IVF ( In Vitro Fertilization ) Center

While couples are informed, success rates of in vitro fertilization can be specified specifically for each patient group or even age of the patient. Main success rate is the annual and average rate and group-based figures are not taken into consideration. This rate reflects the pregnancy rate per embryo transfer and it is generally around 50 percent today. Pregnancy rates may vary significantly especially depending on age of patient, but also according to the underlying cause and presence of male factor. Couples are informed about pregnancy rates per embryo transfer. Our success rate matches with standards of all centers that are preferred globally and work fastidiously.

Yeditepe University Hospitals render healthcare services at all medical departments without making profit, as necessitated by its mission and vision. Continuing operations at this direction, In Vitro Fertilization Center also maintains its activities for providing couples with a pregnancy plan with accurate solutions.

All treatment strategies tailored to special needs of person and couple are planned in the light of scientific data and current approaches.

Physicians and embryologists who are well renowned not only in our country, but also worldwide serve patients in our center, where honesty and ethical values are constantly prioritized.

Yeditepe University Hospitals are notable for a large team of expert physicians, embryologists and biologists in In Vitro Fertilization Center, where a distinctive approach is adopted especially for difficult cases. Treatment and management of all cases are based on joint decision of this team.

Cutting edge technology is utilized and current approaches are followed and tried to be practiced in Embryology laboratory, which plays a very crucial role in management of infertility.

No room is allowed for errors in laboratories that are continuously inspected regarding quality and work flow.

Since in vitro fertilization therapies require maximum attention, our center adopted a patient-oriented approach and our basic principle is to start treatment, after all potential causes of infertility are carefully investigated and the underlying cause is exactly identified. In this way, patients are preserved from unnecessary and excessive treatments without waste of time.

Special treatment protocols are utilized for patients at In Vitro Fertilization Center of Yeditepe University Hospital in case of advanced maternal age and low ovarian reserve. Difficult cases such as Polycystic Ovary Syndrome (PCOS), diseases that are very closely related to infertility, such as endometriosis, and recurrent failures of in vitro fertilization are followed up based on an experience of many years.

Our center closely supports patients in all phases of treatment and makes best efforts to answer all questions of patients with infertility as quickly as possible, while patient rights and confidentiality of personal information are meticulously preserved.

If a couple cannot achieve pregnancy despite regular and unprotected sexual intercourse for 1 year for couples younger than 35 years of age and for 6 months for couples older than 35, the condition is called infertility. Primary infertility implies total absence of pregnancy in obstetric history of the couple, while secondary infertility is characterized by at least one conception, irrespective of giving birth to a living newborn infant.

Number of infertile couples has recently increased due to certain reasons such as stressful living conditions, unhealthy diet and smoking.

Although there are female and male factors for infertility, pregnancy may, sometimes, fail, even if there is no significant problem in both man and woman. This last group is called “unexplained infertility” and it accounts for 10-15 percent of infertile couples.

Therefore, it is critical to determine the exact underlying cause for infertile couples to achieve a healthy pregnancy and eventually have healthy babies. Other important factor that increases the success rate in treatment of infertility is to prescribe correct treatment through the most appropriate personalized treatment approach for couples.

Preimplantation genetic diagnosis (PGD) is a novel technique that screens all chromosomes of an embryo and may detect potential abnormalities for this group of women to increase chance of pregnancy and give birth to a healthy newborn infant. Twenty four chromosomes of an embryo are screened in genetic laboratory, after several cells of the embryo are biopsied by the embryologist without any damage to the embryo, and thus, an embryo without any genetic abnormality is selected and transferred. This method increases chance of pregnancy, ensures the continuation of pregnancy and allows giving birth to a newborn infant with normal genetic features.

Ovaries should necessarily be evaluated in the baseline examination of these women. If ovarian volume is within acceptable ranges and there are follicles that may mature in ovaries or respond to a treatment, platelet rich plasma (PRP) is injected to ovaries and small follicles that are deemed dormant can be stimulated. Thus, it is possible to get oocytes with higher quality.

Signs of polycystic ovary syndrome can vary depending on severity of disease and it may sometimes be asymptomatic. According to a study, PCOS is not diagnosed in 70 percent of patients with this condition. Some patients with mild symptoms are diagnosed with the syndrome, after they see a doctor due to unintended weight gain and difficulty getting pregnant.

Principal symptoms of PCOS are as follows:

Irregular Menstrual Cycles

Menstrual cycles delay as the innermost lining of the uterus (endometrium) does not shed every month due to lack of ovulation.

Heavy Menstrual Bleeding (Hypermenorrhea)

As the innermost lining of the uterus is exposed to hormones for a prolonged time, it becomes thicker than usual and therefore, heavy bleeding occurs.

Abnormal Hair Growth in Face and Body (hirsutism)

Abnormal hair growth is seen in face and body due to increased male hormones in 70 percent of patients.

Acne

Skin becomes more oily due to elevation of male sex hormones. Therefore, acne can develop especially in face, chest and upper back.

Weight Gain / Difficulty Losing Weight

Weight gain is likely in 80 percent of patients due to hormonal imbalance.

Hair Loss / Male Pattern Baldness

Thinning and loss of hair are likely.

Dark Discoloration of Skin

Punctuate discoloration of skin can be seen.

Headache

Headache is more common compared to general population.

Generally, lifestyle changes are recommended before medications in treatment of PCOS. Even losing 5-10 percent of body weight can have positive effect on menstrual pattern. Moreover, weight loss decreases cholesterol and insulin levels and the risk of diabetes mellitus and heart disease is also reduced. Diets with low carbohydrate and low glycemic index are also effective to cope with the insulin resistance. In addition to diet, exercise is also recommended in treatment.

Although there is no curative medical treatment for PCOS, oral contraceptives ensure regular menstrual cycles and are effective on other adverse signs, such as hair growth and acne formations. Drugs that contain metformin may have positive effects in patients with PCOS by regulating insulin levels.

PCOS causes difficulty getting pregnant by impairing menstrual cycle and ovulation. Therefore, approximately 70-80 percent of patients have troubles in achieving pregnancy. This syndrome also increases complications of pregnancy. For instance, preterm labor threat, gestational hypertension and gestational diabetes are more prevalent.

Patients with PCOS can get pregnant thanks to medications that regulate ovulation. Unless there is no problem other than PCOS (blocked Fallopian tube, male infertility etc.), in vitro fertilization may not be needed. However, even if in vitro fertilization is necessary, induction of ovulation may cause release of more eggs than general population. Thus, this group of patients is generally deemed favourable patients without difficulty in management by physicians.

No use of any medication to stimulate release of eggs is the factor that distinguishes natural IVF from conventional in vitro fertilization.

A woman releases only one egg in each period under normal circumstances. A medication is administered for 8 to 12 days to stimulate release of more than one egg in in vitro fertilization patients. In natural in vitro fertilization, no medication is administered or in other words, natural menstrual cycle is followed. This method allows release of one egg, but it is most probably a high-quality one, as it is selected and developed by the body. Oocyte pick-up lasts for a short time and no anesthesia is administered depending on preference of the patient. Rest of the procedure is identical to the conventional in vitro fertilization; picked up oocytes are fertilized by sperms at laboratory settings and embryos are transferred into uterine cavity at the appropriate developmental phase. However, one should remember that the chance of pregnancy is lower than conventional in vitro fertilization, as only one oocyte is picked up.

Certain conditions favor natural IVF. The first one involves patients who fail pregnancy despite conventional in vitro fertilization attempts, as no or too little oocyte could be harvested. In such cases, natural maturation of follicles is tracked with ultrasound scan and oocytes are picked up, after they reach a certain size. Moreover, it is preferred by patients who do not want to use medications and hormones. This approach – the in vitro fertilization method that is closest to natural reproduction – is successfully performed in our center.

In vitro fertilization is an umbrella term for a series of procedures carried out for couples who have difficulty in conception to help them conceive. In vitro fertilization (IVF) has certain stages.

1. Use of medications to induce growth of more than one egg.
   
2. Monitoring growth of egg through ultrasound scans at an interval of several days.
   
3. Oocyte pick-up under guidance of vaginal ultrasound, when follicles reach a pre-defined size. This procedure is usually performed under anesthesia.
   
4. Picked up oocytes are fertilized by sperms at laboratory settings to obtain embryos.
   
5. Development of embryo is followed up and it is transferred into uterine cavity, when sufficient maturity is achieved. Embryo transfer is a pain-free procedure and it does not require anesthesia induction.
   

Baseline Assessment and Evaluation of Couple

In the first encounter with couples at our in vitro fertilization center, our physicians focus on and decide which treatment modality is more appropriate for the couple and whether they need extra treatment or procedure before initiation of in vitro fertilization therapy. In this initial assessment, the couple is evaluated regarding past history of treatments, obstetric history (previous pregnancies, miscarriages and deliveries), documented diseases and past history of operations and reports of all previous tests and examinations (all blood and hormone analyses, hysterosalpingography, chromosome analysis, spermiogram) are reviewed. In this baseline visit, all patients presenting to our clinic have a comprehensive gynecological examination and ultrasound scan. Appropriate treatment and correct time to start therapy are determined in the light of data gained from patients.

Ovulation Induction and Release of Eggs

Medicines that induce ovulation are administered (injection therapy) in order to obtain numerous oocytes from ovaries. Dose of medicine and duration of use are determined in the baseline assessment according to age and ovarian reserve of the patient. Therefore, not all patients are managed with same treatment for identical duration. The period of ovarian stimulation lasts for 8 to 12 days in average until administration of another medicine to assist hatching.

Oocyte Pick-up

Oocytes are picked up 34 to 36 hours in average after the medicine that assists hatching is administered; mature oocytes are aspirated using a needle that is inserted through vaginal route under anesthesia and guided by transvaginal ultrasound; these oocytes are stored at laboratory settings for fertilization. Semen specimen is collected from the spouse of patient with masturbation method, as is the case with spermiogram specimen, while or immediately before the oocyte pick-up.

In Vitro Fertilization or Microinjection (Intracytoplasmic Sperm Injection – ICSI)

Conventional In Vitro Fertilization (IVF): This technique had been more widely used at the preliminary era of in vitro fertilization, before microinjection (intracytoplasmic sperm injection – ICSI) was discovered. Recently, IVF technique is not as commonly preferred as in the past, as the fertilization rate is lower relative to ICSI. *Microinjection (Intracytoplasmic Sperm Injection – ICSI): This technique is far more commonly used also in our clinic; ICSI involves injecting a sperm that is held in a very thin needle directly into the egg under microscope. Resultant embryos of this procedure are developed until Day 7 in an incubator – a device that creates a culture medium, which mimics the temperature of a human body.

Embryo Transfer

Embryos stay in incubator for 2 to 6 days and their growth is closely monitored; next, they are transferred into uterine cavity using special catheters in a pain-free procedure that does not require anesthesia administration. Embryo transfer lasts for 10 to 15 minutes in average.

Pregnancy Test

Pregnancy is verified by quantifying a hormone, called β-HCG, in a blood test that is done 10 to 12 days after embryo transfer. The patient should be checked with ultrasound to verify presence of gestational sac approximately 10 days after β-HCG test points to constant elevation or the concentration of hormone is sufficiently high.

Advanced Maternal Age

Ovarian reserve decreases in women older than 35, especially above 40 years. As number and quality of oocytes (eggs) are usually poor at this age range and genetic disorders are more prevalent, chance of spontaneous pregnancy decreases along with decline in “ongoing pregnancy” achieved with assisted reproductive techniques.

Co-existing Diseases and Habits

Co-existing diseases or endocrine disorders in couple, especially in woman, may result in incompliance to in vitro fertilization treatment and lower efficiency of treatment. Particularly, negative effects of smoking on oocyte and sperm quality are clearly known. This result has been proven by numerous studies. To list a few, co-existing diseases that decrease the success are endometrioma, adenomyosis and hydrosalpinx.

Genetic Problems

Sperm count and quality:
Low sperm count and morphological disorders of sperm also affect pregnancy rates.

Treatment protocols and their type:
Experience of physicians and embryologists and laboratory conditions at in vitro fertilization centers are also important factors that play a role in success rate.

In vitro fertilization center should have a license that is issued by Ministry of Health to verify that in vitro fertilization therapies can be performed. Also, physicians of the center should be qualified to perform in vitro fertilization therapies. This qualification is acquired by the doctors from education and training centers that are determined and authorized by Ministry of Health. Experienced embryologists of the laboratory also increase the success rate.

A list of doctors and embryologists, treatment protocols, quality certificates of the center, licenses and certifications should be available on official websites of in vitro fertilization centers. These issues should be given attention in a preliminary search on centers.

One should remember to prefer a center, where all phase of in vitro fertilization can be reviewed and advanced examinations, investigations and operations are performed, if required, as these criteria will strengthen the patient-doctor interaction and facilitate access of patients to their doctors.

Failed in vitro fertilization attempts can be wearing both emotionally and financially for patients. This fact is also verified by patients with obstetric history of failed in vitro fertilization attempts who present to our center and form a substantial part of admissions. Therefore, investigating the potential underlying causes rather than further attempts of in vitro fertilization in patients with a certain number of failed attempts offers an opportunity of targeted therapy. A healthy pregnancy and its continuum depend on the relation between embryo and endometrium (innermost lining of the uterus). The aim should be to create a healthy relation from the outset.

Conditions that may cause recurrent failure are listed as follows:

• Uterus-related factors (anatomic disorder, adhesion, polyp, myoma etc.)
• Endometrial dysfunction
• Thrombophilia (blood coagulation problem)
• Immunologic factors (immune system)
• Genetic factors
• Cessation of embryonic development in the uterus

At In Vitro Fertilization Center of Yeditepe University Hospitals, detailed examination is planned especially to investigate above mentioned factors for the patients with history of failed in vitro fertilization attempts in the past. Since treatment options vary for each problem that may lead to recurrent failure of in vitro fertilization, “personalized treatment approach” is adopted for all patients.

For some patients, exact cause of infertility may not be identified and pregnancy cannot be achieved, although a high quality embryo is transferred. Studies demonstrate that new treatment modalities, such as intrauterine PRP injection and growth hormone (G-CSF), improve endometrial function and increase pregnancy rates in this group of patients. Maximum attention is paid to patient selection for these novel treatments at our center and positive outcomes are obtained in certain groups of patients.

Each failed attempt in treatment of infertility provides important clues regarding a successful in vitro fertilization attempt. Therefore, history of in vitro fertilization is comprehensively reviewed in all patients who present to our center. Complex cases are discussed in in vitro fertilization council in the light of current scientific data on weekly basis and a tailored treatment is planned for each patient.

The main approach in in vitro fertilization treatment is to reveal out the underlying causes and adopt an accurate, appropriate therapeutic approach. For example, for couples that cannot achieve pregnancy due to metabolic diseases, in vitro fertilization process should be started after the metabolic disorder is cured, if age and ovarian reserve of woman allow this approach. Thus, a treatment that requires “couple-specific approach” should always be planned for a successful in vitro fertilization treatment. The cost is influenced by many factors, including but not limited to treatment method and necessary tests.

Although Social Security Institution coverage is not valid at our in vitro fertilization center, special opportunities are provided in examinations, tests and operations performed at our hospital. For further information, please contact our center.

Oocyte (egg) pick-up is generally performed under sedation -a type of anesthesia- at our clinic, as is the case with many other centers. Sedation ensures that you do not feel pain during the procedure and you will not remember anything about the procedure. It is expected that the pain you will experience will be similar to a menstrual pain at most, as you will be administered painkillers during and after the procedure. Painkillers will be prescribed to manage pain after discharge.

If no additional treatment is needed after the baseline assessment, you will be started on treatment to induce ovulation in the first menstrual cycle. Ovaries are evaluated on day 2 and 3 of the period and transvaginal ultrasound is preferably scanned to select the personalized treatment protocol and adjust dose of the medication. Next, oocyte development is evaluated through intermittent ultrasound scans and hormone tests in blood. Although inter-patient variations apply to development of oocytes, the estimated average interval is 8 to 12 days. Next, a drug is administered to assist hatching and oocytes are picked up 34 to 36 hours after the injection. Sperm is injected into the egg with ICSI at laboratory settings on the same day and thus, an embryo is obtained. Embryo can be transferred 2 to 6 days after the oocyte pick-up, unless there is a condition that may affect success of the transfer adversely (polyp, myoma, OHSS risk etc.).

Analysis of β-HCG hormone in blood is the first and the most accurate way to verify if pregnancy is achieved. Additional symptoms include discomfort or mild pain in groin that is similar to menstrual pain, tenderness in breasts, mild spotting-like bleeding and nausea.

Today, the exact cause cannot be identified in 40 percent of recurrent miscarriages. Recurrent miscarriages can be seen secondary to uterine factors, such as polyp, myoma or congenital septum and adhesion/synechia due to prior surgeries or infections, but co-existing maternal diseases, such as thyroid dysfunction, coagulation disorders and poorly regulated diabetes mellitus may also result in recurrent miscarriages. Structural conditions that include polyp, myoma, uterine septum and adhesion / synechia can be corrected with surgery. Considering medical conditions of the mother (thyroid dysfunction, uncontrolled diabetes mellitus), treatment is planned by consultant doctors in the first encounter before the ovulation induction. For patients with history of and problems related to clotting, certain tests are ordered in the first appointment and medical treatment is started, if it is deemed necessary. Moreover, studies have demonstrated that the reason is genetic disorders of embryo in 10-15 percent of cases. Anomalies can be observed in embryos even if there is no problem in chromosomes of mother and father. Today, embryo biopsies offer a chance to find an embryo with normal genetic features without any damage to embryos. Twenty four chromosomes of embryos are screened with preimplantation genetic diagnosis (PGD) at the genetics laboratory of our hospital and embryos with normal genetic features can be identified. Thus, healthy ones are transferred into the uterus to maximize chance of a healthy pregnancy.

Although Social Security Institution coverage is not valid at our in vitro fertilization center, special opportunities are provided in examinations, tests and operations performed at our hospital. For further information, please contact our center.