BIG GROUP HEALTH TOURISM

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IVF

The road to parenthood can be difficult and long at times. Peace of mind; Our IVF Center Team makes the dreams of couples on this challenging journey come true with a high success rate. In the IVF Unit, specialist physicians offer the simplest and most basic treatment options, along with the most complex treatments. The IVF Unit, which aims for personalized treatment, decides on the most appropriate treatment option together with its guests. Following the first interview, ovulation induction (regulation of ovulation with drugs), surgical intervention, intrauterine insemination (vaccination) or IVF-ICSI (in vitro fertilization – microinjection) treatment may be recommended for the cause of infertility. IVF Unit also produces solutions in terms of psychological support.
What is Infertility?

Infertility is the situation where pregnancy does not occur at the end of one year despite unprotected and frequent intercourse. 85 percent of couples achieve pregnancy within one year, and 93 percent within two years. The remaining group are considered infertile and need assisted reproductive techniques.

In other words, we encounter infertility problems in roughly 15-20% of the society.

Causes of Infertility

With today’s technology, the factor preventing pregnancy can be detected in 85-90 percent of infertile couples. Approximately 40 percent of these are of female origin, while 40 percent are of male origin. All parameters are normal in the remaining 20 percent group, that is, we do not find any tangible cause in the couples in this group with our current knowledge. This condition is called “unexplained infertility”.

The most important factor affecting the success of IVF treatments is the woman’s age and the woman’s egg reserve. Especially in women over 38 years of age, the number and quality of eggs in the reserve begin to decrease seriously; Even with IVF over the age of 40, pregnancy rates drop to 30%. According to the currently accepted criteria, 45 years of age is accepted as the ceiling age for women (with some exceptions) to achieve pregnancy with treatments. While some of the women’s problems may require a surgical operation before IVF treatment, some problems may change the treatment protocol to be applied. For example, congenital or acquired disorders in the uterus are first corrected surgically and then treatment is started, or in cases where the ovarian reserve of the woman is less or more than expected for her age, treatment protocols and drug doses will be adjusted accordingly.

Women-Based Causes

Closed tubes, hydrosalpenx (inflammation of the tubes)
ovulation disorders, polycystic ovary syndrome
uterine and cervix disorders, congenital veil in the uterus
Hormonal and metabolic problems, thyroid dysfunctions
Endometriosis and chocolate cysts
Peritoneal problems, adhesions due to previous operations
advanced female age
vaginismus

Male-Based Causes

In 30-40 percent of infertile couples, the only reason is male. In 10-15%, it accompanies women-related problems. Semen analysis is the most basic and guiding step of infertility tests.

Problems in sperm count or sperm movement
Sperm deformities
Absence of sperm (Azospermia)
Congestion in sperm carrier ducts, absence of ducts
Erection or ejaculation problems (retrograde ejaculation)
Hormonal causes
genetic causes
Varicocele

Treatment Methods IVF unit aims to provide superior service to patients.

Vaccination (Insemination)

It is the process of placing the sperm directly into the uterus, which is prepared by the woman to produce 1-2 eggs with pills or injections, and then selected by special methods just before the egg cracks. For double vaccination, the woman must be under the age of 38 and have a normal ovarian reserve, both tubes must be open, the uterus must be normal, and the male must have at least certain number and motility rates in the sperm test.

IVF (Classic IVF)

It is the process of fertilization of the eggs collected from the woman with the sperm taken from the man under special laboratory conditions. A certain amount of live sperm is required for IVF. In this method, a certain number of sperm is placed in the same environment with each egg and self-fertilization is expected without any intervention. It is now a less and less used method in modern IVF clinics and its success rates are lower than microinjection.

ICSI (Microinjection)

In this process, embryos are created by injecting sperm one by one into each mature egg collected. Therefore, even men with a very low number of sperm can have children thanks to this method. Another advantage of the microinjection method is that the collected mature eggs are fertilized more than the IVF method.

Operation TESE

The absence of sperm cells in the semen analysis is called “azoospermia”. Simple aspiration methods can also be used to obtain sperm when there is azoospermia due to obstruction in the ducts. In azoospermia, where the channels are open, the process of searching for sperm by microsurgical method from inside the testis under the microscope is called TESE. This procedure, which is performed under anesthesia, is more sensitive than the multiple biopsy method without the use of a microscope. The success rate is higher since the channels where sperm can be found are detected by seeing with a microscope. In addition, the complication rate that may occur in men with microTESE surgery is minimal.

We can find 2 types of possible causes in azoospermia.

Due to obstruction: In this case, although there is not a very important problem in the sperm production of the man, there is an obstruction in the genital tract between the testis and the penis caused by reasons such as previous surgery or infection, or the sperm cannot pass from the testis to the semen due to the congenital absence of these reproductive tracts.
Not due to obstruction: This is the more common group. Although there is usually no defect in the genital tract in such men, the problem is insufficient sperm production. Here, too, the cause may be hormonal, genetic or a past infection. In most cases, no specific reason can be found to explain the situation.

Treatment Steps
Evaluation of the infertile couple, gynecological and urological examinations
Planning the treatment method by choosing
development of eggs by stimulating with drugs (ovulation induction)
egg collection under anesthesia (OPU procedure)
Fertilization of the egg with sperm (ICSI)
Embryo Transfer

Current Techniques in IVF

Assisted Hatching

It is the process of shaving and thinning the surrounding membrane to facilitate the attachment of the embryo to be transferred to the inner wall of the uterus. It is thought that it can sometimes increase the implantation rate.


PGD ​​(Preimplantation Genetic Diagnosis)

It is the process of determining abnormal or disease-carrying embryos by biopsying the embryo performed on the third or fifth day of the embryo’s development, and transferring the double normal embryos. It is applied for reasons such as couples who are carriers of a known genetic disease, recurrent miscarriages, recurrent IVF failure, determination of the appropriate tissue type embryo (HLA Determination) for the treatment of sibling with blood disease, advanced female age. Thanks to this process, it is aimed to increase the live birth rate by transferring embryos with healthy chromosome structure.

Sperm Selection by IMSI and Double Refraction Method

In in vitro fertilization procedures, only the number of mature eggs obtained from thousands or millions of sperm cells in the semen sample taken from the male is selected and used. This selection is also usually based solely on the experience of the embryologist. In the IMSI method, more image magnification is provided than the classical microscopes used, allowing a clearer evaluation of the sperm structure. Thus, better, quality sperm selection is aimed. This method can help in the selection of higher quality sperm in cases of severe male infertility, unexplained IVF failures and low quality embryo production.

Hysteroscopy and Laparoscopy

In hysteroscopy, which is the process of reaching the uterus through the vagina and viewing it with a light camera system, problems such as structural defects of the uterus (curtain, double uterus), fibroids, polyps, adhesions (synechia) can be detected and treated at the same time. If the problem detected before the IVF procedure originates from the uterus or if recurrent IVF failure is diagnosed, performing hysteroscopy may increase the success of pregnancy.

Laparoscopy is the process of imaging the inside of the abdomen with a light camera system. Generally, the surgical treatment of ovarian cysts, the opening of adhesions due to previous surgeries, the surgical treatment of fibroids located outside the uterus, and the evaluation of tubes are performed with this method. In fact, almost all open surgeries can be performed by laparoscopy.


Embryo Freezing, Storage and Thawing

Embryos can be frozen with special methods at any time between the second day and the fifth day of their development and then stored in liquid nitrogen at -196 degrees. Embryos that increase after embryo transfer and are of good quality are frozen to be used later for sibling request or in case of treatment failure.

Ovarian hyperstimulation is called OHSS in short, when the ovaries grow by responding excessively to the drugs used in IVF treatment and fluid collection in the body of the expectant mother. In modern IVF treatments, there are special drug treatment protocols for such risky patients, and all embryos formed for the prevention of OHSS are frozen and stored for later transfer. Freezing and thawing of embryos with modern methods reduces the risk of this problem to zero without affecting the embryo quality.