​

1. What are the factors that influence female fertility?

Age is the most important factor that influences fertility in women. The chance of conception decreases as the women ages. There is almost no chance of conception especially in women older than 44. Other factors with negative effect on the chance of conception include past history of sexually transmitted diseases and infections of ovaries and Fallopian tubes.

2.How often gynecological exam should be made in women?

Annual gynecological exam is recommended for all women with active sex life. PAPP-A test, also called smear test, should necessarily be done to screen cervical cancer in these examinations.

3. Do leiomyomas and occluded Fallopian tubes affect pregnancy?

The chance of conception may decrease, if uterine leiomyomas compresses the endometrium, where the fetus develops. However, leiomyomas that are not located in the uterine wall do not pose a risk for conception, unless they grow too much. Blocked Fallopian tubes prevents the conception completely.

4.When should couples with no conception despite regular sexual intercourse seek treatment?

If conception fails in women who are younger than 35 and have no disease that hinders conception, examinations and treatment should be started. Regular attempts should be maintained for 6 months for women who are older than 35 and have any problem that hinders the conception. Treatment should be started, if pregnant fails at the end of this period.

5.What is upper limit of age for in vitro fertilization? How long can treatment be postponed in patients at advanced age?

In vitro fertilization is an option up to age of 45 years, but it is necessary to remind that the chance of conception decreases in women older than 40.

6.What is microinjection?

In conventional in vitro fertilization, the sperm is added in the medium and expected to fertilize the egg. In microinjection method, best sperms with high quality are collected among all sperms and injected into the egg.

7.What Is In Vitro Fertilization?

In vitro fertilization implies development of embryo by fertilizing the egg with a sperm after eggs of the mother are met with sperms of the father in the same medium.

8.How does microinjection differ from In Vitro Fertilization?

In microinjection method, sperms are specially selected and injected into the egg with a special device, called micromanipulator.

9.Who are good candidates of in vitro fertilization or microinjection?

They are used for women who cannot get pregnant with conventional treatment methods.

10.What are stages of in vitro fertilization?

In the first phase, certain medicines are administered to induce ovulation. The second phase involves picking up eggs with a certain size under general anesthesia. In the third phase, embryo forms when the sperm fertilizes the egg, and the last phase is the embryo transfer, where embryos are transferred into the womb.

11.What can be done if sperm count is too low or there is no sperm in semen analysis?

Microinjection can be considered for in vitro fertilization therapy, if sperm count is below the expected range. Sperm can be searched and surgically extracted from testicles, if there is no sperm in the semen.

12.How is oocyte picked up? It is a painful procedure?

A needle is inserted into ovaries with guidance of vaginal ultrasound and a fluid-filled structure, called follicle, is drained, wherein the egg is located. The fluid suctioned into the needle is drained into the tube. An egg with very small cells that can be seen only under microscope is found in the fluid that was added to the tube. Oocyte pick up is not a painful procedure, but it can be performed under mild or general anesthesia to make patients feel comfortable.

13.How do patients feel after oocyte pick up??

Oocyte pick up is a very simple procedure. No pain or ache is felt. The person can be discharged to home and engage in activities of daily life soon after the procedure.

14.Do these treatments deplete the ovarian reserve?

Neither medications used for in vitro fertilization nor the procedures influence the ovarian reserve.

15.Is each egg fertilized?

Not all mature eggs are useful for fertilization. Quality of eggs play an important role in the fertilization. Some eggs may not develop healthy embryos, after they are fertilized.

16.How are embryos transferred into the womb, after eggs are fertilized?

Embryo transfer into the womb is a simple and short-lasting procedure. A thin, plastic catheter is inserted into the cervical os by a physician. The embryo is transferred into the womb through this catheter.

17. Does any embryo remain after the transfer? What happens to them?

Medicines used to induce ovulation may cause development of embryos more than needed. Quality embryos that are not transferred can be frozen and stored.

18.How are embryos selected? How is multiple pregnancy prevented?

Embryos are selected according to maternal age, quality of embryos, number of attempts and number of embryos to be frozen. Pursuant to regulation enacted on March 6, 2010, the limit for embryo transfer is one embryo for women younger than 35 and two embryos for women older than 35.

19.Do patients need to rest after the transfer?

Future mothers are recommended to rest for 45 minutes after embryo is transferred. After the patient is allowed to leave the hospital at the end of 45 minutes, she does not require to rest.

20.When can activities of daily life be resumed after the transfer?

Future mothers may return to all normal activities except for sport activities such as heavy exercises, jogging and sexual intercourse following the transfer.

21.Is sex life affected?

Sexual intercourse is not recommended for future mothers especially after the transfer stage. However, this practice has not been scientifically proven yet.

22.Do hormone drugs used for in vitro fertilization therapy increase the risk of cancer? Do these medications have side effects?

Medications are used in in vitro fertilization to induce ovulation. Here, the major problem faced in administration of these medications that do not increase risk of cancer is intraabdominal effusion, also called hyper-stimulation syndrome.

23.Do these therapies cause ectopic pregnancy?

The prevalence of ectopic pregnancy is 1-3% in the in vitro fertilization. On the other hand, the prevalence of heteropic pregnancy – intra- and extra-uterine pregnancy – is around 0.5 percent.

24.How about results of pregnancy with frozen embryo?

Rate of pregnancies achieved with frozen embryos depends on quality of laboratory in the in vitro fertilization center. Pregnancy is achieved with frozen embryos by 45 to 50 percent in our institution.

25.Is there any difference between babies of classical IVF method and frozen embryo regarding disabilities?

There is no difference.

26.If pregnancy fails although there is no medical problem in future mother and father; what will be the next step?

If in vitro fertilization therapy does not result in pregnancy, both future mothers and fathers should have a detailed genetic test. Treatment should be started, if there is a problem that hinders pregnancy. However, no significant cause is detected in most cases.

27.How long does IVF last?

Approximately 30 days elapse from the first day of medication treatment to the pregnancy test.

28.Is risk of miscarriage higher in IVF pregnancies?

There is no difference between IVF pregnancy and normal pregnancy regarding risk of miscarriage.

29.How many times the patients can try IVF?

Usually, three attempts of IVF are recommended. Pregnancy can be achieved in subsequent attempts, but the chance is too low.

30.Are couple's own sperms and eggs used?

The partners' own sperms and eggs are used in IVF. Sperm or egg donation is illegal in our country.

31.Can we determine the gender in the in vitro fertilization?

Gender of the baby can be determined in IVF, but, it is both ethically and legally prohibited in our country.

32.What kind of measures can be taken for genetic problems in future mother and father before pregnancy?

If there is recurrent miscarriage or a genetic disease, genetic testing is performed on embryos and measures can be taken against genetic diseases.

33.Who are recommended genetic test for embryos?

Genetic diagnosis can be recommended for embryos of future mothers and fathers who have single-gene diseases such as Mediterranean anemia and sickle cell anemia. Genetic diseases can be diagnosed with amniocentesis or chorionic villus biopsy after pregnancy is achieved.

34.What is the success rate in IVF procedure?

Age of future mother and quality of embryo have great importance in success of IVF. Although success of IVF is 55-60% in women younger than 30, this rate decreases to 15-20% in women older than 40.

35.What are factors that affect success rate of in vitro fertilization?

Age of future mother, quality of transferred embryo and healthy uterus affect the success of IVF.

36.What are factors that negatively affect success rate of in vitro fertilization?

Obstruction of Fallopian tubes and intrauterine problems, such as myoma and polyp, hinders implantation of the embryo into the endometrium (the innermost lining of the womb).

37.What are possible risks of in vitro fertilization procedure?

Multiple pregnancies and edema secondary to hyperstimulation of ovaries are the most important risks of the IVF procedure.

38.Is hospitalization necessary throughout the IVF therapy?

Hospitalization is not needed at any stage of in vitro fertilization.

39.Is there any difference between babies of normal pregnancy and in vitro fertilization?

There are no differences between babies of normal pregnancy and IVF method. Risk of some anomalies may increase only in fertilizations by surgically extracted sperms.

40.What are the considerations while choosing an IVF Center?

IVF center has a great role at each stage ranging from doses of medications used in IVF method to embryo freezing (cryopreservation) procedures.

Considerations while choosing an IVF center:

• Operation history of in vitro fertilization center, number of cases and experience of IVF specialist and embryologist working in the center,
• Pregnancy rates and rate of leaving the center with a living baby after the procedures,
• Presence and quality of embryo freezing laboratory, ratio of living embryos after thawing procedure,
• Informing applicants truly and honestly.