The road to parenthood may sometimes be long and difficult. Rest assured; Liv Hospital IVF Unit converts the dreams of the couples to reality with a high success rate in this difficult journey.

Liv Hospital, offers the most advanced treatment options the couples also in the field of reproductive health as in all medical processes. The guests are served with unlimited support, high clinical experience and the latest treatment protocols via quality standards established in accordance with international criteria.

Physicians specialized in their field offers the most complex treatments as well as the simplest and most basic treatment options for our patients in Liv Hospital IVF Unit. Liv Hospital IVF Unit, which aims personalized treatment, decide the most appropriate treatment option together with its guests. Ovulation induction (regulation of ovulation with medications), surgical intervention, intrauterine insemination or IVF-ICSI (in vitro fertilization – microinjection) can be recommended treatment for the cause of infertility following the first interview. IVF Unit also produces solutions in terms of psychological support.

WHAT IS INFERTILITY?

The case that pregnancy did not occur at the end of a year despite of unprotected and enough often intercourse is called infertility (sterility). 85 percent of the couples achieve pregnancy in one year, and 93 percent within two years. The remaining group is considered as infertile and need assisted reproduction technologies.

So roughly, we encounter the problem of infertility in 15-20% of the population.

THE CAUSES OF INFERTILITY

The factor that prevents pregnancy can be identified in 85-90 percent of infertile couples in today’s technology. Approximately 40 percent of these are due women, while 40 percent due to men. All parameters are normal in the remaining 20 percent group, so we do not find a tangible cause in couples in this group with our knowledge at this moment. This case is called “unexplained infertility”.

The most important factor affecting the success of IVF treatment is the age of the woman and the woman’s egg reserve. In particular, the number and quality of eggs in the reserves in women over 38 years begin to decline seriously; pregnancy rates over age 40 falls to 30% even with IVF. The age of 45 (with some exceptions) is considered as ceiling age in order to achieve pregnancy with treatments in women according to currently accepted criteria. Some of problems due to the women arise necessity for surgical operation prior to IVF treatment, while some problems may change the treatment protocol to be applied. For example, congenital or subsequently acquired intrauterine disorders are first corrected by surgery then treatment is started, or treatment protocols and medication doses will be adjusted accordingly in cases that ovarian reserve of the woman more or less than expected depending on the age of the woman.

Women Sourced Causes

• Closed tubes, hydrosalpinx (inflammation of the tubes)
• Ovulation disorders, polycystic ovary syndrome
• Uterine and cervical disorders, congenital septum in the uterus
• Hormonal and metabolic problems, thyroid dysfunction
• Chocolate cysts and endometriosis
• Peritoneum problems, adhesions due to previous surgery
• Advanced female age
• Vaginismus

Men Sourced Causes

The only reason is men originated in 30-40 percent of infertile couples, while also accompany women related problems in 10-15 percent. Semen analysis is the most basic and guiding step of infertility examinations.

• Problems in sperm count or sperm motility
• Sperm deformities
• Lack of sperm (azoospermia)
• Blockage in the sperm carrier ducts, lack of ducts
• Erection or ejaculation problems (retrograde ejaculation)
• Hormonal causes
• Genetic causes
• Varicocele

TREATMENT METHODS

Liv Hospital IVF unit aims to give excellent service to patients.

Insemination

It is the procedure of preparing women in the way to produce 1-2 eggs with pill or injection shaped medications and then placing prepared sperm selected by special methods directly into the uterus just before egg cracking. It is required for the couple to perform insemination that the woman should be under the age of 38 and have normal ovarian reserve, both tubes to be clear, the uterus to be normal and also man to have certain number and mobility rates in the sperm test.

IVF (Classical In Vitro Fertilization)

It is the procedure of fertilization of eggs collected from the woman with sperm collected from man by bringing them together under special laboratory conditions. The presence of a certain amount of motile sperm in man is needed for IVF. In this method, a certain number of sperm is put in the same medium of each egg and fertilization is expected automatically without an intervention. It is now a method increasingly less used in modern clinical IVF clinics, and success rates are lower than microinjection.

ICSI (Microinjection)

In this procedure, each mature eggs collected are injected sperm individually and the embryos are created. Therefore, men with even very low sperm count may have children through this method. Another advantage of the ICSI method is the fertilization of mature eggs collected is more compared to IVF method.

TESE Operation

The condition of not finding any sperm cells in semen analysis is called “azoospermia”. Simple aspiration methods can also be used for obtaining sperm when azoospermia is present due to blockage in the ducts. In azoospermia, in which ducts are open, sperm searching procedure in the testes through microsurgical method under the microscope is called TESE. This procedure performed under anesthesia is a more precise method compared to multiple biopsy method performed without using a microscope. The success rate is higher because the ducts that sperm can be found are detected by observing with a microscope. In addition, the rate of complications that can occur in men with MicroTESE surgery is minimum.

We can encounter two types of possible causes in azoospermia.

. Due to the obstruction: Although there is not a very important problem in sperm production of the man in this case, Failure of the sperm to pass from testes to semen is in question due to a blockage that has occurred because of reasons such as previous surgery or infection in the reproductive ducts between the testicles and penis, or congenital lack of these reproductive ducts.

. Not linked to obstruction: This constitutes more common group. In such man, the problem is insufficient sperm production, although often there is not a disorder in the reproductive ducts. Here too, the reason may be hormonal, genetic or previous infection. In most cases, no obvious reason to explain the situation is encountered.

IVF TREATMENT STEPS

• Evaluation of the infertile couple, gynecological and urological examinations
• Planning of the treatment method by choosing
• The development of eggs by stimulation with medications (ovulation induction)
• Egg collection under anesthesia (OPU procedure)
• Fertilization of the egg by sperm (ICSI)
• Embryo Transfer

CURRENT TECHNIQUES IN IVF

Assisted Hatching

It is the thinning procedure of the membrane surrounding the embryo by trimming in order to facilitate the implantation of the embryo that will be transferred inside to the uterus. It is thought sometimes that implantation (attachment) rate could be increased.

PGD (Preimplantation Genetic Diagnosis)

It is the procedure of transferring normal embryos to the couple by determining normal or disease carrying embryos via performing embryo biopsy on the third or fifth day of the embryo development. It is performed to couples that are carriers of a known genetic disease, due to reasons such as recurrent miscarriages, recurrent IVF failures, determination of the embryo with the appropriate tissue type to treat the brothers with blood disease (HLA determination), advanced female age. Thanks to this procedure, it is aimed to increase the live birth rate by transferring embryos with healthy chromosome structure.

Sperm selection by IMSI and Double Refraction Method

Only the number of sperm cells with same number of mature eggs obtained usually from thousands, millions of sperm cells in the semen sample taken from the man is used in the IVF procedure. This selection is usually just based on the embryologist’s experience. A clearer assessment of the structure of the sperm is provided in IMSI method by ensuring greater magnification compared to classical microscope used. Thus, better quality sperm selection is intended. This method may be helpful to choose the better quality sperm in cases of severe male infertility, unexplained IVF failures and low-quality embryo production.

Hysteroscopy and Laparoscopy

In hysteroscopy, which is the visualization procedure of uterus with an illuminated camera system reaching from the vagina, problems such as structural defects of the uterus (septum, double uterus), myomas, polyps, adhesions (synechiae) can also be identified and their treatment can be performed simultaneously. If the problem determined prior to IVF procedure is due to uterus or recurrent IVF failures are diagnosed, to perform hysteroscopy may increase the pregnancy success.

Laparoscopy is the visualization procedure of inside the abdomen with an illuminated camera system. Generally, surgical treatment of ovarian originated cysts, opening of the adhesions due to previous surgery, surgical treatment of myomas settled out of the uterus and the evaluation of the tubes are performed by this method. In fact, almost all operations performed open can now be performed with laparoscopy. Laparoscopic removal of the tubes in case of “hydrosalpinx”, where inside of the tubes are filled with liquid and which may affect IVF success negatively, is thought that it may increase the pregnancy success.

Embryo Freezing, Cryopreservation and Thawing

Embryos can be frozen using special techniques in any period between the second day and the fifth day of development, then can be stored in liquid nitrogen at -196 degrees. Excess embryos with good quality after embryo transfer are frozen to be used for the request of a sibling or in case of treatment failure.

The state of ovaries to enlarge by giving excessive response to the medications used in IVF treatment and accumulation of fluid in the mother’s body is called “ovarian hyperstimulation”, briefly OHSS. Special treatment protocols are available for patients with such risks in modern IVF treatments; in addition all developed embryos are frozen and stored for subsequent periods to be transferred in order to prevent OHSS. The techniques of freezing and thawing embryos with modern methods, reduces the risk of occurrence of this problem to zero without affecting the quality of the embryos.