What are the Steps of IVF?
In IVF treatment, a protocol will be determined for you according to your age, FSH level, and responses to previous treatments. The medications to be administered, the doses, and the duration and administration of medications vary from person to person. Still, we follow these steps in an IVF procedure:
1- Stimulation of the ovaries
2- Ensuring the ovulation
3- Collection of egg cells from the ovary
4- Preparation of man’s sperm
5- Combination of egg cell and sperm cell in the laboratory
6- Placing the formed embryo into the uterus
7- Medicines to be used for the embryo to attach to the uterus
8- Diagnosing pregnancy
1- Stimulation of the ovaries:
In the IVF treatment process, the egg cell and sperm are combined in the external environment.
In order to combine with sperm, the woman’s egg cells must grow to a certain consistency and complete meiosis.
Since the IVF treatment process is expensive and complicated, in order to increase the success of pregnancy, we give external hormone drugs to the woman at the beginning of the treatment so that she can develop more egg cells.
It is the hormones FSH and LH, which are hormones that normally induce ovulation and are produced from the pituitary. These are produced in the form of injections in the market.
These drugs are sold in special injectors that the woman can inject herself every day.
The required dose is determined by your doctor. The patient injects the dose recommended by the doctor subcutaneously into the abdomen every day. Thus, the FSH and LH hormones that will stimulate the ovaries increase in the woman’s body. The increase of these hormones in the body initiates the development of a large number of egg cells in the woman’s ovaries. In order to follow this development, we call our patient for ultrasound at regular intervals, sometimes every day.
According to the degree of development, the dose of the drug to be made later is determined.
If we see 18 mm or more egg cells in the ovaries, we move on to the next step, the ovulation induction.
If the egg cells seen in the ultrasound have reached sufficient maturity, the woman is given medication for ovulation to occur. This treatment is called egg cracking treatment in the turkish population.
During this period, the average of the woman’s menstrual period is 13-17. coincides with the days.
The main hormone that ensures ovulation in women is LH hormone, which is given to the blood from the pituitary. By using recombinant injections of this hormone, the woman is provided to ovulate the developed egg cells.
In general, as a single dose, the drug is injected under the skin on the day that the doctor deems appropriate. After 36 hours after the injection of the drug, we proceed to egg collection.
3-Collection of egg cells:
36 hours after making the ovulation injection, the woman is called for control on an empty stomach to collect the developed egg cells. We usually do egg retrieval under anesthesia. Some clinics can also do the collection with local anesthesia. While our patient does not feel any pain under anesthesia, we collect their eggs, it is more comfortable.
The woman lies on the gynecological examination table. While under anesthesia, egg cells are collected without any pain. By controlling it with an ultrasound device, we pull the developed egg cells inside the ovaries to the outside with a special needle inserted from the vagina towards the ovaries. Egg cells are collected in a special nourishing serum so that they can maintain their vitality.
After all the developed egg cells are collected, the process is terminated. After egg retrieval, groin pain and mild bleeding from the vagina may occur. You will be followed in the hospital for half an hour after the procedure.
4-Preparation of sperm cells:
On the day of egg collection, your partner also gives sperm sample to the laboratory. He ejaculates by masturbation when he is alone in a special room reserved for this purpose. He delivers the semen in a special container to the laboratory attendant.
The semen is subjected to special processes in the laboratory. At the end of the procedures, the sperm with the best mobility and shape are selected. These sperm are kept in a special nourishing serum until they are injected into the egg cell. The aim is to increase the fertilization abilities of sperms.
5-Sperm injection to the oocytes:
After processing, the sperm are either injected into the egg cells (microinjection or ICSI) or left in the same culture medium to fertilize the egg itself (IVF). If sperm values are bad, we prefer microinjection.
In IVF, each egg cell is cultured with approximately 50,000 sperm cells.
Fertilization should occur after about 18 hours. During this period, egg cells are examined under the microscope. It is checked whether the sperm have entered the egg cell.
6- Transfering the formed embryo into the uterus:
About 18 hours after the sperm and egg cell unite, the embryo should form. Once the embryo is seen under the microscope, it is kept in a nutritious liquid for a while. It is then inserted into the uterus.
Transfering of the embryo in the uterus is done on the 3rd or 5th day after egg retrieval and the man gives sperm. If there is more than one and good quality embryo, we prefer Day 5 transfer because it has higher pregnancy rates. If a single embryo has developed, Day 3 transfer is preferred.
For this procedure, which we call embryo transfer, anesthesia, that is, the woman does not need to be anesthetized. It is a painless procedure. The resulting embryos are examined under a microscope and 1 or 2 embryos of the highest quality are placed in the uterus.
The patient lies on the gynecological examination table. Under sterile conditions, embryos are left inside the uterus using a special tube that is passed from the cervix to the uterus.
After the embryo transfer, you need to rest in the center for about 30 minutes. Embryos placed in the uterus can cause contractions of the uterus. In order to reduce this situation, the woman should rest for a while after the embryo transfer.
7-Medications used for the embryo to attach to the uterus:
After the embryos are placed in the uterus, we give various hormone treatments to induce their adhesion to the uterine lining. Estrogen, progesterone, acetyl salycilic acide, anticoagulant injections can be used during this period. Treatment continues until pregnancy is detected.
8- Diagnosing of pregnancy:
12-13 days after the 3rd day transfer, 10 days after the 5th day transfer, you will be asked to do a pregnancy blood test. If the pregnancy test value is above 40-50 IU, this is a positive result. If the pregnancy test is above these values, we will check the retesting at 2-day intervals. In normal pregnancies, there should be a 2-fold increase in the B-HCG values performed at 2-day intervals.