Q & A – Op. Dr. Ufuk Yılmaz

Q & A

IVF (In Vitro Fertilization) is a treatment method that increases the chances of pregnancy for couples who have little or no chance of conceiving naturally.
As the first step of IVF treatment, the egg cells of the prospective mother are stimulated with hormonal medications. Then, under anesthesia, the egg retrieval procedure is performed. After this procedure, the collected eggs are then fertilized in the laboratory with sperm obtained from the prospective father on the same day. Among the embryos formed through this method, the highest quality embryo is selected and transferred to the uterus of the prospective mother.

  • Advanced maternal age, decreased ovarian reserve, and egg quality
  • Male factor causes such as decreased sperm motility and quality, azoospermia, varicocele
  • Issues related to the uterine cavity and fallopian tubes
  • Cysts
  • Unexplained infertility

The treatment for infertile couples depends on the couple’s specific infertility problem and its severity. Some issues can be easily treated, while others may require advanced techniques and time. The chance of a healthy couple getting pregnant each month is around 20%. In the past, there was not much hope for infertile couples, but with the technology and medications available today,couples can achieve a successful pregnancy and have a child in 85% of cases with the right diagnosis and treatment.

The prices of IVF treatments vary from center to center. However, when choosing a center for IVF treatment, price should not be your sole priority. This is because IVF procedure requires careful planning and evaluation of all factors, making it a delicate process that needs to be thoroughly considered

  • Experience
  • Technology
  • Success-Enhancing Methods
  • Transparency Principle

There is no problem with engaging in sexual intercourse during certain periods of IVF treatment. However, it is not advised to have sexual intercourse after the follicles have reached a certain size

Approximately 1-2% of all pregnancies are affected by ectopic pregnancy. There is also a risk of ectopic pregnancy in IVF treatments, and when looking at the overall pregnancy rates in IVF, this risk is below 1%. However, this condition is not directly related to IVF treatments; it may be caused by other factors that hinder achieving a successful pregnancy.

By detecting potential chromosomal abnormalities in the unborn baby, genetic screening allows the selection of embryos with healthier genetics, thereby increasing the chances of successful pregnancy and preventing unsuccessful IVF attempts. Genetic screening supported IVF treatments are recommended in cases of recurrent pregnancy losses, a history of abnormal or metabolic disorders in previous babies, repeated unsuccessful IVF attempts, advanced maternal age, chromosomal abnormalities in either partner, unexplained infertility, poor sperm quality, and cases with sperm DNA damage.

There is no specific limit on the number of attempts for assisted reproductive treatments. While a treatment cycle may result in an unsuccessful outcome, it’s essential not to lose hope. Many patients who experience initial failures can achieve pregnancy in subsequent attempts. As long as there are no health issues affecting the couple, there is no problem with repeating IVF treatments, allowing for rest periods between treatment cycles

There is no specific rule regarding the exact day of embryo transfer in IVF treatment. The day of embryo transfer varies based on the treatment protocol applied at the IVF center, the number and quality of eggs retrieved from the woman, and the number and quality of developing embryos. However, generally, the 4th, 5th, and 6th days when blastocyst development occurs are preferred for embryo transfer due to their higher success rates in achieving pregnancy.

If there is an erection problem in the male, certain medications that can assist with erections may be prescribed to the patient. If obtaining sperm through masturbation is not possible, in cases of retrograde ejaculation or absence of sperm in the semen, it is possible to obtain sperm from men through some surgical procedures.

Sperm production continues in men at all ages. However, with advancing age, there is a decline in sperm quality. Men aged 55 and above may experience a 54% reduction in sperm motility. The younger the man’s age, the higher the likelihood of a woman achieving pregnancy. Nevertheless, both in natural conception and assisted reproductive treatments, the age of the woman generally holds greater importance compared to the age of the man.

The condition where no sperm is observed in the semen of men is called azoospermia. In general, the probability of finding sperm through surgical sperm retrieval methods is nearly 100% in cases of obstructive azoospermia, while it is around 65% in cases of non-obstructive azoospermia. The sperm retrieval methods used in assisted reproductive treatments include MESA (Microsurgical Epididymal Sperm Aspiration), PESA (Percutaneous Epididymal Sperm Aspiration), TESE (Testicular Sperm Extraction), and Micro TESE (Microdissection Testicular Sperm Extraction).

Our chromosomes and genes come from our parents, so some genetic issues present in the parents can be passed on to the baby. However, in assisted reproductive treatments, genetic screening in IVF can be conducted to select genetically healthy embryos, thus preventing the transmission of genetic disorders to the baby and increasing the chances of a successful pregnancy.

The success rate in IVF treatments varies depending on the following factors:

  • General health condition and medications used by the patients undergoing treatment
  • Reproductive issues of the couple before the IVF treatment
  • History of previous unsuccessful assisted reproductive treatments and the reasons behind them
  • Number and quality of the couple’s reproductive cells, hormone tests, findings from uterine tube imaging, ultrasound data, and sperm analysis test results
  • Advanced age of both the woman and the man
  • Quality and quantity of the transferred embryos
  • Quality and genetic characteristics of embryos in genetic screening IVF treatments
  • The couple’s compliance with the treatment process
  • Experience of the doctors, nurses, embryologists, and biologists at the IVF center.

Turner Syndrome is one of the most common chromosomal abnormalities in females. While their intellectual development is usually normal, they may experience learning difficulties and social challenges in forming friendships. Fertility is rare in women with Turner Syndrome and the XO genotype; however, in cases of mosaicism or X deletion in their chromosomes, fertility can be more common, but this is typically only possible in adolescent girls who have entered puberty naturally. Genetic screening in IVF treatments can be used to achieve pregnancy in these patients.

In patients scheduled for assisted reproductive treatments such as ovulation induction, triggering ovulation, timed intercourse, or intrauterine insemination, it is recommended to undergo hysterosalpingography (HSG) to assess the structural and functional characteristics of the uterus and fallopian tubes before starting the treatment

If there is a problem detected during the hysterosalpingography, irregularities, polyps, myomas, or previous failed IVF attempts, hysteroscopy is important to prepare the uterus for embryo transfer or insemination treatment. However, for patients with no symptoms or history, hysteroscopy surgery is not mandatory before IVF treatment.

Not every fibroid or ovarian cyst hinders IVF treatment, and they do not necessarily cause infertility or pregnancy loss. The type, location, size, number of fibroids, history of pregnancy loss, and previous unsuccessful IVF attempts are evaluated to determine whether surgical intervention for fibroids is necessary and will be explained to the patient by the doctor. As for ovarian cysts, unless they are malignant, there is no need for any surgical procedure.

Sperm count can vary among individuals and even within samples provided by the same individual. For successful conception through sexual intercourse, the father-to-be should have a minimum sperm concentration of 15 million and a total sperm count of at least 39 million.

Sperm production in men continues until advanced ages. However, there is a decline in their reproductive potential as they age. Sperm analysis results can vary based on environmental factors, lifestyle quality, and genetic inheritance. Therefore, it is essential to avoid factors that can reduce sperm count.

In IVF treatment, the quality and quantity of sperm in men and the number of eggs in women are undoubtedly essential. However, the processes of fertilization and obtaining embryos are carried out by experts, so even with a low sperm count, IVF treatment can be performed. However, when the sperm count is low, the number of embryos obtained will also be limited, making it challenging to have many options for selecting the healthiest embryo for implantation. If the semen analysis indicates very low sperm count, microinjection will be applied. In cases where no sperm is found in the ejaculate, surgical methods are used to search for sperm in the testicular channels and tissue

During birth, female babies have approximately 1-2 million egg precursor cells in both ovaries. From birth until the onset of puberty, some of these eggs are naturally eliminated by the body, and by the first menstruation, the count reduces to around 250-400 thousand. However, IVF treatments do not lead to a decrease or depletion of a woman’s ovarian reserve.

Before IVF treatment, there is no need to follow a specific nutrition plan, but a balanced diet is essential for both overall body health and a healthy pregnancy progression. This also contributes to the success of IVF treatment. Therefore, it is essential to assess the couple’s health conditions and medical history to recommend an appropriate nutrition plan accordingly.

For a healthy pregnancy, it is essential to be at an appropriate weight based on the body mass index. Being excessively overweight or underweight can also reduce the chances of pregnancy and IVF success.

When starting assisted reproductive treatments, it is generally preferred to follow a nutrition program that is low in carbohydrates but rich in minerals, proteins, and omega-3 fatty acids. Green leafy vegetables, nuts, and legumes rich in folate, potassium, and magnesium are essential during this period. Fruits and vegetables containing vitamins B and C should be consumed daily. During the treatment process, it is important to drink at least 2-3 liters of water daily. Avoiding artificial sweeteners, canned foods, and processed foods with additives is recommended. Consumption of tea, coffee, and carbonated drinks should be reduced. Maintaining a regular lifestyle and sleep pattern is important.

The preparations before IVF treatment, the treatment process, and the post-treatment phase should be considered as three interconnected and interrelated stages. Therefore, just like before starting the treatment, the healthy eating principles mentioned above should be followed after the treatment as well. Maintaining a healthy and proper diet from embryo transfer to pregnancy and throughout the post-pregnancy period will positively impact the chances of carrying a healthy baby to term.

Polycystic ovary syndrome (PCOS) is a common hormonal disorder in women with an unknown exact cause, leading to ovulation issues. Women with PCOS may experience difficulties in getting pregnant due to anovulation. The chances of achieving pregnancy through assisted reproductive treatments (such as medication or injections to stimulate ovulation, intrauterine insemination, or IVF) are quite high in these cases. However, these treatments require close monitoring and precise adjustment of medication dosages. Uncontrolled treatments may carry a risk of developing ovarian hyperstimulation syndrome, which can lead to life-threatening health problems.

IVF treatments can be initiated between the 2nd and 5th day of the menstrual cycle. A personalized treatment plan is developed for each couple based on previous test results, ultrasound findings, ovarian reserve, the condition of the uterus and tubes, and sperm analysis results.

With the advancement of new drug protocols and techniques, the success rates in IVF treatments are increasing. However, it should be noted that achieving pregnancy is not guaranteed and the success rates are not 100%. There is no specific limit on the number of IVF attempts that can be made. Depending on the couple’s desire and their overall health, they can undergo multiple treatment cycles with intervals between each attempt.

It is not recommended to perform an HSG (Hysterosalpingography) while active menstrual bleeding is ongoing. The medications used can enter the bloodstream and may pass through the tubes into the abdominal cavity along with the menstrual blood. The HSG can be performed within 7-10 days after the end of the menstrual bleeding. If performed after the ovulation period, it should be evaluated in relation to pregnancy.

In the past, there could be complaints of pain during these films; however, with the modern equipment used for hysterosalpingography (HSG) nowadays, the discomfort experienced during the procedure has been minimized. Nevertheless, if the patient becomes stressed, panics during the procedure, or has a condition like vaginismus, anesthesia can be applied. The procedure itself takes about 5 minutes after the preparation. After the HSG film is taken, patients can return to their daily activities.

You can receive your HSG film within 10-15 minutes after the imaging procedure is completed. The captured images are sometimes printed on black X-ray films, and other times they are written to CDs. The written report of the film is delivered to the patient depending on the center’s workload

Sperm freezing can be performed in cases where there are issues with sperm count, motility, and morphology, and in men who want to have children at a later age. It is also done before cancer treatments that may negatively affect sperm development, prior to surgeries that could potentially harm the testes, before vasectomy procedures, and before fertility treatments such as in vitro fertilization (IVF) when the partner is not available on the egg retrieval day or when there is a low sperm count to ensure an adequate sperm sample is available on the day of egg retrieval. Sperm freezing can also be used for sperm banking in individuals with difficulty providing a sperm sample.

Egg freezing is recommended in cases where ovarian reserve is reduced, which is identified through both ultrasound and hormone tests (AMH, FSH, LH). It is also advised for women at risk of early menopause, before cancer treatments, before treatments that may negatively affect egg development, and prior to surgeries that could harm the ovaries.

The egg retrieval procedure is performed under anesthesia to ensure the patient doesn’t feel any pain. There are three different anesthesia options. One is conscious sedation, where various medications are used to put the patient in a light sleep. Secondly, general anesthesia can be applied, where the woman is completely unconscious during the procedure. Thirdly, the egg retrieval can be done under local anesthesia. However, this method can be more painful compared to the other two options.

The success rate of IVF treatments is unfortunately not 100% under current conditions. Therefore, after an unsuccessful IVF treatment, the doctor and the couple have a meeting to evaluate the factors that may have led to the failure and create a new treatment plan. It is sufficient to wait at least 2 months and at most 6 months between two treatments. Longer waiting periods can have negative effects on the woman’s ovarian reserve, belief, and motivation for the treatment

MESA (Microscopic Epididymal Sperm Aspiration) is a surgical procedure performed under local or general anesthesia, used to obtain sperm in cases of obstructive azoospermia (no sperm in the semen) or in patients with difficulty ejaculating or lacking motile sperm. During this microsurgical procedure, sperm is retrieved directly from the epididymis, which is located near the testicles. Alternatively, sperm can also be obtained through percutaneous needle aspiration from the skin.

TESE (Testicular Sperm Extraction) is a surgical procedure performed in the operating room under general anesthesia. It is used to retrieve sperm from the testicles of patients with azoospermia, where there is no sperm in the semen, or in cases where the sperm are immotile, despite having a normal sperm count, or when there are difficulties in ejaculating.

During TESE, small tubes carrying sperm are extracted from the testicles and later subjected to laboratory procedures to obtain viable sperm cells. These sperm cells are then used in the ICSI (Intracytoplasmic Sperm Injection) method, where they are directly injected into the eggs.

Due to the potential discomfort during the procedure, it is recommended to perform TESE under general anesthesia. The procedure is carried out in the operating room under the guidance of a microscope.

PESA (Percutaneous Epididymal Sperm Aspiration) is a procedure where sperm is retrieved from the epididymis, the channels that sperm travels through in the testicles, as it matures and gains the ability to move. This is done by inserting a thin needle into the channels within the testicles, without opening the scrotum, to aspirate the sperm. PESA can be performed in cases of obstructive azoospermia.

TESA (Testicular Sperm Aspiration) is a procedure performed under local anesthesia, where sperm is obtained from the testicles through a needle inserted into the testis. The procedure does not require hospitalization. TESA is a method that can be preferred in cases of obstructive azoospermia due to congenital absence/blockage of sperm ducts or blockage occurring later due to surgery, inflammation, etc., in cases of retrograde ejaculation, and in cases where there is no motile sperm

Frozen embryos can be transferred to a different center if necessary. Patients often have concerns about the embryos being damaged during transportation. However, embryos are stored in tanks filled with nitrogen gas at IVF centers, and as long as the gas levels are maintained, the embryos remain safe. During transportation, the embryos are placed in thermos-sized tanks filled with nitrogen gas and then transferred to another center by the couple. Ensuring the appropriate conditions for the safe transportation of embryos is crucial in this process.

Sperm count and motility disorders not only reduce the chances of natural pregnancy but also lower the success rates of assisted reproductive treatments. The microchip method involves using microfluidic chip technology to select the sperms with the best DNA structure. This allows for the creation of higher-quality embryos. As the technology is relatively new in Turkey, it is not widely used in every center.

OHSS (Ovarian Hyperstimulation Syndrome) is mostly observed in young patients with polycystic ovaries. It occurs when the ovaries respond excessively to the administered egg-stimulating injections.

The condition may lead to ovarian enlargement, fluid accumulation in the abdomen, abdominal pain, bloating, and reduced urine output. Depending on the severity of discomfort, the patient can be managed on an outpatient basis or kept under observation in the hospital.

During egg retrieval, there can be rare cases of bleeding. This bleeding may occur due to the damage of a blood vessel at the site where the needle passes through. In most cases, it can be stopped with a tampon, but occasionally, if a major blood vessel is damaged, surgery may be necessary.

It can rarely occur after egg retrieval. If there is abdominal pain, fever, or abdominal tenderness, it is important to consult a doctor.

The treatment may be discontinued in cases of Ovarian Cyst Formation, Insufficient Egg Development, Failure to Obtain Eggs, Failure to Obtain Sperm from Testicles, Failed Fertilization or Embryo Development.