What you need to do before your IVF treatment starts:
Long Agonist Protocol
1. Stop smoking if you are a smoker.
2. Start using Folic acid pills 0.4 mg/day.
3. We will perform an ultrasound examination and start stimulating your ovaries when you come to Istanbul. Treatment may be initiated any time within the first 3 days of your menstrual bleeding.
Short Antagonist Protocol
1. Stop smoking if you are a smoker.
2. Start using Folic acid pills 0.4 mg/day.
3. Come to the clinic directly on the second or third day of your cycle.
4. We will perform an ultrasound examination and start stimulating your ovaries when you come to Istanbul. Treatment may be initiated if certain conditions are met such as the absence of cysts and the presence of a thin endometrium.
5. In women planned to be treated with the antagonist protocol there is a 10-15% risk of not being able to initiate the treatment due to the presence of functional ovarian cysts or a early growing follicle that will suppress the stimulation of other follicles.
The importance of a thorough evaluation of both partners in the relationship cannot be overestimated. Male factors account for at least 30 to 50 percent of all fertility issues in patients.
The semen analysis is done on an ejaculated sample collected after masturbation. It is best to do this test after a patient has abstained from sexual activity for two to five days. The test can be inaccurate if there has been recent ejaculation (counts too low) or if ejaculation has not occurred in a long time (too many dead sperm). Once the sample has been taken to the laboratory, it is analyzed for many different parameters, including fluid volume, sperm numbers, sperm motility (the percentage of moving sperm), and sperm morphology (the shape and appearance of the sperm). Variations can occur from test to test, even in the same man, and sometimes the test needs to be repeated.
A urologist often is consulted after an abnormal semen analysis is obtained. The most common abnormality discovered by the urologist is a “varicocele.” A varicocele is a dilated vein around the testicle, which raises the core temperature of the testicle and can impair the process of making sperm. The correction of a varicocele involves a minor surgical procedure. The procedure ligates the dilated vein, which improves blood flow around the testicle.
Our fertility specialists will provide you with the highest quality fertility care for your IVF cycle. Medicana IVF Center IVF treatments encompass the following steps:
Your Initial Consultation
You will meet with one of our physicians, at which time we will review your medical history and establish your unique IVF treatment plan.
Pretreatment testing will include blood work to determine hormone levels, blood tests , a semen analysis (if applicable), and a uterine assessment. In order to have the optimal outcome with your IVF treatment, we review your medical history and the results of your pretreatment testing before we finalize a protocol that is tailored for you.
IVF Coordinator Consultation
you will meet with one of our IVF coordinators to review your protocol and plan your calendar.
Controlled Ovarian Hyperstimulation
An IVF cycle begins with ovarian stimulation and ultrasound monitoring. A baseline pelvic ultrasound will ensure a healthy starting point before initiating medication for the stimulation and assessment of egg production. You will take hormone injections to recruit multiple eggs from your ovaries. During this time, follicular development and hormone levels will be monitored for appropriate growth for several days. Once your follicles have reached the ideal size, you will be ready for egg retrieval.
Ultrasound-guided, transvaginal egg retrieval is a procedure in which a long, thin needle is passed through the vaginal wall into the ovary. The physician aspirates the follicles from each ovary and the follicular fluid is collected in test tubes, where the embryologist carefully searches for the eggs. The eggs are cleaned, counted, and placed in an incubator. Later that day, the eggs are fertilized with sperm either by standard insemination or Intracytoplasmic sperm injection(ICSI). Injuries during this procedure are extremely rare. Structures near the ovaries, such as the bladder, bowel, or blood vessels, could possibly be injured and require further surgery. Limited bleeding from the ovaries may occur, but the need for transfusion is extremely rare. Infections following transvaginal egg retrieval are also possible, but are rare.
Embryo Culture and Assessment
During IVF, your embryos are cultured for up to six days in a temperature-controlled incubator. Each day the embryos are evaluated for quality and development. This information is shared with the doctors to help determine the appropriate day for embryo transfer, which is typically performed on day three or day five of embryo culture or day six in the case of PGS/PGD. Our embryologists will call you each day to update you on the embryo quality and to answer any questions you may have.
Embryo Transfer or Blastocyst Transfer
Embryos are typically transferred back to the uterus on day three, when the embryo is at a multicell stage, or day five or six, when the embryo is at a blastocyst stage. This simple procedure usually requires no anesthesia. Your doctor and embryologist will discuss the number of embryos to transfer that will provide you the highest probability of success and the lowest probability of high-order multiple births. You will be given ample time to discuss your embryos and decide on the number of embryos to transfer. You also will receive pictures of your embryos being transferred. You will relax in the room for a short period of time once the embryo transfer is complete. The transfer itself may cause mild irritation to the cervix or uterus.
We will schedule your pregnancy test 10-12 days after your transfer. When your first pregnancy test is positive, a repeat value will be obtained approximately 48 to 96 hours later. To confirm the positive pregnancy test, we will schedule an obstetrical ultrasound two weeks following the second pregnancy test. At this visit we will be confirming the implantation of embryo(s) and fetal heart motion.
IUI involves a laboratory procedure to separate fast-moving sperm from more sluggish or non-moving sperm. It can be performed with your partner’s sperm or donor sperm (known as donor insemination).
Is IUI for me?
You may be offered IUI if:
you are unable (or would find it very difficult) to have vaginal intercourse, for example because of a physical disability or psychosexual problem
you have a condition that means you need specific help to conceive (for example, if you’re a man who is HIV positive and you have undergone sperm washing to reduce the risk of passing on the disease to your partner and potential child).
In the past IUI was offered if you had unexplained infertility, mild endometriosis or when a male partner had mild fertility problems. However, the National Institute for Health and Clinical Excellence (NICE) (an organisation which provides national guidance and advice to improve health and social care) has advised that it should now not routinely be offered in these situations except for in exceptional circumstances.
Instead, if this applies to you, you are advised to try to conceive for a total of two years before IVF will be considered (this can include up to one year before your fertility investigations).
A mild reaction to fertility drugs may involve hot flushes, feeling down or irritable, headaches and restlessness. Symptoms usually disappear after a short time but if they do not, you should see a doctor as soon as possible.
Ovarian hyper-stimulation syndrome (OHSS)
OHSS can be a dangerous over-reaction to fertility drugs used to stimulate egg production. It can cause symptoms such as a swollen stomach, stomach pains, nausea and vomiting.
If you start to experience any of these symptoms you must contact your doctor immediately.
Risks of fertility treatment – OHSS
Although the risk of a miscarriage after IVF is no higher than after a natural conception, nor is the risk lower.
Your clinic will arrange an early pregnancy ultrasound scan if you conceive after IVF. This is to check that the pregnancy is not likely to miscarry. The scan is usually done about two weeks after the positive pregnancy test.
We require a series of tests for fertility assessment / fitness for pregnancy as well as infectious disease screening. Each and every test that we order serves a different purpose and each one of these tests will have an implication for your treatment.
For assessment of fertility, we ask each female patient to have the following testing done on day 2 or day 3 of their menstrual cycle: FSH, LH, Estradiol, Prolactin, TSH and AMH hormone tests. The AMH test is independent from your menstrual cycle and can be done at any time, but our patients find it easier to have all the tests done on the same day during their visit to their doctor. It will also be important to have a base line pelvic ultrasound scan during this visit for antral follicle count in the ovaries and to check that there are no major visible problems in the uterus that can interfere with a successful pregnancy.
The male patient is required to have a semen analysis done. Especially if he has not had a child in the near past, it will be important to observe sperm parameters such as count/volume/motility/morphology/pH level and round cell count. In some cases, a small infection in sperm can compromise the whole process, therefore, it is important to be prepared for possible precautions that we may need to take.
The validity of infectious disease testing is six (6) months. As long as patients have their testing done within the 6 month period prior to their treatment time, we do not require a repeat test. However, if patients do not have current test results, then we will administer these tests here at our practice prior to handling any samples.
Only the test results from reputable clinics and hospitals will be accepted, and original test results will need to be presented at the time of your first visit. Photocopies and scanned email attachments are only accepted as temporary proof of testing until we see the originals.
The infectious disease tests required by our practice are as follows:
For female patient: Anti-HIV, Anti-HCV, HbsAg, VDRL, Rubella IgG, CMV IgG, and Toxoplasmosis IgG
For male patient: Anti-HIV, Anti-HCV, HbsAg, VDRL.