IVF/ICSI

IVF treatments are now standardized all over the world and consist of three basic steps. IVF treatment begins with the stimulation of the ovaries to produce many egg cells. The next step is to collect and fertilize ovum in order to create embryos. Embryos are then stored in incubators for 3-5 days before they are transferred to the uterus. Pregnancy test is performed 10-12 days after the transfer. Even though the IVF treatment protocols are standardized, the laboratory conditions, the experience of the medical team and the embryo transfer methods can cause great variations in pregnancy rates.

IVF centers are under pressure to transfer a greater number of embryos from competition and patients alike. However, this leads to an increase in multiple pregnancy. In many European countries and Australia there are legal requirements that restrict the number of embryos that can be transferred to the patient. In our centre, for women under the age of 39, we prefer not to transfer more than 2 embryos. 3 embryos may be transferred in limited cases where the age of the patient is above 39, had previous unsuccessful IVF attempts or if the patient has low quality embryos.

All IVF related procedures are successfully performed in our centre. We have extensive experience in patients with poor-prognosis (over 39 years of age, previously unsuccessful IVF attempts, low embryo quality).

 

STAGES OF IVF TREATMENT

Stimulation of the ovaries

For patients recommened to start IVF, the first treatment step is the stimulation of the ovaries.

On the second or third day of the menstruation cycle an ultrasound examination is performed, in addition, the blood estrogen levels in the blood are measured to help determine the drug dose to be administered to the patient. After the beginning of stimulation therapy the patient is later invited for periodical check-ups. In these check-ups vaginal ultrasonography is performed to assess the number and size of the developing follicles. Depending on the condition of the ovaries, additional blood estrogen level examination may be required.

The goal of the ivf treatment is to achieve the highest possible number of follicles with a diameter of 16-20 mm. During the follow-up examinations, the dose of medication can be adjusted depending on blood estrogen levels. The target is to reach 200 pg / ml level of estrogen for follicles larger in diametre than 14mm. Once the target follicle sizes are reached, in order to ensure maturity of follicles, 5000-10000 units of human chorionio gonadotropin (hCG) is injected. IVF Treatment durations vary, but on average in our clinic this period lasts 10-12 days. Egg collection (OPU) is performed 34-36 hours after injection to aid the fracturing.

Another factor evaluated during follow-up ultrasound examination is the thickness and quality of the endometrial lining inside the uterus. Pregnancy occurs when the embryo settles on this endometrium. Therefore its quality is extremely important. If on the day of HCG, the thickness of the endometrium is less than 6 mm, the chance of pregnancy decreases.

Oocyte pick up

After oocyte maturation, oocyte pick-up (OPU) is performed. OPU is the collection of fluid-like follicles from the ovaries which is performed with the assistance of vaginal ultrasound. Under microscope, oocytes can be seen in this fluid. OPU is a short procedure usually done with general anesthesia. This procedure lasts 10-15 minutes.

Not all follicles contain oocytes. As a rule of thumb, 70% of follicles contain oocytes. Several hours after OPU, the cumulus cells around the oocytes are cleared and analysed for maturity. For oocytes with good maturity, fertilization is performed. The patient is sent home after a resting period of 1-2 hours after OPU.

Microinjection

Fertilization is performed by either classical IVF or microinjection (ICSI) method. In classical IVF, sperm are placed next to the collected oocytes and naturally fertilize the oocytes. This technique is preferred when the infertility is due to the female and the male has no infertility issues. Microinjection (ICSI) is performed by inserting a single sperm into the oocyte using a device called a micromanipulator. Fertilization is performed 2-4 hours after OPU. Before microinjection is performed, the cumulus cells around the oocytes are cleared.

Around 70% of the collected oocytes are mature and ready for fertilization. For example, if 10 oocytes are collected, on average this will result in 5 well-developed embryos. If a PGD is to be performed, it is done at this stage before the embryo​ ​transfer.

Embryo transfer

Embryos can be transferred to the patient from a 2-cell stage to a multi-cell blastocyst stage. However, in general the 4-8 cell stage is most preferred. Embryos achieve this stage usually in 2-3 days. Embryo transfer can be made on the 2nd - 6th day.

There is a direct correlation between the number of embryos transferred and clinical pregnancy rates. Best results are obtained when 2-4 embryos are transferred. When more than 2 embroys are transferred multiple prgnancy rates increase. However, this rate decreases for women with an older age. Due to the fact that multiple pregnancy increases the possibility of complications and early birth, number of embryos transfered in most countries are limited.

Nowadays, for women under the age of 35, only one blastocyst transfer is recommended. After a speculum is attached onto the vagina, the preparations are done for the transfer. The embryolog then brings the embryolan catheter containing the embryos to be transferred and these are released into the uterus by the doctor with the help of an ultrasound.

Embryo transfer process is not painful and usually does not require anesthesia

After the procedure, in order to support the endometrium some hormone drugs can be administered. This is called the luteal phase and if pregnancy occurs, the ivf treatment continues until the tenth week of pregnancy. If the pregnancy does not occur and mensturation begins, then this treatment is ended. If you would like to learn about IVF treatment costs, you can do so in our dedicated​ ​IVF costs page.

IVF/ICSI FAQ

Assisted hatching and embryo glue is standard and free on all treatments.

If the patient is medically well prepared in advance, 5 days will suffice.

In IVF sperm is placed near the egg allowing the sperm to naturally fertilize the egg. On the other hand, in ICSI, sperm is injected inside the egg with the help of a micro-manipulator

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Dunya IVF's team of experts will be happy to inform you regarding all fertility treatment options available, and recommend the optimal way forward for your specific circumstances. Contact us today and let us help you make the dream of parenthood a reality!

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