One of the assisted reproductive techniques that couples diagnosed with infertility can consider in order to have children is IVF treatment. IVF treatment is a process that consists of stages, and these stages can be supported by additional treatments for couples. In its most basic form, IVF is performed in the form of fertilization of egg cells harvested from the female with the sperm cells taken from the male, outside the body, in a controlled laboratory environment and the transfer of the resulting embryo into the uterus of the expectant mother.2 Bringing the sperm and the egg together for the formation of an embryo is what traditional IVF treatment is. Injecting the highest quality sperm into the egg is called ICSI.

1 https://www.nhs.uk/conditions/ivf/

Although IVF treatment is among the commonly preferred assisted reproductive techniques, it may not be suitable for every couple. IVF treatment cannot be applied in women who have lost the function of ovulation, who entered the menopause phase of their lives, had their uterus surgically removed, or men who can not create sperm cells despite different treatments and surgical techniques. 

Although the first thing that comes to mind when thinking of female-induced infertility is the decrease in egg reserves, the decrease in egg quality is also an extremely important element. Egg quality can decrease for a multitude of reasons. Aging is one of the most important reasons affecting egg quality. In women, the number and quality of their eggs begin to decrease from the age of 30. This reduction accelerates after the age of 40.1 Along with age, lifestyle choices such as stress exposure, smoking, excessive weight, inactivity can also cause a decrease in egg quality.

1 https://www.msdmanuals.com/home/women-s-health-issues/infertility/problems-with-eggs

Stress is a condition that affects the physical and mental state of individuals. There is also an important link between the functions of the female reproductive system and stress. It is known that stress can affect the female reproductive system, especially the ovaries, follicles and oocytes. It is accepted that increased stress hormones such as cortisol can cause a decrease in the quality of oocytes by reducing the production of estradiol.1

1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4812655/

The method, which is based on taking the selected highest quality sperm cell into a thin glass needle and injecting it into the egg cell using a microscope, is called ICSI. ICSI is a treatment method that is mostly used in the case of male infertility. In cases such as low sperm count, abnormal sperm morphology, low sperm motility, azoospermia due to obstruction and sperm retrieval by MicroTESE surgery, ICSI method can be applied. In addition to all these, if an embryo could not be obtained by the classical method in past IVF treatments or if the age of the expectant mother is 35 and over, it may be necessary to apply this method.1

1 https://www.hfea.gov.uk/treatments/explore-all-treatments/intracytoplasmic-sperm-injection-icsi/

When it comes to male-induced infertility, ICSI has been confirmed to increase the chances of fertilization compared to traditional IVF.1 By mechanically inserting the sperm into the egg, the zona pellucida shell surrounding the egg is disabled.

1 https://www.cdc.gov/art/key-findings/icsi.html

Intracytoplasmic Morphologically Selected Sperm Injection - IMSI is an auxiliary technique applied to increase the success rate of IVF treatment. With IMSI, which is the sperm selection technique used in the ICSI method, sperms are examined by enlarging 6000 times. Thus, it is possible to display the sperms in great detail.1 The main purpose of the technique is to select the sperm with the best morphology.

1 https://www.hfea.gov.uk/treatments/treatment-add-ons/intracytoplasmic-morphologic-sperm-injection-imsi/

No, the quality of both eggs and sperm is important for the fertilization process. Although not every egg is fertilized, it is important to know that not every fertilized egg can become a healthy embryo, and healthy embryos cannot always settle in the inner layer of the uterus.

"Assisted Hatching", known by different names such as "artificial weakening of the embryo shell", is an auxiliary technique used to increase the success of embryo transfer in the uterus in IVF treatment. It aims to facilitate the attachment process by creating controlled damage to the hard membrane called zona pellucida surrounding the embryo.

Ovarian hyperstimulation syndrome or ovarian hyperstimulation syndrome is one of the complications that IVF treatment can cause. It can be briefly described as a condition in which the ovaries fill with fluid and swell, and this fluid leaks into the body. It may occur as a result of drug treatment to stimulate the ovaries, or it may occur spontaneously, albeit rarely. It is more common in women who have Polycystic Ovary Syndrome and are undergoing fertility treatment. Abdominal pain, bloating, rapid weight gain, nausea are among the mild symptoms of OHSS. In severe cases, excessive weight gain, severe nausea and vomiting, difficulty breathing, blood clots, decreased urinary frequency, kidney failure may also occur.1

IVF treatment success rates can be influenced by many different factors. It is known that aging, being overweight, past pregnancies including miscarriages and the underlying cause of infertility can affect the success rates of IVF treatment.  The rates of getting pregnant with IVF treatment in the first attempt are closely related to the age of women. It is known that the rate of conception for women under the age of 35 in the first attempt is around 55%, and this rate decreases rapidly after the age of 35. IVF treatment is not a treatment that guarantees 100% success at the first attempt. Through multiple attempts which end with failure, pregnancy can be achieved through IVF by making specific treatment plans for the couple.

Married couples can apply for IVF treatment in our country. It is a legal obligation to use only eggs and sperm cells taken from the expectant mother and father as part of the treatment.1

1  https://www.mevzuat.gov.tr/File/GeneratePdf?mevzuatNo=20085&mevzuatTur=KurumVeKurulusYonetmeligi&mevzuatTertip=5

There may be various reasons behind the failure of IVF treatment. One of the most common causes is the embryo quality not being adequate. When the embryo is not of sufficient quality, it may not be able to attach to the uterus or, even if it does, it may not grow ideally. Another cause of failure is poor egg quality. Other causes may include different factors such as DNA damage in sperm, failure to select the right embryo, egg anomalies, inability to harvest enough eggs, health problems such as hydrosalpinx that prevents the development of the embryo and the presence of chromosomal abnormalities in the embryo.

The most important factor in the success rate of IVF treatment is the age of the expectant mother. The research results confirm this information. The live birth rate was 51% among women under 35 years of age, 38.3% for women between 35-37 years, 25.1% for women between 38-40 years, 12.7% for 41-42 years old and 4.1% for women over 42 years of age.1

1 https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0

When it comes to the age limit in IVF, the female part of the equation becomes important. As a result of the examinations performed before IVF treatment, if no obstacle is found against it, IVF treatment can be performed until the age of 45. It should be known that when the woman's age reaches 40 and above, the success rate drops significantly. For this reason, it is recommended to decide on IVF treatment as early as possible. 

There are no legal restrictions for the number of IVF trials. Couples can continue to resort to IVF for as many times they wish to have children. It can be stated that the chances of success in IVF treatment are the highest in the first 3 trials. State-sponsored IVF treatment however is limited to a maximum of three trials.  But it is possible to apply for the treatment for more than three times.

The answer to this question may vary depending on the age of the expectant mother and the number of IVF treatments performed in the past. If the woman is under the age of 35, 1 embryo is transfered in the first and second attempts, and a maximum of 2 embryos are transfered if the pregnancy does not occur and the treatment process is continued. If the expectant mother is 35 years or older, 2 embryos are transfered from the very first attempt.  

It is the process of freezing healthy embryos obtained during IVF treatment which are not or cannot be transfered to the uterus, under controlled conditions in order to ensure that they can be reused in the coming years. The first successful embryo freezing procedure was carried out in the 1980s.1

1  https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/freezing-embryos

Depending on the nature of embryo freezing and thawing procedures, there is no difference between pregnancy rates from frozen embryos or freshly formed embryos. 

The egg harvesting process, also called OPU, is one of the basic stages of IVF treatment. After the stimulation of the ovaries, egg development is monitored and eggs are harvested, 34-36 hours after the FSH (follicle stimulating hormone) injection is made. The procedure is performed under sedation under the guidance of ultrasound. The follicle fluid in which the egg cells are located is removed with the help of a syringe. This procedure is painless. Some women may experience mild pain and very small amount of bleeding in the process after egg harvesting. Rest is recommended after the procedure.

After embryo transfer, patients can rest in the hospital for 30 to 45 minutes and then they are free to return home. Although it is recommended to rest at home, this period is not too long. A day's rest is enough Lying down for an extended period of time after embryo transfer has no effect in increasing the success of treatment.

It is not recommended to engage in sexual intercourse immediately after embryo transfer. It is the correct approach to practice sexual fasting until the pregnancy test is performed. According to the pregnancy test results, it may be necessary to schedule the sexual intercourse.

Heavy exercises should be avoided after embryo transfer. It is recommended for expectant mothers to rest for 1 day after the procedure. There is no harm in doing light exercises. The level of mobility should be limited until the pregnancy test. There is no need to make any major changes related to everyday life.

The answer to this question may vary depending on the time of embryo transfer. If embryo transfer has taken place on the fifth day, it is possible that implantation will take place within 48 hours on average. 

IVF treatment should be considered as a process. Although a full IVF cycle lasts about 3 weeks, it can be said that additional treatments which may be required for the couple may extend the process.1

1 https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716

Preimplantation genetic diagnosis is the process of genetic examination of embryos created in a laboratory environment. It is an extremely important diagnostic method in order to transfer healthy and high-quality embryos to the uterus. 

It is possible. If the cause of infertility in women is tube obstruction and if fluid accumulation occurs in the tubes due to this, it may have a negative impact on implantation. It may be preferable to remove the tubes, as the liquid leaking from the tubes may harm the embryos. At this point, the treatment to be applied is determined by the physicians specifically for the patient.

Couples undergoing IVF treatment are advised to pay attention to nutrition before treatment begins. It is recommended to stop drinking alcohol and smoking. Although there is no special nutrition plan specific to the process, it is recommended to consume healthy foods with a predominance of vegetables and fruits. 

There is a connection between the success of implantation and the thickness of the inner membrane of the uterus when it comes to IVF treatment. It is considered ideal for the inner lining of the uterus to be thicker than 7 mm. Values below this require endometrial preparation.