In-depth look at procedures.
Microchip
With the introduction of the microchip method, it is possible to select the sperm with the best DNA structure among the sperm to be used in IVF treatment. Selecting the sperm with the best DNA structure and morphology increases the capacity of this sperm to fertilize the egg and allows the development of the best quality embryo, thus preventing the selection of sperm based on chance. Thanks to this quality embryo transfer, a very effective increase is observed in pregnancy rates with the microchip method. Thanks to this method, significant increases are achieved in pregnancy rates in cases of infertility caused by the male factor.
Thanks to the micro channels created in this method, sperms are filtered as they are in their natural environment and the healthiest sperms are selected by sorting the sperms with the best fertilization ability and the best DNA and physiological quality. Therefore, the pregnancy rate increases by obtaining the best quality embryos. Microchip technology, which is also used in other areas of medicine, is a very important development in IVF treatment. The DNA structure of the embryos obtained by using the sperms selected with this method will also be of very high quality. Thus, the embryos hold on to the uterus more easily and the pregnancy continues healthily.
Intrauterine Insemination (IUI)
Insemination (Intrauterine Insemination - IUI) involves depositing sperm into the female reproductive system by methods other than sexual intercourse.
Sperm washing enhances the effectiveness of insemination. The washed sperm, treated with specific chemicals, is directly introduced into the uterus using specialized cannulas and syringes.
In cases of unexplained infertility, the first approach for young couples unable to conceive naturally is insemination (artificial insemination). This method involves depositing sperm from the man into the woman's vagina.
For couples who cannot conceive after one year of unprotected intercourse, infertility may be an issue. The initial evaluation includes sperm analysis in the man, hormone tests in the woman, and hysterosalpingography. Insemination is the first-line treatment for young patients with normal test results and no identified underlying issues.
Intracytoplasmic Sperm Injection (ICSI)
In IVF, the process of combining eggs from the female and sperm from the male under 200-400 times magnification using a specialized microscope (micromanipulator) to create an embryo is called microinjection (ICSI - Intracytoplasmic Sperm Injection).
Previously, sperm with low count, poor motility, or abnormal morphology could not effectively fertilize an egg. Microinjection, developed in 1992, was introduced for patients with severe male factor infertility, providing a high chance of pregnancy where none existed before. Microinjection can also be performed using sperm retrieved directly from the testicles of patients with no sperm in their semen.
ICSI is applied in cases of low sperm count, poor motility, abnormal morphology, azoospermia (no sperm in semen), and in situations where sperm is obtained surgically (TESE, Micro-TESE, TESA, PESA, MESA). It is also used in couples who previously failed fertilization with classical IVF and in cases requiring genetic diagnosis of embryos. Many centers now routinely use ICSI in IVF procedures to ensure fertilization, as it provides high success rates without harming the eggs or affecting the baby's health, thus eliminating the risk of fertilization failure.
Approximately 4 hours after egg collection, the surrounding cells are removed, and the eggs are checked for maturity. Mature eggs, which have a polar body, are in the metaphase II stage (MII) and are suitable for fertilization. Eggs without a polar body are immature, in metaphase I (MI), and cannot be used for fertilization. Eggs with germinal vesicles (GV) in their cytoplasm are also immature. Typically, 70-80% of eggs collected are mature.
Simultaneously, the sperm sample from the male is washed to remove unwanted substances and isolate the best motile sperm. One sperm is injected into each egg using microscopic needles controlled by micromanipulators, completing the fertilization process.
After microinjection, the eggs are placed in special solutions and incubated. Fertilization is checked 16-20 hours after the ICSI procedure. In typical cases (normal sperm count and motility, female age under 35, and good egg quality), the fertilization rate of mature eggs is around 70-80%.
Time Lapse Embryo Tracking
In IVF Treatment, only a limited number of embryos are transferred to the uterus, making the selection of the most suitable embryo crucial.
The embryo tracking system is one of the latest innovations in IVF, aiding in the selection of the highest quality embryo. This system enhances IVF success by continuously monitoring each embryo's development using cameras placed inside incubators.
In routine IVF, embryos are removed from incubators at specific intervals to check fertilization and development under a microscope. However, this method only provides limited information and exposes embryos to external conditions that may negatively impact their development.
With the embryo tracking system, all stages of embryo development are continuously monitored without removing them from the incubator, avoiding exposure to external conditions. Scientific studies highlight the importance of early cleavage, noting that embryos with early cleavage are of higher quality and have better implantation rates. For example, the formation of 3 cells instead of 4 on day 2 of embryonic development suggests a higher likelihood of chromosomal anomalies, indicating these embryos may not be suitable for transfer.
Time-lapse embryo tracking systems, such as EmbryoScope and Primo Vision, allow for detailed monitoring of these critical stages, leading to safer and more informed decisions about which embryo to transfer.
Egg Freezing
The process involves collecting oocytes (eggs) from the ovaries using vaginal ultrasonography, then freezing and storing them at -196°C after treatment with cryoprotectants.
Typically, after ovarian stimulation to increase egg numbers, the eggs are retrieved through negative pressure aspiration using a needle attached to a vaginal ultrasound probe under anesthesia. The eggs are then either slowly frozen in programmed freezing devices or rapidly frozen using vitrification, a device-free method. Although the safe storage period is not definitively established, it is regulated by country-specific IVF guidelines. In our country, the storage period for frozen eggs is limited to 5 years, though pregnancies have been reported after thawing eggs frozen for longer.
The chance of having a healthy baby after thawing is reported to be 3-5% per frozen egg. While this may seem low, considering that multiple eggs are typically frozen, the cumulative chances are significant. For comparison, the success rate for fresh eggs used in IVF is 5-8%, indicating that egg freezing is a viable option.
This technique primarily helps preserve fertility, especially in patients with cancer who may lose ovarian function due to chemotherapy or radiotherapy. For these women, especially those who are not married or do not have a stable partner, freezing eggs without fertilization offers a way to preserve their fertility. Even married women may choose to freeze unfertilized eggs.
Another group that may benefit from this procedure includes women who must delay marriage and childbearing and face the risk of declining fertility with age.
However, the procedure is not suitable for everyone. Candidates should have sufficient ovarian reserves, be under 40 years old, and have adequate time between cancer diagnosis and chemotherapy to undergo the procedure.
Current regulations in our country allow egg freezing only for women at risk of losing reproductive cells due to cancer treatment. Despite this, there is growing demand from women who face age-related fertility decline but have not yet started a family.
The development of vitrification has made egg freezing more accessible and effective, with better outcomes.
According to regulations, medical indications for storing reproductive cells and gonadal tissues in women include:
A) Prior to treatments that damage gonadal cells, such as chemotherapy and radiotherapy,
B) Before surgeries that will result in the loss of reproductive functions (e.g., oophorectomy),
C) In cases of low ovarian reserve, particularly in women who have not yet given birth, or if there is a documented family history of early menopause, as confirmed by a health board report from three specialist physicians.
Sperm Freezing
Human sperm cells can be frozen and stored for many years, then thawed and used in IVF applications as needed. This process is known as cryopreservation.
Sperm freezing is applied for three main reasons:
1. Cancer Treatment: Before undergoing chemotherapy or radiotherapy, which may impair sperm production, sperm can be frozen for future use.
2. Low Sperm Count: In patients with very low sperm count (cryptozoospermia) or intermittent sperm presence (virtual azoospermia), sperm can be frozen when found, ensuring availability on the day of egg collection.
3. Surgical Sperm Retrieval: After retrieving sperm surgically (e.g., MicroTESE, TESA), any surplus sperm can be frozen for future treatments, as these cells are valuable and should be preserved.
It's normal for the vitality and motility of frozen sperm to decrease due to freezing stress, which can physically damage some sperm. However, studies show no significant difference in IVF outcomes between frozen-thawed sperm and fresh sperm.
Frozen sperm for IVF can be stored at -196°C in liquid nitrogen tanks for up to 5 years, with the couple's consent renewed annually. There is no time limit for sperm storage in patients undergoing treatments like radiotherapy or chemotherapy.
According to regulations, medical indications for storing male reproductive cells and gonadal tissues include:
A) Sperm obtained through surgical methods,
B) Prior to treatments that damage gonadal cells, such as chemotherapy or radiotherapy,
C) Before surgeries that will result in the loss of reproductive functions (e.g., testicular removal),
D) In cases of very low sperm count (cryptozoospermia).
Embryo Freezing
Embryo freezing is a crucial aspect of IVF. After embryo transfer, any remaining viable embryos can be frozen at the couple’s request. Embryo freezing is also indicated when ovarian hyperstimulation syndrome (OHSS) occurs, where the patient’s endometrium does not thicken adequately, or when the ovaries are excessively stimulated, posing a risk if pregnancy occurs.
If pregnancy is not achieved, ends in miscarriage, or if the couple wishes to have another child, the frozen embryos can be thawed and transferred to the uterus. This procedure is known as frozen embryo transfer.
Using frozen embryos allows the prospective mother to prepare for transfer without additional hormone injections or egg collection, making the process less costly and less stressful.
In our center, embryo freezing is performed via vitrification and can occur on the 2nd, 3rd, 4th, 5th, or 6th day of development. Once frozen, embryos are stored in liquid nitrogen at -196°C, labeled with the patient’s details.
Thawed embryos retain about 90% viability, with no difference in health outcomes between frozen-thawed and fresh embryos.
Embryos can be stored for up to 5 years, with annual consent required for continued storage.