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In Vitro Fertilization
With the help of some education ovaries are stimulated to produce multible eggs start. Usually fifteen eggs start to grow at the beginning of a cycle but only one of them totally matures. The more eggs are produced the better the possibility of conception is. This medication are started on the second or the third day of the cycle in order to induce the egg development and are used for about 8 to 14 days. Eggs develop in small cysts called folicules. These folicules produce a hormon called estrodiol. It is not possible to see the eggs in the folicule and sometimes folicules may contain any egg. The growth of the follicles is monitored by ultrasonography. At certain times during the treatment, estradiol hormone levels are checked and egg development is monitored. As the the ovulation aproaches, the frequency of monitor the hormone levels increases. The development and number of follicles are monitored via vaginalling ultrasound scans. The number of eggs retrieved might be different from the number seen on the ultrasonography. The time of ovum retrieval is decided upon the oocyte maturation injection (hCG) The eggs are collected under ultrasound monitoring 36 hours after the HCG injection. Estradiol hormone levels in blood, the size and number of follicles play an important role in deciding for the time of egg collection.
Eggs develop in small cysts/spheres called follicles. These follicles release estradiol hormones in relation to their growth rate. It is not possible to see the egg inside the follicle, and, sometimes it is possible that even if there is a follicle, it might not produce an egg. The growth of the follicles is monitored by ultrasonography. At certain times during the treatment, estradiol hormone levels are checked and egg development is monitored. As ovulation nears, the frequency to monitor hormone levels increases. The development and number of follicles are monitored via vaginal ultrasound scans. The number of eggs retrieved (oocyte capture/ovum retrieval) might be different from the number seen on the ultrasonography. The time of ovum retrieval is decided on by means of oocyte maturation injection (hCG) (it is also called as "cracking" in public).
Under ultrasound monitoring, following hCG (oocyte maturation injection), eggs are collected in 34-36 hours. Estradiol hormone levels in blood, the size and number of follicles play an important role in deciding for the time of egg collection.
Human chorionic gonadotropin (HCG), has the effect of LH hormone (Luteinizing/Lutrophin), which leads to the final maturation and rupture of the eggs. It is made 34-36 hours prior to the time decided to retrieve the eggs
The couple should be present, at the laboratory on the day of egg collection. It is important for the patient not to drink or eat anything after midnight the day before the procedure. Moreover, on that day, you can only have a shower and no perfume, deodorant, make-up etc. are allowed. Smoking is strictly forbidden. In the morning of the day of egg collection, the male partner also comes to the clinic for sperm collection. It is recommended that the couple avoid intercourse and especially the male partner retrain from ejaculation about three to five days prior to egg collection. Semen is collected in a special room prepared for the male partner by masturbation. After some laboratory procedures, the healthiest sperms are chosen. No saliva, soap or any other lubricant like Vaseline should be used during masturbation/sperm collection. Semen sample should be delivered in a sterile cup. About 70% of the sperm are within the initially ejected semen.
The egg collection (transvaginal oocyte retrieval-TVOR) is done under general anaesthesia in the operating room by reaching the ovaries through the vagina by use of transvaginal ultrasonography. After screening the follicles under ultrasound scan, through a puncture on the ovary they are reached and the follicles are aspirated into a tube. This tube is immediately taken to an embryologist ready to find and analyze the eggs. Collected eggs are, then, put into a special incubator. In the first few hours after the operation the patients may suffer from sleeplessness, sickness and throwing up. The patients usually feel better afterwords and are ready to go home. Pain similar to menstrual pain in the abdominal area might be felt during the next few days after the operation. There might also be some minor vaginal bleeding and spotting. Medication containing paracetamol can be used in such occasions.
Sperm-Egg Contact /Fertilization of The Eggs in the Laboratory
The process, way in some differ ways or microinjection.
Conventional IVF (In Vitro Metods Fertilization): Some sperm are placed together with each egg. Fertilization occurs when a sperm enters the egg by itself. Fertilized eggs divide to form the embryo.Embriyos are closely monitored by the embriyologiest while they develop for 2 to 5 days and than they are transferred. ICSI (IntraCytoplasmic Sperm Injection) is a procedure which the sperms are injected into the egg by the embriyogiest with the help of micro manipulations. Since fertilization rates are relatively low in IVF, recently, in treatment ICSI (IntraCytoplasmic Sperm Injection) is preferred more. This technics has better fertilization rate compare to conventional IVF which makes it more preferred.
Assisted hatching: is a procedure that the eggs walls are thinned with the help of laser. This helps the embryo to hatch easily and implant in to the endometrium. Before an embryo can attach to the wall of the womb, this technique is used to assist the embryo in breaking out or "hatching" from its outermost layer by means of making a hole by an embryologist under the microscope using laser (or using chemicals or mechanically).
Definitions of fertilization and implantation: Fertilization means the process of fertilizing and egg, involving the fusion of male and female gametes to form a zygote. Implantation, however, means attachment to the wall of the womb.
Uterine Embryo Transfer;
Two or a maximum number of three embryos are placed into the uterus by a method much easier than a regular gynaecologic examination, without any pain, but in a highly sterile operating environment and delicately by use of a catheter, 2-5 days after egg retrieval and fertilization. The procedure takes about 10 minutes. The couple, then, are informed, in detail, about the number and quality of the embryos transferred in addition to the risk of multiple pregnancies and possible precautions. After about half-an-hour of rest, the patient will be allowed to go home. Intercourse, during this period is not permitted, and it is not allowed until the pregnancy test.
In cases when plenty of eggs are retrieved, it is possible to have more than three healthy embryos. These can be frozen and stored for up to 5 years and then used for the same patient when needed. Embryos are frozen and stored in a special environment at -196°C, and they can be transferred into the woman's womb when needed. The aim is to make it possible for the patient to become pregnant (again) without going through the procedure explained above. However, there is a chance that the embryos, which have been frozen, might not be as healthy when thawed. In this case, their transfer will not be possible. Success rate with frozen embryo cycles decreases about 10%.
The use of vaginal suppositories or injection containing progesterone, or hCG (human chorionic gonadotropin) injection is advised for maintaining the pregnancy. The patient is provided with a list/document explaining the descriptions and use of medication and when to have a pregnancy test when leaving the clinic.
Chances of pregnancy depend on the age, diagnosis and the method of treatment to be used. Whereas the chance of success might be about 10-25% in a woman over her 40's, it can reach up to 60% in a patient who is younger and doesn't have an important problem except for fallopian tube obstruction. Having a menstrual period doesn't mean that there is no pregnancy. A definite diagnosis can be made, usually 12 days after egg retrieval, by means of a precise pregnancy test (through beta-hCG hormone tests). The test is done again after two days. 2 weeks later, gestational sac or sacs are monitored by transvaginal ultrasound scan.
In pregnancies via assisted reproductive techniques, complications such as biochemical pregnancies, miscarriages and ectopic pregnancies might occur just as in spontaneous pregnancies. Since more than one embryo is attached to the womb, in these types of treatments the rate of having multiple pregnancies (twins, triplets) is about 20-25% most of which consists of twins. However, higher numbers of pregnancies such as triplets or quadriplegic pregnancies require special care and attention. The rate of anomaly in such cases is around 1% just like in common populations.