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And The Longing Ends
In vitro fertilization is the fertilization of the egg cells produced in the female body with the help of special needles after they are matured with drugs, and fertilization with male sperm in the laboratory environment and the developing embryo or embryos are placed in the uterus.
IVF is a treatment method applied to couples who cannot have children due to reasons related to women, men or sometimes both. We can list the situations in which IVF treatment will be applied as follows;
Our IVF Center provides services with an expert and experienced gynecology staff, an experienced laboratory team that closely follows the developments in the field, an embryology laboratory equipped with the latest technology, and a patient-oriented approach. We frequently update our medical equipment and treatment protocols in line with the developments in the world, and we perform IVF applications with a high success rate.
The SSI covers the in-vitro fertilization treatment expenses for up to three attempts of the insured who are married but do not have children in their current marriage, regardless of whether they have children from their previous marriage or not. The fact that the couples have adopted together does not prevent the in vitro fertilization treatment from being met.
If the following conditions are met, IVF treatment expenses are covered by SSI:
If the woman who started IVF treatment is older than 40 at the time of embryo transfer, the treatment costs are not covered. However, if the woman has a valid health report issued at the time she was younger than 40 years of age and embryo transfer is performed within 30 days from the date of the report, the health services related to in vitro fertilization are covered by the SSI.
Infertility is defined as failure of pregnancy for a 1-year period of time despite regular and unprotected intercourse of couples.
Unexplained infertility can be defined as the situation when the cause of the infertility is still unknown after all the performed tests (spermiogram, egg reserve tests, uterine imaging). In about 20-30% of the infertile couples, no cause of infertility can be identified. Problems in egg quality, fertilization problems and problems in embryo growth can emerge as underlying causes later on during the IVF treatment.
Ovulation therapy (ovulation induction) and vaccination (intrauterine insemination) are recommended as first-line treatment.
In vitro fertilization treatment should be started in those who are older (over 38 years old) and have a long marriage period and cannot achieve pregnancy with the first-line treatment.
Endometriosis (chocolate cyst) is a chronic disease that affects 1 out of every 10 females aged between 15 and 49. The cause of endometriosis is not knwon for sure. Endometriosis is detected in 25-50% of the patients who apply with infertility problems. Endometriosis disease occurs when the endometrium layer, which covers the inner part of the uterus, settles in areas outside the inner wall of the uterus. Endometriosis can be seen in any part of the body such as the ovaries, tubes, peritoneum, bladder or bowels.
While there are no symptoms observed in some patients with endometriosis; some symptoms such as severe menstrual contractions, pain during intercourse, infertility, constant pain in the groin area independent of the menstrual period. Endometriosis can affect fertility negatively. 35 to 50% of females with endometriosis cannot get pregnant.
Endometriosis causes infertility as follows:
The tubes can get blocked due to adhesions developing in the abdomen due to endometriosis and the egg released from the ovaries cannot be caught due to the deterioration of the anatomical relationship between the tube and the egg. The egg formation process can be negatively affected due to the cysts formed in the ovaries. Additionally, the quantity of eggs decreases due to the cysts. Endometriosis has a negative effect not only on the quantity but also the quality of eggs.
The definitive diagnosis of endometriosis (chocolate cyst) is made by laparoscopy, by detecting endometriosis foci and by pathological examination of a piece taken from these foci. However today, diagnosing process is made by ultrasound imaging detecting the chocolate cysts and edometriosis foci. Endometriosis lesions can be removed by laparoscopy, especially in patients who have a predominant complaint of pain and do not respond to medical treatments.
The treatment to be applied in case of infertility in patients with endometriosis is determined according to the patient’s age, period of infertility, whether the tubes are patent or not and the egg reserve. In vitro fertilization treatment should be considered in the first place in patients with reduced egg reserve, chocolate cysts in both ovaries, clogged or swollen tubes, and patients who have undergone previous surgery for endometriosis. Surgery should be considered in cases of problem accessing the follicles during the egg collection procedure or in cases with possibility of cancer.
Isthmocele (cesarean scar defect) is defined as the formation of a sac-shaped space at the cesarean section incision site due to the incomplete healing of the cesarean section incision site. The uterine wall is thin in this area and blood which is to be removed from the body via menstruation accumulates in the sac. With the increase in the number of patients who give birth by cesarean section in recent years, this is frequently encountered in the clinics. It can be seen in 20-80% of patients who gave birth via cesarean however it does not cause complaints in every patient.
The most commonly encountered complaint is irregular bleeding which occurs after the menstruation period. In addition, the risk of heavy menstrual bleeding, painful menstruation, cesarean scar pregnancy (ectopic pregnancy located at the cesarean section incision) may increase. Infertility is seen in some patients with isthmocele. The blood accumulated in the sac-shaped cavity in the cesarean incision site flows back into the uterus and an infective formation develops on the uterine wall which prevents the embryo from implanting on the uterine wall.
On the other side, It is thought that the blood that is constantly in the cervix can cause infertility by preventing the passage of sperm. The diagnosis of isthmocele is most often made by ultrasound. The treatment is planned according to the patient’s complaint, the thickness of the healthy uterine wall and the size of the defect in the area. The treatment can be performed with histeroscopy or laparoscopy (closed surgery) methods.
What are the Treatment Methods of Infertility?
Medication treatments: Regulatory hormone treatments with vitamin, mineral, and herbal medications are used for some patient groups
Surgical treatment: Two patient groups needing this treatment are the ones with varicocele diagnosis and azoospermia condition. Varicocele is the most common problem that causes infertility. Varicocele, which is seen in approximately one in ten men, can be treated with surgery. When a disorder is seen in sperm analysis, varicocele surgery is performed in order to increase success and pregnancy rate if there are unexplainable infertility conditions or there are any supportive reproduction techniques planned. Varicocele surgery has many different methods. Thanks to its high success rate and low complication possibility, microscopic method is more preferred recently.
After the procedure, sperm analysis findings show better results. If there is an occlusion in the sperm canal of a patient with azoospermia, treatment can be provided by repairing these canals. However, it is not usually possible. In this case, sperm can be obtained from the testicle using the microscopic method. In azoospermia patients without any occlusion, if there is a hormonal insufficiency, sperms can be obtained easily in six months using hormone therapy. However, especially in cases with azoospermia stemming from genetic disorders, obtaining sperm via microscopic method is more difficult.
In cases with azoospermia, there is not any sperm in seminal fluid. Azoospermia, which is encountered in one out of every hundred men, is seen in 10-15% of infertile men. Azoospermia is caused by different reasons such as sperm production disorder in the testicles, the obstruction of the canals the sperm exits, or the decrease in pituitary hormone secretion. The most common cause is the sperm production disorder in the testis. This condition is generally caused due to testicle not developing (anorchia), undescended testis, chromosomal disorders, injuries, surgical interventions, testicular tumor, testicular torsion (interruption of blood flow by turning the testis around itself), inflammation of the testicle due to mumps, toxic substances (chemotherapy), exposure to radiation (radiotherapy). If azoospermia is caused by occlusion, this occlusion is eliminated during a surgical intervention and sperm leaves the canal.
If the patient has occluded sperm canal, that means the sperm is produced in the body but it cannot get out. For these patients, sperm can be obtained with needle aspiration techniques such as tesa or pesa. Pesa is the process of obtaining sperm from the epididymis section using a needle. Tesa is the practice of obtaining sperm from the testicles using a needle. Tesa procedure is commonly used. The tesa procedure can be applied not only in cases with obstructive azoospermia, but also in cases who has sperm in the semen but the testicular sperm is preferred.
Tesa is applied under following conditions: The tesa procedure can be applied in cases with a diagnosis of occlusion-related azoospermia, as well as in cases with retrograde ejaculation and sperm not leaving the body (aspermia), cases with low fertilization rate with semen sperm, and the presence of immobile and low viability sperm in the semen. In cases with a diagnosis of production-related azoospermia, open surgery method for in vitro fertilization is used in order to obtain sperm by magnifying the tissues under the microscope. This procedure is called microTESE.
Varicocele is the enlargement, varicose formation that can occur in the veins of the testis. Varicocele is seen in about 15 percent of all men and 25 percent of men with poor sperm quality. In adulthood, 80-90% of varicocele is on the left side and 10% is bilateral. Only right-sided varicocele is extremely rare, and in this case, it is recommended to investigate the presence of an intra-abdominal mass. Its frequency increases with the adolescence period and peaks at the age of 13, and it is seen with a similar frequency to adults between the ages of 10-19. If there is varicocele diagnosis in a first degree relative (such as father or brother), varicocele is seen 3-4 times more. Today, the reason why varicocele causes male infertility is still discussed. Possible hypotheses include increased temperature, changes in testicular blood flow and venous pressure, hormonal dysfunction, autoimmunity, increased oxidative stress, and genetic causes. Testicular fever is the most widely accepted reason for testicular function change secondary to varicocele. Scrotal temperature is a few degrees lower than the body temperature in order to perform normal testis functions. The veins coming out of the testicles form a web around the arteries.
This structure creates a heat exchange mechanism to reduce the temperature of the arterial flow entering the testicles. This mechanism does not work in patients with varicocele; thus, the scrotal temperature increases. Secondarily developed artery pressure increase may also affect testis blood circulation. If there is varicocele diagnosis, it should be treated in cases with increased DNA damage or semen parameter disorder. Unrelated to the infertility; treatment need may arise due to pain or discomfort in testis extending towards groin or leg. Conditions that require varicocele treatment in children and adolescents are as follows; varicocele and accompanying small testicle, additional testicular pathology that will affect reproduction, varicocele that can be detected in bilateral examination, impaired sperm quality (in late puberty), symptomatic (pain).
Varicocelectomy is the surgical procedure performed for varicocele. There is open surgery, laparoscopic, robotic and interventional radiological treatment methods of varicocele. It is the golden standard in open microsurgery treatment. Microsurgical varicocelectomy is an operation that can be performed with high success rates (improvement in seminal parameters and spontaneous pregnancy rates) and low complication rates (recurrence, hydrocele, vascular injury etc.). With this method, after the operation, an increase is seen in more than 50 percent of the total mobile sperm count in approximately half of the patients. After the surgery, pregnancy is achieved in 36-43% of the patients. In microsurgical varicocelectomy; After a 4-5 cm incision performed from the inguinal region, the testicular veins are tied and cut under the microscope view. Depending on whether it is applied unilaterally or bilaterally, the procedure takes approximately 30-90 minutes. Afterwards, the patients are discharged from the hospital the same or the next day. They can return to their normal life after resting for 7-10 days.
DGC (Density Gradient Centrifugation) Success in IVF treatment increases with the selection of quality sperm. Routine sperm preparation techniques Density Gradient Centrifugation (DGC) and swim-up methods are currently the basic components of assisted reproduction processes. With this method, sperms are separated and selected under a special microscope. Afterwards they are injected inside the egg with ICSI method. Sperm’s shape is inspected in order to create the best quality embryo. Mobility, and shape of the tail, head, and neck must be smooth. In the selection of good quality sperm, classical methods are still used. There are also new methods that are used and even newer ones being developed.
HOST-EOSIN Y (Sperm Selection According to Sperm Membrane Integrity) Normal structure of the sperm membrane is important during the evaluation of sperm viability. Eosin Y and HOST tests provide information on this subject and they are routinely performed in cases with immobile sperm in the diagnostic semen analysis. Additionally, HOST test is applied for mobile sperm selection in cases with total immotile sperm sample and necrospermia.
PICSI (Sperm Selection According to Sperm Membrane Development) There is a protein called hyaluronic acid (HA) in the wall of the female egg and there are areas where mature sperm binds to this protein during the normal fertilization process. PICSI Dish: A special container with HA area. Washed sperm sample is placed near this area and after 15 minutes, HA-bound sperms are collected. These are used for ICSI.
MICRO CHIP (Sperm Selection with Micro Fluid Channel System) Sperm chip is the most natural way of sperm selection. It is a small channel system filled with tamponed fluid that allows the sperms move as if they are in a natural environment. Sperm movement in the cervical canal is the base of this method. In micro fluid channel system (Micro Chip = Sperm Chip), sperm sample is placed on one end and it is expected to move inside the small channel towards the other side by itself. The advancing sperms are thought to have normal morphology. The sperms that are collected in the small pool are taken and used in IUI and assisted reproduction treatments.
PICSI and MICRO CHIP methods are still regarded as experimental. These can be applied as an alternative to people with male infertility who do not have severe morphology problems, and who have suitable sperm motility. These methods are not applied to the ones who have very low sperm count and very low sperm motility. Additionally, it is not suitable if sperm is obtained from the testis via TESA/TESE methods.
A detailed history of the couples is taken from the couples who apply to the clinic due to infertility at the first interview. Then, gynecological examination and ultrasonography are performed to the expectant mother. With this examination, the ovarian reserve, uterus and cervix of the expectant mother are evaluated. Information is given about the necessary tests to reveal the causes of infertility. Uterine X-ray of the expectant mother is requested. A spermiogram (semen analysis) is requested from the father-to-be. The purpose of all these tests is to determine the causes of infertility.
IVF treatment is recommended for couples in the presence of the following conditions:
Female
Male
IVF treatment consists of 5 stages.
Stimulation of the Ovaries Hormone tests are requested after ultrasound is performed on the 2nd or 3rd day of menstruation. If the ultrasound and blood test are appropriate, hormone injections are started to obtain a large number of eggs from the ovaries. Generally, the stimulation period of the ovaries with hormone injections lasts between 8 and 14 days, but it is 10-12 days on average. During this period, the patient is called to the hospital 2-3 times for re-assessment, ultrasound is performed and, if necessary, the hormone level in the blood is checked. When the follicle size (small sacs containing eggs) reaches 18-20 mm and sufficient number, a cracking needle is required for the eggs to mature.
Ovum Pick-up (OPU) Ovum Pick-up (OPU) procedure is done 35-36 hours after the cracking needle. Anesthesia is applied during the collection procedure. It is a procedure that is usually easy and does no cause severe pain. An OPU needle attached to the vaginal ultrasonography probe is passed through the wall of vagina and the follicles in the ovaries are collected and sent to the embryology laboratory in a sterile tube. This procedure takes about 15-20 minutes, depending on the number of eggs to be collected. There may be mild abdominal pain and tenderness on the day of the procedure. If the number of eggs collected is high, the feeling of fullness and pain in the abdomen may last for several days.
Fertilization In The Laboratory Environment About 2 - 3 hours after egg collection, the eggs collected are evaluated under a microscope whether they are mature or not. On the same day, the fertilization procedure is carried out with the sperm obtained from the semen sample taken from the man by masturbation, with special washing and preparation techniques. In some cases where sperm cannot be obtained (from testicles or epididymis), sperm can be obtained by surgical procedure.
Microinjection (ICSI = intracytoplasmic sperm injection) is the procedure of injecting sperm into the egg under a magnification of 200 to 400 times. After the procedure is over, the fertilization of the eggs is checked 18 to 20 hours later. Since microinjection provides a high rate of fertilization, it is routinely applied by many centers today.
Embryo Culture IVF uygulamalarında en önemli basamaklardan biri laboratuvar şartlarında embriyo gelişiminin sağlanmasıdır. Döllenme sağlandıktan sonra embriyo gelişimi takip edilerek uygun olan günde transfer işlemi gerçekleştirilir. Transfer günleri, kadından elde edilen yumurta sayısına, gelişmekte olan embriyo kalitesine göre değişim göstermektedir. 5. gün (blastosist) transferi sıklıkla uygulanmakla birlikte embriyo gelişimine göre 3’üncü gün veya 4’üncü gün transferleri de yapılabilir.
Embryo Transfer Embryo transfer is an important process, which is the last step of the IVF procedure. It is a painless procedure and does not require anesthesia. Before embryo transfer, couples are informed about the quality and final status of the embryo to be transferred. The transfer procedure is performed with a full bladder (urine bag) and ultrasonography in order to transfer the embryo to the most appropriate place in the uterus. The embryo, which is brought in a catheter by the embryologist, is left approximately 1 cm below the upper part of the uterus by the doctor who will make the transfer, and the catheter is removed. After the transfer, half an hour of rest is sufficient. It has been found that longer-term bed rest does not have an effect on increasing the chances of pregnancy.
Egg freezing (oocyte freezing) is the freezing and storage of egg cells obtained from the woman's ovary in order to have children in the future. The egg freezing procedure is similar to the classical in vitro fertilization procedure, and the mature eggs obtained after egg collection are stored by freezing with a rapid freezing method called vitrification. According to Assisted-Reproduction Treatment (ART) regulation published in our country in 2014, women's eggs can be frozen in the presence of the following conditions:
In women who will undergo chemotherapy/radiotherapy due to cancer treatment, ovarian stimulation for IVF can be started immediately regardless of the menstrual period. Hormone injections are started to stimulate the ovaries and this process usually takes 10-11 days. In cases where we do not want the estrogen levels in the blood to rise, such as breast cancer, the medicine deemed appropriate by physician is used, so that sufficient number of eggs is obtained without increasing the estrogen levels in the blood. In cases with decreased ovarian reserve, treatment is started on the 2nd-3rd day of menstruation and the stimulation of follicle development using hormone needles usually takes 10-12 days.
When the eggs reach a certain size, a cracking injection is made and egg collection is performed 34 to 36 hours after this injection. Mature eggs are frozen by embryologists in the laboratory. While egg collection is performed vaginally in non-virgin women, it can also be performed abdominally in virgin women. More than one treatment cycle may be required in women with low ovarian reserve. The storage period of the eggs is 5 years, which can be extended if desired. Clinical pregnancy rates are between 4-12% per egg collected. Two important factors that determine pregnancy rates after egg freezing are: the age of the woman at the time of egg freezing and the number of frozen eggs.
The continuous embryo monitoring system is a system that enables the 24-hour follow-up of the developmental processes of the embryos formed after fertilization until they are transferred to the uterus of the expectant mother. Embryos obtained during IVF treatment are followed up in special devices called incubators. In this process, every day, the embryos are taken out of the incubators and evaluated under the microscope by the embryologist in order to evaluate the embryo development and to select the embryo with the highest probability of attachment to the uterus. Embryoscope is an incubator produced with the latest technology, and embryos are imaged at certain intervals with the special cameras in the device. Thus, by closely monitoring the fertilization and division stages of the embryo, it is possible to select the embryo with the highest probability of attaching to the uterus.
Advantages
Embryo transfer is the most critical and sensitive stage in the IVF treatment process. Embryo glue is a liquid rich in hyaluronan and human albumin, which is used during embryo transfer and supports the placement of the embryo in the uterus. Its implementation is actually quite simple. The embryo/embryos to be transferred to the uterus are kept in the embryo glue for about 30 minutes and the transfer procedure is performed in this liquid. Hyaluronan is also found in high amounts in the uterus during natural fertilization. By using embryo glue, the chance of success in IVF can be increased by increasing the hyaluronan in the uterus. In particular, it has been shown to increase pregnancy rates in women over the age of 35 with recurrent IVF failure.
Who is PGD recommended for?
How is the PGD performed?
From the embryos obtained after classical in vitro fertilization, cell samples are obtained from the ones suitable for biopsy on the 5th day, and the embryos are frozen. After the genetic analysis of the cells obtained by biopsy, the embryo with a normal chromosome structure is placed in the mother's womb. Next generation sequencing (NGS) is one of the genetic analysis technologies that allows us to perform comprehensive chromosome scanning in embryos.
With this test, all 24 chromosomes are scanned, giving more detailed and sensitive results and better determining the rate of mosaicism in embryos. It has started to be used as an advanced technique for PGD. With NGS, embryos are scanned quickly and effectively, and genetic problems at the chromosome level are detected before the pregnancy.
Successful attachment (implantation) is a complex process involving two main factors (mother and embryo). IVF failure can be caused by anatomical reasons, endometrium layer and factors originating from the embryo.
Which Tests Should Be Done for the Couples with Recurrent IVF Failure?
Study of Anatomical Causes In these cases, 3D ultrasonography and Hysterosalpingography (HSG; uterine x-ray) should be performed. Myoma, endometrial polyps and intrauterine adhesions that disrupt the inner integrity of the uterus should be studied. It is also known that the closure of the tube’s tip and swelling of the tube from the inside after filling with liquid (hydrosalpinx) cause a 20-50% decrease in live birth rates.
Assessment of the Endometrium A receptive endometrium is important for embryo attachment (implantation). Assessment of the thickness and appearance of the endometrium with ultrasound examination is necessary for a successful attachment. Endometrial thickness should be at least 6–8 mm. The treatment of a thin, unresponsive endometrium is difficult. Difficulties in embryo transfer can also reduce the attachment rates. In all reproductive treatment cycles, the embryo transfer should be performed as smoothly as possible, without stimulating the uterus.
Asessment of Embryo Quality Sperm and egg quality can affect the embryo quality and reduce the chance of attachment.
Studying the Genetic Causes Chromosomal abnormalities are observed to be increased in cases with recurrent IVF failures. Therefore, to study chromosome abnormalities of mother and father, chromosome analysis should be performed from peripheral blood.
Sperm Factor During the study of the causes of recurrent IVF failure, some advanced morphological analyzes of the sperm can be performed and special sperm selection methods can be tried, because the contribution of the sperm cell to the production of normal and healthy embryos is very important. It has been reported that in cases of recurrent miscarriage and recurrent implantation failures, the ratio of T helper 1/T helper 2 (helper immune system cells) is higher than in fertile couples.
Although natural killer cells have been found to increase in some studies, this finding has not been completely proven. The argument that immunological factors may play a role in the failure of implantation has led to the testing of applications mentioned in scientific studies such as steroid use, intravenous immunoglobulin (IVIG) administration, intravenous lipid infusion, fertility vaccine and allogeneic lymphocyte therapy. However, the benefits of these treatments have yet to be proven.
AMH (Anti-Mullerian Hormone) It is a hormone secreted from follicles of between 2-6 mm in the ovaries. There is no special period of menstruation to do the test, it is a test performed with the blood taken on any day of the menstrual cycle. Nowadays, Anti-Mullerian Hormone (AMH) is the most important blood test that provides information about ovarian reserve. AMH value below 1.1 ng/ml indicates decreased ovarian reserve.
FSH (Follicle Stimulating Hormone) The FSH rate measured on the 2nd or 3rd day of the menstrual cycle is used as a measurement of ovarian reserve. High values (> 12 IU/L) indicate decreased ovarian reserve. However, it does not mean that the chance of getting pregnant is greatly reduced. Basal FSH value can vary from month to month. If the FSH value is above 20 IU / L, it is considered as an indication that the chance of pregnancy is reduced.
E2 (Estradiol) The E2 level is often below 50 pg/mL on the 2nd and 3rd days of the menstrual cycle. In women with reduced ovarian reserve, high E2 values (above 60-80 pg/mL) in the early follicular phase indicate accelerated egg development.
LH Luteinizing Hormone LH hormone, which increases in the middle of the menstrual period and ensures ovulation, is also the main hormone that cracks the egg. The ratio (FSH/LH) is normally greater than one at the start of the menstrual period. LH/FSH ratio greater than 2.5 may raise the suspicion of polycystic ovary syndrome. In addition, LH hormone values are measured high in the menopause period and at the onset of the menopause.
Prolactin This hormone, secreted by the pituitary gland, provides milk production in women. It is responsible not only for milk secretion but also for functions such as reproduction and the menstrual cycle. In women, it should be at the level of approximately 15 to 25 µg/L. High levels of prolactin hormone prevent ovulation. Therefore, getting pregnant becomes more difficult than normal conditions.
TSH (Thyroid-stimulating hormone) Thyroid hormone test is the measurement of the pituitary gland (TSH), which is responsible for the stimulation of the thyroid gland, with the hormones triiodothyronine (T3) and thyroxine (T4) produced from the thyroid gland, in order to evaluate the functions of the thyroid gland. Hyperthyroidism can be considered when the thyroid gland works more than normal, and hypothyroidism can be considered when it works less than normal.
DHEA-S (Dehydroepiandrosterone Sulphate) DHEA-S is secreted mainly from the adrenal gland in men and women. It may increase in women with polycystic ovary syndrome, increased hair growth, and when there are problems with the adrenal glands.
Ovulation medications can be used in the treatment of some women who have not been able to become pregnant naturally. Ovulation medications are the main treatment method, especially in women with ovulatory disorders. The most commonly used ovulation drugs are
Gonadotropins In women who cannot ovulate with medication or who do not become pregnant despite ovulation, ovulation stimulation is made with injection therapy. Injection therapy is started with low doses on the 2nd and 3rd days of menstruation (37.5-75 IU). After 5 days of injection use, follicle development is followed by ultrasound. Follow-up is continued at 2-3 day intervals depending on the follicle size. Although there is no need for vaccination in injection therapy in women with polycystic ovary syndrome, Vaccination therapy can also be added to increase the probability of conception.
Pregnancy test is a test to detect pregnancy by measuring the amount of Beta-HCG hormone, which starts to increase in the body with the onset of pregnancy, in the blood or urine. Although this hormone is usually associated with pregnancy, it is actually a hormone that can increase due to some other diseases. The results of the test with a single tube of blood taken from the arm can usually be obtained on the same day.
A blood test for pregnancy is more reliable because it directly measures the level of Beta-HCG in the blood. Under normal conditions, the level of Beta-HCG hormone in healthy women who are not pregnant is in the range of 0-10 mIU/mL. With the onset of pregnancy, the level of this hormone begins to increase rapidly. Urine pregnancy tests, which are the first choice of many people with suspected pregnancy, are performed by dripping a small amount of urine onto the kit.
The test kit measures the level of Beta-HCG in the urine, giving a single line (negative) or double line (positive) result. Although the reliability rate of urine tests is high, it is useful to refer to blood tests for a definitive result, as test kits can sometimes give false results.
Ultrasound is a type of sound vibration with a high frequency that the human ear cannot realize. Since the harmful rays contained in the X-ray are not used in ultrasound, it can be easily used for imaging almost all ailments. Ultrasonography, which is one of the imaging methods that is indispensable for modern medicine, evaluates the structure of the reproductive organs, uterus, and ovaries. Any anomaly in the appearance of the uterus (double uterus, polyps, adhesions in the uterus, fibroids, curtains in the uterus), the structure of the ovaries, whether there is a cyst in them, whether there is any enlargement in the tubes (hydrosalpinx) is evaluated and its relationship with infertility is examined.
On the 3rd and 5th days of menstruation, ovarian reserve is evaluated by ultrasonography. The purpose of this ultrasonography is to evaluate the ovarian capacity in women, which decreases especially with age. It is estimated how much you will respond to the treatment to be applied by evaluating the antral follicle (follicle with diameters between 2-5mm) count and serum AMH level, which is the numerical evaluation of the follicles with USG. The protocol and medication doses to be used in the treatment are planned in line with this information. This evaluation plays a significant role in the selection of the treatment to be applied and in determining the chance of success of the treatment.
Advances in cancer treatments have allowed most people to beat cancer. However, cancer and treatments have negative effects on fertility (reproduction). Fertility preservation before the cancer treatment preserves these people's dreams of starting a family in the future.
Cancer treatments such as chemotherapy, radiation, and surgery may cause early menopause or damage to the ovaries in women while impairing sperm production in men.
When women are born, they have around 1-2 million eggs (which is the most they ever have). Eggs are constantly lost over time, and around 400,000 eggs remain during puberty. Chemotherapy medication, on the other hand, causes the woman to deplete these eggs even faster. It causes early menopause due to the decrease in the number of eggs.
Fertility preservation approaches in cancer patients
Fertility preservation approaches in women are:
Both methods are in vitro fertilization and it is recommended to be performed before cancer treatment is started. In cases of chemotherapy treatment should be started immediately in the patient, fertility preservation approaches can be performed during the periods when chemotherapy is interrupted.
Embryo freezing
That method is applied only to married couples. In women who will be performed chemotherapy/radiotherapy for cancer treatment, stimulation of the ovaries for in vitro fertilization can be started immediately, regardless of the menstrual period. Hormone injections are started to stimulate the ovaries, this period usually takes 10-11 days. As in the classical vitro fertilization treatment, when the eggs reach a certain size, a cracking injection is performed. And egg collection is performed after 34 to 36 hours from the injection. Good quality sperms selected by embryologists is placed in mature eggs under a microscope. The embryos are frozen and stored on the 5th day after fertilization. Cancer treatment can be started after 1-2 days from egg retrieval. These periods take an average of two weeks. If you are ready to become a mother after the cancer treatment is over and your hemato-oncologist gives permission, the uterus is prepared and the embryo is placed in the uterus.
Egg freezing
That method is preferred treatment in single patients. Egg freezing is performed similarly to the classical in vitro fertilization procedure and obtained mature eggs after egg collection are stored by freezing with a rapid freezing method that is called vitrification. Hormone injections are started regardless of the menstrual period, and this period usually takes 10-11 days. When the eggs reach a certain size, a cracking injection is made and egg collection is performed after 34-36 hours from the injection. The obtained mature eggs are stored by freezing with the vitrification method. Cancer treatment can be started after 1-2 days from egg retrieval.
Ovary newer treatments such as tissue freezing, especially in children who have not yet reached puberty, it is a fertility preservation approach to be considered in cancer patients who do not have time to wait for periods such as oocyte/embryo freezing, and who need to start chemotherapy immediately.
Getting counseling from an in vitro fertilization specialist is recommended to protect the possibility of having children in the future before starting cancer treatment.
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