Information on IVF in English

Information on IVF in English

What Is IVF (Test Tube Baby) Treatment?

IVF treatment encompasses the treatment process which involves the fertilisation of the ovaries, the female reproductive cells, and of the sperms, the male reproductive cells, in a laboratory environment outside of the body. As the fertilised eggs start to divide, they live out their initial developmental stage in the laboratory environment, and, once they become embryos, they get implanted in the uterus of the mother-to-be.

Once this stage is complete, the pregnancy is no different from a naturally occurring one. The only difference form a natural pregnancy is that the fertilisation process has taken place under laboratory conditions and the fertilised eggs have later been placed back in the mother's uterus.

Fertilisation procedure in the laboratory environment takes place through two different methods: One method is to place the sperms beside the eggs and wait for them to penetrate the eggs and thereby achieve fertilisation by themselves (the classical IVF), a second method is to place the sperm under a microscope and directly inject it into the egg with the help of a pipette (microinjection).

IVF specialists base their method of choice on the characteristics of the couple. The objective is to maximise the couple's chances for success.

Who Needs IVF (Test Tube Baby) Treatment?

1. IVF should be considered in cases where the fallopian tubes of the female (popularly known as the ovarian tubes) are obstructed, have sustained serious damage or have been surgically removed. For natural pregnancy to occur, the ovarian tubes of the female should be open and functioning normally.

2. IVF treatment may also be considered in cases where there are attachments around the reproductive organs of the female which will prevent the eggs developing in the ovaries from being caught by the fallopian tubes. These intraabdominal attachments may either be due to previous operations (for instance, an ovarian cyst operation, myoma removal, ectopic pregnancy operation etc.) or to diagnosed or non-diagnosed inflammatory conditions of the female internal genital system. In such cases, as the first stage of treatment, these attachments may be freed through laparoscopic (closed) surgery in order to achieve a normal tube-ovary relationship. If this cannot be achieved, or natural pregnancy does not occur within a certain period of time following successful intervention, then IVF treatment may become the treatment of choice.

IVF (Test Tube Baby) Treatment

If possible, the first interview prior to starting treatment should take place within the first few days of your period, because some laboratory tests have to be performed during the first several days of your period.

When coming to the interview, you should bring;

On your first visit, a gynaecological examination and transvaginal ultrasonography will be performed. The uterus, tubes and the ovaries will be evaluated, and, if needed, a simulation of embryo transfer procedure will be carried out. This is the final stage of in vitro fertilisation and this simulation allows for the detection of potential future problems that may be encountered during an actual in vitro fertilisation.

During the first assessment, both the woman and the man will be screened for certain infections:

The following hormone tests may be requested from the woman:

In the meantime, in the absence of a previous test and the presence of a need for a final assessment, a sperm analysis may be requested from the man.

What are the Stages of In Vitro Fertilisation?

1. First stage: Education

The first step of the treatment consists of the education provided by the test tube baby coordinator.

At this stage, information is provided regarding the procedures, treatment plan and how the treatment plan is going to work. Instructions are given on how to self-medicate and the required informed consent forms are signed.

2. Second stage: The Suppression of the Ovaries

The basis of test tube baby treatment consists of the full suppression of the female ovaries. GnRH agonists or GnRH antagonists are used for this purpose. The physician in charge of your treatment will be deciding on which one of these two medications is best for you.

These medications will prevent you from ovulating before the right time. These medications are either nasal sprays or subcutaneous injections.

You will be educated on how to self-administer these medications.

3. Third stage: The stimulation of the eggs and the monitoring of egg development

The success of in vitro fertilisation treatment depends on the production of a multitude of eggs in the female ovaries. For this purpose, the ovaries which have been suppressed with the above-mentioned medications get stimulated with medications which stimulate egg development. These medications are injected subcutaneously or intramuscularly. It takes approximately 10 days for your ovaries to be stimulated through these medications. You have to be checked out a couple of times throughout this process for the monitoring of your egg development. During those checks, ultrasonography will be performed, and, if deemed necessary, the hormone levels in your blood will be checked to readjust the dosage of your medications.

4. Fourth stage: Egg collection

During the monitoring of egg development, on the day it is determined that a sufficient number of eggs have matured, hCG (human chorionic gonadotropin) injection is carried out in order for the eggs to complete their final step of maturation. The collection of the eggs is scheduled for the 36th hour following this final medication injection. You may be given a sedative or a medication to make you drowsy during egg collection. Alternatively, the entire procedure may be performed under full anaesthesia. The procedure is similar to the vaginal ultrasonography performed during your egg development follow-ups. The only difference is the needle connected to the vaginal ultrasonography device which is inserted through the vagina to collect the eggs inside your ovaries. The procedure lasts for an average of 30 minutes.

Fertilisation with sperm cells takes place on the same day that the eggs are collected.

5. Fifth stage: Laboratory procedures

One day after the egg collection, the couple is informed about the number of eggs fertilised normally. Following this stage, the normally fertilised eggs are monitored under laboratory conditions for 2 to 5 days. When the time is right, the most superior quality ones among them are carefully selected in certain numbers and placed back in the mother's uterus. The couple gets informed on the timing of this implantation procedure.

6. Sixth stage: Embryo transfer

Prior to transfer procedure, the couple is informed on the number and the quality of the embryos to be transferred. Transfer procedure is no different than a simple examination procedure. No anaesthesia is required. The only requirement before the procedure is for the mother to drink a lot of water in order to fill up the bladder. The transfer procedure is performed under ultrasonographic observation which requires the bladder to be partially full. During transfer procedure, a catheter loaded with embryos is passed through the vagina and the cervix and placed inside the uterus, and the embryos are released inside the uterus. If there remains any superior quality embryo or embryos following the transfer, consent is obtained from the couple to freeze and keep those embryos for future use.

Following the transfer, the couple is kept in the hospital for rest for 2 hours and later sent home. The woman is advised to spend the day resting. In order to support the pregnancy, she may be started on progesterone, oestrogen and/or hCG supplements once the eggs have been collected and the embryos have been transferred.

The result of the treatment may be found out with the help of a pregnancy test 10 to 14 days after the transfer. If the result is positive, an ultrasonography appointment is made to observe the heart rate of the baby within 3 weeks.

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