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IN VITRO FERTILIZATION?

IVF treatment is a long and tedious procedure that necessitates commitment from both the couple and the team. Despite significant advances in the field, unfortunately not all couples are expected to conceive.

Outcome of the treatment is directly related to woman’s age and her ovarian reserve. For women who produce an adequate number of eggs and who are < 39 years old, the outlook is bright, as cumulative conception rates of 80% can be expected with 3 treatment cycles. That is to say approximately 80 couples out of 100 will conceive when 3 treatment cycles are undertaken. In women > 39 years old, particularly when the ovarian reserve is diminished, however, the outcome is bleak as cumulative conception rates will be in the range of 10-30%. IVF treatment entails basically three steps that have been fairly standardized throughout the world. Treatment starts with stimulation of the ovaries to produce many eggs.

The next step is egg collection and fertilization to produce embryos. After fertilization the embryos are kept in incubators for approximately 3-5 days after which they are transferred into the mother’s womb. Pregnancy test will be performed 10-12 days after the transfer. Despite standardization of treatment protocols there is a wide variation in pregnancy rates that basically stem from laboratory conditions, experience of the medical staff, and embryo transfer policy.

In the past, IVF clinics have been pressurized from the patients and their competitors to increase the number of embryos transferred into the uterus. However, this has been associated with an alarming increase in multiple pregnancy rates. Regulatory bodies in most European countries and Australia issued imposing restrictions on the number of embryos that can be transferred to a patient.

The most recent legislation in Turkey passed in 2010 allows only one embryo to be transferred for the first two treatment cycles in women35 years of age. American Hospital Assisted Reproduction Unit has been first in the country to incorporate into routine practice procedures such as embryo freezing, blastocyst transfer, PGD, assisted hatching, embryo glue, and vitrification. We have broad experience in dealing with couples with poor prognosis (age>39, less than optimal quality embryos, poor ovarian reserve and previous multiple failed treatments).

Third party reproduction that entails the use of donated gametes is not allowed in Turkey

HOW MUCH MEDICATION AM I GOING USE?

The amount of medication used to stimulate the ovaries depends on the age of the woman and her ovarian reserve. While younger women with normal ovarian reserve use lesser amounts, older women and women with diminished ovarian reserve need higher doses to stimulate the ovaries. Variation in drug dosage may be up to two-fold.

CAN MY TREATMENT BE CANCELLED?

If there is inadequate response from the ovaries (poor response) meaning that the ovaries did not produce enough eggs to be successful, then the treatment may be cancelled and reinitiated with another protocol. Sometimes only one egg gains dominance and prevents other eggs from growing (asynchronous growth). This is another reason for canceling the treatment. When too many eggs are stimulated (hyper response), it may result in ovarian hyper stimulation syndrome if the treatment is continued. There are several options that may be exercised in this case.

ONSET OF TREATMENT

An ultrasound examination is performed when the patient arrives in Istanbul. This examination should coincide with the third to fifth day of the cycle if a long protocol (the nasal sniff or subcutaneously administered Leuprolide acetate) or the second day of the cycle if a short antagonist protocol has been planned. If you don’t have any cysts and the inner lining of the uterus is thin, then treatment is initiated.

You may need to have a blood test to check for your estrogen levels if your doctor finds this necessary. How long does the treatment last? The treatment usually lasts for 10-12 days. During this phase you will be asked to come for periodic ultrasound examinations. The frequency of these examinations will increase as the treatment progresses.

When the eggs appear to be mature, a final injection will be given at a specific time and the eggs are collected after approximately 36 hours.

OUTCOME OF IVF PREGNANCIES

Approximately 80% of pregnancies achieved via IVF/ICSI carry to term and result in delivery of healthy baby/s. Delivered infants were shown to be normal when compared with infants that were naturally conceived. Only certain subsets of IVF babies (those that were conceived with the use testicular spermatozoa) may carry sex chromosome abnormalities detectable by amniocentesis or alternatively with PGD. In all other instances, long term follow-up of infants showed normal motor, neurological and behavioral development.

LONG TERM CONSEQUENCES OF IVF TREATMENT

Ovarian stimulation has been linked to an increased risk of ovarian and breast cancer. However, none have been proven beyond doubt. As infertility itself has been reported to be a risk factor for both malignancies it is still unknown whether some of the reported increased risks are associated with the treatment or infertility itself. Studies and long term follow-up of the patients are still ongoing. In the mean time women who received IVF treatment but failed to conceive are advised to have their annual gynecologic check-ups and yearly mammograms (depending on their age).