What is In Vitro Fertilization (IVF)? How is IVF Performed?

IVF treatment is one of the assisted reproductive techniques that significantly increase the chances of having a child in couples with infertility problems. “What is IVF? What does it mean in the medical literature?”, “How does IVF happen?”, “Is the success rate of IVF the same in every couple?” “How is IVF treatment performed?” Frequently asked questions about IVF treatment such as the above-mentioned are discussed in detail in the continuation of the article.

What is In Vitro Fertilization (IVF)?

In cases where pregnancy cannot be achieved for 1 year despite regular and unprotected intercourse, couples should be evaluated in terms of infertility. If there are health problems in women such as a decrease in egg reserve due to advanced age, congestion in the fallopian tubes, polycystic ovary syndrome, and factors such as low sperm count and/or quality, hormone imbalance in men can make it difficult to have a baby. The process of having children naturally in couples may not always be easy for various reasons. Today, infertility is one of the most common health problems worldwide that prevent couples from having a baby. Researches show that about 10-15% of couples of reproductive age have infertility problems.

Infertility can only be caused by a woman or a man in some cases, and about 20% of couples diagnosed with infertility have a problem that prevents both women and men from having a baby. With the help of developments in the field of science and technology, pregnancy can be achieved with assisted reproductive techniques such as intrauterine insemination and ivf treatment in couples who cannot achieve pregnancy by natural means.

So, what is IVF? IVF treatment can be briefly explained as combining an egg, which is a female reproductive cell, with sperm, which is a male reproductive cell, in a laboratory environment and then transferring it to the woman's uterus.

How is IVF Performed?

IVF treatment is the fertilization of mature eggs taken from a woman's ovaries in a laboratory environment with sperm taken from a man by natural means or by auxiliary techniques such as micro TESE. After fertilizing the egg cells, one or two of the high-quality embryos obtained are selected and transferred to the uterus of the mother-to-be.

How does IVF Happen?

Eggs collected from the mother-to-be in IVF treatment are fertilized in a laboratory environment with sperm taken from the father-to-be. One or two of the embryos with the highest quality formed as a result of this are selected and transferred to the uterus of the mother-to-be with the help of a thin catheter.

What are the Stages of IVF Treatment?

During IVF treatment, mature egg cells are collected from the woman under general or local anesthesia, and the collected eggs are combined with a sperm cell in a laboratory environment to produce an embryo. The steps usually followed in the in vitro fertilization treatment process are as follows:

• Stimulation of egg cells: One of the main stages of IVF treatment is the stimulation of egg cells. At this stage, depending on the woman's general state of health and egg reserve, IVF needles or various medications that help with egg stimulation are used. Under normal conditions, in a healthy woman, one egg matures every month and is excreted from the ovaries. It is aimed to stimulate more than one egg cell to increase the chances of success in IVF treatment.
• Egg collection: In the process of stimulating egg cells, a specialist doctor monitors the development of follicles with the help of ultrasound approximately every 2-3 days. When the eggs reach sufficient maturity, the egg collection stage is started.  This stage is usually performed with the help of general anesthesia. Mature eggs are collected with the help of an empty needle inserted into the ultrasound probe. Since local or general anesthesia is used during the procedure, pain is usually not felt in patients.
• Sperm collection: Sperm should also be taken from the man on the same day as egg collection. Under normal circumstances, men give a sperm sample by masturbation in a sterile environment. In case the man cannot give sperm by normal means or in case the man has azoospermia i.e. no sperm cells, a sperm sample can be taken by entering with auxiliary techniques such as micro TESE.
• Combining eggs and sperm: At this stage, the eggs collected from the woman and the sperm taken from the man are expected to combine spontaneously in the laboratory environment and fertilization will occur. Today, with the positive developments in assisted reproductive techniques, techniques such as micro-injection technique are also coming to the fore. Since the sperm is injected directly into the egg in the micro-injection method, the chances of obtaining a high-quality embryo may be higher.
• Embryo transfer: After fertilization, embryo development is regularly checked by specialists working in the laboratory every few days. At this stage, couples who have a genetic health problem in their family may request a genetic diagnostic test. The day of embryo transfer is decided by considering the development of the embryos. Usually, the transfer process is performed 3-5 days after fertilization. At this stage, it is decided how many embryos will be transferred by considering at the woman's age and previous unsuccessful IVF attempts. Usually, one or two embryos of high quality are selected and placed in the woman's uterus with the help of a thin catheter. There is usually no need to administer any anesthesia for embryo transfer.

After the embryo transfer, a pregnancy test is performed 10-12 days later and it is checked whether the embryo has been attached, that is, whether pregnancy has been achieved.

What are the Risks of IVF Treatment?

Rarely, some complications may occur during or after IVF treatment. The main risks of IVF treatment are as follows:

• Transferring more than one embryo at the transfer stage may increase the risk of multiple pregnancies. However, thanks to the positive developments in the field of health technology today, the chances of achieving a pregnancy with a single embryo transfer are also quite high. According to the regulation published in the Official Gazette in 2010 about Reproductive Assisted Treatment Practices and Reproductive Assisted Treatment Centers, in our day one embryo can be transferred in all first and second applications up to the age of 35, two embryos in the third and subsequent applications, and a maximum of two embryos can be transferred in all applications in women aged 35 and older.
• Some studies show that the risk of premature birth may be higher in pregnancies achieved by in vitro fertilization method.
• Drugs used to stimulate the ovaries during treatment can rarely cause overstimulation of the ovaries, and ovarian hyperstimulation syndrome.

What Is The Difference Between IVF And A Normal Baby?

The only difference between IVF and a normal baby is the fertilization of sperm and eggs in a laboratory environment under the supervision of specialist doctors. There is no difference between pregnancies achieved by in vitro fertilization method and pregnancies achieved normally in terms of the pregnancy process.

What is the Difference Between Intrauterine Insemination and IVF?

Intrauterine insemination like IVF treatment, is one of the treatment options that helps reproduction in cases where pregnancy cannot be achieved by normal means. There are some differences between intrauterine insemination treatment, which is usually preferred in the case of male-related infertility, and IVF. Sperm taken from a man in intrauterine insemination treatment is inserted directly into the woman's uterus, while in IVF treatment, sperm and eggs are fertilized in the laboratory environment (8).

Who Does the Sperm Belong to in IVF Treatment?

According to the laws of the Republic of Türkiye, only reproductive cells taken from couples can be used in assisted reproduction techniques. In other words, it is forbidden to use a donor in IVF treatment or to use the sperm sample taken on another candidate.

Who Are the Suitable Candidates For IVF Treatment?

IVF treatment is one of the preferred assisted reproductive techniques in couples who cannot achieve pregnancy despite wanting a baby. In couples who apply to in vitro fertilization centers with a complaint about not being able to have children, first of all, doctors specializing in obstetrics and gynecology ask the woman to have some blood tests. In these blood tests, hormone values such as FSH, LH, TSH are examined and they are usually conducted on the 2nd or 3rd day of patient's menstruation. These tests provide information to specialists about whether a woman has a health problem such as polycystic ovary syndrome. In addition, the AMH level, which is checked in the blood test, also provides important information about a woman's egg reserve. In addition to blood tests, a woman's uterus and fallopian tubes are evaluated using imaging methods such as ultrasound and hysterosalpingography. After the woman passes a detailed examination, if the specialist considers it necessary, men are also examined in detail by a specialist urology doctor.

IVF treatment may not always be the first option for every couple diagnosed with infertility. Depending on the source of the problem, the specialist doctor may primarily benefit from assisted reproductive techniques such as ovulation induction therapy or intrauterine insemination therapy. However, in cases when there are negative results from intrauterine insemination treatment, a decrease in egg reserve or a low sperm count, IVF treatment may be the only option. So in which cases is IVF treatment performed? The main cases of IVF treatment can be listed as follows:

• Causes of female origin: When making a diagnosis of infertility, imaging techniques such as hysterosalpingography are used primarily to check whether a woman has a blockage in the fallopian tubes. If there is a blockage in the tubes, pregnancy cannot be achieved because the sperm cannot pass through the channels and reach the egg. In this case, IVF treatment may be necessary. In addition, polycystic ovary syndrome is one of the main health problems that cause infertility in women. Ovulation problems may occur due to an imbalance in FSH/LH hormone levels in polycystic ovary syndrome, the cause of which is not known for sure. In this case, IVF treatment may also need to be used.
• The risk of genetically transmitted diseases: If any of the couples has a genetically transmitted health problem such as thalassemia (Mediterranean anemia), or Behçet's disease, IVF treatment can be used to minimize the risk of having the same health problem in the baby.
• Causes of male origin: Reproductive problems can be seen in men as well as in women. Researches show that in 40% of couples diagnosed with infertility, the problem is caused by the man (1). After examining the semen analysis taken by masturbation in men in the laboratory environment, and after detecting problems in sperm count, quality and/or mobility, the specialist doctor may recommend IVF treatment.

In addition to those listed above, in case of recurrent pregnancy losses in vitro fertilization treatment may also be required.

How Many Times Can IVF Treatment Be Tried?

Although there is no definite limit to the number of times IVF treatment can be tried, according to some studies, trying it more than 3 times does not have a positive contribution to the success rate of treatment.

In How Many Months Is Vitro Fertilization Treatment Repeated?

In couples who have started IVF treatment, the treatment process consists of a cycle of about 3-4 weeks. If pregnancy cannot be achieved at the end of this period, treatment can be continued without interruption depending on the general state of health of the mother-to-be.

What Should I Eat After The Transfer So That the Embryo Attaches on to the Uterus?

There is not enough evidence to show that any food after embryo transfer can help the baby to attach on to the uterus. However, consuming foods high in fiber, rich in vitamins and minerals before and during pregnancy, drinking plenty of water can help the pregnancy process progress in a healthy way.

What Should I Not Eat After the Transfer?

There are no specific food restrictions after embryo transfer. Choosing foods with low fat content and eating a healthy and balanced diet are important during pregnancy. In addition, it is recommended to avoid harmful habits such as smoking and alcohol during this process.

Symptoms of Attachment After IVF Transfer

Lower back and groin pain may be observed in the first few days after embryo transfer. However, as with pregnancies obtained naturally, implantation bleeding may also occur after in vitro fertilization transfer. However, these symptoms do not indicate that the embryo is firmly attached. The most effective way to determine whether there is attachment after embryo transfer is to measure the Beta HCG hormone levels in the blood about 10-12 days after the transfer.

In How Many Days Does Embryo Attach in In Vitro Fertilization?

In successful IVF treatment, it becomes clear within about 10-12 days whether the embryo attaches to the uterus of the mother-to-be.

In Which Cases Can IVF Baby Can Not Attach Itself?

The success rate of IVF varies depending on some factors such as the age of the mother-to-be, the quality of the obtained embryos, and the fact that the mother-to-be has harmful habits such as smoking and alcohol.

Does Miscarriage Occur After the Embryo Attaches Itself?

As with pregnancies achieved by natural means, there is a risk of miscarriage in pregnancies obtained by IVF treatment during the first 3-month period, known as the first trimester.

What are the IVF Prices? What is the Cost of Treatment?

The price of IVF may vary depending on the healthcare institution where the treatment is applied and whether techniques such as micro TESE, micro-injection are used during the treatment.

Frequently Asked Questions About IVF

IVF treatment is one of the most commonly used methods among the techniques that help reproduction today. Some of the frequently asked questions about IVF treatment are detailed below.

Until What Age Do I Have The Chance For İn Vitro Fertilization?

The success rate of IVF varies depending on many different factors. While the chances of success of IVF treatment are higher in young women, this rate may be lower in women over the age of 42. However, being at the ideal weight, eating healthy, staying away from harmful habits such as alcohol consumption and smoking can also increase the chances of success of IVF treatment.

Is IVF Safe?

Pregnancies achieved by in vitro fertilization are no different from pregnancies acheived naturally. However, some complications may occur due to excessive egg stimulation during treatment. However, IVF treatment applied by doctors who are specialists in their field is generally a safe method.

How Many Hours Does Ivf Surgery Take?

During IVF treatment, the egg collection stage takes about 15-30 minutes. In addition, the transfer phase is completed in about 10-15 minutes.

Can Those Who Are Pregnant With Ivf Have A Normal Birth?

Mothers-to-be who become pregnant by in vitro fertilization method can have a normal birth if deemed appropriate by a specialist physician.

What Should I Eat For The Baby To Attach On To The Uterus?

There is no definitely proven food that will help the baby to attach on to the uterus. However, as before every pregnancy, it is recommended to eat a healthy and balanced diet after IVF.

When Should Couples Who Cannot Have Children Resort To Ivf Treatment?

Couples who cannot have a baby despite a regular, unprotected intercourse for a year are evaluated for infertility. Couples, who do not get positive results from other assisted reproductive techniques such as ovulation induction, or when the woman's egg reserve is reduced, the man's sperm count is insufficient, can apply to in vitro fertilization clinics.

Does The First Ivf Baby Result In Miscarriage?

With the help of science and technology developing today, IVF embryo has a chance to attach at the first attempt.

Is There An Age Limit In Ivf In Men?

There is no age restriction in IVF for men.

After How Many Minutes Is It Safe To Go To The Toilet After The Transfer?

After the transfer, the mother-to-be is asked to stay in bed for a while. You can go to the toilet after about 20-30 minutes.

Does Miscarriage Occur After The Embryo Attaches Itself?

There is a risk of miscarriage in the first 3 months, as in pregnancies achieved in the normal way. In couples who cannot achieve pregnancy by natural means, this situation can also be psychologically uncomfortable. Nowadays, couples with infertility problems can increase their chances of having a baby with the help of assisted reproductive techniques such as IVF treatment.