IVF ( In Vitro Fertilization ) Center

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 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.

Services Available at In Vitro Fertilization Center

In Vitro Fertilization Center of Yeditepe University Hospitals practices all modern approaches to meet the needs of couples suffering from infertility. Besides, following services are available at the center to list a few:

  • Training of infertile couples
  • Evaluation of infertile couples
  • Sperm analyses
  • Hormone tests
  • Hysterosalpingography (HSG)- X-ray imaging of uterus
  • Ultrasound-guided examinations
  • Ovulation monitoring
  • Intrauterine Insemination (IU) I-insemination
  • In Vitro Fertilization (IVF)
  • Micro injection (ICSI, IMSI)
  • Testicular biopsies and microscopic TESE procedures
  • Freezing and storing egg and ovarian tissue
  • Embryo biopsies
  • All genetic tests (PD, PGS, NGS)
  • Assisted Hatching (opening the shell of embryo using laser energy)
  • Microchip method
  • Freezing and storing egg, sperm and ovarian tissue
  • PRP (for selected cases)
  • Co-Culture
  • Histeroscopy
  • Laparoscopy and treatment of hydrosalpinx
  • Treatment of intrauterine adhesions
  • Treatments of recurrent miscarriage
  • Treatment of infertility in endometriosis cases
  • Treatments of Polycystic Ovary Syndrome (PCOS)
  • Nutrition and management of metabolism
  • Acupuncture and psychological support therapies

What Are Success Rates of 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.

Why Is In Vitro Fertilization Center Different From Other Centers?

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.

What is Infertility?

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.

Causes of Female Factor Infertility

Advanced Age

Best reproductive ages for a woman are her twenties. Fertility gradually decreases in around 30 years of age and especially after the age of 35. Chance of pregnancy is 20 percent for a healthy, fertile woman at the age of 30 in every month she tries to get pregnant. This figure also implies that pregnancy is achieved by 20 out of 100 women at reproductive age, who try to get pregnant in a certain menstrual cycle and that other 80 women should try again in subsequent periods. At the age of 40, chance of a woman is less than 5 percent in each cycle. Therefore, less than 5 out of every 100 women are expected to be successful every month.

When women are in mid 30s, their chance of pregnancy decreases and risk of miscarriage increases, since the quality of eggs reduce along with a decline in number of eggs. Thus, age of a woman is the most accurate finding for egg quality. A significant change in quality of the egg is seen in the presence of genetic anomalies, called aneuploidy (too many or few chromosome in an egg). As a woman gets older, too many or few chromosomes exist in most of the eggs. This means that there will be too many or too few chromosomes in the embryo, if fertilization is achieved. Pregnancy may fail or otherwise, it may result in miscarriage, if an embryo has too many or too few chromosomes. This fact helps explain why pregnancy rates decrease and risk of miscarriage increases in women at advanced ages.

Decrease in follicles that contain oocytes in ovaries are called as “low ovarian reserve”. As women are born with all follicles they are supposed to have, the follicle pool is slowly used throughout the lifetime. As ovarian reserve decreases, follicles become less sensitive to be stimulated by FSH; therefore, more stimulation is needed for an egg to mature. First, periods may approximate to each other and this may result in short cycles at 21 to 25 day intervals. Eventually, follicles cannot react well enough for continuous ovulation and this causes long, irregular cycles. Diminished ovarian reserve is generally related to age and it is caused by natural loss of eggs and decrease in average quality of remaining eggs.

What Are Methods That Increase Success of in Vitro Fertilization For Women at Advanced Age?

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.

Polycystic Ovary Syndrome

Polycystic Ovary Syndrome (PCOS) is the most common hormonal disorder in women. Women with PCOS produce more testosterone (male sex hormone) than normal. This hormone imbalance causes ovulation disorders and irregular menstrual cycles. Women with this condition experience more difficulty achieving pregnancy than normal population.

Combination of following two factors is required to establish diagnosis of PCOS:

Irregular Menstrual Cycles

Not having menstruation for more than 35 days or less than 9 times a year.

High Male Sex Hormone (Androgen) Levels

High level of male sex hormone can be determined in physical examination or blood test. Elevation of these hormones is the reason of symptoms such as abnormal hair growth, male pattern baldness and acne.

Cysts in Ovaries

Ovaries generally enlarge and contain multiple small cysts. Ovarian functions are also problematic.

What Are Signs Of Polycystic Ovary Syndrome?

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.


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 is more common compared to general population.

How Is Polycystic Ovary Syndrome Treated?

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.

Can Polycystic Ovary Syndrome Cause Infertility?

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.

Can Patients with Polycystic Ovary Syndrome Conceive?

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.

Early Menopause

Women have a certain ovarian reserve when they are born and the number of eggs gradually decreases through both ovulation and cell death (atresia). Menopause takes the scene when the ovarian reserves deplete. Average age of menopause is 51. “Early menopause” implies menopause that happens before 45 years of age. On the other hand, “primary ovarian insufficiency” (POI) is a condition characterized by cessation of periods before 40s.

While no exact cause is identified in some cases of early menopause or primary ovarian insufficiency, an underlying cause is detected in others. Some of these cases are as follows:

  • Family history
  • Smoking
  • Chemotherapy/radiotherapy
  • Surgical removal of ovaries
  • Some autoimmune diseases
  • HIV and AIDS
  • Some chromosomal disorders
  • Chronic fatigue syndrome

Early menopausal women with pregnancy plan are challenging cases for In Vitro Fertilization physicians. The literature did not recommend a treatment option for these patients until near past, while a recent discovery, PRP injection to ovaries (ovarian rejuvenation), is a promising treatment for these patients and in vitro fertilization doctors. However, patient selection is very crucial, as this treatment does not help all patients. At our hospital, PRP is injected to ovaries of patients who require this treatment.

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Blocked Fallopian Tube

Fallopian tubes originate from both sides of uterus and act as a path between ovaries and uterus. One egg (oocyte) released by right and left ovaries in each month pass through these tubes into the uterine cavity. Blockage or dysfunction of these tubes lead to infertility – a condition called tubal factor.

Infections are the most common cause of infertility secondary to tubal factor. Other common etiologies are endometriosis, pelvic inflammatory disease, sexually transmitted diseases (primarily Chlamydia and Gonorrhea), ectopic pregnancy and past history of surgery. All these conditions may damage tubes.

In some cases, it may be possible to repair the tubes with laparoscopic surgery. Assisted reproductive technologies are considered for patients who do not respond to this method. Hydrosalpinx (accumulation of fluid in these tubes) decreases chance of pregnancy, as the fluid that accumulates in lumen of these tubes flows into the uterine cavity. In this case, communication of the tube with the uterus is stopped through a laparoscopic surgery or the tube is removed, before in vitro fertilization therapy is started.


Vaginismus implies failure of penetration during sexual intercourse due to involuntary contraction of vaginal muscles in women. This spasm hinders sexual intercourse; even if penetration is achieved, it becomes seriously painful. The underlying cause of vaginismus is mostly psychological in nature. Incidence of this condition is, unfortunately, higher in populations, where sex is a taboo topic. History of sexual harassment, unpleasant first sex experience and the thought that sex is bad or incorrect may pave the psychological way for vaginismus.

Our in vitro fertilization center also admits patients who cannot have a sexual intercourse due to vaginismus. These patients may be offered in vitro fertilization therapy. However, it is necessary to start treatment of vaginismus, before in vitro fertilization therapy is considered. Treatment of vaginismus is guided by gynecologist and obstetrician with education and certificate on sexual dysfunctions and psychiatrists.

Vaginismus is generally refractory to sex therapy. Sex therapy generally focuses on feelings during penetration and involves gradual penetration exercises. In case of an underlying trauma, psychotherapy reveals out and solves the problem. Moreover, the patient is allowed to gain control of vaginal and pelvic floor muscles by instructing pelvic floor exercises.


Endometriosis implies a condition characterized by presence of endometrium – the innermost lining of uterine cavity – in any other part of body other than uterus. The most common sign is pelvic pain that aggravates especially in periods, but infertility is also detected in around 30-50% of patients with endometriosis.

Endometriosis lesions may cause scar formation in the future by triggering inflammation at the location of origin. Moreover, they may result in bleeding at the location of endometriosis during periods.

Several theories are suggested for infertility in cases of endometriosis:

  • The inflammation caused by endometriosis result in release of cytokines that make fertilization difficult by influencing sperms and eggs.
  • Scar formation and adhesion leads to blockage of the tubes.
  • If located over ovarian tissue, endometriosis challenges the ovulation, resulting in difficulty releasing the egg.

There are two treatment options for endometriosis: medical treatment and surgery. In vitro fertilization is a viable option for patients who suffer from infertility due to endometriosis.

Low Ovarian Reserve (AMH)

“Ovarian reserve” is used to determine quality and quantity of eggs in women. Aging-related reduction in ovarian reserve is a natural result. On the other hand, low ovarian reserve implies number of eggs in ovary lower than expected for the age of a woman. A woman may conceive despite low ovarian reserve. However, a woman with documented low ovarian reserve should not hurry up for conception.

Low ovarian reserve is diagnosed through ultrasound scan in first several days of the period and with blood tests. Earlier it is diagnosed, more likely pregnancy will occur. Therefore, the recommended interval to visit a doctor regarding infertility is 1 year for women younger than 35, while women who are at or older than 35 should visit an in vitro fertilization doctor without unnecessary delay, if pregnancy fails for 6 months.

PRP injection to ovaries can be recommended for women with ovarian reserve low enough to make in vitro fertilization therapy unnecessary, before IVF Therapy is started. Moreover, some studies suggest that certain supplements increase chance of pregnancy.

Causes of Male Factor Infertility

Infertility is classified as female factor, male factor, both male and female factor or idiopathic cases. Female factor is accompanied by male factor in around 35% of infertile couples, while male factor is the only identified cause in approximately 10% of cases.

Oligozoospermia – count of sperm in ejaculate lower than the accepted normal range – or azospermia – total absence of sperm in ejaculate – is detected in a certain percentage of men with infertility, while sperm count is within normal ranges in others with infertility. Sperm concentration is low along with poor sperm quality, low motility (astenozoospermia) and/or count of sperms with abnormal morphology are more than healthy sperms in 80 percent of infertile men. In a low percentage of infertile men; there are normal sperm concentrations, with low quality sperms having normal sperm count, morphology and motility, although these cases are rare.

Male infertility can be caused by insufficient production of sperm in testes, poor functioning of sperms and blockage in tubes that pass sperm in the body. Other potential causes of infertility are chronic diseases, endocrine disorders, genetic problems, congenital anomalies, past history of infection, trauma, varicocele (dilated veins around testicles) and surgical operations.

Infertile men may not have a complaint other than failure of pregnancy in partner. However, others may suffer from signs that point to chromosomal or hormonal problems, such as sexual dysfunctions (e.g. problems in erection or ejaculation, low sex drive), testicular swelling, redness and pain as well as recurrent respiratory tract infections, anosmia (inability to sense one or all smells), abnormal enlargement of breast (gynecomastia) and loss of scalp or body hair. Evaluation requires review of detailed medical history, physical examination and semen analysis. They can be supplemented by hormone tests, imaging of accessory gland and channels and genetic tests, whenever required.

How Is Sperm Analysis Done?

Sperm analysis is a relatively simple test to evaluate etiology of male infertility and it requires sexual abstinence for 2 to 7 days. Generally, patient is asked to ejaculate into a sterile container through masturbation in a private room. However, the sample should be obtained at home and transferred to the clinic within 30 minutes, if the former approach is not feasible. It is recommended to do semen analysis at least twice due to inter-sample variability.

Semen specimen is evaluated according to the criteria set by World Health Organization (World Health Organization Laboratory Manual for the Examination and Processing of Human Semen).

Severe Oligospermia and Azospermia

The condition implies very low count or absence of sperm in ejaculate (fluid ejected from the male reproductive tract in orgasm – semen). The condition may be caused by failure to produce sperm in testicle, poor development of sperm channels or their blockage, genetic diseases (Y chromosome problems, Klinefelter syndrome), infection, trauma, chemotherapy, radiotherapy or cystic fibrosis. Patients with azospermia or severe oligospermia require certain hormone tests (FSH, LH, and testosterone), genetic analyses and imaging of ejaculatory channels.

Treatment of Male Factor Infertility

Considering treatment of male infertility, the underlying cause should be, first, corrected. Lifestyle changes, reduction of stress factors, regular eating, weight loss and cessation of smoking and alcohol consumption are recommended. Medication treatment is principally reserved for hormone deficiencies.

Insemination can be recommended, if sperm count is above 10 million in semen and there is no severe morphological abnormality. In this method, sperm is cleaned off dead cells and toxic substances and inserted into uterine cavity through cervix with a catheter. Chance of pregnancy is 10 to 15 percent in this method. In vitro fertilization (IVF) is considered, if insemination is not indicated or fails. Intracytoplasmic sperm injection (ICSI) differs from IVF, as sperms are injected into the egg under microscope rather than a natural fertilization.

Sperms are harvested from testicles with surgical approach in patients with non-obstructive azospermia who have no sperm in semen. The procedure that is carried out under anesthesia is called TESE. It is not possible to produce sperm, if analysis of Y chromosome points to total deletion of Azf A locus, total deletion of Azf B locus or deletion of Azf A, B and C loci. Therefore, these patients are not candidates forTESE. In case of obstructive azospermia, sperm can be aspirated with TESA method.

As is the case with oocyte cryopreservation, sperm freezing allows storage of sperms for future use. Viability of sperms can be maintained for many years, if they are frozen correctly. Sperm cryopreservation is considered for patients before cancer treatment, before surgery or in case of failure to give semen specimen while on treatment of infertility or those with low sperm count.


It refers to swelling and varicose formations in blood vessels that drain testicles. Varicocele is the most common correctable cause of male infertility. Although the exact cause is not known, it is believed that the condition correlates with heat dysregulation at testicular locus. Diagnosis requires physical examination by an urologist and scrotal Doppler ultrasound. Surgical intervention may improve count and function of sperm.

Which Methods Are Used In Treatment of Infertility?

In Vitro Fertilization

What Is Drug-free in Vitro Fertilization?

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.

What Is in Vitro Fertilization?

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.

Phases of In Vitro Fertilization

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.

Factors That Affect Success Rate of In Vitro Fertilization Treatment

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.

What Should Be Taken Into Consideration While Choosing A Center for In Vitro Fertilization Treatment?

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.

Repeated failures In In Vitro Fertilization: Should You Stop or Keep Going?

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.

How Much Does In Vitro Fertilization Cost?

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.

Is Social Security Institution Coverage Accepted for In Vitro Fertilization Therapies?

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.

Is Oocyte Pick-up A Painful Procedure?

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.

How Long Does In Vitro Fertilization Process Take?

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.).

What Are Signs of Successful In Vitro Fertilization Therapy?

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.

Which Treatment Methods Are Recommended for Habitual Abortion?

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.

Is Social Security Institution Coverage Accepted for In Vitro Fertilization Therapies?

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.

Which Methods Increase Success in Treatment of Infertility?

In addition to the scientific approach adopted at In Vitro Fertilization Center of Yeditepe University, following methods are used to achieve healthy pregnancies and allow birth of healthy newborn infants.

Assisted Hatching

The term is defined as thinning or opening a certain part of the membrane that surrounds embryos (the zona pellucida) mechanically or using acidified Tyrode’s solution or laser. This technique aims to facilitate implantation of embryos into the uterine wall (endometrium).

Embryos need to implant into endometrium to ensure pregnancy along with nourishment and development of embryos (fertilized egg). If the membrane that surrounds the embryo is unusually thick, pregnancy may fail, as embryo may not implant into the uterine wall. The membrane is thinned or a very small hole is created in a certain part of the membrane through various methods to prevent this adverse event and facilitate implantation of embryo.

Although various chemical substances and enzymes were used in the past, laser systems are recently utilized for this procedure. Laser is used in women at or older than 35 who failed pregnancy in past in vitro fertilization attempts. Moreover, it is considered for embryos that will be biopsied for genetic diagnosis, embryos that are frozen and thawed and for women with failure of pregnancy in previous attempts despite high-quality embryo as well as women with high or borderline FSH.

Endometrial co-culture

Endometrial co-culture is a new hope for couples, who cannot achieve pregnancy despite multiple ART (assisted reproductive techniques) attempts or have poorly or slowly growing embryos. A tiny tissue piece is biopsied from endometrium on Day 21 of the period and an artificial endometrial tissue is obtained by growing the biopsy specimen at laboratory settings. Embryos are implanted into this tissue. Since native endometrial cells of the women are used for this practice, risky conditions are eliminated, such as jaundice, AIDS and others. Endometrial cells are not hazardous for development of embryo and even, they increase chance of growth by maintaining the development.

JCI Accredited first and only medical education center in Turkey

Yeditepe University Hospital Healthcare Institutions are thefirst and only medical education center in Turkey to be accredited by Joint Commission International (JCI), recognized worldwide as the “Gold Seal” in patient care and safety.

Blastocyst culture

Blastocyst is the term that refers to embryo on day five of fertilization. In assisted reproductive technologies, generally acknowledged practice is to transfer embryos three days after fertilization. Transfer of embryos in blastocyst phase yields certain significant gains. For example, embryos that can survive until this phase are more likely to implant. These embryos have higher capability of survival until day five relative to other embryos.

Pre-implantation Genetic Diagnosis

Numerous hereditary diseases can be diagnosed even at embryonic phase. This technique, called Preimplantation Genetic Diagnosis (PGD), allows selection of only healthy embryos that will be transferred into the uterus. In this method, 1 or 2 blastomer cells are biopsied from each embryo and the genetic locus that is responsible for the disease is amplified through single-cell PCR, when embryos with normal development reach 7- to 8-cell stage following the fertilization.

Embryo Freezing

Embryos are frozen due to absolute indications that are linked to female factors. For example, all embryos are frozen, when a certain condition, such as ovarian hyperstimulation syndrome, occurs during hormone therapy at the phase of embryo transfer. Posing a life threatening risk for the woman, this clinical picture should be regressed and embryo should be thawed and transferred in a safer time. However, embryos can also be frozen and stored, if the thickness of innermost lining of the uterus (endometrium) is not suitable for pregnancy, and embryos are transferred when intrauterine cavity is better prepared.

Removal of Fallopian Tubes

Hydrosalpinx implies total block of Fallopian tubes at the ovarian end and the condition is a major barrier against pregnancy. The condition that affects implantation of embryo adversely can be diagnosed with ultrasound and it is among most critical and common problems that decrease chance of in vitro fertilization. Accumulating in lumen of Fallopian tubes, the fluid flows into uterine cavity and thus, embryos cannot implant or pregnancy results in miscarriage in early phases. After intrauterine cavity is imaged to determine severity of hydrosalpinx more clearly, a laparoscopic surgery can eliminate this problem. In this case, laparoscopic removal of tubes or ligation of tubes at the junction of the tube and the uterine cavity increases the success rate significantly.

Micro-dissection TESE

Micro-TESE is a surgical method that is used for treatment of severe male infertility. In case of azospermia that is not associated with blockage of reproductive channels, Micro-TESE is considered to harvest sperm under microscope. Sperms can actually be obtained in twenty percent of cases without obstruction in reproductive channels in conventional testicular biopsy (TESE), while the figure is 45 percent for micro-TESE.

Opening new horizons for couples who plan pregnancy, micro-TESE is an outpatient procedure that is performed under local or general anesthesia and it lasts for 1 to 4 hours depending on complexity of the case. If the procedure is carried out under local anesthesia, patients can very soon engage in daily routines. In case of general anesthesia patients are mobilized within 1 to 2 hours and they can return to activities of daily life in several days.

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In Vitro Fertilization Center

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