IVF PROCEDURES
Our IVF team
FREEZING PROCESSES
In previous years, the “slow freezing technique” was used in which the vitality and quality of the cells during thawing could be adversely affected. Therefore, the method of choice used today is the “fast freezing” (vitrification) method in which the cells and embryos maintain the same quality and vitality after thawing.
Egg (oocyte) freezing
‘Egg freezing’, also known as ‘mature oocyte cryopreservation’, is a method used to save a woman’s ability to get pregnant in the future. In order to retrieve eggs for freezing, a patient undergoes the same hormone-injection process as with in vitro fertilization (IVF). The only difference is that following egg retrieval, high quality eggs are frozen for a period of time before they are thawed, fertilized and transferred to the uterus as embryos.
Egg freezing is performed in the following circumstances:
- Before cancer surgery
- Before cancer treatments such as chemotherapy or radiotherapy
- Before operations that may adversely affect ovarian functions
- For those with a family history of early menopause
- If there is a diminished ovarian reserve
- During IVF treatment, in patients who cannot obtain live sperm cells from their spouse on the day of egg collection
Freezing sperm cells
We carry out the sperm freezing process in the following situations:
- Freezing can be done to protect reproductive functions in patients who will be treated with chemotherapy and radiotherapy due to a diagnosis of cancer.
- On the ovum pick-up day, if men are not able to be present at the IVF center or not able to provide semen, ejaculate given previously can be frozen.
- During an IVF cycle, if there are any leftover sperms that are obtained by the MicroTESE method, these can be frozen and stored for later procedures.
- Before any surgical procedure for the testicles, sperm can be frozen and stored in order to guarantee reproductive function.
Sperm freezing
Embryo freezing
Often with IVF or Intracytoplasmic sperm injection (ICSI) treatment, there may be high quality embryos left over after embryo transfer. Sometimes out of medical necessity, sometimes at the request of the couple, instead of discarding them, embryos can be frozen to preserve fertility, so that it may be possible to have a baby at a later date.
Embryo freezing procedure is applied in the following situations:
- In PCOS (Polycystic Ovary Syndrome), we prefer to freeze high quality embryos obtained by IVF treatment. If an embryo is transferred and pregnancy occurs in that same cycle, ovarian hyperstimulation syndrome (OHSS) might develop. OHSS can be lethal for women.
- In women with cancer before any type of therapy, embryos obtained by the IVF method are frozen and stored.
- In some IVF cycles, there may be more high quality embryos than were needed for transfer. Then, high quality embryos left over after embryo transfer are frozen.
- During IVF treatment, if the thickness of the inner membrane of the uterus (endometrium) is below 7 mm, close to the embryo transfer time, the chances of pregnancy decrease. In such cases, the high quality embryos obtained are frozen, and then only transferred in the following months after treatments that have improved the inner lining of the uterus.
- Embryos biopsied for preimplantation genetic diagnosis (PGD) are frozen, since the results of this analysis are available in a few weeks. According to the results of the PGD, healthy embryos are thawed out and transferred to the mother.
- If the ovarian reserve is decreasing in the woman and the couple does not want to have a child yet, the embryo freezing procedure can be applied.
Embryo freezing
ASSISTED HATCHING
As the embryo develops, it is surrounded by a protective membrane. For pregnancy to occur, the embryo must naturally get rid of this membrane and attach to the uterus. Sometimes embryos can have a thicker membrane than normal for various reasons. In this case, it is thought that thinning out this membrane will be beneficial so as to facilitate the budding of the embryo before the transfer.
Assisted hatching
With this process, also called “assisted hatching”, the membrane is thinned out within a certain area and the budding of the embryo is facilitated from this point. We use a laser method for this process, because laser technology is much faster and more reliable for the embryos than other techniques.
Assisted hatching is used for the following reasons:
- When our patients are aged 35 and over
- After three or more IVF failures
- In cases where the membrane around the embryo is extremely thick
- In cycles with frozen embryo transfer
EMBRYOSCOPE
For IVF treatments, the most ideal conditions from the time of embryo formation till the time of embryo transfer are provided in a laboratory environment. The embryo is protected from external factors in an incubator and its needs are met by the culture medium in which it is placed.
In order to follow the embryo development and to determine the ideal embryo transfer time, embryos should be examined under a microscope. A “Continuous Embryo Monitoring System” (embryoscope) has been developed in order to reduce the need to frequently take the embryos out of the incubator and examine them under a microscope.
This embryoscope is a safe incubation system used in IVF laboratories. With this technique, the development of each embryo is continuously recorded with a specially developed camera system. Thus, the embryo development process, which lasts about 5 days, can be recorded and later watched on an accelerated video.
GYNAECOLOGICAL OPERATIONS
Our operation theater
Hysteroscopy
Hysteroscopy is the evaluation of the cervical canal and uterine cavity using an illuminated camera system through the cervix. It is used for both diagnosis and treatment. Hysteroscopy is performed following the first few days after menstruation.
In infertility, hysteroscopy is used in the following situations:
- For diagnosis and treatment of intrauterine masses like fibroids, polyps or intrauterine adhesions.
- For treatment of some congenital uterine anomalies (uterine septum or T-shaped uterus)
Uterine septum
- For the evaluation of women with three unsuccessful IVF treatments, to check the intrauterine cavity
- For treatment of intrauterine adhesions
Laparoscopy
Laparoscopy is a type of surgical procedure used to examine the organs inside the abdomen. Laparoscopy uses an instrument called a ‘laparoscope’ which is a long, thin tube with a high-intensity light and a high-resolution camera at the front. It is a modern surgical method which can be used both for diagnostic and for surgical purposes like cutting intraabdominal adhesions, removing tubes, closing tubes, and the removal of ovarian cysts and fibroids.
The major advantages of laparoscopy are that they leave small scars, there is less postoperative pain, rapid recovery time, a short hospital stay, and a low risk of adhesion between postoperative tissues and organs.
The main uses of laparoscopic surgery in infertility are:
- For diagnostic purposes:
To check the uterus, tubes and ovaries
For a diagnosis of endometriosis
- For operative purposes:
For treatment for fallopian tube pathologies such as hydrosalpinx, or ectopic pregnancy
For treatment of adhesions involving the ovaries, fallopian tubes and uterus
For removal of endometrioma (chocolate cyst) and other ovarian cysts
For fibroid removal
For correction of ovarian torsion (rotation of the ovary around its own axis)
Laparoscopic surgery
MICRO TESE
‘Microscopic’ or ‘Microdissection Testicular Sperm Extraction’ (micro TESE) is a surgical procedure performed in the operating room under general anaesthesia to retrieve sperm for IVF/ICSI by using an operative microscope. The operation takes approximately 1 to 2 hours. Micro TESE can improve sperm retrieval for men without any sperm in their semen (azoospermia) due to non-obstructive reasons, compared to methods achieved previously through standard testis biopsy techniques. If there is any remaining sperm, this can also be frozen.