Fertility treatments (IVF) Infertility is manifested by the absence of conception in obstetric history or inability ot conceive despite successful previous conceptions. Almost 25% of all women will face infertility at any time of their lives.

Women achieve maximum reproductive efficiency around 25 yeras of age. There’s significant reduction by age of 35 years. For young couples under the age of 25, infertilty workup can be postponed up to 2 years. For couples above the age of 30, it is recommended to wait for 6 to 12 months before infertility tests are started.
Influence of age on fertility is contradictive for men. Men achieve maximum fertility level around the age of 35, followed by a remarkable reduction after the age of 45. However, it is known that there are men who can be father even at 80 and accordingly, age of male is not as important as for women.

What is IVF?
In vitro fertilization (ivf) implies a complex prodecure, where eggs produced by ovaries are collected using special needles and fertilized with sperms of the male at laboratory conditions. The resultant embryo(s) is/are transferred to the uterus. One or more of the egg is harvested using a special needle under anesthesia with ultrasound guidance. The are fertilized eggs (embryos) are placed into the womb of the mother using a catheter in 2 to 5 days.

Who are good candidates of the procedure?

- Patients with occluded or surgically removed Fallopian Tubes,
- Patients with endometriosis or who cannot conceive with surgical treatment,
- Patients with ovarian problem who do not respond to medical treatment,
- Patients diagnosed with idiopathic infertility,
- Patients with low sperm count or no sperm in the semen.

What are the stages of the in vitro fertilization?

- Maturation of follicles
- Oocyte pick-up (collecting the eggs)
- Preparation of sperms and fertilization of eggs
- Thinning the embroyal membrane
- Embryo transfer
- Pregnancy test

The age, ovarian reserve, blood hormone levels and height/weight ratio are considered to determine an appropriate treatment protocol and the dose of medication for patients who will receive in vitro fertilization therapy.

For long-term protocol, the medications that suppress ovarian functions are administered in the form of nasal spray or subcutaneous injection approximately for 10 to 12 days. When the patient menstruates, the second part of the treatment is started and the hormone therapy is maintained for 8 to 10 days in average, which will ensure maturation of eggs. Next, oocytes are picked up.
For short-term therapy protocols, egg maturation hormones are started as of second to third day of menses, and ovarian suppression hormones are added to the treatment in subsequent days in order to suppress spontaneous hormone secretion of ovaries.

Patients are monitored with blood hormone analyses and vaginal ultrasound, and when the follicles reach the appropriate size, human chorionic gonadotropin, colloquially known as egg hatching injection, is administered and oocytes are picked up 33 to 26 hours later. This procedure is carried out under anesthesia to suppress pain and it takes about 10 to 15 minutes.

Embryos are selected 2 to 5 days after oocytes are picked up and a thin catheter is inserted through the cervix and embryos are transferred. Embryo transfer is a pain-free procedure and patients can watch the procedure as it is performed with ultrasound guidance. Patients are discharged to home after resting in bed for 30-45 minutes following the embryo transfer.

ARE SPERMS AND OOCYTES HARVESTED FROM THE COUPLE?
Absolutely yes. Submission of marriage documents is one of the prerequisites of the procedure. Irrespective of the underlying factor, a man who cannot produce sperms or a woman who cannot produce egg is not admitted to the treatment. Own germ cells of the officially married couples are used for the treatment.

WHAT IS THE SUCCESS RATE OF THESE TECHNIQUES?
The success rate of the in vitro fertilization therapy should be determined according to health-related characteristics of the couple. The success rate of the in vitro fertilization is influenced by many factors, including but not limited to ovarian reserve, age and serious male factor. For couples who are transferred embryo, the success rate is around 55-60% if women is ≤35 years old and has good ovarian reserve, while the figure is around 30% for women older than 40. Considering the high rate of genetic anomaly in this age group, preimplantation genetic diagnosis should be considered and thus, genetically normal embryo is transferred to increase the chance of conception.

IS IN VITRO FERTILIZATION THE ONLY TREATMENT OPTION FOR COUPLES WHO CANNOT ACHIEVE CONCEPTION?
Four couples with difficulty in conception, the underlying problem should be identified with a detailed examination and the best treatment method that would most possible achieve the conception should be determined and the couple should be informed.

Treatment methods broadly include surgical treatment of problems in Fallopian tubes, ovulation induction and monitoring, insemination and in vitro fertilization. For couples who meet particular requirements, conception can be achieved with intrauterine insemination that implies instilling the specifically processed sperms into uterus after ovulation is induced by medications.

WHAT IS INSEMINATION?
Insemination is, in fact, a procedure that is performed to increase chance of sperm to fertilize the egg.
The woman is given pills or injections to have two or three oocytes mature in the period, while sperms of the man is irrigated and prepped with special methods. Thus, sperms with good motility are harvested. The timing of hatching is manipulated with egg hatching injections and sperms are placed into the uterus through a special plastic tube, and sperms can easily reach the egg(s), as the route they follow is shortened.

Certainly, minimum a canal or tube should be patent in order to perform the procedure. Therefore, the uterine cavity should be imaged before the insemination.
As it is known that the chance of conception does not increase after three or maximum 4 attempts, it is not necessary to rep