WHAT IS INFERTILITY? WHAT IS THE OPTIMAL TIME FOR TREATMENT?
Infertility is the failure of pregnancy in the presence of regular sexual intercourse at least for a year. Conceptional rate is nearly 20-25% for young healthy reproductive aged women and nearly half of the patients get pregnancy during first six months. It is recommended to have a gynecological examination at the end of twelve weeks of fertility trial.
WHAT IS INFERTILITY TREATMENT?
Components of infertility treatment are ovulation induction, oocyte retrieval, sperm collection, fertilization of sperm and oocyte at laboratory conditions and than transfer of embryo to uterine cavity. IVF treatment modalities are used in endometriosis, immunological infertility, male infertility and infertility without an apparent courses.
There are 4 steps in treatment protocol;
- Ovulation induction: Exogeneous gonadotropins are used to induce ovaries to make increased numbers of follicular development.
- Ovum pick up: Oocytes are retrieved with the help of transvaginal ultrasonography under general anesthesia.
- Fertilisation of oocytes with sperm: Oocytes and sperm are fertilized in a laboratory conditions under special circumtances.
- Embryo transfer: Embryos are transfered to uterine cavity via soft catheter on apropriate date.
WHAT ARE THE FACTORS THAT INCREASE THE TREATMENT OUTCOME?
Assisted hatching is a technique used during some IVF procedures. It helps an embryo to hatch out of its protective layering. In this way it increases the implantation rate. During the initial stages of development embryo is covered with a membrane known as the zona pellucida. It protects the embryo until it reaches the blastocyst stage of development. In order to implant into the uterine lining, the embryo needs to hatch out of this zona pellucida. Assisted hatching causes these embryos to break out from the zona pellucida by creating a small hole in this layer with substances like acid tyrode or laser. We use a laser technique in our clinic. It is usable if the zona pellucida is too thick ( over 15 microne ), the age of patient is over 35, in the presence of history of previous failed IVF treatment and in cryopreserved cycles.
Does laser theraphy is used only in embryos retrieved from women of increased age?
We use laser technique if the zona pellucida is too thick ( over 15 micron ) or in the presence of previous failed IVF-ICSI treatment. In this way there is ability to concieve after history of several failured treatment. Also laser theraphy is used to wash out the toxic metabolites from embryo and make more qualified embryo.
After 2 days of fertilisation 2-4 cells embryo is produced in laboratory environment and it is used in usual IVF treatment. In the usual pregnancy conditions embryo forms blastocyst stage and enters the uterine cavity at the end of 5.thday. A blastocyst is an embryo that has developed for five to six days after fertilisation. Implantation rate of blastocyst is much more higher than 2-4 cells stage embryo. Nowadays it is easy to culture embryos in the laboratory incubator to the blastocyst stage before they are transferred to the uterine cavity. With this techniques higher implantation rates are seen. Embryo transfer on alternate days that was first used in Singapore is also a new technigue that includes day 2 embryo and day 6 blastocyst transfer. In this way implantation failure rates are lowered and pregnancy rates are increased.
This procedure involves growing of embryos in a culture medium with cells of the endometrium. Endometrial cell sampling is performed during 20-23.rd day of mensturation with endosampler and cells are incubated under special conditions to make artificial endometrial cavity. Embryo development is stimulated in this medium in the laboratory. These feeder or helper cells will stimulate development of the embryos by removing toxins from the medium, adding growth factors, or some other beneficial effect as in the usual endometrium. Pregnancy rates and the numbers of best quality embryos are increased in this way.
The aim of our IVF Clinic is to serve the most suitable and succesful treatment choise to our patients with the help of multidisciplinary gynecology, embryology, genetic, urology, biology departments and good care of IVF nurses.
IVF treatment as a whole (treatment to βhcg testing) takes about 1 mounts. Diagnostic and treatment protocols for patients coming from abroad, airport transfers, accommodation of setting close to the hospital services, clinics providing support for entry and exit procedures, including follow-up appointments, scheduling, payment procedures and to facilitate financial transactions, their cities, according to the needs of patients in cities that own their realizing the framework, such as comfort feel.
During the treatment our doctors, nurses and consultants, patients, based on the principles of mutual trust and honesty at all stages of treatment, establishing a relationship based on shared principles.
Prof. Dr. Cem FIÇICIOĞLU