Everything you need to know about IVF treatment
Although only one stage comes to mind when in vitro fertilization is mentioned, the journey on which people embark with the goal of bringing a “live baby home” is comprised of various stages. Here are all the processes that take place in IVF from the very first test to determining the pregnancy and the actual birth…
Changes in living conditions, rising age of motherhood and unexplained infertility are all factors that have increased the number of people resorting to IVF. Infertility is defined as the inability to become pregnant despite having regular sexual relations for one year. About 15 percent of couples fall into this category. First of all the reason for infertility is investigated for such couples who wish to have a baby. Disorders in the fallopian tubes and uterus, ovulation problems, irregularities in the sperm parameters are all among the important causes for unexplained infertility. Prof. Dr. Volkan Noyan, Clinical Director for the Acibadem Adana Hospital In Vitro Fertilization Unit, said that the couples who have these problems come to IVF centers with the goal of “taking home a live baby” and explained the various stages of this treatment process…
When investigating the causes of infertility whether ovulation is taking place must first be established. A variety of tests are used to determine this. One of the indications of ovulation is regular menstruation cycles. However measuring the progesterone (the sex hormone that is secreted from the ovaries) level on the 21-24th day of the cycle produces a clearer result. Then whether or not the uterus and fallopian tubes are anatomically normal must be established and in order to do this ultrasonographic examinations and x-rays of the uterus can be used.
The first of the tests that can be run on men, which is the spermiogram, counts the sperm and examines their mobility and structure. These assessments give information about the male’s infertility. If problems are detected in the couple, various treatments are given accordingly.
WHEN IS THE IVF APPLIED
When one or both individuals in the couple have infertility issues it is necessary to start IVF treatment.
Here are some such causes:
Tubal factor: If the woman’s fallopian tubes are not functional or severely deformed anatomically the couple resort to in-vitro fertilization to have a baby.
The Ovarian reserve: The ovarian reserve in women begin to decline after 30 years of age. This speeds up after 35 and increases as of 40. In order to examine the ovary reserve, a measurement of FSH and E2 hormones can be done on the third day of a period and of AMH hormone on any given day of the period. Also an ultrasound can count antral follicles (ovarian cysts). Patients with an advanced case of decreased reserves must start IVF without delay.
Ovulation disorders: When a variety of ovulation treatments that are applied for a certain amount of time towards ovulation disorders do not result in achieving a pregnancy, IVF can be resorted to.
Unexplained infertility: When the reason for the infertility is not known, taking into account the woman’s age and degree of infertility either intrauterine insemination is applied first or IVF is applied directly.
Male infertility: Sperm concentration, mobility and structure are examined and intrauterine insemination and IVF are applied to those who do not respond to urological treatment.
THE STAGES OF THE TREATMENT
The first stage in the in-vitro treatment is to stimulate the woman’s ovaries. During this method that is called “Controlled ovarian hyperstimulation” the ovaries are stimulated to develop follicles. The stimulation, which is achieved through various agents and protocols, lasts about 8-14 days in the short protocols that are frequently applied today.
Later the eggs are triggered by the HCG hormone to mature. 34-36 hours after the HCG hormone injection, the eggs are harvested. This process is done by the transvaginal method entering the patient’s ovaries with the help of an ultrasound and aspirating the follicles with a special needle. Embryologists examine the aspirated follicle liquid in the laboratory and determine the number of eggs that have been harvested.
On the same day that eggs are harvested from the woman, sperm is taken from the man. After this sperm sample goes through a special cleansing process the best sperm are singled out.
The maturation of the eggs is assessed. The mature eggs in the “Metaphase 2” period are fertilizable. The selected sperm are injected into these eggs by microinjection. While in previous years the sperm had been left next to the egg for fertilization to take place, in the present days the microinjection method called ICSI is preferred. The sperm cells are placed directly inside the egg under a microscope.
The fertilized eggs are placed in an incubator that provides the conditions and heat that they need to develop. The gas and humidity is adjusted and the eggs, which are placed inside a special liquid, are monitored. 16-18 hours must go by before it can be determined whether the insemination has been successful or not. The results can be obtained from the first check that is done at the end of this period.
If the insemination is successful, it is followed by the cell division of embryo. The embryo consists of about 4 cells in 36-48 hours and 8 cells in 72 hours. On the fifth day the embryo is classified as a blastocyst.
The embryo transfer is usually done on the third or fifth day with the help of special catheters but recently the fifth day is being favored. The reason for this is that the rate of selecting the best embryo and the rate of the embryo in blastocyst stage latching onto the uterus is higher. However if not enough good quality embryos have been achieved there is no need to wait for the fifth day. The process of positioning the embryo in the uterus can also be done with three-day embryos that have shown sufficient development.
Once the transfer is completed the female patient is released after a 30-60 minutes of bed rest. During this period patients are warned not to do anything that requires a lot of physical effort, not to lift heavy items or do high impact exercises. The patient must use the medications that have been prescribed on time, eat well and drink plenty of fluids.
11-12 days after the transfer blood tests are done to detect pregnancy. Women who test positive for Beta HCG are tested again in a few days to check the increase of the hormone level. Later an ultrasonography is done. In 7-10 days after the test it is possible to see a gestational sac in the cervix using an ultrasonography. Thus the clinic can determine whether the pregnancy has taken place or not.
THE SUCCESS RATES IN IVF
Presently a success rate of about 55-60 percent per transfer can be achieved in IVF, but of course the real success is regarded as the rate of actually “taking home a live baby”. This rate varies by age. It is 40-45 percent in women under 30, 30-35 percent in women 35 to 37 years old, 20-25 percent in women aged 38-40, 12-15 percent in women 41-42 and 4-5 percent in women over 42.