Assoc. Prof. Dr. Çağlar Helvacıoğlu

In Vitro Fertilization (IVF) Treatment

This treatment offers couples who dream of having children an opportunity to realize their dream with the help of medicine and science. Let's embark on this journey together, exploring fundamental information such as IVF treatment, success rates, and the treatment process.
In vitro fertilization (IVF) is a reproductive technology used to help couples diagnosed with infertility have children. It is an abbreviation for "in vitro fertilization" and refers to the process of combining sperm and egg in a laboratory setting. This process results in the creation of embryos.

These embryos, whose development is monitored in the laboratory, are transferred to the expectant mother's uterus at the end of the predetermined time interval. Approximately 12 days after the transfer, a pregnancy test is performed on the expectant mother to determine the result.

In vitro fertilization (IVF) treatment is a process that requires teamwork. It must be carried out through teamwork involving a gynecologist (obstetrician/gynecologist), andrologist (urologist), embryologist, nurse, and support staff. Thanks to this collaboration, the treatment is meticulously planned and monitored for the best possible results.
Success rates in IVF treatment vary depending on age and the cause of infertility. The determining factor for success is having a sufficient number and quality of eggs. The state of egg reserve directly affects the success of the treatment.

The number of eggs in women decreases with age. A significant decrease in egg reserve begins, especially around the mid-30s. From this age onwards, in addition to the decrease in quantity, a decline in quality also becomes noticeable. Therefore, the younger the prospective mother, the higher the number and quality of eggs.

For couples who want to have children, starting treatment without delay is extremely important to increase the chances of success. Early initiation of treatment increases the chance of achieving more positive results.

In vitro fertilization (IVF) treatment, It is a treatment method applied when a couple is unable to conceive a child despite having unprotected sexual intercourse.

How Does the IVF Treatment Process Work?

1. Preliminary Interview
The first step before starting IVF treatment is a preliminary consultation. During this stage, we listen to your medical history and review any previous treatments and test results. This preliminary consultation is the most important step in properly planning the treatment process.

Schedule a Preliminary Consultation Appointment: +90 532 677 88 56
2. Examinations and Tests
The expectant mother comes for an examination on the second or third day of her menstrual cycle. Our doctor will perform an examination to obtain information about her ovarian capacity and uterus. An AMH test is also recommended to determine her egg reserve. If needed, additional tests such as a hysterosalpingogram (HSG) or hysteroscopy may also be requested.

In addition, thyroid function tests, prolactin hormone levels, complete blood count, blood type, and serological tests (such as for Hepatitis and HIV) may be requested for the woman.

Tests for Female Patients Starting IVF Treatment for the First Time:
Anti-HCV
Anti-HIV 1-2
HBsAg
Prolactin
Rubella IGG
Free T3
Free T4
Complete blood count
Anti-Müllerian Hormone (AMH)
FSH
LH
Estradiol (E2)
Progesterone (P4)

Tests for Male Patients Starting IVF Treatment for the First Time:
HBsAg
Anti-HCV
Anti-HIV 1-2
Spermogram
3. Increasing Egg Production and Monitoring Egg Development
In IVF treatment, based on examination results, the physician prescribes hormone medication to stimulate the patient's ovaries and promote the development of numerous mature eggs. The patient is given detailed information about the medication, and a course of hormone therapy lasting approximately 8-14 days begins. During this period, hormone injections are used to obtain mature eggs. The injections are quite simple to administer, and patients can do it themselves.

The number of developing follicles is a crucial factor directly affecting treatment success. Therefore, the dosage of hormone injections is determined considering the woman's age, weight, previous treatments, and health status.
4. Follow-up Examinations
During the IVF treatment process, the prospective mother administers hormone injections herself and visits her doctor at specified intervals to monitor egg development.

To monitor follicle development, blood estrogen levels and the number and size of follicles observed on ultrasound are measured. Based on this data, the dosage of injections containing FSH and HMG is determined. As follicles grow, blood estrogen levels increase. Sometimes, LH and progesterone hormones are also measured to better understand the situation.
5. HCG/Ovulation Induction Injection
During the IVF treatment process, follow-up examinations are scheduled daily or every other day, depending on the ovarian response. After approximately 8-10 days, when the largest follicle reaches 18-20 mm in size, an HCG injection, also known as the "trigger shot," is administered. Egg retrieval takes place approximately 34-36 hours after this injection.
6. Egg Retrieval (OPU)
In the in-vitro fertilization (IVF) process, the process of collecting the developed eggs from the body is called "egg retrieval" (OPU - oocyte pick-up). This procedure takes approximately 10 minutes and the patient is given anesthesia.

The patient lies in the vaginal examination position and feels no pain while the eggs are collected. After the procedure, the patient is allowed to rest in the clinic for a maximum of 1 hour and then go home.
7. Sperm Collection
On the day of treatment, the male patient provides a sperm sample in a private room via masturbation. Lubricants, soap, or other harmful substances should not be used during masturbation. The collected sperm sample is sent to the laboratory, and after the necessary processing, the fertilization procedure begins.

If fresh sperm is not available for fertilization, previously frozen sperm samples can be thawed and used.
8. Embryo Formation (Fertilization)
Classic IVF: In this method, sperm and egg cells are placed in the same environment, and motile sperm naturally reach the egg, resulting in fertilization.

Microinjection: In this method, a selected sperm cell is injected into the egg using microcannulas.

After fertilization, the eggs are kept in devices called incubators. These devices support the development of the fertilized eggs by mimicking the uterine environment as best as possible.
9. Embryo Development and Selection
By monitoring the development of embryos daily, we select the highest quality embryos with the highest probability of implantation in the uterus. Thanks to devices also known as embryoscopes, we can observe the embryos live 24/7 without disturbing their environment. With this method, we can select the embryos with the highest potential more accurately and safely. Through this meticulous monitoring, we aim to achieve the best results in the treatment process.
10. Embryo Transfer
The most critical stage in IVF treatment is the embryo transfer stage. This is because the correct transfer of the embryo, developed throughout the entire treatment process, to the uterus under the right conditions is a crucial step that determines the chances of success.

Embryo transfer is performed between days 2-6 after OPU (egg retrieval). The number of embryos is determined based on their development, the mother's age, and treatment history. Mature embryos are placed into the uterus using special catheters.

Following the transfer, it is recommended to perform a pregnancy test with Beta HCG on day 12 for fresh cycles and day 15 for frozen cycles.

Therefore, in the IVF process, the experience and success of the doctor performing the transfer are just as important as the quality and selection of the embryo.

Mother-to-be's Age

If it's less than 35

👉 For one year Couples who are unable to conceive naturally despite unprotected and regular sexual intercourse are offered in-vitro fertilization (IVF) treatment.

Mother-to-be's Age

If it's greater than 35

👉 For 6 months Couples who are unable to conceive naturally despite unprotected and regular sexual intercourse are offered in-vitro fertilization (IVF) treatment.

What can be done to increase success?

The most important factors affecting success in IVF treatments are the quality of the embryology laboratory and the experience of the embryologists. A successful laboratory, with its state-of-the-art infrastructure, uses high-quality materials and equipment to produce and select the best embryos.

In vitro fertilization (IVF) treatment requires collaborative teamwork. It is crucial that the doctor, embryologist, geneticist, and nurse are all experts in their fields for success. The doctor's experience and ability to create personalized treatment plans by assessing the couple's situation are also of great importance.

Couples also have certain responsibilities during the treatment process. Adopting a healthy lifestyle before starting treatment is recommended. Managing stress, exercising regularly, and eating a healthy diet positively influence treatment outcomes. Following these recommendations and supporting the treatment process increases the chances of success.

👉 Increase your fluid intake: Make sure to drink 2-3 liters of water daily.

👉  Quit Smoking: Smoking is harmful to both egg and sperm cells; you should definitely quit.

👉 Reduce or Stop Drinking Alcohol: Reduce or, if possible, stop drinking alcohol; it's important for healthy reproduction.

👉 Follow a Mediterranean diet: Focus on a diet rich in fruits, vegetables, whole grains, and fish.

👉 Increase Folic Acid: Increase your folic acid intake by consuming plenty of leafy green vegetables and nuts.

👉 Get Rid of Excess Weight: Lose excess weight and support your reproductive health through exercises like walking, running, and cycling.

Frequently Asked Questions

Causes of infertility in women
Ovulation problems are the most common cause of infertility in women. Polycystic ovary syndrome (PCOS) is the primary cause of irregular ovulation in women. PCOS, a condition that frequently leads to infertility along with menstrual irregularities and is caused by ovarian cysts, can be accompanied by excessive hair growth and weight gain. In addition, an excess of prolactin, a hormone secreted from the pituitary gland in the brain that normally enables breastfeeding, also negatively affects ovulation in women. In such cases, medication can reduce prolactin secretion, allowing the woman to ovulate regularly again.

Similarly, in cases of underactive thyroid gland in women, ovulation can be restored through thyroid hormone replacement therapy. Excessive exercise or dieting in women can also suppress ovulation and lead to menstrual irregularities.

Generally, ovulation problems are treated with medication.
Blockage of the tubes
This is another common problem in women. Previous infections of the reproductive organs, ectopic pregnancy, appendicitis, or endometriosis (the growth of uterine lining tissue in another area) can cause adhesions in the fallopian tubes, leading to blockages. If a blockage develops, pregnancy cannot occur because the egg and sperm cannot meet due to the mechanical obstruction. Such blockages can sometimes be opened surgically. However, in tubes with severe damage, the success rate is significantly lower, and the likelihood of re-blockage is high. In this case, treatment continues with in-vitro fertilization (IVF).
Structural anomalies of the uterus
These types of structural abnormalities can be congenital or develop later due to fibroids. A congenital condition where an extra septum forms in the middle of the uterus, like a curtain, is an example of such a deformity. More common problems are fibroids or polyps that develop later and cause irregularities within the uterus. All of these can prevent the fertilized egg from implanting in the uterine wall and developing healthily, leading to infertility.
What is IVF?
In vitro fertilization (IVF) is a treatment method we use to help those who cannot have healthy children due to infertility or genetic reasons to conceive. After the necessary examinations and tests, the stages of IVF treatment are ovulation induction, egg retrieval, sperm retrieval and fertilization, and then embryo transfer, all performed at the most opportune time.
When should the decision be made to undergo IVF treatment?
Before deciding on IVF treatment, the cause of infertility must be investigated. IVF treatment is initiated for those who have no chance of success with surgical or medicinal treatments. For example, couples with very low sperm count or blocked fallopian tubes should start IVF treatment without delay.
Should IVF be the first treatment option?
Infertility problems are not always treated with IVF (in vitro fertilization). The first option is medication and, if appropriate, surgical treatment. However, in cases where there are no other treatment options, such as azoospermia (very low sperm count) or completely blocked fallopian tubes, IVF may be the first treatment option.
Are genetic diseases a cause of infertility?
There may be situations where a healthy pregnancy cannot be achieved due to a genetic problem in one or both partners. In such cases, to avoid encountering genetic problems in the resulting embryo, preimplantation genetic testing (PGD) is performed, and only healthy embryos are transferred, thus ensuring babies without genetic problems.
Can women who don't menstruate get pregnant?
Women who do not menstruate cannot get pregnant. Menstruation usually begins two weeks after ovulation if pregnancy does not occur. If no egg is produced during ovulation, pregnancy does not occur. However, if pregnancy occurs again after a previous pregnancy (such as childbirth or miscarriage) with the first ovulation, it is possible to become pregnant without menstruation. This is most common in breastfeeding women.
What is the definition of success in IVF treatments?
Success is conceiving, then carrying the pregnancy to term and having a healthy child.

If we look at global statistics regarding the probability of having a live child in relation to age:

· 35 yaş altı: %29
· 35-37 yaş arası: %23
· 38-39 yaş arası: %15
• Ages 40-42: %9
• Ages 43-44: %3
• Ages 45 and over: %2

Bu oranlar yaşa bağlı çocuk sahibi olma oranlarıdır. Ancak tüp bebek ile gebe kalma oranları %50-55 ile % 10 arasında değişmektedir
How long does the egg retrieval process take?
The procedure takes between 5 and 15 minutes, depending on the number of eggs being collected. Since it is performed under general anesthesia, the patient needs 20-30 minutes to recover afterward.
Is there any pain during embryo transfer?
The most painful procedure during embryo transfer is the insertion of the speculum. In almost all women, speculum insertion can be done without any pain. The second potentially painful procedure is the passage of the catheter through the cervix. Again, this is usually painless because the cervical opening is wider than the catheter. However, if the uterus is significantly tilted forward or backward, using a rigid catheter may cause minimal pain.
Can eggs be frozen? Who is it recommended for?
Egg freezing can be done by anyone who plans to become pregnant at an older age for any reason, or whose ovaries will be damaged due to radiotherapy or chemotherapy. Treatment begins like IVF; after egg retrieval, the eggs are frozen before embryos are created.
Do cancer treatments, specifically chemotherapy, impair sperm production?
Chemotherapy and radiotherapy primarily damage organs containing rapidly growing and multiplying cells. Therefore, since the testes will be damaged by treatment, sperm production will also be impaired.
Which infections cause blockages in the fallopian tubes?
The most common infection is chlamydia. Any type of infection that causes abscesses in the ovaries and fallopian tubes leads to blockage and dysfunction of the tubes. In addition, infections that form granulation tissue, such as tuberculosis and actinomycetes, also cause blockage in the fallopian tubes.
Do the drugs used in IVF treatments cause cancer?
Studies on whether IVF treatment drugs cause cancer have found no significant increase in cancer rates. Since these drugs cannot be used for very long periods, their side effects are not continuous.
What preparations should be made when coming from outside the city or from abroad for IVF treatment?
No special preparations are needed. You can make your preparations as you would for other reasons when traveling out of town.
How long does IVF treatment take?
Now that we use a shorter protocol, the process isn't very long. Treatment begins on the 3rd day of menstruation. Within 8-10 days, the eggs reach a size suitable for retrieval, and then you need to wait another 3-5 days for embryo transfer. During this process, follicle monitoring and other procedures are usually performed every 3-4 days, so it's possible to come for an outpatient visit from nearby areas.
If stitches open after a normal delivery, what kind of treatment can be applied in this situation?
Perineoplasty, also known as perineal repair surgery, corrects deformities in the area.
I'm still having trouble controlling gas after a normal delivery. It's been 6 months; can I have surgery?
There may be damage to the muscles around the anus. We recommend you get examined first. Surgery is possible to resolve this problem.
Are there any health risks associated with babies born after IVF treatment?
Health problems in babies born via IVF are no different from those born through natural conception.
What is preimplantation genetic diagnosis (PGD)?
In cases where a healthy pregnancy cannot be achieved due to a genetic problem in one or both partners, preimplantation genetic testing (PGD) is performed to ensure that only healthy embryos are transferred, thus resulting in babies without genetic problems. Healthy embryos are selected and transferred using PGD.
What is the reason why embryos, despite being of good quality, fail to implant during transfer?
İnfertilite sorunu olmayanlarda da gebelik oranı %27 dir. Her oluşan embriyonun tutunama nedeni endometrium (rahim iç dokusu) tabakasının endometriumu kabul etmemesi veya oluşan embriyonun tutunma kapasitesinin az olması nedeniyledir. Kullanılan ilaçlar, alerjik rekasiyonlar, çevresel koşullar, embriyo oluşum kalitesi tutunmayı engelleyebilir.
Are there any side effects of the medications used in IVF treatment?
Like all medications, IVF drugs also have side effects. The most important side effect is the development of OHSS syndrome. This is mostly seen in patients with PCOS. In patients at risk of OHSS, this problem can be eliminated by using the lowest possible dose of medication and freezing all embryos, allowing for later transfer of frozen embryos.
Is there an age limit for IVF treatment?
Tüp bebek tedavisinde yaş sınırı yok. Ancak yaş ile birlikte başarı oranı çok düşmekte. 35 yaşından önce canlı çocuk doğurma oranı % 30’lar da iken 38 yaşında %15, 40 yaşında %9, 43 yaşında %3 ve +45 yaş üzeri % 2’ler de.
What is endometriosis?
Endometriosis is a condition where the endometrium, the inner lining of the uterus, is found anywhere else in the body besides its normal location. While most commonly found in the fallopian tubes and ovaries, it can affect any organ, including the liver and brain. During menstruation, bleeding occurs in these organs, leading to various symptoms.
Is the risk of multiple pregnancies higher with IVF treatment?
In IVF treatment, if only one embryo is transferred, the risk of multiple pregnancy is the same as with naturally occurring identical twins. If more than one embryo is transferred, the risk of multiple pregnancy increases.
What is the maximum number of times IVF can be performed?
Bilinen bir sınırlama yok. İlk 3 denemede gebelik ihtimali %60-70’lere çıkmakta.
What is the maximum number of vaccinations that can be given?
There are no specific limitations for those who meet the criteria to be inseminated. However, if it hasn't worked after 2-3 attempts, it's necessary to stop insemination and proceed with IVF treatment.
If a couple doesn't conceive after their first IVF treatment, how long after that can they try IVF again?
If fresh embryo transfer is to be performed, i.e., after ovulation induction, it is necessary to wait at least for the third menstrual period. Frozen embryo transfer can be done even during the first menstrual period.
Can a man's sperm count be increased using medication?
Medications containing LH can increase sperm count. Drugs used for treatable diseases that reduce sperm count can also increase it.