Stages of IVF

1. Stimulation of ovaries using drugs (stimulation and follow-up)

2. Taking sperm sample from man and selecting good quality sperms by means of IMSI

3. Pick-up of oocytes

4. Fertilization of oocytes in laboratory and development of embryos

5. Replacement of embryos into the expectant mother (transfer of embryo)

Stages of treatment (long protocol)

If micro-injection treatment is summarized:

1. It is ensured that many follicles develop in ovaries of a woman by administering some drugs to her (stimulation and follow-up). The doctors decides what kind of stimulation will be applied [Antagonist, Long] according to the data such as hormone values, age and history of the patient.

2. During use of drugs, ultrasound and blood tests (E2, LH) are applied to the woman periodically. In that way, growth of follicles is traced. Diameters of follicles are measured during ultrasound follow-ups. HCG is applied when 2-3 follicles over 18-20 mm develop in the ovaries. Oocyte pick-up is initiated nearly 35-36 hours after HCG injection.

3. Oocyte Pick-up Process is performed through local anesthesia or short term general anesthesia. Under ultrasound control, a needle is inserted into the follicles in the ovaries and the liquid within each follicle is emptied. It is tried to obtain 1 oocyte from each follicle.

4. In the laboratory, the oocytes in follicle liquid are detected and searched. Number of oocytes varies from patient to patient.

5. Within the same day, husband of the patient gives sperm through masturbation. Sperm washing and preparing operations are performed. If the man has Azoospermia (no sperm in ejaculate), the sperms are obtained directly from testis or epidym using the methods of PESA/MESA/TESE/TESA/M.TESE. If these operations are performed in advance, the sperm or testis tissue may be kept by freezing. The frozen sperm or testis tissue is prepared for ICSI by thawing on the day of oocyte pick-up.

6. Selection of sperms is very important. The best quality sperm is chosen using IMSI method. After the selected sperms are made stable, they are put into micro-injection needle. The needle with single spermatozoa is inserted into the oocyte. After the sperm is left into cytoplasm of oocyte, the needle is got out.

7. Following completion of ICSI operation, the oocytes are placed into a special device called incubator. The special liquids within culture media include substances required for feeding and growth of embryos. The internal side of incubator is a very sensitive device which keeps heat, humidity and gas concentrations required for normal split and growth of embryos at a certain level. An incubator contains significantly purified and filtered air.

8. The best quality embryos of those kept within the incubator for 2-6 days until the day of embryo transfer are transferred into uterus of expectant mother.

9. If there remain quality embryos which can be frozen and preserved, it can be performed using vitrification which is the most advanced method.

10. Risk of abortion is decreased by use of medicine after transfer (luteal support).

11. On the 15th day after oocyte pick-up operation (OPU), it is determined whether pregnancy has occurred or not by examining Beta HCG value in blood.

12. If pregnancy exists, gestational sac is examined through ultrasound 15 days after Beta HCG test. After 7-10 days, fetal heart beat (FK) is controlled. The patient having undergone all of these stages is followed routinely for pregnancy.

Implementation of IVF is shown schematically.
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