IVF Treatment
HEALTH APPLICATIONS
If a married couple cannot conceive despite not using protection for a year, infertility tests should be started. If there are 20 million sperm per ml in the spermiogram and half of these sperm are mobile and around 10% are normal in shape, there is no problem. In order to evaluate the woman, a basal hormone profile performed on the 2nd or 3rd day of the menstrual period, HSG (hysterosalpingography) performed after the menstrual period, and ultrasonographic evaluation are required. Intrauterine insemination (insemination) If the sperm count is around 10 million and the woman's tubes are open, insemination treatment can be performed. For this, ovulation-supporting injections are started on the 2nd or 3rd day of the menstrual period. When the growing egg reaches a certain size, an egg-cracking injection is made and the prepared sperms are given into the uterus. Normally, the sperm count in 1 ml should be around 20 million. If the sperm count is between 5-15 million and the woman's tubes are open, IUI can be considered. The main factors affecting success in IUI cycles are the cause of infertility, the duration of infertility, the woman's age and the type of ovulation induction agent. Clomiphene citrate (CC), aromatase inhibitors and gonadotropins can be used in ovulation induction depending on the patient's characteristics. The chance of success in IUI performed with gonadotropins (ovulation stimulating injections) is higher than in IUI treatment performed using oral medication. In IUI treatment, drug-related side effects and the risk of multiple pregnancy are lower. If the sperm count is below 5 million and the woman's tubes are closed, IVF treatment is recommended. The aim of in vitro fertilization treatment is to grow more than one egg in the woman and to fertilize these eggs in a laboratory environment after collecting them under anesthesia. Depending on the number and quality of the embryos formed, 2., 3. and 5. day is transferred. Ovarian Stimulation: If the ovaries are ready for treatment after the USG control performed on the 2nd or 3rd day of the menstrual period, the injections are started. When the growing follicles in the ovaries reach a certain size, an egg cracking injection is administered and egg collection is performed 36 hours later. Egg collection is performed under anesthesia in the operating room and a sperm sample is taken from the man during this time. EGG COLLECTION IN ASSISTED REPRODUCTIVE TREATMENTS (ART) (TSRM IVF - EMBRYOLOGY GUIDE) 1.1 Before the egg collection procedure in ART, follicular development should be evaluated and HCG should be administered with appropriate timing. For this, at least one follicle should be > 17 mm or two follicles should be > 16 mm. The E2 value for each follicle over > 17 mm should be 150-250 pg/ ml. HCG dose (Empirically) 10,000 I.U. It should be applied IM. 1.2 The importance of administering HCG at the appropriate time should be explained to the patient. 1.3 The HCG time should be set 36 hours before the planned egg collection time. 1.4 The type of anesthesia to be applied during the egg collection procedure should be discussed with the patient in advance. (General anesthesia, monitored anesthesia care, with sedation or local anesthesia..) 1.5 Necessary tests for egg collection and anesthesia should be completed in advance (serology, blood values, bleeding time...) 1.6 Patients who choose methods such as general anesthesia or computerized anesthesia care should be reminded that they should not take anything orally for at least six hours before the procedure. 1.7 Laboratory team should be informed about egg collection day and time, estimated egg number and they should be provided with preliminary preparations. 2.1 Before the patient is taken to the operating room, HCG application time, fasting status and whether sperm was obtained from the partner should be learned. 2.2 Appropriate dose of broad-spectrum antibiotic parenteral should be administered 30 minutes before the OPU procedure. 2.3 It should be checked whether the anesthesia officer, IVF laboratory team, physician responsible for egg collection and assistant team and equipment are ready. 2.4 The bladder should be emptied. 2.5 The patient should be taken to the sterile area by dressing appropriately and should be informed again about the procedure to be performed and its complications. 2.6 The status of the follicles should be checked with vaginal ultrasonography performed in the lithotomy position in the operating room. 2.7 The aspiration needle to be used in egg collection should be checked by passing medium. 2.8 The functionality and pressure setting of the vacuum system to be used in aspiration (the pressure reflected on the follicles should not exceed 100-120 mmHg) are checked. 3.1 The patient is laid in the lithotomy position. If general anesthesia is to be performed, the legs are fixed. 3.2 Vaginal cleaning should be performed. (povidone iodine or physiological serum) 3.3 Vulva and Vagina are covered with sterile covers after cleaning and local application. 3.4 The physician who will perform the aspiration puts the ultrasonography probe on after putting sterile gel inside with a sterile tool (e.g. sterile powder-free gloves). He/she attaches the device that will guide the aspiration needle to the ultrasonography probe. He/she ensures openness and cleanliness by passing physiological serum through the guide device. 3.5 The probe is inserted into the vagina after speaking with the team that will administer the anesthesia and when they are ready or when they prepare the patient. When performing this procedure, the labia minora are opened to the side and the intraocular area is opened.