberries, pomegranate, green tea, red cabbage, spinach, legumes (peas, beans, etc.), nuts, seeds and spices.

Q: Will IVF significantly increase my chances of having twins or triplets?

A: Generally, anytime when more than one embryo is transferred, the chance for a multiple pregnancy exists. At Acibadem, we prefer single embryo transfer to avoid risks of complications and ensure a healthy pregnancy. Transfer of two embryos might be used, depending on many prognostic factors, including the patient’s age, quality of embryos, etc. It is also possible to have twins after IVF even with one embryo, as one egg can split to form two zygotes. Your physician will discuss all your preferences with you prior to the IVF procedure.

Q: Are there any side effects associated with IVF?

A: We all respond differently and there is no chance to predict your body reactions. Fatigue, emotional stress and mood swings are among the most common complaints during an IVF procedure. In a limited number of patients, ovarian hyperstimulation syndrome (OHSS) may be observed. Usually, it comes with mild symptoms, such as loss of appetite, nausea, diarrhea and feeling bloated. If you experience such symptoms, you should notify your doctor immediately. OHSS needs to be handled correctly, as in rare cases it might bring serious complications. However, with modern treatment options, the risk is now less than 1%.

Q: How many days should I have to stay in Turkey for the treatment?

A: While the entire IVF procedure takes up to four weeks, we will need to see you at your first appointment, and afterward you will have to visit your doctor regularly for an average of 1 week to 16 days prior to the embryo transfer. Our International Patients Team will support you with all necessary arrangements and logistics to ensure your safe and comfortable stay.

Q: Does my male partner have to stay with me in Turkey all the time?

A: We need to see your partner during the first consultation, when your doctor will schedule tests and regimen for both of you, according to your specific case, to ensure a comprehensive fertility evaluation. His presence may be needed later depending on planned tests and procedures. Beyond these circumstances, your partner is always welcome but you are free to decide on his presence depending on your comfort, preferences and availability.

Q: What are my chances of a successful pregnancy with IVF?

A: The IVF success rates depends on various factors, including your medical history, test results, the age of the female partner and the infertility cause. The share of IVF treatments that result in live births is around 60% under 35 years of age. It drops to 20-25% between 40-42. You can discuss your options in detail with your doctor.

Q: Why my IVF cycle failed?

A: Unfortunately some IVF efforts do fail. It might be due to the quality of the embryos, implantation problems, immunity problems, etc. Analysing the core reason for failure will help you to draft next steps. You are welcome to discuss with our fertility doctors your previous IVF attempts and what can be improved for successful results.

Q: If I am not pregnant, when can we try again?

A: We usually recommend at least two months between two IVF treatment cycles. Please consult your doctor for specific recommendations regarding your case.

Q: What happens if I get a positive pregnancy test after IVF?

A: After fertility treatment, you can perform an HCG level test 2 weeks after the embryo transfer. A second one follows 48 hours later. Heartbeat can usually be detected 6 weeks after gestation. If you have reached that far, relax and let nature take its course. You will have to inform your obstetrician that this is an IVF conception, as you will be monitored more intensively than a patient who conceived naturally. We wish you a happy and healthy pregnancy!