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İN VITRO FERTILIZATION
Infertility and in vitro Fertilization
Test tube baby is the operation in which the ovum picked from future mother and sperms taken from the father are fertilized in laboratorys and the embryos are again placed back to mother’s uterus. Firstly the ova are developed and picked on the right time, then they are put together with the sperms and fertilized. Embryos are placed into the mother’s uterus. Centers we have agreement serves with the latest technological equipment, background and experienced personnel and clinical staff specialist in their field. Embryo freezing and thawing embryo, embryo manipulations with laser, embryo biopsy and preimplantation genetic diagnosis, techniques for attaining sperm by surgical operations (spermectomy) and detailed androlocigal inspections are done with great success.
What is Infertility?
Infertility is pair’s inability of having children although they regularly have sexual intercourse without using any birth control methods for at least one year.
What are the Reasons of Infertility? What are the Factors?
Sexually transmitted diseases, infection of gynaeceum, infection of testis and seminal ducts, mumps in men, irregular menstruating or amenorrhoea, Endometriosis (cells from the lining of the uterus appear outside of the uterus). Congenital anomalies of uterus, chronic illnesses, advanced age, cigarette, alcohol and narcotics addiction.
IUI (Intrauterine Insemination) – Vaccination Treatment
Sperm samples produced by masturbation are selected and concentrated the best ones by processing. This operation is to place the sperm samples of the father by picking the best ones to future mother whose ovum is matured with hormone drugs.
IVF (In Vitro Fertilization- Test Tube Baby) Method
Around 500 qualified sperms are put near to the every 7-8 ova. A sperm is supposed to fertilize ovum ion its own by getting into it. Fertilized ovum cells develop embryo by splitting. Young future mothers who cannot be pregnant to the occlusion in IVF tubes and does not have problems with ovum and man factor are suitable for this operation.
ICSI (Intracytoplasmic Sperm Injection- Microinjection Method)
Only one sperm is placed into each ovum by selecting with the help of an injection under the microscope. This technique, first applied in 1992, becomes a revolutionary development especially for the pairs who cannot be pregnant due to man factor. Microinjection is preferred for advanced aged patients and the ones with few ova in order to reduce the risk of infertility.
To whom is Test Tube Baby applied?
The ones who have ovulation problems
The ones whose both of the tubes are occluded in the highest degree
The ones who have severe disorder in quantity, movement and appearance of sperm
The ones with severe endometriosis disease
The ones with ovulation problem due to advanced age
Opening the membrane of the ovum (zona pellucida) mechanically or with the aid of laser under the microscope makes moving out of the embryo before placing to the wall of uterus easier.
Defragmentation (Removal of cell remnant)
Embryos take cell remnants out from time to time while splitting. These remnants decrease the quality of embryo and may block the development of splitting. These remnants should be cleaned by getting into the embryo with the aid of a thin pipet.
One or two of the cells composing embryo is sent to the genetic observation if preimplantation genetic diagnosis will be performed. Thus, the selection of the healthiest embryos is aimed.
Pgd (Preimplantation Genetic Diagnosis)
If there are more than three healthy embryos, embryos may be kept by freezing for 5 years for the patients with many embryos. These embryos are kept in -196C in liquid nitrogen under special conditions and may be placed into the patient’s uterus on demand. The probability of pregnancy is a bit lower and early pregnancy loss is a bit higher in frozen embryos when compared with fresh embryo.
Placing Embryos into the Uterus (Embryo Transfer)
2-3 of embryos forming 3 days after the ova are picked and fertilized are placed into the uterus with a special catheter, more easily than a normal gynecologic examination, without pain but in a very careful and sterilized way. This operation lasts around 15 minutes, patient is informed about the quantity, quality of embryos placed, the risks of possible multiple pregnancy and the precautions that can be taken. The patient who rests about half an hour can go his or her home. Sexual intercourse is not suitable for this term.
After the Embryo Transfer
Oestrogen band or vaginal bougies containing progesterone are suggested to patient for the continuation of pregnancy. Final diagnosis is established with the indication of beta-HCG hormone 11 days after the embryo transfer. Gestational sac and baby should be seen in the uterus with ultrasonography after 2 weeks from this. There may also be problems in pregnancy attained with the assistant reproduction techniques just like natural pregnancies such as early pregnancy losses, extrauterine pregnancy. Because more than one embryo are placed into uterus, multiple (twin, trigeminus) pregnancy ratio is around 40% in this treatments and the essential part of these is twin pregnancy.
How should spermiogram sample be given?
The ideal one is to give sperm after 3-4 days of abstinence. As the span of the abstinence extends, the quantity increases and movement decreases. As the span of the abstinence declines, movement increases and quantity declines. Before giving sample, hands should be washed with soap, rinsed and dried. Before giving semen sample, bladder should be drained. Thus, microbes in the lower urinary tract are removed and a clean sperm sample can be attained. During masturbation, any surfactant material (soap, vaseline, oil, salivary etc.) should not be used. As the inner part of the sample jar is sterilized, this part should not be touched. All the sperm should be given in the jar, if not laboratory should absolutely be informed. As the first coming part of the sperm is more moving, care must be taken to put this part to the jar. If it is not possible to give sperm in the room shown, team must be informed about this; another room of the hospital may be arranged where you can give sperm with the help of your wife. If you would like to bring sperm from your home, you can bring it to our laboratory without exposing to temperature difference and sun and taking care that it does not exceed 30 minutes after taking a sterilized jar from the hospital.
The criteria evaluated in spermiogram and normal values are as follows: Sperm volume: 1.5-5 ml. Sperm quantity: More than 20 million in milliliter Movement: normal above 60% formal structure: above 4% according to Kruger criteria, above 60% according to World Health Organization. Besides, agglutination (many sperms stick together), suggestive of immunologic factors and leukocyte (inflammation cell) over 1 million in milliliter suggesting of infection are undesirable features.
Treatment of Man’s Infertility
Small operations may be performed to attain sperm with surgery from testis or sperm ducts fort he men who has no sperm due to disorder in the production of sperm or occlusion in the ducts. Nowadays if there is disorder in production of sperm, TESE (attaining sperm with open operation from testis); if there is occlusion in the ducts, TESA( attaining sperm with needle biopsy from testis) is preferred.
In our centers, these operations are successfully performed by an experienced team.