IN VITRO FERTILIZATION TREATMENT PROCESS

While some couples have knowledge and experience about in vitro fertilization treatment, a significant number are not familiar with the stages of this process. In my other writings, I discussed special cases, but here I wanted to provide general information.

Initial Assessment

The treatment process actually begins with the first examination and assessment. We have a standard evaluation to perform. The uterus and ovaries are examined via ultrasound, blood tests are requested from the woman, and if not done recently, a sperm analysis from the man and, if necessary, a hysterosalpingography (HSG) is requested. If the couple has a specific medical condition, previous unsuccessful IVF attempts, or recurrent miscarriages, additional tests may need to be added to the routine evaluations.

Preparation

During this time, we start some vitamins and supplements that are important for both the treatment and the pregnancy process. Of course, lifestyle changes also affect the outcome. Positive changes such as quitting smoking, maintaining a healthy weight, eating right, exercising, getting good sleep, and reducing stress positively reflect on the treatment outcome. Additionally, we begin to address any problems identified in the test results during this period.

Afterward, the couple’s medical conditions and test results are evaluated together, and a treatment plan is created. If any operations need to be performed, they are done before the treatment or postponed until after the egg retrieval process. It is important to remember that each couple is ‘unique.’ A method that did not work in your cousin’s treatment may be the solution for you, or a ‘miracle’ technique you saw on TV may be ineffective for you.

Stimulation of the Ovaries with Medications

Generally, with some exceptions, the egg growth process in IVF treatment starts on the 2nd or 3rd day of the menstrual cycle. During the first examination, we evaluate the ovaries and check for the presence of functional cysts. This examination is crucial for determining the appropriate medication dosage. In the presence of cysts or other specific conditions, it may be possible to postpone treatment to the next menstrual cycle.

We use hormone injections that can be administered subcutaneously. Our patients can self-administer these or have them done at healthcare facilities. It is very important that they are administered at the correct dosage and times. The egg development phase of the treatment lasts approximately 8-12 days, and during this period, doctor check-ups are required 3-4 times at intervals. During each check-up, we assess the overall condition of the ovaries, the number of growing follicles, the diameter of the largest ones, the uterine lining, and, if necessary, the hormone levels in the blood. After each check-up, we decide again which medications and dosages to continue with.

‘Trigger’ Injection

Finally, the follicles reach a certain size, hormone levels rise, and a ‘trigger’ injection is necessary for the eggs to mature before retrieval. Of course, this injection is misnamed. We do not want the follicles to ‘burst’—to ovulate. After this injection, we schedule the egg retrieval procedure usually 34-36 hours later. Our goal is to collect mature eggs without ovulation occurring. This injection, which is the most important one in the treatment, must be administered at the right time and correctly. During this period, we recommend that the male partner abstains from ejaculation for 2-5 days before the egg retrieval.

Egg Retrieval

The egg retrieval procedure (OPU) is performed in an operating room under very light anesthesia. The procedure typically lasts between 5-15 minutes. The patient wakes up shortly after, and after all checks are done, including the number of eggs and the sperm condition, they are discharged within a few hours. A microinjection procedure is performed on the mature eggs a few hours after retrieval.

The next day, we are informed about the fertilization of the eggs, and the embryos continue to be monitored in the laboratory. If a fresh embryo transfer is to be done, the embryos are placed in the uterus between the 2nd and 5th days after retrieval. Any remaining good-quality embryos can be frozen for storage.

Another option is to freeze all embryos without transferring them and prepare the uterus for transfer during a later menstrual cycle. Although this method slightly prolongs the process, it allows the couple to be more physically and mentally prepared, and most importantly, the pregnancy rates achieved through the transfer of frozen embryos are higher than those of fresh transfers. This difference is related to the uterus’s receptivity to the embryo being greater with this method.

Embryo Transfer

The transfer procedure is painless and is performed on a gynecological table. It lasts about 5-10 minutes. From our perspective, it is a very delicate and special procedure. No matter how experienced you are, breaths are held, and excitement is felt. Some women may hesitate to undergo the transfer procedure, thinking they will feel discomfort. In this case, we perform the procedure with light anesthesia.

On the day of the transfer, you can walk, climb stairs, and travel within the city by car. Remember that the process you experience from this point on is the same as natural pregnancies, aside from the medications you use. You will be thoroughly informed about the medications you will use and what you need to do.

I wish everyone who desires to experience the joy of becoming a parent.