In Vitro Fertilization
In the case of infertility, the treatment method applied by couples who want to have children is called IVF treatment. Infertility is a condition that can be seen in 15 to 20 individuals out of 100 people in the world. The reason for this condition, which is caused by the failure of the reproductive function, can be related directly to a specific problem of the reproductive organ or different independent factors. If the condition is incurable in spite of the diagnosis, and infertility is permanent, then it is impossible for the person to have a child through natural means. With the urge to have children, couples resort to treatment methods, and among these, the most common type of treatment in the modern era is known as IVF treatment.
IVF treatment is a long-term treatment carried out with the follow-up of specialist physicians as well as there are some points that the patient should pay attention to before, during and after treatment to have a healthy child. If you pay attention to these points, it is possible to have healthy children with IVF treatment.
Types of IVF Treatment
Several health screenings are obtained for couples to be treated before the initiation of IVF. After examining the results and pregnancy history, it is decided to the protocol to be treated.
This protocol uses injectable drugs called antagonists (Cetrotide and Antagon) to prevent premature ovulation. The medication is to suppress the LH surge and ovulation until the developing eggs are ready. Since these effects are seen in a very short time, the name of the application is referred to as a short protocol. In the course of this protocol, to benefit from the effects of antagonist drugs, ovarian suppressing and ovarian stimulating drugs are used consecutively while the menstrual period of the expectant mother is going on.
GnRH* implementation is started on the first day of menstruation during IVF treatment. After the application of the protocol is continued for three days, the application is stopped and continued with FSH and Hmg drugs.
*The purpose of using GnRH antagonist medications such as cetrotide and orgalutran is to prevent premature cracking of the eggs of the expectant mother to be treated with IVF for pregnancy.
Micro-dose Short Protocol
The short protocol implementation is generally used in women who have problems in egg production and who are inefficient in the number of eggs. Microdose is preferred in cases where this is at an advanced level. The treatment is continued by diluting the drug obtained from the pharmacy at the IVF service.
On the twenty-first day of the menstrual period, administration of the GnRH treatment is started and the blood test is performed within the third day of the next menstrual period to determine whether the suppression occurs. If there is a decrease in the level of oestrogen, that means suppression has occurred. If the suppression level is appropriate, the treatment is continued with the stimulation step, but the GnRH process is also continued. On the other hand, treatment should be continued until the date that OVIDREL* or PREGNYL** injection is required. At this stage, it is determined how the IVF treatment will continue and which protocol is suitable for the pregnant candidate.
*OVIDREL: Ovidrel (choriogonadotropin alfa) Injection is the hormone (hCG) that causes the growth and release of a mature egg (ovulation) used to treat certain fertility problems in women. Ovidrel is usually used in combination with another hormone (FSH) that helps cause healthy ovaries to produce eggs.
** PREGNYL: Pregnyl (chorionic gonadotropin) is a hormone used to cause ovulation and to treat infertility in women, and to increase sperm count in men. Human chorionic gonadotropin (HCG) is also used in young boys when their testicles have not dropped down into the scrotum normally. This can be caused by a pituitary gland disorder.
Before IVF treatment
Before IVF treatment, both men and women need to prepare for some issues. These are the factors that support both healthy sperm formation and healthy ovulation process.
When starting IVF treatment for pregnancy, the pre-consultation with the couple must be carried out by the doctor in the first step. The medical history of the couple who is experiencing infertility is recorded by the doctor. In parallel with this record, the test, film and epicrisis data obtained from the couples are discussed. Afterwards, various examinations are performed by the physician for both male and female, and then the IVF protocol is selected. After the doctor examines the female, it is investigated whether a surgical procedure is necessary. If there is an anatomic problem, the surgical application is performed by hysteroscopy technique. At this stage, the age of the pregnant woman, egg capacity, previous surgical operations, hormone level and the protocols that has been applied in previous IVF trials are evaluated and the selection of the protocol is completed.
Stimulation of the ovaries
One of the most important elements of getting a positive result in IVF treatment for pregnancy is that the ovaries of the woman who wants to become pregnant can produce many eggs. Therefore, stimulating medications are used to increase the development of ovaries under control. Generally, these drugs are known as subcutaneous or intramuscular injections. This stimulation process lasts for 10 days and egg development is monitored during this period. In this process, a few checks are performed and if necessary, the medication dose can be changed by observing hormone level. If estrogen reduction is observed after the tests that means the process is proceeding normally.
Egg Collection (Oocyte Pick-Up [OPU])
Egg collection is a simple surgical procedure performed with vaginal aspiration in accompany of ultrasound. Egg pick-up process is performed under general anaesthesia (sedation anaesthesia) at our centre. The vagina is entered by an ultrasound probe to identify mature follicles then the follicle is entered by a needle. The eggs are then aspirated by a needle attached to a pump unit from follicles. The egg collection process is usually completed in 10-20 minutes. Some patients might experience cramp-like pains on the day of process but it will subside the following day. Feeling swollen and/or compressed might continue for a few weeks after the procedure because the state of grown eggs continues in that period.
Although it is very rare during OPU which is one of the natural stages of the IVF process, it is possible to develop some complications. Some of these complications are seen with a very low incidence rate; ovarian bleeding, vaginal bleeding and pelvic infection.
After the OPU process, mature eggs are identified and separated from the collected eggs. After the eggs are stored at an appropriate temperature for 2-4 hours in particular environments called incubator, the fertilization process starts. At this stage, the man is asked to masturbate to give sperm. If the male cannot give sperm or in the case of azoospermia, sperm is obtained from the male by micro TESE application. Then the preparation for fertilization of the eggs is completed. Following fertilization, the embryo gets formed and the embryo develops in the uterus and the baby develops.Fertilization can be carried out in two alternative ways. In-vitro fertilization method, the sperm cells taken from the male is left close to the egg cell and one of these sperms can fertilize the egg itself. This method is known as the classical in vitro fertilization method and it is aimed to give 50-100 thousand sperm for each egg cell. The other method is the microinjection. This method ensures that only one sperm is given to an egg by microscopic methods and fertilization is completed. Microinjection method is more widely applied in modern period and it is more likely to fertilize. Egg cells suitable for IVF treatment with microinjection are in the Metaphase-II stage. Metaphase-I eggs cannot be used for fertilization since they are not fully mature.
After fertilization is completed, the specified number of embryos are placed in the mother's womb and this is called embryo transfer. The pregnancy test to be performed during the 12 days following the transfer procedure is also tested to determine whether pregnancy has occurred. Embryo transfer is done 2 to 5 days after fertilization. The structure of the embryo is in a 4 or 8 cell form during this period. On the other hand, the embryo remaining on the 5th or 6th day turns into a hollow structure and is called blastocyst. In rare cases, the transfer can be performed on the 5th or 6th day, but this is called blastocyst transfer. Embryo transfer takes 5 to 10 minutes. Because it is painless and does not cause discomfort, anaesthesia is not required. Can be discharged from the hospital shortly after the procedure is done. In order to perform the procedure, the speculum is placed in the examination position at the gynaecology table and the cervix is cleaned with special fluids before this. Embryos brought by the embryologist from the laboratory are inserted into the uterus through a catheter. The decision on how many embryos are placed in the uterus is determined by some basic criteria. It is considered inconvenient that the transfer of large numbers of embryos as it has a risk of twins or triplets babies. However, a small number of embryos are transferred to young pregnant candidates with good quality embryos, and a larger number of embryos are transferred to older pregnant candidates with poor embryo quality. If the outer layer of the embryo to be transferred is thick, it is thinned by laser method and then transferred. After embryo transfer, the remaining quality embryos can be frozen and utilized if they are to be used in the future. Progesterone drugs are frequently recommended during the embryo transfer process and their use is explained by the physician. Medications may be given as capsules, vaginal gels or injections. Besides, if vitamins and different drugs have been prescribed, they should be used with caution. 12 days after embryo transfer takes place, the pregnancy test can be performed. Immediately after a period of 10 to 14 days, the baby can be monitored by ultrasound. Trace amounts of stain or bleeding may occur during embryo transfer, and this often ceases spontaneously on the same day, but if you observe the severity of bleeding, a doctor should be consulted. There may also be low-grade groin or low back pain after the transfer and pain killer should not be used without a doctor's advice. After the embryo transfer phase, you should not have sexual intercourse unless the doctor permits. If there is no positive result from the pregnancy test at the end of the 12-day period, sexual intercourse can be initiated and if pregnancy occurs, sexual intercourse is prohibited until the doctor's consent is obtained. In the stages following the pregnancy, the prohibition of sexual intercourse is abolished if there is no negative effect on the growth of pregnancy in 2-3 months.
After embryo transfer, hormone medications are often prescribed by the doctor and the dosage, frequency and usage are described to the patient. In addition to these medicines, some vitamin medicines are also recommended if required. The regular use of these drugs as described is important for the healthy progress of the treatment process and accurate data monitoring.
12 days after completion of embryo transfer, the pregnancy test is performed by blood. Since the drugs used by the patient cause a delay in menstrual bleeding, the patient should not think directly that she has conceived. A pregnancy test should be done and the situation should be clarified by looking at the result. If the pregnancy test is positive in the blood, it is necessary to wait 10 days for the ultrasound application and the number of settled embryos can be monitored by ultrasound. 2 or 3 embryos can be seen at this stage, but embryos that can naturally settle at this stage may disappear later.
The hormone level of the woman who will receive IVF treatment is examined as she has a problem with reproduction. If the woman who is going to be in vitro fertilized is a smoker, negative examination results are frequently encountered with her ovaries besides if the male candidate is a smoker, sperm production could be greatly affected and infertility may occur. As it is known, in vitro fertilization is applied when there is a problem with infertility, and infertility can occur in the mother or father. In addition, pregnancy may not occur due to hormonal changes and anatomical conditions in elderly people. In addition to the negative results of IVF treatment in smokers, it can cause serious harm even to routine pregnancy. Because smoking contains a chemical that damages the estrogen hormone. It is also known that smoking affects not only hormones, but also ovaries in women. Especially in the advanced age group, the probability of a positive outcome of IVF is less than 30%, It should be kept in mind that this rate can be lowered with smoking.
Scientific studies have shown that smoking causes damage to the ovary and sperm structure of individuals, so it is essential to stop smoking for couples planning pregnancy with IVF, at least 3 months before treatment. Since the aim is pregnancy, even the smallest factor that may adversely affect the treatment is tried to be eliminated and smoking is the first amongst them. In another study related to males, it was observed that the sperm quality of the fathers who smoked was decreased as well as the number of sperm. In this context, failure to meet the sperm production required for IVF treatment negatively affects the treatment process.
Scientific studies have shown that smoking causes damage to the ovary and sperm structure of individuals, so it is essential to stop smoking for couples planning pregnancy with IVF, at least 3 months before treatment.
Folic Acid Supplement
Folic acid is a form of vitamin B9 that's the essential component in the formation of the nucleic acid, which is naturally needed by the body and forms part of the genetic structure. Folic acid which is a complex vitamin similar to B12 is required to form the red blood cell, to prevent loss of hearing, and to protect the health of the baby during pregnancy. Folate and folic acid, a derivative of vitamin B9, provide the necessary red blood cell production in the body, as well as repair and synthesize DNA and RNAs, promote cell division and growth, and prevent hearing loss. It is important that women in pregnancy meet their folic acid needs. Because folic acid prevents deformities that may occur in the baby's brain and spine before birth and helps development. Folic acid supplementation, particularly for women who are considering pregnancy, plays an important role in supporting the healthy development of the baby during pregnancy. According to another study, women who take folic acid supplements for 1 year before pregnancy proves that the risk of preterm birth is less than fifty per cent and reveals the importance of folic acid in the development of the baby's spinal cord. Naturally to ensure folic acid intake; broccoli, asparagus, cauliflower, egg yolk, baked potato, cabbage, kidney, milk, spinach, peas, sunflower seeds, papaya, kiwi, oranges are recommended to be consumed regularly.
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