How Does the IVF Process Work? IVF Specialist Dr. Hande Akbaş Told

What is infertility? In which cases to vaccinate a couple with infertility problems; In which cases is IVF recommended? How does the IVF process work? What is the genetic screening method in IVF? Who is IVF for? What is recurrent pregnancy loss?

What is infertility? How to evaluate an infertile couple?

“Infertility is the inability of couples to have children after one year of unprotected intercourse, usually after marriage. We regularly accept at least three times a week. Infertility has female causes and male causes. Therefore, couples should come to the interview together. In the first evaluation, different questions are asked to the woman and the man. After evaluating both, some analyzes are requested. As a result of the analysis, it is planned which treatment is suitable for the couple.

HOW IS EGG CAPACITY MEASURED IN WOMEN?

. What is egg capacity?

“Ovarian capacity in women can now be measured. Those who postpone having a child to pursue a career should have their ovarian reserves checked once a year before the age of 35 and every 35 months after the age of 6. Because menstruation doesn't always mean ovulation.

With the ultrasonographic method, it can be seen very clearly how long the egg drafts remain in both ovaries. In addition, some blood values ​​(AMH / anti-müllerian hormone test) and ovarian values ​​are examined and the patient is informed about how much and how long after the freezing process of eggs may be on the agenda.

In which cases to vaccinate a couple with infertility problems; In which cases is IVF recommended?

“If there is severe male infertility or low female egg reserve, IVF is usually used. The man's sperm are very good, the woman's ovarian reserves are very good, the tubes are definitely open, but if the couple has been married for two years and has no children, especially if the woman is young, one or two vaccinations are recommended. The method of vaccination is the preparation of sperms in the laboratory and placing them directly into the uterus with a tiny catheter on the day of ovulation.

GENETIC SCREENING METHOD IN IVF

What is the genetic screening method in IVF? For whom is it done? What kind of results do genetic screening tests reveal?

“Now, under laboratory conditions, some cells can be taken from embryos formed after egg and sperm fertilization and their DNA can be analyzed under laboratory conditions. Of course, for this, the couple must be undergoing IVF. It is not made for everyone. Genetic screening, especially if there is a genetic disorder on the maternal or paternal side and a diagnosis has been made; if the couple has previously lost pregnancy due to a genetic disorder; It is done if there is a child with genetic diseases such as Mediterranean anemia and some muscle diseases. Rarely, if a previous child had a bone marrow transplant necessary for tissue compatibility; If there is a disease in the first child such as leukemia and the age of the woman is usually 40 and over, genetic diagnosis is recommended for embryos.

The purpose of the screening test is to ensure that a healthy embryo is genetically sequenced. Not every genetic diagnosis indicates that the baby is 100 percent healthy. Because there is a 1% risk of skipping. Therefore, after the mother becomes pregnant, the necessary genetic tests of the child should be done by the specialist who followed her during pregnancy. For a definitive diagnosis, if some suspicious parameters are observed during pregnancy, these should be confirmed with some blood tests. There are two methods that give 100 percent diagnosis.

11-14. A small piece of the placenta is taken in the CVS procedure performed between weeks. Or 15-18. Between weeks and weeks, a tiny needle is inserted through the navel of the mother through the liquid in which the baby swims, and the cells there are evaluated. However, with this method, if there is really an abnormality in the baby, the pregnancy can be terminated up to the 24th week with the right granted to us by the state. There is a belief in society that amnio-synthesis is a risky procedure. 300 in 1 pregnancy loss may occur. But in the end, if we are faced with an abnormal child, we definitely recommend having it done.

CAUSES OF REPEAT PREGNANCY LOSSES

What is recurrent pregnancy loss? What problems could be behind?

''Recurrent pregnancy loss is generally defined as the termination of more than two pregnancies of the woman starting from the 5th month. Losses after the 5th month are considered premature birth. Generally, 10% of pregnancies end in the first pregnancy. Second pregnancy loss is around 4 percent; Three pregnancy losses are less than 1 percent. Chromosomal disorders are the most common cause of recurrent pregnancy loss. There may be some numerical or structural chromosomal defects in the mother or father. There may be some congenital defects of the woman's uterus. There may be curtain disorders in the uterus. Sometimes, there may be some diseases and antiphospholipid antibody syndrome (APS) accompanying bleeding and coagulation disorders. But in a very serious rate of 40-50 percent, no cause is known. As in vitro fertilisers, we sometimes recommend genetic diagnosis if the woman's age is advanced in cases of repeated loss without a cause. However, even though we know that the embryos are very healthy, there are pregnancies that do not continue even if we place them.''

STEP BY STEP IVF TREATMENT

Which techniques are applied step by step to couples who come for IVF treatment?

''After evaluating and clarifying why he needs IVF treatment in the first meeting with our couple, we want his period to come on the second or third day at the latest. Even with male infertility, we always start with the woman. Because first we need to prepare the egg.
We use certain hormones in the egg preparation process. Most of the hormones are given in the form of injections with tiny needles. Since our belly area is fatter, it is mostly applied three fingers to the right or left of the belly button. We observe the treatment doses of these by calling the couple every 3-4 days. An ultrasound is done when they arrive. If necessary, some blood values ​​are requested.

This process takes 10-12 days in total. After the eggs are ready, a cracking needle is given. This usually means that after 35-36 hours the eggs will be ready for collection one by one. On the day of the procedure, the patient is put to sleep with light sedation anesthesia and the collected eggs are placed into the woman's vagina one by one under ultrasound guidance. Meanwhile, his wife gives a sperm sample in the laboratory. We give the eggs that we raised one by one to the laboratory environment. After that, it is under the observation of embryologists. They fertilize those eggs and sperm one by one, usually on the 3rd or 5th day.

They report to us the stages of division every day. Afterwards, if the number of eggs is too high for the woman (usually more than 15-20), the method of resting the uterus is used. Because in cases where the hormone is too high, the probability of embryos to attach decreases. In order to bring this to the most ideal conditions, we freeze the embryos for 1-2 months in our laboratory. Then, after making the uterus ready with some hormones (this time in pill form), the small embryos are thawed and placed one by one in the laboratory.

GENETIC TREATMENT TO EMBRYO IN THE FREEZER

Do you apply any genetic treatment to embryos that are in the freezer?

If the mother or father has a genetic disorder, a special condition in the family, or if the mother has more than three previous IVF failures or recurrent pregnancy losses, genetic analysis can be performed on the 3rd or 5th day embryos. However, usually the embryos are at the 3-cell stage on the 8rd day and are more sensitive. Since taking a single biopsy can damage the embryo, our general approach now is to take the embryos to day 5, the Blastocyst stage. Since there are too many cells in the embryo at that time, we take a cell from there and refer the embryos to genetic diagnosis accordingly.”