What is IVF baby ?
IVF (in vitro fertilization) is a Latin definition of combining eggs with sperm in laboratory. It was first invented in 1978 and after that it started to be widely used. In 1993, it marked a new epoch, especially for the couples where men have problem, by using method of inserting sperm into egg with a needle.
What are the steps in the Tube Baby treatment?
The main aim of the tube baby treatment is to provide sperm to enter into healthy egg (previously obtained) in laboratory environment and to put health embryo into uterus. To reach this goal the stages are as follows:
Stimulation of the ovaries
Egg collection with the help of ultrasound
To bring together eggs with sperm in the laboratory
Transferring the embryo into the uterus
1. Ovaries stimulation
Normally, every month women produce one egg and leave it in the tubes. To increase the chances of pregnancy with tube baby process, much more eggs are produced. According to this goal, the patient use medicine for the stimulation of the ovaries. Drugs are used as injection and applied subcutaneous or intramuscular. Currently various medicine are used in the world (Ganal- F, Merional, Menogon, Puregon and similar).
Medicine that stimulates the ovaries is applied to two different protocols:
1. You can use it at the third day of the period (short protocol)
2. At previous period, before twenty-first day, you can start using medicine called Lucrin to enable pressure on the ovaries and after that use stimulation medicines (long protocol). Which medicine and method is the most appropriate for the women will be decided after evaluation. Result of the 10-14 days of ovaries stimulation is called follicle and it is growing inside of the egg vesicle. Diameter of this vesicle is examined with ultrasound and it is expected to grow until 17-18mm. Also by taking blood, estrogen hormone, which is released from ovary, is measured. During the medicine stimulation the most important problem that can occur is follicle´s early crack, or said in other words, early ovulation. In order to prevent this, Lucrin medicine is used for long protocol or Cetrotide/Orgalutran named medicine for short protocol.
These medicines used in long term are not harmful for women´s health. Even though some of the previous studies showed that ovary stimulation medicines can increase the chances for ovary cancer, in the latter studies this was not the case. While the medicine is used it can cause getting weight, swelling and tension, but this is all temporary.
15% of the women that use this medicine must cancel the treatment because the ovary gives no or very weak response to the medicine. In situation like this the treatment should be continued with different approaches, without worrying or loosing hope.
2. Collecting eggs
Eggs are collected from vagina by sticking needle, applied through an ultrasound device (you can watch from our video gallery). Short 15-minute procedure is applied, under light anesthesia and it is not painful. From fluid-filled vesicle called follicle, with the help of aspirator, egg is absorbed outwards. Although it rarely occurs, the biggest risk of the procedure can be bleeding. When the procedure is over, after two hours stay in hospital woman can get back to its normal life.
During ovary stimulation, in follow-up procedure follicles are monitored and measured; it cannot be seen on ultrasound because egg is too small (the small side of a needle). Because of this, from some follicle seen on the ultrasound there is a possibility that egg will not come out. As a result of this the number of really obtained eggs can be less than the expected.
3. Bringing together egg and sperm in the laboratory
The collected eggs are being quickly sent to laboratory and kept in the environment most similar to body temperature and atmosphere in the woman´s tubes (storages called incubator). The eggs are incubated for about 2-4 hours and later are combined with the sperm.
When classical IVF was applied for the first time in 1978, sperm was left next to egg and it was waited for it to enter into egg on its own. However, in 1993, this method was further improved and sperm was injected into egg with the help of a small needle. This is called ICSI – micro injection (you can watch from our video gallery). The goal with this method is to decrease the risk of sperm not entering into egg, but instead to be directly inserted into it. In the past this method was applied on men who were in the advanced stadium of sperm decrease, but latter it became widely-used. In Turkey, in most of the IVF centers, instead of classical IVF the ICSI method is used.
Sperm is taken from men at the same day when eggs are collected and after a short preparation period it is ready for injection. In case no sperm is found in semen, sperm is obtained with operation from the testicles called TESE. Couples that are participating in the tube baby program, TESE procedure is performed either on the egg collection day or one day before the egg collecting. With some couples, TESE is done before the beginning of the tube baby program. After the sperm is taken, it is frozen and stored.
4. Transfer of embryo
Progress of the eggs combined with the sperm is monitored in the laboratory. First day sperm and egg cores are combined. This is called - to be fertilized or inseminated. In the second day it becomes a 4-cell embryo. In the third day it transforms into 8-cell and in forth day approximately it becomes morula consisted of 200 cells. On the fifth day it becomes more mature embryo with accumulated fluid in the middle which is called blastocyst (you can watch from our video gallery).
Embryos are generally transferred after three or five days after collecting the eggs. The reason for embryos to be hold in the laboratory environment and waiting fifth day to be transferred is because in this way, the better embryo selection can be made. Because of this, couples with at least 7-8 developed embryos on the third day are the appropriate candidates for the transfer on the fifth day. For the couples where small number of embryos is developed, there may be no chances to transfer embryo if waiting for the fifth day to come. It was suggested that pregnancy rates are better when blastocryst is transferred but this topic is still controversial.
In Turkey, according to a regulation from March 2010, the new rule started to implement: for women under 35, one embryo and for those over 35, two embryos can be transferred. The aim of this new regulation was to prevent the multiple pregnancies. Normally when 3 embryos are transferred, multiple pregnancy rate is about 35%. By decreasing the number of embryos transferred, this rate will drop. However, there is a possibility that average pregnancy will drop, too.
Embryo transfer procedure is like a normal gynecological examination. There is no need for anesthesia and it last 3-4 minutes. Generally embryo transfer is made with ultrasound control and embryo is left in the empty middle part of uterus (you can watch from our video gallery).
After the embryo transfer and 1-2 hours of lying in bed, patient can get back to her normal life.
The important factor, that enables embryos to stay inside and develop, is embryo´s structure and uterus inner layer. During the follow-up of ovary stimulation period, the thickness of uterus inner layer (endometrium) is measured and it is necessary to wait until it reaches 7 mm. In situations when uterus inner layer is thinner than 7 mm pregnancy rate is significantly lower.
After the embryo transfer, the first pregnancy test is made after 12-13 days. Blood Pregnancy test (B hCG) is the certain parameter. One week after the first pregnancy test is made; gestational sac is controlled with ultrasound. Vaginal ultrasound examinations during the pregnancy are no harmful for the baby. The reason for closely monitoring the pregnancy in this period is to early recognize ectopic pregnancy or state of having miscarriage.
Embryo freezing has been made for almost 20 years in the whole world. There are two methods for embryo freezing: slow and fast freezing. Fast freezing method has been very popular in the world in the last 5 years and it shows better pregnancy rates.
Embryos can be frozen on the third of fifth day and can be stored in Turkey for 5 years. It is common to freeze third day embryos.
On request, after preparing the uterus inner layer, embryos can be transferred into uterus.
When transferring frozen embryos, in order to prepare uterus inner layer the tablets containing estrogen are orally used. These medicines used do not have long term harmful effects on woman health.
SIDE EFFECTS OF TUBE BABY PRACTICES
Like in all other medical processes, tube baby procedures also have its side effects.
Some of them are as follows:
Hyper stimulation (ovary over stimulation). In order to obtain eggs, medicines are used. 1% of patients that use medicines may end up staying in hospital.
These medicines are not increasing risk of ovary cancer, but woman who have never given birth, may be prone to this type of cancer. It is also known that usage of these medicines is not increasing risk of breast and uterus cancer.
Ectopic Pregnancy: during the IVF process, although embryos are transferred inside the uterus, sometimes going directly to tubes they can settle there. This is one of the reasons for ectopic pregnancy. Between 1-2% of couples that enter the tube baby program can face the ectopic pregnancy.
In case of diagnosing early pregnancy together with ectopic pregnancy, it is possible to start treatment with the medicine.
Risk of child anomaly: Until today thousands of babies have been born as a result of tube baby practice. Examinations among the born babies have not determined a significant increase in disabilities or anomalies. However, it is reported that if couples, where men having a very low sperm count, stay pregnant and a baby boy is born, in the future he will also have a problem with sperm production.