IVF
What is In Vitro Fertilization?
In Vitro Fertilization (IVF) is a treatment method that can be applied for couples who want to have a baby but cannot have a baby for various reasons. In vitro fertilization (IVF) treatment aims to fertilize eggs and sperm in a laboratory environment and implant the resulting embryos into the uterus so that the expectant mother can become pregnant. In the light of this method, expectant parents are involved in a process with various stages. Although this process has a promising functioning, we care that couples who choose our center for IVF treatment feel peaceful, understood and safe above all. In line with this primary goal, we treat each couple’s situation as unique and individual, taking into account the principle of individuality.
If pregnancy does not occur despite regular sexual intercourse for 1 year for expectant mothers under the age of 35, 6 months for expectant mothers over the age of 35, and 3 months for expectant mothers over the age of 40, it is strongly recommended to consult a fertility specialist to be evaluated for infertility.
Eggs, sperm and uterus (uterus) are needed for pregnancy to occur. Each of them should be evaluated separately for infertility and the fallopian tubes, which act as a kind of channel or bridge, should not be forgotten. In cases where there are no eggs and sperm, in vitro fertilization is not possible and a solution is found with donation treatments.
In vitro fertilization treatment aims to identify problems in men and women and to find solutions to these problems in order to have a child. As a result of the tests and examinations carried out to detect these problems, after the existing problems are eliminated (such as surgery etc.), the prospective parents are taken into the treatment program.
In Cyprus, there is no official marriage requirement for IVF treatments as in Turkey. In addition, the number of embryos planned to be transferred is max 3 according to the law and since it is more than in Turkey, the chances of success are many times higher. For this reason, Cyprus has become an attractive country due to the lack of marriage requirement and the number of embryos transferred.
Who can undergo IVF treatment?
The most common problems related to men and women detected in today’s technology and which are mostly solved by IVF treatment are as follows.
Woman
Immunological factors
Unsuccessful vaccination attempts
Those with problems in the uterus (myoma, polyp, adhesion, septum, etc.)
Those with hormone disorders (prolactin, thyroid, fsh, amh etc.)
Those with obstruction or damage to the tubes (hydrosalpenx, etc.)
Those with endometriosis (chocolate cyst)
Unexplained infertility (unexplained infertility)
Those with premature ovarian failure (premenopausal state)
Polycystic ovary syndrome (ovary with multiple eggs)
Vaginusmus (inability to have intercourse)
Male
Low sperm count.
Low sperm movement,
Those who have problems with erectile potency
Cystic fibrosis disease
Absence of sperm in semen (Azoospermia)
Poor sperm morphology (misshapen sperm)
Testicular Damage or Infection
In women, age (over 35 years of age), smoking, alcohol and drug use, stress, overweight or underweight can also have a negative impact on conception.
Tests Requested in IVF Treatment
Tests Requested from the Expectant Mother:
FSH, LH, E2, Progesterone (to be done on the 2nd or 3rd day of menstruation)
AMH (In expectant mothers with a value below 0.5, an insufficient number of eggs may not develop and this may prevent successful completion of the treatment. If pregnancy occurs, there is a risk of miscarriage)
TSH, T3, T4, prolactin (morning on an empty stomach)
Complete Blood Count, blood type
Fasting Blood Glucose (morning on an empty stomach)
Urea, SGOT, SGPT
PTT, INR, APTT
Vit B12 and Vit D
HBsAg, Anti-HCV, HIV, VDRL (Infectious diseases test)
Karyotype (according to condition)
USG (Vaginal Ultrasonography) is preferred between the 14th and 20th days of the menstrual period. The appearance of the intrauterine lining, fluid accumulation, adenomyosis (a structure that looks like a black hole in the endometrium), fibroids, polyps are detected more accurately by ultrasound. The thickness of the intrauterine lining (endometrium) is particularly important and is preferably 8 mm or more. Fluid accumulation in the endometrium is usually due to intrauterine operations such as cesarean section and suggests adhesions. In addition, fluid accumulation may also develop due to enlargement of the tubes called hydrosalpenx. The ovaries (ovaries) are also evaluated with USG. It is checked whether the egg reserve is suitable for this procedure. In order to have a high chance of success, a target of 10-15 mature eggs is desired. In cases where the egg reserve is low, the pool method is applied. In the pool method, egg collection is usually performed 2-3 times. This method can be time-consuming as well as a bit costly and tedious. In such cases, egg donation may sometimes be preferred.
HSG (Hysterosalpingography) is the most important and indispensable test in investigating the causes of infertility. It is a kind of x-ray that allows the uterus and tubes to be visualized, a special device is inserted into the entrance of the uterus and a contrast fluid is given and taken. It is also known as a uterine film. Since it can be painful due to the pressure, we recommend that it is performed under anesthesia. Although it is performed with X-rays, the radiation dose is very low. With this X-ray, conditions such as swelling in the tubes (fallopian tubes), polyps, fibroids, adhesions in the uterus, which are known to adversely affect pregnancy and cause ectopic pregnancy, especially due to the fluid in the fluid touching the embryo, are detected. In principle, HSG is performed within 2-3 days following the end of menstruation. In cases where it is certain that there is no pregnancy, there may be flexibility on the day of the filming. In the presence of infection, the filming is postponed.
The uterine film is valid for 2 years and if surgical intervention has been performed, it is recommended to repeat the film in terms of adhesions etc.
Tests Requested from the Expectant Mother:
If there are any diseases and medications that may adversely affect the treatment or pose a risk to health, they must be reported to us in order for us to take the necessary precautions. In particular, blood thinners, diabetes medications, blood pressure and heart medications, as well as the use of harmful substances such as smoking and alcohol are also important information for us.
Tests Requested from the Prospective Father:
Spermiogram (3-5 days of sexual abstinence)
HBsAg, Anti-HCV, HIV, VDRL (Infectious diseases test)
FSH, LH, Testosterone hormone analyzes (on a case-by-case basis)
Karyotype (according to condition)
Information Requested from the Prospective Father:
If he has a disease that prevents him from giving sperm (such as diabetes) or if he is unable to give sperm due to stress, we should be informed. In such cases, supportive medication may be given or it may be necessary to remove the sperm from the testicles with a small operation. The presence of heart disease may pose a risk due to complications of the medication. Blood thinners may also pose a risk for the operation. Again, the information about whether he has undergone sperm-related treatment or operation (Tese, Tesa, varicocele, etc.), whether he has used harmful substances such as smoking and alcohol should be made to us fully as it will shed light on the course of treatment.
Stages of IVF Treatment
Our most important priority in IVF treatment is to understand the expectations of the couples who consult our center and to advance our processes with open and transparent communication, accepting that each couple has their own special and unique processes.
Treatment processes consist of the following stages:
Preliminary Assessment and Counseling
Objective: To provide an overview of couples’ medical and reproductive health.
Process: Information about medical history, previous reproductive experiences, lifestyle and general health is collected. Necessary medical tests (blood tests, ultrasound, semen analysis, etc.) are performed.
Stimulation Therapy (Ovulation Induction)
Objective: To allow more than one egg to mature.
Process: The woman receives hormone therapy to stimulate the ovaries to produce more than one egg. During this process, egg development is monitored with regular ultrasound follow-ups and blood tests.
Ovum Pick-Up
Objective: To collect mature eggs from the ovaries.
Process: The eggs are collected under ultrasound guidance using a fine needle, usually under short-term anesthesia.
Preparation of the sperm sample
Objective: To select suitable sperm for fertilization.
Process: The sperm sample from the man is processed in the laboratory and the healthiest sperm are selected.
Fertilization and Embryo Culture
Objective: To fertilize eggs with sperm and monitor the development of embryos.
Process: Eggs and sperm are brought together in the laboratory. If fertilization is successful, the embryos are left to develop in special incubators for several days.
Embryo Transfer
Objective: To implant the healthiest embryo (or embryos) in the woman’s uterus.
Process: The best quality embryo(s) are transferred into the uterus, usually in a painless procedure.
Luteal Phase Support
Objective: To support the continuation of pregnancy.
Process: After embryo transfer, support is provided with hormones such as progesterone.
Pregnancy test
Objective To determine the outcome of treatment.
Process: Approximately two weeks after the embryo transfer, a pregnancy test is performed with a blood test.
Additional Stages and Special Situations
Genetic Screening (PGD): In some cases, embryos may be genetically screened to detect genetic diseases or for sex selection.
Donation and Surrogacy: Egg and sperm donation or surrogacy services may be offered when necessary.
IVF Treatment Process
In cases where the egg and sperm cannot unite naturally or, even if they do, a healthy fertilization does not occur, fertilization is performed in the laboratory by expert embryologists. Even if the problem is caused by sperm, the main step of the treatment is to stimulate the ovaries of the expectant mother.
The treatment starts on the 2nd or 3rd day of the expectant mother’s menstruation. If there are no conditions such as asynchronous egg development, cysts, etc. as a result of the examination, treatment is preferably started by performing hormone tests such as Estradiol-Lh-Progesterone. A treatment protocol is determined according to the age, weight and egg reserve of the expectant mother. The most preferred of these protocols is the antagonist protocol known as the short protocol. In this protocol, hormone injections that stimulate the ovaries are started at the dose deemed appropriate. The duration of the treatment varies from person to person, but it takes a little longer in those with high egg reserve (such as pcos) and is completed in an average of 10-14 times. During this period, vaginal ultrasound is performed every 2-3 days to evaluate the number, size and development rate of the eggs as well as the uterus.
In this treatment, it is also possible to have the examinations in your country. If you have one, you can be under the control of your own doctor or a doctor recommended by us.
When the eggs reach a sufficient number and size (18-20 mm), the egg retrieval procedure is planned after 34-36 hours by giving a hatching needle.
The last needle of the treatment is the hcg needle, known as the hatching needle. The day and time of the injection is very important and affects the success of the treatment. The time difference between countries should also be taken into consideration when determining the time of the injection. In cases where more than 20 follicles develop in the ovaries and the E2 (estrogen) hormone is 3000 or more, a special ligation needle is used to prevent the development of the complication known as OHSS. OHSS (Ovarian Hyperstimulation Syndrome) is a very serious complication in which the ovaries overgrow and fluid outflows out of the veins. In this case, embryos are frozen and transfer is planned in the following months.
Usually, the trip to Cyprus starts on the morning of the hatching injection, i.e. the day before the egg collection.
The Treatment Process of IVF Treatment in Cyprus
Day 0
Since it will be convenient for you to come to Cyprus 1 day before the egg collection process, your travel is planned with the organization carried out by our transportation team. At the end of your journey, which starts under the control of our team, you will be welcomed with our private vehicle when you land at Cyprus Ercan Airport. After your transfer to the hotel of your choice in Kyrenia or Nicosia, you can spend your day resting. During your journey in Cyprus, you will notice that the traffic is on the left lane and the steering wheel is on the right side. For this reason, crossing rules are also different and you need to be careful when crossing the road. Our team will call you or send you an information message to remind you about the points you need to pay attention to before the transaction. In particular, it is the most important issue that you should be hungry and thirsty 8 hours before your transaction time so that your transaction is not delayed or canceled. It is usually requested to fast after 00.00 (you should not eat or drink anything, just like fasting).
Day 1
You will be transported from the hotel to our clinic with our private vehicle at the time we tell you. Due to the importance we attach to information security, all transactions are carried out with great care and confidentiality. After the interview with our doctor, you will be examined according to the situation. After the preliminary preparation (insertion of an IV drip, wearing a gown, signing information and consent forms), your egg collection (OPU- oocyte pick up) takes place in 10-15 minutes under anesthesia. The sperm sample taken from the father-to-be and the eggs are combined with the microinjection (ICSI) method by our expert embryologists in our laboratory. Our specialist nurses will start you on additional medication for the remainder of your treatment. If your treatment includes an injection procedure, our nurses will arrange for it to be performed at your hotel.
Day 2
The egg and sperm cells are combined in the laboratory by microinjection and it is checked whether they are fertilized or not, or if so, how many of them are fertilized. We call the cell formed from this combination an “embryo”. Your phone should be on during the day as you will be informed by our embryologists after the controls.
Day 3
Day 2 of your embryos. While you enjoy your vacation in the unique nature and beautiful sea of Cyprus, your embryos will be safely monitored by our expert embryologists.
Day 4
Your embryos will be transferred on the 3rd day and their quality and number will be evaluated. In some special cases, transfer can be planned on the 3rd day of embryos. If you do not have a transfer, you do not need to come to the hospital, you can enjoy your vacation or rest. Again, you will be informed by our embryologists.
Day 5
It is the 4th day of your embryos and you do not need to come to the clinic again. You will be informed by our nurses during the day about your transfer time and the things you need to pay attention to before the transfer.
Day 6
Transfer day To achieve high success and reduce the risk of multiple pregnancy or increase the chance of multiple pregnancy, embryo transfer is usually done on day 5. We call this blastocyst embryo transfer. On the day of transfer, your emotions such as excitement and anxiety may peak. Our team is always with you in this process. In order for the embryo transfer to take place more easily, you need to urinate and therefore you are asked to drink about 1 liter of water 1 hour before the transfer. After the pre-transfer preparations are completed, you will be informed about your embryos and your transfer will be completed. The embryo transfer process will take 10 minutes in total, and after 30 minutes of bed rest, you will be informed about your treatment and the issues to be considered after transfer.
If you have remaining embryos, the freezing process is applied after the information. In this way, if there is any negative situation, you will have the chance to try again at a lower cost.
Day 7
Now it’s time to return, hoping that your transaction went well. Our private car will pick you up from your hotel and transfer you to the airport in comfort.
The Process After IVF Treatment
We hear so often that 12 days is worth 12 years. We are as excited as you are and we sincerely hope that this process will be successful. If your pregnancy test is positive, we recommend that you make an ultrasound appointment 10 days later. Depending on the result, you may sometimes be asked to repeat the pregnancy test 2 days later. If your pregnancy test is negative, the medication will be discontinued and a repeat test may sometimes be requested.
