IVF (In Vitro Fertilization)

In vitro fertilization implies fertilizing the ovum of the female subject with the sperm of the male subject at laboratory settings.

WHAT IS INFERTILITY?
Infertility implies inability to conceive after having regular sexual intercourse for minimum 1 year without the use of contraception.

The first step in treatment of infertility should be to investigate and examine the etiology or underlying cause of the infertility. Because the treatment of infertility varies depending on the etiology. The chance of conception is usually 15-20% per the menstruation cycle. Accordingly, 85 out of 100 couples achieve this desire at the end of one-year period.

While male factors account for 40% of all infertility cases, the figure is 45% for female factors. Infertility is diagnosed in 15% of cases, although no female or male factor can be identified. This condition is referred as “idiopathic infertility”.

IN VITRO FERTILIZATION
In vitro fertilization (also known as “test tube baby”) implies fertilizing the ovum of the female subject with the sperm of the male subject at laboratory settings, as various medical condition(s) hinder the process of fertilization in female genital organs.

In vitro fertilization that sounds like terms used by science fiction authors was first introduced to the literature in 1978, when the first baby of IVF pregnancy was born, and this method had gradually gained popularity. Ever increasing new discoveries had boosted success rates and number of IVF (or “test tube”) babies, and this method had turned into a very important source of hope for couples, who are bursting to conceive. In vitro fertilization is, recently, used as an up-to-date and very important treatment option, which supplements other methods such as ovulation therapies, insemination and surgical therapies, in management of infertile couples.

Many medical conditions in men and women may lead to inability to conceive. Medical conditions written below are etiologies, which can be overcome with in vitro fertilization therapy;

Female factors:
Occlusion of Fallopian tubes
Adhesions (between uterus, ovary and other organs)
Endometriosis (chocolate cysts)
Idiopathic factors (all conditions, which result in infertility, but cannot be identified with available diagnostic methods and cannot be overcome with other therapeutic approaches)
Advanced age
Anovulation or interrupted ovulation
Inability to conceive although other methods (surgeries or inseminations) are used for sufficient time.
Male factors:
Low sperm count
Low sperm mobility
Absence of sperm in ejaculate
In Vitro Fertilization Methods
In vitro fertilization offers a wide array of approaches, since diverse methods are developed over years to harvest and fertilize ovum (the egg cell).

1. In Vitro Fertilization (IVF)

The in vitro fertilization, the first test tube baby technique, uses medications in order to mature more than one ovum in ovaries. After an ultrasound scan verifies maturation of eggs, they are harvested. They are placed in the same container, where sperms of the male subject are available, at the laboratory settings. When fertilization - union of eggs and sperms - is achieved, cell division is monitored. Embryos, the first form of the baby, with highest conception chance are selected and transferred to the womb of the mother.

2. Microinjection (Intracytoplasmic sperm injection- ICSI):

On the contrary to IVF, ova are collected and sperm cell is directly transferred, using a thin needle, into ovum.

3. TESE-microTESE

If no sperm is found in the ejaculate due to occlusion of relevant canal or a production problem, sperms are surgically harvested from the testicle(s). Micro-TESE implies a more detailed procedure that is performed under surgical microscope.

4. PESA

It varies from TESE due to lack of a procedure directly carried out on a testicle. If there is no sperm in the ejaculate due to the occlusion of the canal, but sperms are collected behind the occlusion, the canal is accessed and sperms are harvested.

Preimplantation Genetic Diagnosis (PGD)

For couples who cannot have healthy babies due to inherited diseases, genetic analysis is done on embryos obtained through IVF therapy and embryos with no genetic link to the inherited disease are transferred to the mother.

What are examination required before insemination or In Vitro Fertilization?

Female:

Gynecologic Examination
Contrasted imaging of uterus to evaluate uterus and tubes (hysterosalpingography – HSG)
Hormone tests to evaluate status of ovaries
Diagnostic laparoscopy and hysteroscopy (for some patients)
Chromosome analysis
Male:

Spermiogram
Hormone tests
Ultrasound scan of testis to evaluate status of testes
Chromosome analysis
Risks of in vitro fertilization therapy

As the case for all other treatment methods, in vitro fertilization poses some risks for the patient. Most significant ones are listed below.

Stimulating ovaries using medicines
Problems related to transfer or egg cell harvesting
Miscarriage (comparable to natural conceptions)
Ectopic pregnancy
Multiple pregnancy
Prevalence of twin and triplet pregnancies has significantly increased worldwide after in vitro fertilization therapies as more than one embryo is transferred to candidate mothers in order to increase the chance of conception. Severe problems secondary to premature births, such as death and disability of infants, have also increased as a consequence of the quick climb in rates of multiple pregnancies. This fact necessitated to limit the number of embryos transferred to one or two embryos.

Congenital anomaly
Prevalence of anomaly in test tube pregnancies is comparable to that of natural conceptions.

Cancer
After in vitro fertilization therapies and hormonal medicines are commonly used, no increase is observed in the prevalence of breast or ovarian cancers.

In Vitro Fertilization Glossary 

Other Assisted Reproductive Techniques

Male Diseases

Female Diseases

Phases of In Vitro Fertilization

Foods That Increase Quality of Eggs

How to Increase Sperm Quality

Sperm Selection