Millions of couples who want to have children have this news; miracles' that will fulfill your dreams. Our country is the forerunners of in vitro fertilization practices. Dr. Mustafa Bahçeci explained the details that families should absolutely and absolutely know, and he warned: "In vitro fertilization methods and practices are developing at a dizzying pace. IMSI, Embrioscope, ice cream techniques are some of them. What matters is which pairs, when, and how new techniques will be implemented. While the family is following the innovations, the careful institution, the experienced team and the center should pay attention to the rate of "taking live children to home".
Our country is the forerunners of in vitro fertilization practices. Dr. Mustafa Bahçeci pointed out the increasing infertility problem in our world and our society and warned families about the center selection for treatment and the news in the media. Bahçeci, 'the media in the news of the infertility problems with the family's approach is a kind of' miracle solution 'is like. They decide to try these without thorough research. Often the result is failure. It is a fact; In vitro fertilization methods and applications are rapidly developing at a dizzying pace. IMSI, Embrioscope, ice cream techniques are some of them. What is important here is which pairs, when, and how new techniques will be implemented. While the family is following the innovations, the careful institution, the experienced team and the center should pay attention to the rate of "taking live children to home".
'10 Things You Need to Know' in Tube Baby Treatment
Professor Dr. Mustafa Bahçeci explained the absolute and absolute knowledge of the families in the treatment of IVF, the details that should be decided in this direction.
1. When should a couple without a child go to a doctor?
The age of the woman is very important here. If there is no risk associated with this issue in couples' biographies and family trait below 35, a doctor should be consulted if unprotected-regular one year pregnancy can not be achieved after sexual intercourse. Under the same conditions, if the woman is older than 35 years, she will have to go to the doctor immediately if she has had an operation related to chemotherapy or ovary that could affect her ovaries and 6 months, if there is chemotherapy or surgery to affect sperm values badly.
2-Tube baby treatment without vaccination is correct?
Depending on the cause of infertility (infertility), some patients should be given pre-vaccination induction methods such as ovulation induction or vaccination. In this group of patients, however, if these methods are unsuccessful, they are transferred to in vitro fertilization. However, if there is a certain group of patients, the success rate of other methods is either zero or very low. In this patient group, IVF should be the first option.
* Women with clogged tuba uterine (tubers)
* Azospermia cases (absence of sperm in man)
* Advanced women's age (eg women over the age of 38) are couples that need to be administered directly to the IVF.
3.Which tests will be performed in which order in which the infant is treated?
Infertility research should be done simultaneously on pairs. The basic tests in the initial phase are:
a. The sperm test,
b. blood (hormone) tests for the investigation of laying eggs,
c. Tests to investigate whether the female's tubes are open and the uterus is normal. For this purpose, the most common medicated uterine X-ray film (hysterosalpingogram, HSG) is taken.
4. What is the success rate in IVF?
The success rate of the tube baby is evaluated with more than one criteria.
1-Fertilization (Fertilization in Laboratory): This rate should be over 80% in centers with good laboratories.
2-Biochemical Pregnancy (Positive outcome of caloric pregnancy test): This rate is around 50%.
3-Ultrasound-guided and followed-up pregnancy rate: This rate is around 40%.
4 - Ratio of delivering '' Eve Live Child '': This rate is around 30%. The core value that interests the patients must also be the last.
Unfortunately, after three failed trials, the rate of getting pregnancy for families is unfortunately not much. Additional applications are being made, such as preimplantation genetic diagnosis (genetic research before embryo transfer), co-culture (creation of artificial embryo in the laboratory environment), and sperm selection methods. However, there is not yet enough evidence that these methods have significantly increased success. My personal experience suggests that blastocyst transfer should be recommended for this disease, and that if these embryos do not go to blastocysts, they should not be transferred. Thus, the patient is prevented from waiting with great hope for nothing after the transfer.
5. What is the transfer of the blastocyst? In which situations is this method applied?
The embryos that develop through days and increase cell numbers divide into two separate cell types from the fifth day and accumulate a liquid between them. This embryo is called a 'blastocyst'. Unfortunately, not every embryo can continue its development until this stage, it stops its development at an earlier stage. Only if the sperm and egg qualities that make up the embryo are not too low, the embryo continues to develop, otherwise it stops the development of embryos that are formed by the combination of low quality cells as an end result of the body defense mechanism. Studies have shown that even some of the embryos that reach the blastocyst stage contain low quality cells that are too low to allow for pregnancy formation or continuation of the pregnancy. However, this rate is much lower than those who stopped early development. As a result; Transferring blastocyst to the patient means increasing the chances of pregnancy. The fewer embryos transferred to the patient, the greater the chances of pregnancy by transferring the blastocyst. For this reason, the application of blastocyst transfer in cases where the number of transfers is constrained has a boosting effect. As an example, the regulation introduced in our country two years ago has restricted the number of transferred embryos. This application resulted in a significant reduction in multiple pregnancies, which were the result of in vitro fertilization, which were very risky pregnancies. This new situation has led some clinics, including our centers, to move to more blastocyst transfer. In our centers it is now on the fifth day, near to half of all transfers. If the patient is receiving sufficient amounts and quality blastocysts, it may be useful to refer to non-embryonic causes as the reason for failure of treatment. Why do not all embryos wait until the blastocyst stage and then transfer? In the answer to this question, we should not mention the disadvantages of blastocyst transfers. It is hard to say that we can imitate the sophisticated and perfect mechanism of the human body, as long as the technological developments in IVF practice today are evolving. Because as much as we know about the human body and its biology, we continue to realize that we do not know and new questions. As a result, we do not know how much we have compromised according to their ability to leave their embryos in their laboratory for an extended period of time while waiting for them to reach the blastocyst stage by waiting for long periods of time in their lab environment. In summary we ask ourselves if we are asking for water: this embryo did not form a blastocyst, but would I have reached the blastocyst there if I had given a womb in an earlier period of this embryonic development? This is the risk of transfer of the blastocyst, so it is not applied in every case. We must have the real reason that we must be able to cope with the long-term development of the embryos, regardless of whether the embryos are worth the risk or as I say.
6. What are innovations in sperm selection?
Nowadays, when the quality of the sperm is considered, we do not consider the parameters such as the number of sperm, motility, shape as it used to be. We know that the real quality of sperm is, as I said in the above question, its hereditary nature and how it is influenced by environmental factors. These are the spermatic contributions to embryo development. No direct relationship has been shown between traditional sperm assay parameters and the status of the hereditary properties I have mentioned. We are now trying to understand the state of actual qualities that will affect embryo development when conducting sperm analysis. What is important is to be able to choose the sperms that have been least damaged, have never been seen if possible, and are able to combine them with the egg cell. Selection of the sperm cell at high magnification (IMSI), selection of binding or not binding of the bass part of some molecules (PICSI or MACS-like methods) has been used for this purpose. Unfortunately, the validity of these electoral methods has not yet been proven with full and accurate scientific methods. More time is needed for this. There are, however, many centers that use this type of innovation, including our laboratories, to increase the likelihood of patients becoming pregnant.
7-When is genetic studies needed?
The cases where genetic studies are definitely needed are; are the states in which the responsible chromosome or gene region is known, which can pass through the hereditary pathway to the baby in the family. This region or chromosomes can be examined on embryos and disease free embryos transferred. Another situation is repetitive pregnancy losses, that is, repeated miscarriage or vice versa. In both cases, sometimes embryos should be genetically problematic. Therefore, detailed examination should be performed before starting the in vitro fertilization procedure and other causes other than the genetic problem of the embryos that may cause the same problem should be screened. A few years ago, the woman called for the necessity of genetic studies on the embryo in cases such as advanced age, advanced sperm problems (with or without a very limited number of sperm). Nowadays, this view seems to be a little more relaxed.
8. What are the innovations in IVF treatment methods?
In vitro fertilization methods and practices are developing at a dizzying pace. One of the most recent techniques is the dynamic follow-up of embryos. (Embriyoscop) These techniques brought to Turkey for the first time and most of our team being implemented in our laboratory. The embryos are now analyzed through videos composed of images taken from seven regions every 15-20 minutes, rather than with very limited time periods during follow-up, qualities are determined according to this data. This means that there is now much more information about the development of the embryos. We have been able to collect so much data about embryo development for the first time since the years of in vitro fertilization, and this information is invaluable. Currently an international group of scientists, including from Turkey, which we are continuing to work on this data. How much is your chances of success with innovation? We need to wait a little longer to answer this question. However, the dynamic monitoring technique offered for embryo selection really increases the chances of success. However, the point to be careful here is; it can be done in several different ways to follow a dynamic embryo, and they do not all give the same result. The system we use is now the most sophisticated dynamic tracking system in the world. We and the other centers that use the system that we use (now around 100 in the world) have shown that their success rates are increasing. I hope that the scientific studies that make scientific comparison of this system with others are published as soon as possible and the proof of the difference is proved.
9. What is the final stage of the freezing technique?
Today, there are two different ice cream techniques; slow and fast. While slow ice cream is applied more than five years ago, fast freezing technique is preferred today. Because with this technique, it is more likely that all of the embryos, that is, all of their cells, will sustain their undamaged vitality. This naturally reflects on success rates. Here is what I would like to draw your attention to; they are a bit hesitant about freezing-thawing the impression we have received from our couples who have applied to us. But the tube is for the baby's future freezing-thawing process. Because; now internationally, success is measured as the rate of pregnancy after several treatments applied in a double. Naturally, it is desirable to have freezing-thaw cycling in several of these treatments, because instead of stimulating the ovaries by giving the hormone from the beginning to the woman in each treatment, several quality embryos obtained at one time are kept in storage and then resolved in later applications. Moreover, freeze-thaw treatments have another advantage; sometimes drugs used in treatments for stimulating the ovaries can damage the embryo receiving mechanism of the uterus while enlarging the eggs. However, in freeze-thaw treatments, uterine tissue is much more natural than the other case and the embryo acceptance mechanism is not damaged. Today, many centers in the world (including our centers) evaluate this condition before the transfer and freeze all the embryos we have obtained in order to increase the chance of double pregnancy and transfer it to the next month when the uterus becomes natural. The validity and double benefits of this application have now been proven by scientific publications. To summarize briefly, freeze-thaw techniques have an important place in the overall success of centers. I say that patients should examine this parameter very well.
10. How many times should the baby test be repeated?
I will answer this question; average three! But I have to explain this too. 95% of the couples who applied statistically to in-vitro fertilization should repeat three times. There is no limit for the remaining 5%. When a patient who applied to us got pregnant she had already done sixteen tests outside. This was in my double five percent. However, scientific publications show that ninety-five percent of couples entering the IVF treatment can not increase their chances of pregnancy significantly after the first three attempts.
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