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IVF/ICSI


IVF AND JINEMED

When the first “test tube baby” was born in London in 1978, even the doctors couldn't have known how this development would open a new era in treating infertility. Louise Brown was born after years of hard work and several failed attempts. Since that first success, in vitro fertilization (IVF) has provided the key to treating infertility not only in England, but worldwide.

Through IVF, gynecologists learned more about hormonal treatments, and patients gained new hope. Great successes led to the opening of many centers around the world. Jinemed opened the first private IVF center in Turkey, and today has three units serving both domestic and foreign patients. Our patients come from both Europe and the United States.

Currently, we offer the following techniques directly at Jinemed Hospital:
  • Laser-Assisted Hatching
  • Embryo Freezing
  • Ovarian Cortex Freezing
  • Blastocyst Transfer
  • PGD ( Embryo Biopsy)
  • ICSI ( microinjection)
  • TESE ( testicular biopsy)

What Every Fertility Patient Should Know


IVF is a wonderful solution to infertility; however, it is not the only solution. We begin with each patient by asking about prior treatments, such as ovulation induction and artificial insemination. We explore with them whether or not IVF treatment will be the best for their needs. At this stage, if male-factor infertility is a possibility, the urologist checks the patient. Necessary hormonal and ultrasound tests are done. We try to resolve male infertility via medication and/or surgery. In women, ovulation problems will be solved first. If blocked tubes are present, laparoscopic surgery will be needed. If taking these first steps does not result in pregnancy, intrauterine insemination (IUI) or IVF should be tried.

I caution patients against believing blanket statements such as the solution for all infertility has been found, or that all couples will have children. Despite great developments, there will be couples who won't have any children. For example, azoospermic males and males from whom no sperm can be found with testicular biopsy procedure (Micro-TESE) have currently no chance of having their own biological child. The same situation exists for women. Women who entered menopause at an early age or who cannot produce eggs have currently no chance of having a biological child. In the future, we expect both males and females may have the option of freezing their sperm and eggs at an early age and use them in the future to solve their infertility. Also, stem cell research looks promising, it may be everyday therapy 5-10 years from now. At present, all women should know about their mother`s menopausal age and if that age is early, they should start considering their “conception plans.”

Women should also know that smoking and being overweight decreases the pregnancy chance. Women with PCOS condition should use medications to decrease their blood sugar level; otherwise, the eggs are not of good quality. Endometriosis, on the other hand, affects the implantation of embryos, and decreases the pregnancy chance. If HSG (hysterosalpingography) shows that tubes are blocked (as in the case of a hydrosalpinx) or if inherited anomalies exist in the uterus, laparoscopic sugery will be needed. Also, the importance of myomas or fibroid tumors, the most frequently-found type of tumors in the uterus, has increased greatly. Currently, myomas that expand towards the interior of the uterus are being removed via Hysteroscopy surgery. Myomas on the wall of the uterus or that expand to the exterior of the uterus should be taken out if they are larger than 4 to 5 cm in size.

Why Our Patients Choose Jinemed

Several factors attract a great variety of patients from all parts of the world.

Jinemed's success rates are above the world standards. For women under age 38 and using healthy sperm, the success rates are at 60 percent. Over age 40, this number decreases.

Since becoming the first Turkish clinic to utilize intracytoplasmic sperm injection (ICSI) beginning in 1995, Jinemed now uses the procedure for all IVF cycles. The reason is that ICSI increases the chance of fertilization greatly and has a positive affect on the chances for pregnancy.

All standard and developing techniques regarding gynecology and obstetrics are being performed by consultants and doctors at Jinemed. Continous research is ongoing for women over age 38 regarding age as a serious factor affecting IVF treatment. The decreased chances are trying to be increased with re-examining of medical protocols. In working against the maternal age factor, Jinemed uses antagonist, letrozol, microflare-up and modified natural and natural cycles, and in vitro maturation (IVM) procedures.

ICSI, blastocyst transfers, and assisted hatching are being done routinely for no extra charge. The reason is that the staff of Jinemed wants to increase the pregnancy chances of couples.

PROBLEMS:
Problems encountered during treatment:

Some problems may occur during the in vitro fertilization or microinjection procedure which would cause the treatment to be discontinued.
These are as follows:
  • Formation of cysts : Cysts may develop on the ovaries at the beginning of the treatment due to the medication. Because hormone production continues from the cysts, they may have a negative effect on the development of eggs. For this reason, they must be emptied or the treatment stopped so that the cysts can be shrunk with medication and removed, after which treatment can be resumed.
  • Insufficient egg development : In spite of the medicinal stimulation, it is possible that the ovaries will not respond to the treatment and a sufficient number of follicles will not form. This problem is more frequent in patients who already have reduced egg reserves but can happen in any patient. In this situation, it may be necessary to stop treatment and cancel the procedure. However, what the patient wants to do in this situation is also very important.
  • Failure to obtain eggs : It is possible to aspirate the follicles that develop on the ovaries and still not obtain any eggs. This condition, known as Empty Follicle Syndrome, may be caused by the patient not having the HCG injection done at the specified time or in the specified amount or it could be the result of the medication itself. In this situation the treatment is terminated because it is impossible to continue to the next stage.
  • The man's inability to provide sperm or obtain sperm from the testicles : Knowing whether or not the male has a problem providing sperm makes it possible to take precautionary measures. For this reason, do not hesitate to inform your doctor beforehand if there is such a problem. If the man has no such problem but for psychological reasons is still unable to provide sperm on the day the eggs are collected, then the assistance of a urologist may be requested. However, if this is also unsuccessful, the testicles may be opened to obtain sperm.
    If sperm cannot be obtained from men with azospermia on the day of the procedure, it will be necessary to cancel it. For this reason, even in situations where sperm is known to be present from prior pathology reports, performing a procedure known as testicular sperm extraction before beginning treatment will inform us of the situation before beginning treatment and help us find appropriate solutions.
  • Failure to realize fertilization : Failure of the eggs to fertilize even though the sperm and egg are combined in the laboratory occurs with both IVF and micro-injection procedures. This situation is rarely encountered when micro-injection is used for the procedure but may be the result of anomalies in some eggs or sperm. For this reason, it is critical to determine which treatment is most appropriate for which patients. However, if fertilization does not occur, the treatment must be stopped and research conducted to determine the reasons for the failure.
  • Failure of the embryo to develop : Sometimes cell division and the development of an embryo does not occur even though fertilization was successful. Again, this may be due to a developmental problem in either the sperm or the egg. For this reason, treatment will be terminated and research will have to be conducted.
 
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