Private Approaches

Private Approaches

You can think of it as an incubator that records the first photos and videos of your future baby at the beginning of their biological life. This pioneering technique allows embryos to be screened for cell division in real time. It captures moments from the beginning of life and tells us what is the ideal time for the embryo to be transferred.

What are the advantages of embryoscope as per the conventional incubators?

• It allows us to see exactly when cell divisions occur, improving our embryo selection criteria. Our knowledge of this technology has increased our knowledge of optimal cell division times in embryos with higher adherence potential.

• Provides morphological observation without having to remove the embryo from the incubator for observation. Thus, temperature, gas and pH variables in the culture condition remain stable and the environment of the embryo is improved. The development of the embryo without external stress is better, which is reflected in pregnancy rates.

• Images and videos provide parents with more information about their future babies

In which situations should an embryoscopy be used?

Embryoscope can be used in any type of patient who is applying for IVF treatment. It may be preferred to increase the chance of pregnancy in terms of providing superior embryo selection criteria, especially in patients with multiple embryos.

What is the effect of embryoscopy on results?

This technology improves pregnancy rates by ensuring good embryo development, as there is no need to remove the embryo from the incubator for evaluation. In embryo development, uterine retention rate increased significantly with the selection of embryos that fit the models developed for specific division times.

The optimal times for cell division can be easily controlled. In cases where this technology can be used, pregnancy rates can be increased by getting a better choice.

Pregnancy may not occur even though good quality embryos are obtained and transferred in IVF treatments. One of the reasons is that the membrane surrounding the embryo does not tear and the embryo cannot hold onto the uterus. For this purpose, we apply membrane thinning or completely opening method to embryos on the 2, 3 and 4 days before transfer. The process can be carried out in 3 different ways: mechanical, acid solution and laser. We prefer laser method because it is easy to apply and takes less time.

Today, the age of having children is increasing upwards due to socio-cultural reasons. As the age progresses, the number and quality decrease, so the chance of conception decreases and the risk of miscarriage increases. Even in this case, the chance of pregnancy decreases even with IVF treatments. For this reason, new scientific attempts and experiments have been started to renew the ovarian tissue recently and it has been aimed to obtain better quality ovos and get successful results in advanced ages.

PRP (Platelet-rich plasma) is a completely natural blood product containing platelet and high concentration growth factors obtained from the patient's own blood. These factors play an important role in the regeneration, healing and vascularization of the cells. Therefore, it is used for increasing the reduced ovarian reserve. For PRP, 150 mL of blood is first drawn from the patient and PRP is prepared in the laboratory, then under general anesthesia, this fluid is injected into the patient's ovaries under ultrasound or laparoscopy. Then, monthly AMH, FSH, E2 levels can be examined and evidence of ovarian renewal can be sought. If AMH rises, FSH and E2 decrease, you may have the benefit of PRP.

Since this process has just started in the world, there is not much data about the success of the process. Studies showed the presence of stem cells in the ovaries. Growth factors within PRP are thought to have a chance to activate these stem cells. There are publications claiming pregnancy in women who have never had menstruation.

As a result, ovarian rejuvenation with PRP may be an option for patients with low chance of success, depletion of ovo reserves, advanced age, who have tried several times before but could not develop ovos.

The eggs developed in standard IVF treatment are collected, mature eggs are fertilized with sperm, then the developing embryos are placed in the uterus on the 3rd or 5th day and this is called fresh embryo transfer.

During this treatment, many ovos develop with ovo stimulating injections and E2 hormone levels in the blood reach very high values. This hormone provides the development of the inner layer of the uterus called the endometrium and thus the embryos can settle into the uterus. However, it has been claimed that high levels of hormone levels in the standard IVF treatment may have an adverse effect on the endometrium which is the inner layer of the uterus and decrease the success of pregnancy. Therefore, it is thought that the chance of pregnancy can be increased by transferring frozen embryos after waiting about 2 months and instead of transferring the good quality embryos which are developed for normalization of the effects of the drugs from the body, the ovaries and these high hormone levels return to normal. This is called Frozen Embryo Transfer (FET). In our clinic, we apply this method especially in our young patients with many ovos. One of the main advantages of this method is that there is no side effect called OHSS due to overstimulation of the ovaries. While OHSS was one of the most feared and extremely severe complications of IVF treatments, it is no longer seen with uterine resting method.

For the last 5 years, we have been evaluating each patient separately and we have been trying to determine which method our patient can get better according to the developments and apply that method. In this method, ovo and embryo development, patient age, uterine internal development according to criteria such as the individual test is one of the methods we recommend to our patients.

This method is also applied to patients receiving cancer treatment before chemotherapy or radiotherapy. Again, preimplantation is applied in Genetically Tested IVF Therapies where genetic diagnosis is applied and the best quality embryos are kept frozen until the genetic test results are obtained.

It has been suggested that there may be problems in the immune system as one of the causes of failure in IVF treatments. It has been claimed that the density of the Natural Killer Cells described in the CD56 test may cause failure in the uterus and may hinder the attachment of your embryo to the mother's uterus. Although there is no gold standard, ie evidence-based treatment, intralipid treatment consisting of soybean oil, egg yolk, glycerin and water has been reported to be successful.

The scheme of this treatment, which is also possible for you, is as follows: The first intralipid infusion is performed one week prior to the ovo collection or embryo transfer procedure and on the day of the procedure. If positive, third intralipid infusion is performed after the pregnancy test. 2-3 weeks after the third infusion, infusion is continued every 2-3 weeks until the maximum 12th week of pregnancy. The infusion will be given to you by intravenous route. In the event of a possible intolerance or allergy development, the procedure is terminated rapidly. The resources related to the latest current studies about the process are added below.

There is a certain day interval for the embryo to hold on to the uterus and this is called a settling window. In other words, the embryo cannot settle in the uterus any day, the inner membrane of the uterus called the endometrium must be in a certain day and maturity. If we cannot transfer the embryo to the uterus on the appropriate day, pregnancy will not occur. For this purpose, ERA test is used to determine which day is suitable for transfer in patients with previous failed IVF trials. This test is determined by examining a small piece taken from the uterus 7 days after ovulation cracking hormone elevation and 5 days after ovulation. By looking at 248 genes in the cervical membrane part taken with ERA test, the ideal day for the settlement window is determined. In the next month, embryo transfer is planned in such a way that the pregnancy chance is tried to be increased. Personal embryo settling day is determined. Intrauterine biopsy can be performed under examination conditions or under general anesthesia or mild sedation.

IMSI (Intracytoplasmic Morphologically Selected Sperm Injection), which is one of the developments in the field of assisted reproduction techniques, is the method of using sperm in microinjection which is found to have normal structure with high microscopic magnification. In classical laboratory applications, sperm can be examined morphologically by magnifying 200-400 times in microinjection process. This level of amplification allows a very limited examination of the morphological defects in sperm. Although sperm cells can be examined by staining with special dyes in spermiogram tests, sperm with normal morphology cannot be used during fertilization as they lose their viability during the staining process.

However, in IMSI method, sperm can be enlarged up to 8000 times using high magnification lenses and those with normal morphology can easily be selected. Numerous publications have shown that defects in sperm, particularly the head region, may be associated with defects in DNA structure. Damages in DNA are known to cause low fertilization rate, slow and/or poor embryo development. It is preferable to detect many structural problems carried by sperm by IMSI method, for better quality embryo development and pregnancy rate increase compared to conventional ICSI.

For which patients is the IMSI application suitable?

• In patients with severely impaired sperm count and quality

• In patients with recurrent failed IVF trials

• In patients with recurrent miscarriage

• In patients fail in pregnancy despite adequate quality and number of eggs

• In inffertility cases of unknown cause

• In patients with low fertilization, slow and/or poor embryo development

In addition, it can be used in these patients to provide a more comprehensive understanding of the effect of sperm on the embryo and to obtain more embryos with good quality blastocysts.

Conventional sperm preparation methods for in vitro fertilization are based on centrifugation and flotation. The prepared sperm sample is examined under a microscope and morphologically uniformly shaped sperm are selected and combined with the ovo cell. Centrifugation during preparation can cause ROS (reactive oxygen derivatives) in sperm cells and cause DNA damage. In the microchip technology developed, sperms are floated in micro channels similar to the progression in the uterus, uterine canal and vagina as if they were in the natural environment without being centrifuged. The sperm sample is loaded with a pipette into the top channel entrance and healthy, DNA-free, mobile sperm moving along the channel try to cross the channel as if they would reach the ovo. Poor quality motile sperm with DNA damage and low mobility are eliminated in this race. Healthy sperm collected in the pool at the end of the canal are collected and used for microinjection. It is possible to increase embryo development rates on the 5th day with the sperm obtained in this way.

For which patients is the microchip method suitable?

  • In patients receiving IUI (fertilization) treatment
  • Infertile patients with high sperm DNA fragmentation
  • In patients with recurrent miscarriage of unknown cause
  • Although it is a good quality oocyte, it is a technology that can be easily used in patients who develop weak embryos and who have at least one failed experiment.

Uterine wall thickness during IVF treatment is an important clinical sign that determines the chances of the embryo to adhere to the uterine wall. The thin uterine wall is usually determined as 7mm below the uterine wall by transvaginal ultrasonography, which reduces the chance of pregnancy. There are studies suggesting that white blood cell (leukocyte) growth factor (G-CSF granulocyte colony stimulating factor - Filgrastim) treatment is applied as an infusion into the uterus using fertilization catheter in patients who do not thicken the uterine wall despite routine estrogen treatment.

Although there is no gold standard in this regard, that is evidence-based treatment, successful results have been reported with this treatment.

Administration Type

In the case of fresh embryo transfer, 300 µcq (0.5 ml) granulocyte colony stimulating factor (Filgrastim) is infused into the uterus on the day of hcg (ovo fracture injection). Your treatment will then be resumed without any change in your IVF treatment protocol.

In Frozen Embryo Transfer trials, when you come to control on 2nd day of your menstruation, the thickness of the uterine wall, cysts in your ovaries are checked and if your doctor deems necessary, after evaluating your serum estrogen value, you will use the drug treatment given to you after evaluating your estrogen value, and then use it in the manner and time that your doctor recommends. Filgrastim infused - granulocyte colony stimulating factor of 300µcq (0.5 ml) with the help of injection catheter. Then, treating your uterus wall for embryo transfer continues in the way your doctor sees appropriate.

In the presence of adhesions polyps, fibroids or other possible pathologies within the uterus, first of all treatments are applied to eliminate the problems that may prevent the implantation.

In patients with recurrent miscarriages, or in patients with recurrent IVF failure (implantation failure) as appropriate, the systemic (subcutaneous injection) may be administered in addition to intrauterine administration, if your doctor considers it appropriate.

Recent studies have shown that the inside of the uterus is not completely free of microbes and has a unique structure called microbiome. Useful microbes can be found there as well as microbes that can cause inflammation in the uterus, causing pregnancy to occur and in vitro fertilization to fail. Here, Emma and Alice tests are used to help us understand the diversity of germs in the uterus and to regulate the treatment accordingly and make the uterus suitable for the placement of the baby. With the Emma test we can determine the density of beneficial bacteria called Lactobacillus. If there is an abnormality, it is tried to increase the chance of pregnancy by arranging the necessary support treatment before embryo transfer. In the same way, it is possible to detect harmful bacteria in the uterus with the Alice test, and thus the embryo transfer can be performed in a healthier environment by pre-transfer treatment. These tests are performed with the biopsy sample taken from the uterus as in the ERA test. In fact, Emma and Alice test together with the same piece of ERA test by performing both the gene and germ structure of the uterus by examining the whole map can be extracted and tried to achieve the most successful results. Test in which all three tests are performed is called ENDOMETRIO.

Natural Killer Cells, which are part of the immune system, have been found to adversely affect pregnancy formation when elevated levels are present in the uterus.

The CD56 test is a test that allows us to understand the amount of killer cells in the uterus called the endometrium. It has been recommended for in vitro fertilization patients who have not been pregnant despite very good quality embryo transfer.

CD56 test is performed by pathological examination of a small biopsy specimen taken from the uterus on 21-24 days of menstruation. If the pathologist can determine the density of these cells by special staining techniques, it is claimed that the chance of pregnancy can be increased with appropriate treatments.

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