IVF TREATMENT

In vitro fertilization (IVF) is an assisted reproductive technology used for couples experiencing infertility. In this method, an egg and sperm are fertilized in a laboratory environment, and the resulting embryo is transferred to the uterus. IVF treatment consists of several stages and typically includes the following steps:

1. Preparation and Evaluation:

• Evaluation of Couples: Both the male and female reproductive systems are evaluated. This evaluation includes hormone tests, sperm analysis, ultrasound, and other necessary tests.

• Treatment Plan: The doctor prepares a treatment plan tailored to the couple based on their condition, previous treatments, and genetic test results.

2. Ovulation Treatment (Induction):

• Hormone Therapy: The woman's ovaries are stimulated to produce multiple eggs. This is done with hormone medications (usually FSH and LH).

• Follow: Ultrasound and blood tests are performed to monitor the response of the ovaries and the maturation of the eggs.

3. Yumurta Toplama (Oosit Aspirasyonu):

• Oosit Aspirasyonu: The eggs are collected using a needle, usually guided by vaginal ultrasound. This procedure is usually performed under mild sedation.

4. Sperm Preparation and Fertilization:

• Sperm Sampling: A sperm sample is taken from the man and prepared in a laboratory setting.

• Fertilization: The prepared eggs are combined with sperm. This process can be performed using conventional fertilization methods or intracytoplasmic sperm injection (ICSI).

5. Embryo Culture:

• Embryonic Development: Fertilized eggs (embryos) are grown in a laboratory environment for several days. Transfer is usually preferred on the 5th day at the blastocyst stage, or embryos that reach the 5th day can be frozen after a biopsy is taken from the outer cell mass for genetic testing. In some cases, embryo freezing and transfer is performed on the 3rd day.

6. Embryo Transfer:

• Transfer: The mature embryos are transferred to the uterus. This procedure is usually painless and is performed using a catheter.

7. Supportive Treatment:

• Progestin Use: Progesterone hormones are used to support the uterus after embryo transfer.

• In some patients, anticoagulants and immunosuppressive therapies may be administered depending on the situation.

8. Pregnancy Test:

• Test: A pregnancy test is performed approximately 10-12 days after the transfer. The treatment process is evaluated based on the test results.

Additional Notes:

• Success Rate: The success rate of IVF treatment varies depending on the woman's age, health status, ovarian reserve, and other factors.

• Risks and Side Effects: Possible risks include hyperstimulation syndrome, infection, multiple pregnancy, and miscarriage. Therefore, the treatment process must be carefully monitored.

• IVF treatment can be a complex process and requires individual assessment. Therefore, it is advisable to work with an IVF specialist who communicates with other specialists during the treatment process.

Hormonal Therapy and Immunology Research

• Personalized Hormone Regimens: Hormone treatment plans customized to women's individual needs.

• Immunology: Research on immune factors affecting embryo implantation in the uterine environment may play a role in achieving successful results.

These new applications and technologies are constantly being developed to increase the success of IVF treatment, improve treatment processes, and enhance the patient experience. It is important to collaborate with comprehensive centers to determine the most appropriate treatment option for each patient.

DOUBLE SPECIAL TREATMENT PLANNING

IVF treatment planning tailored to couples is an approach that takes into account each individual's unique health conditions, genetic makeup, and reproductive health. Such customized planning aims to make the treatment process more effective and successful. Here are the main steps and methods to consider in IVF treatment planning tailored to couples:

1. Comprehensive Health Assessment

• General Health Checks: The general health status, lifestyle, and medical history of both partners are reviewed.

• Reproductive Health Assessment: Factors such as the health of the female and male reproductive organs, hormone levels, ovarian reserve (AMH test), sperm count, and motility are evaluated.

• Genetic Tests: Genetic screening and testing may be performed, especially if there is a history of genetic disease in the family. Preimplantation genetic testing (PGT) may be considered at this stage.

2. Individual Treatment Strategies

• Treatment Plan for Women:

  • Ovarian Reserve Assessment: The health and reserve of the ovaries are assessed through hormone tests and ultrasound.

  • Personalized Hormone Regimen: The most appropriate hormone treatment plan is determined to stimulate the ovaries. Changes may be made to the protocol and dosage used in cases of unsuccessful results.

• Treatment Plan for Men:

  • Sperm Analysis: Factors such as sperm count, motility, and morphology are evaluated.

  • Treatment Options: If there is a problem with sperm quality, sperm selection techniques such as ICSI (intracytoplasmic sperm injection) and new technological developments and artificial intelligence can be used.

3. Treatment Methods and Technologies

• Yumurta ve Embriyo Kriyoprezervasyonu: Freezing embryos provides flexibility during treatment. This method is particularly preferable when a large number of eggs are produced.

• Time-Lapse Embryo Tracking: The highest quality embryos can be selected using systems that continuously monitor embryo development.

• Artificial Intelligence and Machine Learning: Artificial intelligence-assisted analyses can be used to achieve better results in embryo selection.

4. Individual Risks and Management

• Management of Ovarian Hyperstimulation Syndrome (OHSS): If there is a risk, appropriate treatment and monitoring are carried out to prevent the development of OHSS.

• Examination of Immunological Factors: If there are problems with the immune system, appropriate immunological tests can be performed and included in the treatment plan. Macrophage vaccination increases treatment success in suitable patients.

5. Personal and Psychological Support

• Consulting and Support: The IVF process can be stressful. Psychological support and counseling services are available for couples.

• Lifestyle and Nutrition: A healthy lifestyle and balanced diet can support the treatment process.

6. Monitoring the Treatment Process

• Regular Monitoring and Checks: Treatment response is monitored through regular ultrasound and blood tests throughout the treatment process.

• Treatment Modifications: Changes may be made to the treatment plan when deemed necessary.

7. Evaluation and Follow-up of Results

• Pregnancy Tests and Monitoring: After embryo transfer, pregnancy tests are performed and the pregnancy is monitored to ensure it progresses healthily.

• Early Pregnancy Management: When pregnancy occurs, necessary measures are taken to monitor early complications.

IVF treatment planning for couples should be carried out meticulously, taking into account the unique needs and health status of each individual in order to achieve the best results. Working in collaboration with a specialist reproductive endocrinologist or IVF clinic to create a personalized treatment plan can increase the success rate of the treatment process.

SPERM SELECTION TECHNIQUES

Sperm selection techniques are methods used in in vitro fertilization (IVF) and other assisted reproductive technologies to improve sperm quality and viability. These techniques aim to increase embryo formation and pregnancy chances by selecting the highest quality spermatozoa. Here are the main techniques used in sperm selection:

1. Sperm Morphology and Motility Analysis

• Sperm Morphology: It evaluates the shape and structure of sperm cells. Spermatozoids with normal morphology may be healthier and genetically sound.

• Sperm Motility: The motility of spermatozoa is evaluated. Sperm with high motility may have a better chance of fertilizing the egg.

2. Intracytoplasmic Sperm Injection (ICSI)

• ICSI (intrasitoplazmik Sperm Enjeksiyonu): It involves injecting a single spermatozoon directly into the egg. This technique is used in cases of low sperm count or motility and ensures the highest quality sperm selection.

3. Washing and Filtration Techniques for Sperm Selection

• Sperm Washing: Sperm samples are washed with auxiliary fluids to separate spermatozoa with better quality and motility.

• Sperm Filtration: Various filtering techniques are used to select high-quality spermatozoa. These techniques enable the selective separation of spermatozoa.

4. Flow Cytometry in Sperm Selection

• Flow Cytometry: It is a technique that analyzes spermatozoa according to various physical and chemical properties. In particular, analyses can be performed on sperm DNA integrity and viability.

5. Sperm DNA Fragmentation Test

• DNA Fragmentation Test: It evaluates damage to sperm DNA. It prevents the selection of spermatozoa with low DNA integrity and improves embryo quality.

6. Rapid Sperm Tests for Sperm Selection

• Sperm Motility Tests: Tests that quickly assess sperm motility help select the best motile spermatozoa.

• Sperm Morphology Tests: Methods that quickly evaluate the shape and structure of spermatozoa are used.

7. High-Resolution Microscopy for Sperm Selection

• High-Resolution Microscopy: It is used for detailed imaging and evaluation of spermatozoa. It helps select spermatozoa of the highest quality.

8. Extracellular Vesicle (EV) Analysis for Sperm Selection

• Extracellular Vesicles: The vesicles surrounding spermatozoa may contain genetic and biochemical information. EV analysis may help determine sperm quality and function.

9. Microscopic Selection and Sperm Membrane Tests in Sperm Selection

• Microscopic Selection: It enables spermatozoa to be carefully selected under a microscope.

• Sperm Membrane Tests: It assesses the health and integrity of the outer membrane of the sperm cell, which can be an indicator of sperm quality.

10. Artificial Intelligence and Machine Learning

• Artificial Intelligence (AI) Supported Analyses: By using artificial intelligence algorithms in the analysis of spermatozoa, sperm quality and motility can be assessed more accurately.

11. Non-invasive Tests for Sperm Selection

• Non-invasive tests: Tests that evaluate sperm quality and do not require intervention can improve the sperm selection process.

12. Micro-Microscopy for Sperm Selection

• Micro-Microscopy: Examining spermatozoa under high magnification can help select spermatozoa of the highest quality.

13. Biochemical Tests for Sperm Selection

• Biochemical Tests: Tests evaluating the metabolic and biochemical properties of spermatozoa are used to select healthier spermatozoa.

These techniques help identify high-quality, healthy spermatozoa for sperm selection in IVF treatment, thereby increasing the chances of embryo formation and pregnancy. Since each couple's situation and needs are different, the combinations and preferences of sperm selection techniques should be determined individually by fertility specialists.

REPEATED IVF FAILURE

Recurrent IVF failure is when multiple IVF treatments fail to produce the desired pregnancy outcome. This situation can be extremely challenging and stressful for couples. However, understanding the causes of this problem and developing appropriate strategies can increase the chances of a successful treatment. Here is detailed information about the causes of recurrent IVF failure and possible solutions:

Causes of Repeated IVF Failure

1. Genetic Factors

• Embryo Abnormalities: Genetic abnormalities in embryos can affect implantation success. Preimplantation genetic testing (PGT) can detect such problems in advance.

• Genetic Diseases: Genetic disorders or chromosomal abnormalities in both men and women can affect treatment outcomes.

2. Problems Caused by Unsuitable Endometrial (Uterine Lining) Conditions

• Endometrial Receptivity Issues: Occurs when the inner lining of the uterus is not suitable for embryo implantation.

• Uterine Anomalies: Structural abnormalities such as polyps, fibroids, and septums may be present in the uterus. These conditions may require surgical intervention via hysteroscopy.

3. Hormonal and Metabolic Factors

• Hormonal Imbalances: An imbalance of estrogen, progesterone, and other hormones can cause the lining of the uterus to be insufficiently supported.

• Polycystic Ovary Syndrome (PCOS): Hormonal disorders such as PCOS can affect ovarian function and reduce treatment success.

4. Ovarian and Sperm Quality

• Low Ovarian Reserve: Low ovarian reserve can affect healthy embryo formation.

• Sperm Quality: Sperm DNA damage or poor sperm quality can negatively affect embryo development.

5. Immunological Problems

• Autoimmune Diseases: The immune system may recognize the embryo as foreign and reject it.

• Antiphospholipid Syndrome: Blood clotting disorders can cause pregnancy loss.

6. Lifestyle and Environmental Factors

• Smoking, Alcohol, and Drug Use: These habits can negatively affect reproductive health.

• Stress and Psychological Factors: Psychological stress can affect the treatment process and success rate.

7. Technical and Laboratory Factors

• Laboratory Conditions: The embryo culture medium and laboratory conditions can affect embryo development.

• Transfer Techniques: The techniques and timing used during embryo transfer can also affect success.

Assessment and Solutions for Repeated IVF Failure

1. Comprehensive Assessment

• Genetic Tests: Genetic screening can be performed for couples, and preimplantation genetic testing (PGT) can be performed for embryos.

2. Immunological and Metabolic Investigations

• Immunological Tests: Diseases or conditions that may affect the immune system are investigated.

• Metabolic Tests: Hormone levels and metabolic conditions are reviewed.

3. Review of Treatment Strategies

• Hormone Treatment Plan: Appropriate treatment plans are developed to regulate hormone levels and support the lining of the uterus.

• Sperm and Ovarian Health: Additional treatments and support methods can be used to improve sperm and egg quality.

4. Surgical Intervention and Treatment

• Treatment of Uterine Anomalies: Intrauterine abnormalities such as polyps, fibroids, or septums can be corrected surgically.

• Ovarian and Endometrial Treatments: Surgical or medical treatments can be used to improve ovarian function and the lining of the uterus.

5. Lifestyle and Psychological Support

• Lifestyle Changes: Healthy lifestyle habits, nutrition, and exercise routines can be established.

• Psychological Support: Stress management and psychological support can help improve the treatment process.

6. Technological and Laboratory Improvements

• Advanced Laboratory Techniques: Optimization of embryo culture media and techniques.

• Macrophage Vaccine

• Artificial Intelligence and New Technologies: Artificial intelligence-assisted embryo evaluation and selection methods can be used.

Result

In cases of recurrent IVF failure, creating a personalized assessment and treatment plan, bringing together multiple disciplines for a council evaluation, can increase the chances of success.

OVARIAN HYPERSTIMULATION SYNDROME

Ovarian hyperstimulation syndrome (OHSS) is a complication that commonly occurs during fertility treatments. It is particularly prevalent during in vitro fertilization (IVF), when the ovaries are stimulated and egg production is increased. OHSS is characterized by excessive enlargement of the ovaries and fluid accumulation.

Symptoms of OHSS may include:

1. Mild Symptoms:

   • Mild bloating in the abdomen

   • Mild nausea

   • A slight discomfort in the stomach

2. Moderate Symptoms:

   • Noticeable swelling in the abdomen

   • Severe nausea and vomiting

   • Diarrhea

   • Increased weight gain

   • Fatigue and general malaise

3. Severe Symptoms:

   • Severe abdominal pain

   • Severe bloating

   • Rapid weight gain

   • Shortness of breath or chest pain

   • Decrease in urine output

   • Severe nausea and vomiting

   • Blood clotting problems (sometimes)

Cause of OHSS:

OHSS usually occurs as a result of the use of ovarian stimulating drugs. These drugs encourage the ovaries to produce more eggs and can sometimes cause the ovaries to become overstimulated. OHSS causes the ovaries to swell due to fluid accumulation and fluid to collect in the abdomen.

Treatment and Management:

Treatment for OHSS depends on the severity of symptoms. Mild cases can usually be managed without treatment, while moderate and severe cases may require medical intervention.

• Mild OHSS: It is usually managed with rest, fluid intake regulation, and painkillers.

• Moderate and Severe OHSS: Your Doctor monitor fluid intake, reduce fluid retention, and recommend hospitalization when necessary. In addition, certain medications and treatment methods may be used to control the severity of OHSS.

Risk Factors:

The risk of OHSS may be higher in younger women and in women with polycystic ovaries who produce a large number of eggs. The risk may also be higher in women who have had OHSS in the past.

Prevention:

• Treatment Plan: When planning fertility treatment, it is important to carefully adjust medication dosages to minimize the risk of OHSS.

• Egg Tracking: Regular ultrasounds and blood tests can be performed to monitor ovarian response and detect OHSS symptoms early on.

The management and treatment of OHSS should generally be carried out under the supervision of an IVF specialist. Therefore, it is important to contact healthcare professionals if any symptoms arise during the fertility treatment process.