What is IVF?
In vitro fertilization is a form of treatment applied to couples who cannot become pregnant with classical methods. It is based on the principle of transferring the embryos, which are formed as a result of combining male (sperm) and female (egg) progeny cells under laboratory conditions, to the uterus.
Fertilization performed under laboratory conditions is achieved spontaneously (in vitro fertilization-IVF) or by human hand, by injecting a single sperm into a single egg (microinjection-ICSI).
IVF treatments now consist of 3 basic steps that have been standardized all over the world. IVF treatment begins with stimulating the ovaries to produce a large number of egg cells. The next step is to collect these eggs and fertilize them with the sperm to form an embryo. After fertilization, the embryos are stored in incubators in the laboratory for 3-5 days until they are transferred to their mother’s uterus. A pregnancy test is done 10-12 days after the transfer.
How is IVF performed?
First consultation and examination:
At the first consultation, a careful and comprehensive history is taken, and previous tests are examined. Afterwards a gynecological examination and ultrasound are performed. If the semen analysis is normal and there is no sexual dysfunction, the man does not need to be examined. The examination of the woman is of great importance in terms of determining the chance of conceiving in vitro. In the examination, the capacity of the ovaries, the presence of any cysts in the ovaries, the structure of the uterus, the presence of fibroids or congenital abnormalities, and the presence of space-occupying formations such as fibroids or polyps in the inner layer of the uterus are evaluated. If it has not been done recently during the examination, PAP Smear test and if there is discharge, culture could be done.
Following the evaluation of the history, examination and tests, the stages of the procedure are explained in detail and realistic information is given about the pregnancy success that the couple can expect from the treatment. In the meantime, information should be given about the results of the applications made in the unit, the number of embryos to be transferred, and the implantation rates of the center (the chance of each transferred embryo to hold in the uterus). Information about the potential side effects and long-term risks (in terms of mother and baby) of the application should also be shared with the couples. Complications related to multiple pregnancies should also be clearly explained to the couples in our country, where the demand for multiple pregnancies is common.
Preparation for IVF Treatment:
Things to do in preparation for IVF treatment:
- Smoking should be stopped
- A multivitamin containing folic acid should be started.
- It is beneficial to lead a regular and stress-free life as much as possible, including night sleeps, during IVF treatment.
- There is no data that a particular diet is beneficial. Animal studies have shown that a protein-rich diet is beneficial.
- Depending on the treatment protocol to be used, 20-21 days of the period. Some drugs may need to be used to suppress the ovaries (such as Lucrin, Suprecur, Synarel, Suprefact, Decapeptyl)
In some cases, it may be necessary to use birth control pills or estrogen before treatment. - Laboratory tests that must be done before IVF treatment should be completed (such as hormones, hepatitis B and C screening, HIV, Rubella IgG, blood count, blood groups determination)
IVF steps:
1. Stimulation of the ovaries:
In all protocols used in IVF treatment, basic ultrasound examination is performed on the second or third day of menstrual bleeding, and the dose of medication to be used is decided. After the start of warning therapy, the patient is called for control at regular intervals.
In these controls, the number and size of the developing follicles are checked by performing vaginal ultrasonography. From time to time, depending on the condition of the ovaries, a blood estrogen analysis may be required.
The aim of IVF treatment is to obtain as many follicles with a diameter of 16-20 mm as possible. When the follicles reach a sufficient size, 5,000-10,000 units of human chorionic gonadotropin (hCG) are injected to ensure final maturation. Although the duration of treatment is variable, it averages 10-11 days in our clinic. Egg collection is done 32-36 hours after the trigger injection.
Another factor evaluated during ultrasound follow-ups is the structure and thickness of the layer that covers the inside of the uterus, called the endometrium. Its structure is extremely important as the embryo will settle in the endometrium when pregnancy occurs. When the endometrium is 6 mm or less on the hCG day, the chance of pregnancy decreases. In our practices at the Istanbul American Hospital IVF center, the clinical pregnancy rate in such patients is 11.8%. Having an endometrial thickness of more than 14 mm also creates a negative effect and the possibility of miscarriage increases even if pregnancy is achieved.
2. Egg Retrieval Process:
After the eggs mature, collection is done. The egg collection process (oocyte pickup-OPU) is the aspiration of fluid-filled structures called follicles, which contain eggs by entering the ovaries with a needle under the guidance of vaginal ultrasound. In the fluid taken into the tube, the egg is a very small cell that can be seen under a microscope. OPU can be performed under local or general anesthesia. In women whose ovaries are close to the vaginal ultrasound probe and who are not mobile, the procedure can be performed painlessly with local anesthesia. In women whose ovaries are far away or behind the uterus, the procedure is performed under general anesthesia. The process takes about 10-15 minutes. Eggs do not come out of each follicle. In general, 70% of the follicles contain eggs. A few hours after the eggs are collected, the cells around them are cleaned and evaluated whether they are mature or not. Fertilization is applied to mature eggs. After resting for 1-2 hours after egg collection, the patient is sent home.
3. Fertilization:
In IVF treatment, fertilization takes place by classical in vitro fertilization (IVF) or microinjection (ICSI) method. In classical in vitro fertilization, the sperms are left next to the collected eggs, and they are expected to fertilize the egg on their own. It is used in cases where the man is completely normal, and infertility depends on the woman. In microinjection (ICSI), a single sperm is injected into the egg with the help of a special tool called a micromanipulator. Fertilization takes place approximately 2-4 hours after the eggs are collected. In fertilization with microinjection, first of all, the cells around the eggs (cumulus cells) are cleaned. Then, the egg is held with a stabilizer pipette and the sperm is injected into the egg with a very fine needle. Approximately 70% of the collected eggs are mature and suitable for fertilization. About 70% of them will also be fertilized. For example, a woman with 10 eggs will develop an average of 5 embryos. This is an average and the number may be above or below it.
4. Embryo Transfer:
Although embryos can be transferred at any stage from the two-cell stage to the multicellular blastocyst stage they are usually transferred on 3rd or 5th day after egg retrieval
There is a direct relationship between the number of embryos transferred and clinical pregnancy rates in IVF treatment. The best clinical results are obtained with the transfer of 2 embryos. Multiple pregnancy rates increase considerably when more than two embryos are transferred. Due to the high complication rates of multiple pregnancies and the increase in costs due to reasons such as premature birth, in vitro fertilization centers restrict the number of embryos transferred in many countries. Currently, it is recommended to transfer only one blastocyst in every patient younger than 35 years of age. According to the regulations in our country, 1 embryo is transferred to women under the age of 35, and 2 embryos are transferred to women aged 35 and over.
During embryo transfer, the patient is placed in the gynecological examination position. After the speculum is inserted into the vagina, it is cleaned with sterile saline. Then, the cervix is cleaned with special culture fluids. The embryologist brings the embryos to be transferred from the laboratory in a catheter, and the physician who will perform the procedure leaves the embryos into the uterus under ultrasound guidance from the abdomen.
Embryo transfer is not a painful procedure and does not require anesthesia.
To support the endometrium after the procedure, the patient is given hormone drugs in the form of injections, suppositories or creams. This treatment, called luteal phase support, continues until the 10th week if pregnancy occurs. In cases where pregnancy does not occur and there is menstrual bleeding, treatment is discontinued with the onset of bleeding.
On the the 10th or 12th day after embryo transfer, the patient is called for a pregnancy test.
5. Pregnancy Test:
A pregnancy test (beta-hCG) is performed in the blood. According to the results of the blood test, it is decided whether or not there is a pregnancy. Those who have a positive test are called for a blood pregnancy test two days later, the relationship between the results of the two tests is evaluated and it is decided whether the pregnancy is healthy or not. In a healthy pregnancy, the blood beta-hCG value should increase approximately twice after two days. In some cases, after a while, the blood beta-hCG value decreases to zero. This condition is called a biochemical pregnancy.
Other than expected increases in beta-hCG are one of the findings suggestive of ectopic pregnancy.
Cases whose beta-hCG values increase as desired on the 12th and 14th days are considered clinical pregnancy and are called for the first pregnancy ultrasound 2 weeks later. In this first ultrasound, it is investigated whether there is a gestational sac in the uterus and if there is, how many sacs there are.
You can also refer to Your Treatment section for more detailed information.
How long is IVF in Turkey?
Treatment begins on the second day of menstruation. If your first visit coincides with the second day of
your period, your treatment can start on the same day. To start your treatment, you will take medicines
that stimulate the ovaries. Our team will give you the dosage instructions.
For about 10 or 11 days, you takes these medications, and we will ask you to come back to the clinic 4 to
5 times in order to carry out ultrasound checks. The treatment lasts about 20 days from the 2nd day of
menstruation.
How much does IVF cost in Turkey?
ART Fertility Center offers state of the art technology in IVF and pregnancy rates equivalent to
the most successful centers around the globe combined with lower costs.
Basic IVF price starts from 3.200 US Dollars which includes:
Medication
Controlled Ovarian Stimulation
Ultrasound examinations
Egg Retrieval
General Anesthesia (Sedation)
Fertilization (IVF or ICSI)
Assisted Laser Hatching, embryoscope and embryo glue
Embryo Transfer
Follow-up and consultation of results of the treatment
If PGD or TESA/TESE are required, they are not included in this price.
Cost of freezing of extra, good quality embryos is 500 US Dollars (including one year storage
cost)
Is Turkey good for IVF?
Turkey’s achievements in this field are well known to European countries, the United States, Russia and
the Middle East. Turkish scientists reveal their skills to the whole world. The flow of patients in Turkey
has increased gradually, as IVF treatments are cheap and give much more positive results than any other
country.
Turkey’s achievements in this field stem from the interest of doctors and clinics who closely follow the
developments on the issue and have managed to implement all the treatments listed in the current
literature.
Turkey’s IVF success rate is much higher than any other country in the world and its low costs make the
country an attractive destination for foreigners.
Prices vary in all countries and clinics. In the United States, each treatment costs between 10,000 and
20,000 dollars, while in Europe prices range from 3,000 to 4,000 euros. The prices also depend on the
different types of drugs used in the treatments. However, their success rate is much lower. Some people
wait their turn for four or five years for IVF treatment in countries like the UK. In our country, such an
expectation is out of the question.
The price advantage and tourism opportunities make Turkey a top destination.
According to data provided by the Turkish Ministry of Health, some 50,000 foreigners have traveled to
the country to undergo gynecological and reproductive treatments.
References:
– Oocyte morphology does not affect fertilization rate, embryo quality and implantation rate after intracytoplasmic sperm injection
– The effect of pronuclear morphology on embryo quality parameters and blastocyst transfer outcome
– Blastocyst quality affects the success of blastocyst-stage embryo transfer