1.
Controlled ovarian hyperstimulation First step of IVF treatment is to obtain good quality oocytes.
Several hormon preparations are being used to develop oocytes.
Purpose of these preparations is to obtain more oocytes and embryos of good quality and to increase pregnancy rates.
Various protocols are being used.
Basal ultrasonographic examination and serum estradiol level assessment are performed on second or third day of the menstrual cycle in each protocol.
Appropriate protocol and medication dose are decided for each patient according to patient age, ovarian reserve and blood hormon levels.
Once ovarian stimulation is initiated, patient is called for follow-ups with regular intervals.
During each follow-up visit, a transvaginal ultrasonography is performed to assess follicular development.
Main goal of treatment is to obtain as much follicles of 16-20 mm as possible.
Serum estradiol levels are measured during follow-ups to titer hormon preparation doses.
Goal is to achieve 200 pg/ml serum estradiol level for each mature follicle above 14 mm.
As follicles reach appropriate size, 5000-10000 units of human chorionic gonadotrophins are injected to trigger final maturation.
Length of treatment varies for each patient with a mean of 12-16 days.
32-36 hours after chorionic gonadotrophin injection, oocyte pick-up is performed.
2.
Oocyte pick-up (OPU) OPU is performed via a needle inserted to the vaginal ultrasonography probe.
It includes aspiration of follicular fluids to retrieve oocytes.
Aspirated follicular fluids are examined for the presence of oocytes under microscope by embryologists.
If there is no oocyte, follicle is washed by a special fluid and aspirated again to retrieve oocyte (Flushing).
All follicles are aspirated by this way.
OPU is terminated as all follicles above 10mm are aspirated.
The procedure lasts around 30 minutes.
Oocytes picked up are examined in labarotory for quantity and quality.
Mature oocytes are inseminated.
Patients are discharged 1-2 hours after OPU.
3.
Fertilization (IVF/ICSI) Oocytes picked up are examined under microscope.
Once immature or degenerated oocytes are spared, mature oocytes (MII oocyte) are put in culture mediums and kept at 37 0C and at %5-6 CO2 concentration for 4 hours.
The male partner provides sperms the day OPU is performed.
Surgical sperm retrieval is performed for those patients with no sperms in ejaculate.
Semen obtained is collected into special tubes and left for liquefaction.
Once semen is liquefied, sperm number, motility and morphology are evaluated.
Semen is prepared by swim-up techniques.
Once oocyte culture and sperm preparation are over, fertilization is the next step.
During classical IVF, sperms are put around picked up oocytes and fertilization is expected to occur.
Intra-cytoplasmic sperm injection (ICSI) is preferred for patients with sperm number 16-18 hours after the procedure, oocytes are checked for fertilization.
Fertilized oocytes are put again to culture mediums and left for development.
Good quality embryos are transferred to the uterus.
4.
Embryo transfer (ET) The procedure is performed under ultrasonography (US) guidance to better determine the site of ET.
The procedure is free of pain and requires no anesthesia.
A vaginal speculum is inserted and vagina and cervix are washed with sterile fluids.
As embryos are deposited to an appropriate site in the uterus via a thin catheter, the catheter is pulled back slowly.
To be sure that all embryos have been transferred, the catheter is examined under microscope by embryologists.
Number of embryos transferred change between 2 to 4.
Number is decided according to patient age, embryo quality and presence of previous IVF failures.
As number of embryos transferred increase, multiple pregnancies increase.
Once best quality embryos are transferred, remaining good quality embryos may be freezed.
Patient is discharged 1-2 hours after ET.
5.
Pregnancy testing Pregnancy testing is performed 12 days after ET.
Controlled ovarian hyperstimulation First step of IVF treatment is to obtain good quality oocytes.
Several hormon preparations are being used to develop oocytes.
Purpose of these preparations is to obtain more oocytes and embryos of good quality and to increase pregnancy rates.
Various protocols are being used.
Basal ultrasonographic examination and serum estradiol level assessment are performed on second or third day of the menstrual cycle in each protocol.
Appropriate protocol and medication dose are decided for each patient according to patient age, ovarian reserve and blood hormon levels.
Once ovarian stimulation is initiated, patient is called for follow-ups with regular intervals.
During each follow-up visit, a transvaginal ultrasonography is performed to assess follicular development.
Main goal of treatment is to obtain as much follicles of 16-20 mm as possible.
Serum estradiol levels are measured during follow-ups to titer hormon preparation doses.
Goal is to achieve 200 pg/ml serum estradiol level for each mature follicle above 14 mm.
As follicles reach appropriate size, 5000-10000 units of human chorionic gonadotrophins are injected to trigger final maturation.
Length of treatment varies for each patient with a mean of 12-16 days.
32-36 hours after chorionic gonadotrophin injection, oocyte pick-up is performed.
2.
Oocyte pick-up (OPU) OPU is performed via a needle inserted to the vaginal ultrasonography probe.
It includes aspiration of follicular fluids to retrieve oocytes.
Aspirated follicular fluids are examined for the presence of oocytes under microscope by embryologists.
If there is no oocyte, follicle is washed by a special fluid and aspirated again to retrieve oocyte (Flushing).
All follicles are aspirated by this way.
OPU is terminated as all follicles above 10mm are aspirated.
The procedure lasts around 30 minutes.
Oocytes picked up are examined in labarotory for quantity and quality.
Mature oocytes are inseminated.
Patients are discharged 1-2 hours after OPU.
3.
Fertilization (IVF/ICSI) Oocytes picked up are examined under microscope.
Once immature or degenerated oocytes are spared, mature oocytes (MII oocyte) are put in culture mediums and kept at 37 0C and at %5-6 CO2 concentration for 4 hours.
The male partner provides sperms the day OPU is performed.
Surgical sperm retrieval is performed for those patients with no sperms in ejaculate.
Semen obtained is collected into special tubes and left for liquefaction.
Once semen is liquefied, sperm number, motility and morphology are evaluated.
Semen is prepared by swim-up techniques.
Once oocyte culture and sperm preparation are over, fertilization is the next step.
During classical IVF, sperms are put around picked up oocytes and fertilization is expected to occur.
Intra-cytoplasmic sperm injection (ICSI) is preferred for patients with sperm number 16-18 hours after the procedure, oocytes are checked for fertilization.
Fertilized oocytes are put again to culture mediums and left for development.
Good quality embryos are transferred to the uterus.
4.
Embryo transfer (ET) The procedure is performed under ultrasonography (US) guidance to better determine the site of ET.
The procedure is free of pain and requires no anesthesia.
A vaginal speculum is inserted and vagina and cervix are washed with sterile fluids.
As embryos are deposited to an appropriate site in the uterus via a thin catheter, the catheter is pulled back slowly.
To be sure that all embryos have been transferred, the catheter is examined under microscope by embryologists.
Number of embryos transferred change between 2 to 4.
Number is decided according to patient age, embryo quality and presence of previous IVF failures.
As number of embryos transferred increase, multiple pregnancies increase.
Once best quality embryos are transferred, remaining good quality embryos may be freezed.
Patient is discharged 1-2 hours after ET.
5.
Pregnancy testing Pregnancy testing is performed 12 days after ET.