IVF involves joining a woman’s egg and man’s sperm under laboratory conditions (in vitro). IVF starts on the second or third day of a period.  

THE FIRST STEP OF IVF IS THE STIMULATION OF OVARIES. The goal is to stimulate the growth of follicles from which the eggs are subsequently retrieved. This step lasts about 10-12 days, includes daily subcutaneous injections of drugs and ultrasound monitoring of ovaries. When the follicles are grown adequately, trigger injection with HCG is done and two days later follicles are punctured and eggs are retrieved which is named as oocyte pick-up (OPU).   

THE SECOND STEP OF IVF IS OOCYTE PICK-UP (OPU) AND FERTILISATION OF COLLECTED OOCYTES WITH SELECTED SPERM WITH ICSI (intracytoplasmic sperm injection), a method that significantly increases the chance of fertilisation. In OPU procedure, eggs are retrieved under monitored, short anaesthesia, via transvaginal route which usually lasts no more than thirty minutes. After a maximum of one hour's rest in the recovery room, you can leave the clinic. Please, make sure you have someone to accompany you, as you cannot drive a car following general anaesthesia. On the same day of OPU before the procedure, the patient’s partner provides his ejaculate in the sampling room at the clinic. Mature eggs are fertilised with the partner’s best quality selected sperms, usually by micro-injection (ICSI) directly into the egg. ICSI involves the injection under a specialized microscope of one selected sperm directly into the one mature egg. Using ICSI, we are able to minimise interruption of the cycle because eggs are not fertilised using the “classic or conventional IVF” method, where the egg is fertilised with sperm in a culture dish spontaneously. The selection of best quality sperm is vital for better embryo development. We use various sperm selection tools such as PICSI, Sperm Chip. Sperm selection process has a positive effect on the later formation of the blastocyst. It was found that sperm affects embryogenesis in two phases. In the first early phase, poor sperm selection can affect fertilisation, the fusion of germ cells (i.e. the egg and sperm). In the second phase, sperm also affects the genetic material of the embryo. If the genetic material in the sperm is damaged and subject to fragmentation, this can lead to a reduction in the number of cultured blastocysts, a reduced level of implantation, or to miscarriage. Hence embryos formed with selected sperms show fewer chromosomal abnormalities. In the absence of live sperm in the ejaculate, there is the possibility of obtaining sperm surgically from the epididymis (PESA or MESA) or testis (microTESE). Micro TESE operation (testicular sperm extraction) attempts to obtain sperm directly from the testicular germinal epithelium. Tissue samples are taken from small incisions in the outer testicular layer and referred to the embryology laboratory. The procedure is performed on an outpatient basis under short general anaesthesia. The advantage of our clinic is that the procedure can be scheduled for the same day as egg retrieval from the female partner. The fresh sperm retrieved are immediately used for egg fertilisation using the ICSI method. Unused tissue is cryopreserved to avoid the need to repeat the procedure. The joint team of a gynaecologist and urologist at the clinic is a prerequisite for both excellent cooperation and a high success rate of treatment. The following day after ICSI, it is checked whether the embryos are formed. If the embryos are formed, further three to five days embryo culture is done. This means embryos when formed after ICSI are followed in the laboratory in specialised incubators. In this step the best embryo is tried to be found to transfer to the uterus (womb). The purpose of the complex process of assessing embryo quality is to determine the optimal time for embryo transfer to ensure the highest chance of pregnancy. 

THE THIRD AND THE LAST STEP OF IVF IS EMBRYO TRANSFER, the transfer of the embryo into the endometrial cavity which is performed without anaesthesia using a thin flexible catheter, the end of which is guided by ultrasound for precise placement of the embryo. İt takes about ten minutes and just 40-60 minutes rest is enough following transfer procedure. Successful IVF culminates with a positive pregnancy blood test on the 9-12^th day after embryo transfer. Avoid strenuous physical activity, sexual intercourse and hot baths. You can go back to your normal routine after three days, but we still recommend avoiding strenuous physical activity. You will be informed about the medications and instructions in detail in your discharge report.

All in all the duration of the whole IVF process usually takes three weeks starting on the second or third day of period.

WHAT IS THE SUCCESS RATE OF IVF?

It depends on many factors mainly woman age. Our clinic has a success rate of up to 80%. In woman below 35 years it is about 60-80%, between 35-40 years it is about 40-60% and after 40 years over it drops to 5-20%. 

WHEN SHOULD I TAKE A PREGNANCY TEST AFTER IVF?

A blood pregnancy test will not be conclusive earlier than the 9^th day after embryo transfer. If the test is negative, we recommend repeating the test on the 11^th to 12^th day after embryo transfer. If the pregnancy test in blood is POSITIVE 9-12 days after embryo transfer, continue with the prescribed medication until the 12^th week of your pregnancy. Contact us and we will arrange an ultrasound at the clinic, which should take place approximately 7-10 days after your confirmed pregnancy test. Standard prenatal screening takes place, together with a check-up at your gynaecologist´s. After a positive test, booking an ultrasound to rule out an ectopic pregnancy is of utmost importance.

What if the pregnancy test is NEGATIVE? Don't despair; you don't always get pregnant the first time. If the pregnancy test is repeatedly negative, stop taking all medication and contact us after your menstrual cycle to prepare for the transfer of your frozen embryos, or to discuss the next steps.

IVF is not always successful on the first try. Or even on the second. This is a relatively common occurrence, so don’t lose hope. We will advise you how to increase your chances of a successful pregnancy and will be by your side throughout the treatment, until your pregnancy is confirmed. In frozen embryo transfer (FET), embryos retrieved in previous IVF cycles and safely stored in a frozen state are transferred to the uterus. Thanks to FET, we can significantly reduce the cost of IVF treatment. Because with good quality surplus embryos frozen in the previous failed cycle, a pregnancy rate of 80% can be achieved. However, before FET, meticulous endometrial cavity evaluation is mandatory mainly with hysteroscopy. It’s important to consult your doctor on what you should do next following failed IVF cycle. If your attempt is unsuccessful, you need to stop taking the prescribed medication and contact us during your next menstrual cycle to schedule another attempt or if present FET. Following a failed cycle we usually advise hysteroscopy and genetic evaluation of the couple before proceeding with a new attempt or FET with cryopreserved embryos.   

AN INTEGRAL PART OF IVF TREATMENT: EMBRYO FREEZING

For many infertile couples, we will be able to culture more high-quality embryos than will be needed in the given cycle. We recommend freezing those embryos that are not used right away. Reproductive cells or embryos can be stored this way for many years. Up to 95% of embryos can be used after thawing. 

Embryo cryopreservation is suitable and advantageous in following cases; 

IS IT POSSIBLE TO INCREASE THE SUCCESS OF IVF WITH PGT: PREIMPLANTATION GENETIC TESTING

It is possible to detect genetic problems of the embryos before transferring into the uterus. By determining the genetic makeup of embryos, we can detect problems in time. We then only transfer embryos that have a greater chance of producing a healthy baby to the uterus. Genetic abnormalities are a common cause of early miscarriages in the first trimester of pregnancy. Preimplantation testing helps prevent those losses. Technically, we wait for 120 hours after fertilisation, when the embryo has a greater number of cells. We carefully separate one or more cells and analyse them. The analysis is carried out using various methods – FISH (fluorescence in situ hybridisation) aCGH (microarray-based comparative genomic hybridisation), PCR (polymerase chain reaction). The embryo is not damaged by this intervention and is frozen using vitrification. Once PGT results are available, it can be used for transfer. We will recommend the best normal embryo(s) for transfer to the uterus after evaluating the results. 

PGT is recommended in following cases;

PGT has a very positive effect on the success of embryo implantation in a woman's uterus. PGT also significantly reduces the frequency of miscarriages, especially in women over the age of 40.