It is the dream of every man and woman to be a parent. However, it is not easy for each couple to realize this dream. Today, one of the 6 couples faces the threat of infertility. The hope of a significant portion of these couples is the IVF method. Related to this method Yeditepe University Hospital IVF Center Director Dr. View Cem's Full Profile answers the questions.
: What is vaccination treatment?
Professor Dr. Cem Ficicioglu: Intrauterine insemination therapy, also known as vaccination, is one of the most common treatments for couples without children. Vaccination treatment is applied to patients whose sperm count, structure and motility are below normal. Before the vaccination treatment, the semen sample taken from the man is examined in detail in terms of number, movement, structure and antisperm antibodies. It is necessary to assess whether the female spouse has open tubes. Before this procedure, the woman may use medication to stimulate the ovaries of her partner. With this application the probability of multiple pregnancy increases. During the period of the drug use, the spouse is monitored by ultrasonographic examinations and the hCG injection (the needle that makes the follicle crack) is given when the diameter of the sac called the follicle reaches 18-20 mm. Vaccination is performed 34-38 hours later.
On the day of application, the semen taken from the man is prepared by special methods and enriched from the sperm with good mobility and structure. It is inconvenient to use semen without preparation during vaccination. This can cause allergic reactions, infections and pain in the woman. The prepared sample is given to the mother's womb through a special catheter. Women with regular menstruation, open tubes, no endometriosis disease and under 35 years of age have higher success. The chance of pregnancy with vaccination is around 15-20% in each application.
: What is IVF treatment?
Professor Dr. Cem Ficicioglu: In vitro fertilization is the fertilization of the eggs from the ovaries by the sperm taken from the male spouse outside the body and transfer of the obtained embryos to the mother's womb.
: Who needs IVF treatment?
Professor Dr. Cem Ficicioglu: IVF treatment for the first time in 1978. Edwards et al. This treatment method was initially applied to women who could not have children due to obstruction in the tubes (ovarian ducts). Today, in vitro fertilization is successfully applied in cases of endometriosis, immunological infertility due to antisperm antibodies, male infertility and infertility of unknown cause.
: What are the steps of IVF treatment?
Professor Dr. Cem Ficicioglu: IVF application consists of four steps;
- Development of eggs; hormone drugs are used to stimulate the ovaries and a large number of eggs are matured.
- Collection of eggs; The eggs are collected under ultrasound-guided and local anesthesia.
- Laboratory fertilization of eggs; the sperm obtained from the male spouse and the eggs obtained in laboratory conditions are brought together in special media.
- Transfer of embryos to the mother's womb; The resulting embryos are transferred to the mother's womb through a thin catheter.
: What are the benefits of producing a large number of eggs by stimulating the ovaries with medications?
Professor Dr. Cem Ficicioglu: When a large number of eggs are developed in the ovaries, a large number of embryos can be obtained. The chance of pregnancy increases by selecting the best quality of the embryos and transferring them to the mother.
: What are the side effects of treatment for ovarian stimulation?
Professor Dr. Cem Ficicioglu: There may be slight irritation at the injection site. Transient fever and joint pain are very rare side effects. The most important side effects associated with hMG and FSH treatment are multiple pregnancy and hyperstimulation (overexcitation of the ovaries). Multiple pregnancy is seen in 25% of women who are pregnant with hMG treatment. Most of these pregnancies are twins, rarely seen in triplet or quadruple pregnancies. In multiple pregnancies, problems such as miscarriage, preterm birth and high blood pressure are more common. The risk of multiple pregnancy and hyperstimulation when hMG is used can be reduced with good clinical follow-up. During hMG treatment, ultrasonographic examination and hormone follow-up and egg development should be monitored.
: How is the development of eggs monitored?
Professor Dr. Cem Ficicioglu: The most reliable methods for this are the measurement of the developing follicle diameter and the intrauterine thickness by ultrasonography and determination of estradiol hormone levels in the blood.
: How are eggs collected?
Professor Dr. Cem Ficicioglu: Egg collection was performed laparoscopically at the beginning of IVF applications. Nowadays, eggs are collected with a much simpler procedure by vaginal ultrasound. There is no need for general anesthesia in egg collection performed with ultrasonography. The patient is given pain relief and local anesthesia. Vaginal eggs are collected by a needle inserted into the ultrasound probe. During this procedure, patients may experience slight discomfort or short-lived pain.
: Does the collection of eggs harm the ovaries?
Professor Dr. Cem Ficicioglu: The process of collecting eggs is a safe process, but the person performing the process must have experience. It is extremely rare that the needle enters the vein or damages the intestinal tissue. Egg collection does not harm the ovaries.
: How and when are embryos transferred?
Professor Dr. Cem Ficicioglu: Fertilized eggs, called embryos, are transferred to the mother's uterus two or three days after egg collection. In this period, embryos are usually 4-8 cells. Embryos are transferred to the uterus with a thin tube called a transfer catheter specially produced for this process.
Embryo transfer is a very simple and painless procedure for the expectant mother. Embryos are taken to the catheter and the cervix is cleaned and then it is left vaginally into the uterus by ultrasonography. The number of embryos to be transferred is determined according to the age of the expectant mother and the quality of the embryos obtained.
: What is the number of embryos to be transferred?
Professor Dr. Cem Ficicioglu: Multiple pregnancies caused by embryo transfers adversely affect mother and child health. Assisted Reproductive Treatment Centers in Turkey, the number of embryos to be transferred in accordance with amendments to the Regulation trilogy is limited. According to the new regulation, transfer of more than three embryos is allowed only in cases of age factor, embryo quality and similar medical necessity.
: How long to rest after embryo transfer?
Professor Dr. Cem Ficicioglu: It is reported that reaching at least 10 minutes after embryo transfer increases the likelihood of pregnancy. After the transfer date, the person can return to his / her daily life and start working. After embryo transfer, heavy activities such as sports should be avoided.
: Is it necessary to use medicine after embryo transfer?
Professor Dr. Cem Ficicioglu: Progesterone hormone is used to support the expected pregnancy after embryo transfer. Today, it is preferred that these hormone preparations (progestan, crinone) be used vaginally.
: When is the pregnancy test done?
Professor Dr. Cem Ficicioglu: On the 10th day after the transfer, the level of b-HCG hormone is determined in the blood to determine whether pregnancy occurs. Two weeks after the pregnancy is detected in the blood, a gestational sac is seen by ultrasonographic examination.
: What is the probability of multiple pregnancy after IVF applications?
Professor Dr. Cem Ficicioglu: The probability of multiple pregnancies which is 1% in naturally obtained pregnancies is around 24% in pregnancies obtained with assisted reproductive techniques.
: Can ectopic pregnancy occur after IVF applications?
Professor Dr. Cem Ficicioglu: The possibility of ectopic pregnancy after IVF applications is 2-5%.
: Can the sex of the baby be selected in IVF application?
Professor Dr. Cem Ficicioglu: The sex chromosome carried by the sperm that fertilizes the egg determines the sex of the baby. The sex of the baby can be determined by examining the parts taken by biopsy from the fertilized ebmryos. This method can be applied to couples with sex-related genetic disease.
: What is embryo freezing and how is it done?
Professor Dr. Cem Ficicioglu: After enough embryos are transferred to the mother, the remaining embryos are frozen and stored for later transfer. Embryos are mixed with special protective solutions called cryoprotectants and stored in liquid nitrogen tanks.
: How many times can IVF be applied?
Professor Dr. Cem Ficicioglu: If 2-3 months have elapsed between the applications, IVF can be applied until the couple has children.