You can find all the details about infertility and IVF treatments in our website. First, let’s start with an overview, the causes of infertility, necessary tests and further steps.
Infertility- an Overview
We can define “Infertility” as the failure to get pregnant after one year of unprotected, well timed sexual intercourse. Moreover, research has found that about the reason of 40% of infertility is by female factors, 40% of male factors and 20% by a combination of both.
WHAT CAUSES INFERTILITY?
Ovulation occurs most frequently about 14 days before menstruation begins. Then, an egg goes out from the ovary and is swept into the fallopian tube where fertilisation occurs. After 2-3 days, the fertilised egg implants in the lining of the Uterus. Any factor that impedes this process can prevent conception. Common causes of infertility include: hormonal problems, blocked fallopian tubes, endometriosis and sperm of insufficient quality or quantity.
WHAT ARE TESTS for INFERTILITY and IVF ?
Diagnostic tests are prescribed based on your medical history. We analyze the physical examination and the results of any previous testing and/or treatment. This could include a semen analysis (spermiogram), blood workup, pelvic ultrasound and a Hysterosalpingogram (an x-ray to evaluate the uterus and the fallopian tubes), Anti-Mullerian Hormone (AMH) test (a blood test in order to check your egg reserve). During the planning, for the doctor to be able to diagnose the issue and decide about the best treatment option, those results are necessary.
WHAT IS THE NEXT STEP in INFERTILITY AND IVF?
The next step in infertility and IVF treatment is that you and your partner will need to meet with our medical staff to discuss the results of the work up. Then, our staff will take you through a personalized step-by-step treatment plan. Do not be afraid to ask the medical or nursing staff for clarification of anything you are told or asked to do as part of your on-going care.
In Vitro Fertilization (IVF)
In Vitro Fertilization (IVF) is inseminating the eggs, which we retrieve from the female, with the sperm that we collect from the male and process in the laboratory. Then, we keep the fertilized eggs for 2-3 days in incubators. After that, those which developed to good quality embryos are suitable for transferring into the womb.
What are the steps of In Vitro Fertilization (IVF)?
We wash the eggs that we retrieve and place them into special fluids for fertilization and embryo development. In the laboratory, the team washes the semen produced by the male to remove the seminal fluid. This enables them to clean most of the dead or immotile sperm and to concentrate good quality sperm. The number, motility and morphology (shape) of the sperm are the important factors that we focus. Sperm is brought to a concentration per egg and added into the fluid that contains the eggs.
The day after (16-18 hours later) collection, we examine the eggs under the microscope for assessment of fertilization and transfer those whose fertilization happens naturally into a new dish with fresh solution. Tracing cleavage goes on for 2-3 days and we score the embryo qualities. After selecting one or two best quality embryos, transfer into the uterus occurs. We also freeze remaining embryos with good quality after obtaining informed consent from the couple.
Who can go for IVF?
There are certain criteria to apply In Vitro Fertilization (IVF). Sperm and Oocyte qualities should meet certain standards. In cases with low sperm count, or poor morphology (shape) as with poor oocyte quality, fertilization can be compromised or even not occur at all. Therefore, it is appropriate to apply IVF to couples with good sperm and Oocyte quality.
Intra-cytoplasmic sperm injection (ICSI) is one of the most widely used insemination method in assisted conception treatments. It is simply the injection of a single sperm cell into one egg. ICSI is especially useful in cases with low sperm count, or poor sperm morphology. Additionally, the usage of it in the cases, which conventional IVF resulted in poor fertilization, is common.
As ICSI is an easy technique and results in acceptable fertilization rates, it is widely used in most clinics around the world.
Under normal circumstances, sperm penetrates the egg membrane by the aid of its motility and certain organelles (structures). This fertilization procedure enables us to select healthy sperm while we can eliminate those with abnormal genetic content. During ICSI however, the embryologist select the sperm, so the selection of unhealthy sperm is impossible. While keeping the risk to a minimum, it is essential to remember that elimination of embryos arising from unhealthy sperm (or the egg) during development occurs.
To whom is ICSI applicable?
Cases which previously failed conventional IVF attempts, cases with low sperm count, and/or poor sperm morphology or motility, as well as those with poor egg quality can benefit from ICSI. First trial cases where sperm or the egg does not display any structural or physiological abnormality should try conventional IVF.
IVF Treatment in some form is needed for all kinds of fertility treatment, whether it is a donation cycle or own egg cycle.
Summary of the Procedure
For the kind called donation cycles, hormone treatment stimulates the egg donors during the preparation for an egg collection. First our expert team collects the eggs from a donor, and the eggs are injected with sperm from the couple. The fertilised embryos are then transferred to the recipient after she has been prepared in synchronisation with the donor. This method of IVF has been used widely for nearly 30 years.
History of Egg Donation
Dr. Jon Buste carried out the first Egg donation transfer in America during the 80’s. This cycle resulted in a pregnancy and a live birth on the 3rd February 1984 in California.
Egg donation was a new way for women who had no eggs or poor quality eggs, which disabled them to get pregnant via IVF treatment. It is widely used in many European countries and few Muslim countries such as Iran, Lebanon and Egypt.
It is forbidden in some European countries. However the laws in Greece, England, Spain and Belgium allow it. North and South America, Africa, Australia and in many Asian countries also accept this method.
How do we carry out Egg Donation Treatment?
Deciding about the donor
There are two choices when a recipient is looking to choose an Egg Donor.
Anonymous: It is the situation when the couples(recipients) do not know and trace the donor and they do get limited information during the treatment process, i.e. Blood group, hair and eye colour, height, skin tone, country born etc..
Non-Anonymous: It is the situation when the couples know the donor and even the born child has a right to contact her in the future.
The egg donation procedure is when the donor goes through the stimulation process to increase the possibilities of the number of eggs produced. In turn we make the female recipient start on separate medication not to stimulate her eggs but to prepare her body for transfer and possible pregnancy. When women undergo Egg donation. the main focus for development is the thickening of the endometrium lining in synchronisation with the donor while she undergoes egg stimulation. It is the same preparation method that we use for women undergoing a frozen embryo cycle. The statistics at our clinic have showed that there is no difference in the percentage of women falling pregnant via a fresh or frozen donation cycle.
Fresh donation cycle
When there is a a fresh donation cycle, we collect the sperm from the recipient’s partner on the same day of the donor’s egg collection and conduct Microinjection (ICSI) procedure with which we inject the sperms that we collected into the healthy egg. The gamete (egg and sperm) fertilise. Once fertilisation takes place, the embryo develops for either 3 or 5 days before the transfer to the recipient. We also freeze embryo sometimes at these stages too. After the transfer, at least two weeks later on, our patients run the pregnancy blood test.
Who is eligible for Egg Donation ?
Egg Donation is the most effective treatment for women who are of an age where they are unable to produce eggs or have poor egg quality.
The following are the situations that we assess before commencing treatment for the women;
who have a womb but have entered menopause early and are unable to produce eggs are candidates for Egg donation;
with hereditary disorders e.g. Turners Syndrome, where a female can suffer from Premature Ovarian Failure;
who have undergone chemotherapy or radiotherapy for treatment of cancer;
whose ovaries are poorly stimulated or cannot be stimulated once hormone treatment has begun
with Hemophilia, Duchenne’s muscular dystrophy, Huntington’s chorea, in which the transporter gene maybe passed to the child from the mother also prefer Egg donation to prevent the risk of having children with inherited diseases;
who have continuous unsuccessful IVF cycles;
who are advanced aged with poor egg reserve or no eggs to conceive; Please check our blog about Menopause in women
who have genetically inherited diseases passed by the mother;
There are some rules for freezing the egg cell. For this purpose, egg cells should be ready for fertilization which is called M2. In M2, there is a diamond-shaped core called spindle containing 23 chromosomes. The other 23 chromosomes are located outside the cell. These are called polar body pole bodies
The most important issue in the process of freezing eggs, is the liquid contained in the cell. Although the egg cell is the largest cell in the body, most of it consists of water. In the freezing process, these liquid ice crystals become organelles that break down inside the cell and break down and break down the core contents of the cell during freezing. Therefore, it is necessary to remove the water inside the egg as much as possible before freezing. In the process of freezing the eggs, the water inside is taken out without damaging the cell with specially prepared liquids. Instead, a special liquid is introduced into the cell.
This special liquid is similar to antifreeze used in vehicles and is toxic to cells. This application will prevent damage caused by the crystallization of water in the freezing process, glassization ie vitrification will occur.
Two different techniques are used in egg freezing process
The egg cell is frozen in a special freezing liquid and then cooled by slow cooling with a device. In this embodiment, the eggs which are slowly cooled down to -30 / -35 degrees are dipped in liquid nitrogen at -196 degrees. Although the slow freeze technique is successful in sperm and embryo freezing, it is not preferred because the egg freezing process is not successful enough. The process of freezing eggs is mostly done by vitrification technique.
Fast freezing (vitrification-glassization):
This technique, which has been used in the freezing of sperm and embryos in the past, has been developed and made suitable for freezing of eggs. In this technique, the egg cell is cooled from room temperature to -186 degrees. This method, which could not be applied in egg freezing process, has been developed and started to be done successfully with current applications. The cytoplasm structure of the unfertilized egg in the cytoplasm of the genetic material, the size of the egg was difficult to implement the process. However, with the introduction of new techniques and freezing solutions, vitrification technique has been made suitable for egg freezing. Therefore, high success rates have been achieved. Egg freezing process may use different protocols even if the clinics perform the same technique. But the result is the same.
Sperm Donation is necessary for males who have zero sperm count or have poor sperm morphology that prevents them from producing viable sperm. (You can look at our article about Azospermia)
Males from a young age, who have had the mumps, or illnesses involving very high temperatures, can lead to many different problemsin their fertility. New born males who are born with ascended testicles are in need of an operation as the testicles develop in the abdomen during pregnancy, they then drop down into the scrotum. Sometimes part of the fetal structure fails to detach from the abdomen, resulting in an upward pull on the testicle. This then requires surgery in order to return the testicle.
Cancer patients who have undergone chemotherapy, radiotherapy or surgery on the testicles may have Sperm Donation as only option. Anabolic medication such as steroids can also lead to the deterioration of sperm. The reason for that, it can affect the tissue in the testicles vulnerably
“There is unfortunately no treatment to improve sperm quality or quantity.”
All that patients can do is seek the help in the form of donated Sperm.
Before deciding however whether Sperm donation is the only option, there are techniques to try to gain better quality of sperm.
Masturbation is the first option when obtaining a viable sperm sample. The sperm sample may show no sperm or low motility sperm. In that case, within the guidance of an Urologist, who can perform a prostate massage, we collect sperms and check under a microscope for viable cells. If this is not successful, surgery is necessary. There are different techniques available such as TESE, micro TESE, TESA, MESA and PESA. We have applied these techniques within our clinic and have succeeded in obtaining viable sperm samples
HOW DO WE APPLY THE TREATMENT?
When couples under Sperm donation treatment, we first provide them information about the donor sperm details. These involve blood tests and the risks involved with treatment. Before beginning treatment, couples are obliged to sign that they are both consenting and they are satisfied with the information.
In the first instance, we give more detailed information to the couples about sperm donation and the donor sperm. Details of the donor sperm are the screening results and the quality of the sperm. Before the process begins, couples must accept the term and conditions as well as sign a consent form. Afterwards, we prepare them for the treatment.
The two treatments available is standard IVF or Intrauterine Insemination (IUI).
1. Intrauterine insemination (IUI) with donated Sperm. It involves a laboratory procedure to separate fast moving sperm from more sluggish or non-moving sperm After that, we inseminate it into the women during once ovulation begins. IUI carries a success of 20%.
2. IVF is more detailed. We lead the female’s hormone stimulation to increase the number of eggs. Once the eggs are ready, we collect them. Afterwards, we carry out ICSI with the donor sperm to prepare the embryos for the transfer
GENETIC SCREENING TEST (PGD)
When we look at the history of Genetic Screening Test (PGD), over the past 2 years, developing techniques have enabled us to recognise various permanent illnesses. After the creation of the Human Genetic Map, general knowledge is rapidly developing. It has been discovered that humans have 45 chromosomes and 90 000 genes.
The illness cystic fibrosis is widespread over Western Europe and can consist of 500 various mutations. Couple that have recurring miscarriages are often tested for Cystic Fibrosis. We reveal which partner carries these illnesses via embryos that have been formed and have had a biopsy performed on them. Couples can have this expensive screening which finds isolates the specific mutations of up to 1400 genetic conditions