1.What is infertility?

Infertility can define as the inability of having a baby.

Approximately 85% of couples can achieve pregnancy within one year of trying. The highest likelihood of conception occurs during the earlier months. Only an additional 7% of couples will conceive in the second year. We generally recommend seeking the help of an infertility expert if conception has not occurred within 12 months.

However, there are various conditions where one may be advised to seek help earlier

2.When should a couple who wants to get a baby to apply to an infertility expert?

This question is an excellent question because time is very important for having a baby.

If a woman under 35 years old, a couple may wait one year and try to get pregnant in natural ways. Over the 35 years, a woman’s egg reserve and egg quality are decreasing, and the possibility of chromosomally abnormal egg-producing is increasing. In additionally ovarian cysts, endometrial problems such as fibromyoma, polyps, and adenomyosis frequency are increasing. These conditions can cause difficulty in getting pregnant — that’s why between 35-40, only six months enough for trying natural ways.

After 40 years old, without seeking the natural way, the couple should consult by the infertility expert. I want to emphasize an issue; all gynecologists are not infertility expert. An infertility expert is evaluating the couple not only abnormalities of gynecologically but also evaluate their potential of conceiving. Consulting by an infertility expert is very important if the couple wants a parent.

3.How many days does in-vitro fertilization treatment last?

Actually, the treatment duration depends on the treatment protocol. In the old days, we used to apply long medication protocol. But in the last ten years, because of there aren’t significantly difference between long and short protocols, we prefer short medication protocols. The patient calls us on the first day of her menstrual cycle, and we do a gynecologic echo on the second day, we check her ovaries and uterus, then start medication for stimulating the follicles.

Between eight and ten days, follicles become big enough to the egg ovulation size. In this stage, we give some medication for egg ovulation triggering, and before ovulation of the eggs, we collect the eggs under very light anesthesia. We perform this procedure with a very thin needle, which is attached vaginal echo probe. We aspirate the follicle fluid, which contains the egg cell, and give it to the embryologist to find and keep the eggs. All these procedures generally finish in twelve to fourteen days. Most of the medical investigation shows that hormone level changing can affect embryo implantation negatively.

Because of this adverse effect, we prefer frozen embryo transfer to fresh embryo transfer generally in our practice. We follow the embryos until the fifth day of an embryo growing, then freeze them. When we do this protocol, we can use NGS (next-generation sequencing) to our embryo to genetically select the right embryo.

4.How does life after the embryo transfer? Should the women do bed rest until the pregnancy test?

In fact, the patient doesn’t need bed rest. After the embryo transfer procedure, the patient may rest one or two hours in the clinic. The medical studies and medical literature don’t support long time bed rest. There isn’t any significant difference in pregnancy results, between the patient who prefers bed rest and who doesn’t prefer. After embryo transfer, the patient can live a regular life. She can walk, she can go out, she can take a shower.

However, we don’t recommend to carry heavy things or do heavy exercises. Also, we don’t advise smoke and drink alcoholic beverages and eat raw meat and raw fish.

The important thing after the embryo transfer is to continue to medication properly. She has to maintain the medicines until pregnancy test results come.

5.After embryo transfer, what happens to the other embryos?

As you know, in-vitro fertilization is a sophisticated procedure. After the one or two good quality embryo transfer, if we have more excellent quality embryos, we recommend to our couple freeze the embryos.  Even an excellent in-vitro fertilization treatment, the highest chance of the pregnancy is up to 60-70%. If we can freeze other good quality embryos, we can continue to the treatment without no more injections and egg collection, and ICSI procedure. We prepare for the endometrium, which is the lining of the uterus to embryo transfer and adjust to timing for embryo implantation, and we transfer the embryos. Medical literature shows that consecutive treatments increase the cumulative chance of pregnancy in proper patients.

There are two different methods of embryo freezing, which are slow freezing and vitrification. We use the vitrification method in our clinic. This method helps protect the embryos and increases their rate of survival during thawing.

After the process of freezing is complete, the embryos are stored in liquid nitrogen lower than -190 centigrade degrees.

The process of thawing an embryo after cryopreservation has a relatively high success rate and research suggests that women who use thawed embryos have good chances of delivering healthy babies.

In addition, we can use frozen embryos not only after unsuccessful treatments, but also, we can use after successful treatment to have a second baby.

6.What tests necessary for the evaluation of fertility? Are there too many tests and analysis necessary before infertility treatment?

Evaluation of fertility and uncover the reason for the infertility is essential for couple’s consultation.

The first step is the gynecologic examination and gynecologic echo of the woman. In this step, we can investigate the abnormalities of pelvic organs. We can see Fibromyomas, endometrial polyps, ovarian cysts, some pelvic infections.

The second step is analyzing the hormonal balance, ovarian reserve doing some necessary blood tests such as AMH, TSH, FSH, Estradiol, etc.

The third step is HSG film, which shows us tubes are open or blocked or congenital uterine abnormalities such as septum (pared) in the uterine cavity.

The conditions such as uterine septum, submucosal fibromyomas, endometrial polyps should treat in hysteroscopycally before the infertility treatment.

And a very crucial part of the evaluation is semen analysis. The count, motility, and morphology of sperm cells affect the fertilization of the egg. Therefore, changing in sperm parameters may play quite an essential role in choosing the treatment options.

7.If a man has not had sperm in his ejaculate, can he become a father?

To have a baby, we need egg and sperm cells. If a man’s semen does not contain any sperm cells, we call this condition azoospermia. There are two types of azoospermia, which are obstructive and non-obstructive. In obstructive type azoospermia, sperm production present in testicular tubules, but sperm cells can’t come out because of the blockage of tubules. Obstructive azoospermia consists of 40% of all azoospermia patients.

In non-obstructive azoospermia, sperm production is deficient.

For discrimination of the type of azoospermia, we may need to check hormone balance, Y microdeletions, karyotype analysis, and cystic fibrosis gene mutations.

Whatever reason, the solution is to try to get sperm cells from testicles via surgically. These procedures call testicular sperm extraction or testicular sperm aspiration.

Sperm cells, which get surgically, can use ICSI procedure for fertilizing the egg.

So, if we can get sperm surgically from testis, a man who has azoospermia, can become a father with in-vitro fertilization.

The condition that cannot find sperm surgically, sperm donation is the only way to achieve pregnancy.

8.Does menstrual irregularity affect the pregnancy chance of the woman?

Menstrual regularity is an essential factor in having a baby. If a woman has a regular menstrual period, we think that her ovulation and hormonal balance are regular. When a woman has irregular menstrual cycles, we should consider polycystic ovarian syndrome, premature ovarian failure, or menopause. All these conditions affect the ovulation of the egg cells, egg reserve, and egg qualities. Premature ovarian failure is one of the most challenging conditions in infertility treatment. A woman born a certain number of eggs, and until adolescence period she loses a vast amount of her eggs.

Genetic factors, environmental factors, prior surgeries, chronic diseases affect the woman’s egg reserve, and quality. And when she wants to have a baby, she may meet the egg and ovulation problems. AMH level is a good indicator to show the risk of infertility. When we meet the low AMH level, even she is young; we know that we cannot develop enough numbers and quality of egg and embryo. Some of these patients, like in menopause period women, egg donation is a very successful and hopeful option.

9.If a couple has a genetic disorder, can they have a healthy baby?

Yes. In- vitro fertilization and genetic screening of embryos excellent options for these couples. In some couples, the woman and the man both carry the same chromosomal abnormalities, and this means when they have a baby, the baby has a risk of having this sickness. Selecting a healthy embryo is essential to have a healthy baby. We can choose the healthy embryo before transfer into the woman’s uterus. The new generation sequencing (NGS) technique is a sophisticated technique in preimplantation screening methods. We cannot screen known genetic abnormality, but also, we can screen aneuploidies.  We can use NGS single-gene disorders such as cystic fibrosis, thalassemia, sickle cell anemia, Robertsonian Translocations, etc. For this genetic screening, we make a biopsy from the trophoblastic part of the fifth-day embryo. So, it is a safe and reliable technique.

NGS is also used maternal age over forty, recurrent pregnancy loss, repeated IVF treatment failure, severe male infertility.

10.Can a woman whose Fallopian tubes blocked get pregnant?

Yes and no. Fallopian tubes play an important role in spontaneous pregnancy. Egg and sperm cells meet in the tubes. And sperm fertilize the egg in the tubes. After fertilization, the embryo continues development it’s development in the tubes and then comes into the uterus and attaches to the endometrium. If both tubes blocked any reason, sperm and egg can’t meet each other, and other consecutive processes can’t occur. Because of this reason, evaluating the tubes essential for the infertility diagnosis. HSG (hysterosalpingography) is a technique that shows if tubes are open and have regular structure and function.

 If one of both tubes is open, she can get pregnant spontaneously.

If both tubes are closed, in-vitro fertilization is an excellent option for the treatment for her. In in-vitro fertilization, after ovarian stimulation, eggs are collecting by the infertility expert, and sperm meets with egg in the Petri dish in the embryology lab. On the 3rd or 5th days of the embryo developing, embryo transfers into the uterus by the doctor. Tubes are not necessary for the in-vitro treatment.

So, a woman whose both tubes are blocked can’t get pregnant spontaneously, but she can get pregnant with in-vitro treatment.

11.Does the age of a woman important for having a baby?

Yes, It’s very important. The best time to get pregnant between 23-35 years. After age 35, egg reserve and quality usually are decreasing. Chromosomal abnormalities are increasing. This means pregnancy capability is falling, and because of chromosomal abnormality of the egg, embryo quality is declining, abortion risk is rising.

After 40, these adverse changings are much more detrimental to her fertility. That’s way as an infertility expert, we recommend egg cryopreservation to the woman who is less than 40 and doesn’t plan pregnancy near future.  Egg cryopreservation is an excellent choice of fertility preservation. We can keep her eggs for years to use when she wants.

Egg cryopreservation is also important for some cancer patients. Chemotherapy and radiotherapy treatments have devastating effects on egg cells. Before chemotherapy and radiotherapy, we may collect her eggs and keep them, after these treatments and cure of cancer, we may make embryo and embryo transfer. She can preserve the chance of her own baby’s delivery.

Same as in male cancers, we can freeze sperm cells for future usage.

12.May the medications which are using in in-vitro treatment, cause cancer such as breast and ovarian cancer?

In- vitro fertilization treatments have been performing since 1978. There is a large number of scientific investigations and studies about the relationship between in-vitro therapies and cancer. Until now, studies have not shown that any significant risk increase. So, in-vitro fertilization therapies are accepted as safe treatments.

13.May the Medications which are using treatment cause bodyweight rising?

In fact, these medications may cause very slight edema. She may see 1-2 kg bodyweight changing. After treatment, usually, this edema disappears.

14.What is the difference between ICSI and Classical IVF?

If we put an egg and 50 000 or 100 000 sperm cells in a Petri dish and wait for one of the sperm cells to fertilize the egg, this calls classic IVF. In classical IVF, we need at least 50 thousand healthy motile sperm cells for each egg cells. But as we mentioned in azoospermia patients, finding this number of sperm cells is impossible, and fertilization rates lower than ICSI.

 ICSI is the most sophisticated technique of the in- vitro treatments. Embryologists put sperm into the egg cell under the microscope. So very few numbers of sperm can use for fertilization. In this technique, embryologist’s experience and equipment quality are paramount.

In fact, both classical IVF and ICSI procedures are needed to be experienced embryologists, well, and updated equipment and laboratory conditions. We are proud of our embryology team and laboratory. In our clinic, before embryo transfer, we are discussing every detail of the patient’s condition and adjust our decision according to the patient’s situation. That’s why our pregnancy rates are very satisfactory.