At Başkent University Adana Dr. Turgut Noyan Practice and Research Center Obstetrics and Gynecology Clinic Reproductive Endocrinology and IVF Center, we serve couples who want to have children with our highly experienced expert staff.
In our center, individualized state-of-the-art and modern treatment methods are used to make couples have children.
Our priority is to have a healthy pregnancy and have a baby on their own naturally. If this is not possible, appropriate advanced treatment methods are offered to our patients.
In our center, all treatment methods that are used worldwide, and scientifically proven to contribute to pregnancy formation, are followed, supplied, and offered to you. Our expert staff also tries to contribute to our country and world literature with their experiences and studies.
Who Should Apply to the IVF Center?
Classifying couples according to the important factor for pregnancy, the age of the woman:
- If pregnancy does not occur despite 1 year of unprotected and regular sexual intercourse and the woman's age is under 35,
- If pregnancy does not occur despite 6 months of unprotected and regular sexual intercourse in couples and the woman's age is 35 and over,
- We recommend that women aged 40 and over apply to our center for infertility evaluation.
In addition, women with irregular menstruation, a family history of early menopause (before the age of 40), who have undergone abdominal surgeries, who have had surgery on the reproductive organs, who have received treatment that may damage the ovarian reserves for any reason, are advised to apply to our center for ovarian reserve evaluation and egg freezing and infertility counseling before the time they want children.
We also recommend that male patients who experience erection-ejaculation problems, who have to receive treatments that may damage sperm cells, and who have undergone testicular operations be evaluated as soon as possible.
Prevalence of Infertility
The infertility problem is encountered in about 15% of married couples in general population. Normally, the success rate of getting pregnant as a result of regular intercourse for healthy couples is about 20% per month. At the end of one year, 85% of couples can get pregnant, but 15% fall into the definition of infertility.
Infertility can be caused by the medical conditions in females in 35% of cases, in males in 30% of cases, or in both in 20%, and any cause cannot be identified in 15%.
Causes of Infertility in Women
- Ovulation problems
- Low ovarian reserve
- Advanced age
- Tubal factors
- Problems originating from the uterus
- Endometriosis (chocolate cyst)
- Genetic reasons
Causes of Infertility in Men
- Azoospermia or cryptospermia
- Oligospermia or asthenospermia
- Erectile dysfunction and ejaculatory problems
- Genetic factors
Ovulation Problems
In female patients with a menstrual cycle of 28 days, ovulation occurs on the 14th day of menstruation. This condition can be diagnosed with an ultrasound image applied on these days or with a high progesterone level on the 21st day. In those with fewer or more menstrual days, this can be determined by examining the progesterone level one week before menstruation. While 90-95% of women with regular menstruation have regular ovulation, 5-10% may not have ovulation even though they have regular menstruation. It is accepted that patients whose menstrual bleeding does not occur without medication do not have ovulation. It can be seen that those whose periods are more than 45 days have late and irregular ovulation, or even not at all. These groups of patients are first to be provided with medical treatment to have ovulation, and then they are directed to pregnancy treatments.
Low Egg Reserve
Low ovarian reserve, although mostly unknown, can develop after ovarian surgery or cancer treatment. In patients with low ovarian reserve, if there is no advanced age barrier, the chance of getting pregnant is higher than in advanced age, but they should prioritize child treatment in their lives due to the lack of reserve.
Advanced Age
In light of current scientific knowledge, it should be said that the most important factor affecting IVF success is maternal age. Unfortunately, with the age of 35, even if the ovarian reserve is good in women, the chance of achieving a healthy pregnancy decreases with age. This decrease accelerates after the age of 38, becomes more difficult after the age of 40, and drops to around 10%. Unfortunately, there is no compensation for this situation, so it is recommended to apply earlier in advanced-age marriages.
Tubal Factor
It is infertility caused by a decrease in the natural peristaltic movement of both tubes due to adhesions in the intra-abdominal structures due to reasons such as past abdominal surgery, ectopic pregnancy surgeries, inflammation of the abdominal inner lining, pelvic inflammatory diseases
or endometriosis. It is the type of infertility that requires IVF treatment the most.
Causes Originating from the Uterus
It occurs due to adhesions on the uterine wall due to past curettage, infection, and surgeries, acute or chronic inflammation in the uterine inner lining (such as tuberculosis), adenomyosis, pathologies such as myomas that press on the uterine inner lining.
Endometriosis
Endometriosis causes infertility by causing adhesions in the surrounding tissues being found in the ovary, the inner lining of the abdomen, the uterine wall, or the base of the pelvis behind the peritoneum, disrupting the tubal movement. It impairs the quality of the egg cell where it is located in the ovary and also causes infertility by causing changes in the inner lining of the abdomen. While it is 10% in women, this rate increases to 25-40% in infertile women. In our center, laparoscopic surgical options are offered to our patients when surgical intervention is required due to endometriosis.
Genetic
In patients with early reserve-reducing diseases such as Turner Syndrome, healthy babies can be obtained by collecting eggs early or by IVF treatment with genetic screening in patients who are carriers of genetic diseases and do not want to pass this disease to their children.
Causes of Male Infertility
Male infertility is around 25-30% and may experience infertility due to a decrease or absence in sperm count, erectile dysfunction (erection problem), or ejaculatory dysfunction (ejaculation problem). In our center, we have a doctor who specializes in the urology of IVF, and if a problem is detected in the man after the first interview or the tests, the evaluation of our urologist is requested and the treatment is carried out multidisciplinary.
Azospermia-Cryptospermia
In azoospermia, contrary to what is thought, semen is present, only sperm cells are not seen in the semen, or in cryptospermia, very few can be counted in the smear under the microscope. In this case, after the examination and tests of our urologist, if necessary, medical treatment or surgical treatment (micro TESE/surgery to obtain sperm from the testicles) is performed and IVF is applied.
Oligo-Asteno-Teratospermia
Sperm parameters detected in men are reduced in number or movement, or abnormalities in shape are evaluated together with Urology and first treatment, then insemination or IVF treatments are applied.
Erectile Dysfunction - Premature Ejaculation
Males with erectile dysfunction or premature ejaculation are referred to our urologist. If there are methods to help with pregnancy, they are again applied in our center.
Genetic
If the male patient is a carrier of a disease, genetic counseling is provided first, then healthy babies can be given the chance to be born with the support of IVF with genetic screening in collaboration with the genetic center.
Egg (Oocyte), Sperm Freezing
Reproductive cells of women and men can be damaged due to diseases (cancer, chronic diseases, autoimmune diseases) they have undergone in childhood and adulthood, and surgical and medical treatments, causing difficulties or impossibilities in having children for those who are completely cured of their disease. Therefore, before receiving chemotherapy, radiotherapy, or surgeries for reproductive organs, they are provided to visit our center. In addition, in our center, counseling is provided under the name of preserving reproduction, the extent of the treatments to be given and the extent to which they can damage the reproductive organs and their chances of reproduction afterward, and if they want to freeze and store their reproductive cells, all these methods and their chances of success in later periods are informed.
Reproductive cells of our patients are frozen and stored for later use. In this way, women and men can have children in the future.
Who Can Freeze Eggs (Oocytes) or Sperm?
In our country, who can freeze oocytes and sperm is determined by laws.
- Presence of early menopause (condition of having low egg reserve) with appropriate tests and examinations,
- Presence of reproductive organ cancers (ovarian cancer, testicular cancer)
- Necessity of a treatment that may damage reproductive organs for any reason (chemotherapy, radiotherapy/radiation therapy, surgeries for reproductive organs)
You can get more detailed information about egg (oocyte) and sperm freezing by making an appointment at our center.
Infertility Treatments
Ovarian Monitoring and Planned Intercourse
This method is applied only to couples with ovulation problems. Ovulation is to be achieved by using drugs taken orally or by injection, mostly orally. It is recommended to use these drugs for an average of
3-6 months. However, some patients may not respond to oral medication (this situation can be seen in 20% of patients). In these patients and patients with another ovulation problem, hypogonadotropic hypogonadism, treatment should be started directly with egg-stimulating injections.
Insemination
The insemination program is the first step in advanced infertility treatment applied to patients with appropriate sperm parameters and at least one known open tube who have not received treatment before. Patients taken into this program come when they have their period, and if there is no obstacle to their treatment after the control examination and blood tests on the 2nd or 3rd day of their period, they are started treatment with a suitable drug (daily pills or daily injections). Patients are called periodically for examination by our doctors to control the development of follicles (eggs). After the mature follicles are observed with the ultrasonographic size suitable for ovulation, the ovulation injection is made. 35-36 hours after this injection, insemination is performed. On the day of insemination, the male gives a sperm sample in the morning, and the concentrated sperm prepared after washing is injected into the uterus with the help of a catheter, and insemination is performed. The success rate of the insemination procedure is between 10-20%.
IVF Preparation Phase
Patients who have previously applied to our center and whose IVF treatment is planned should contact our center when they have their period and come to our hospital on the 2nd or 3rd day of their period. After the control examination and blood tests during menstruation, if there is no obstacle to the treatment, you will be started on ovarian stimulating drugs that our doctors deem appropriate for you. After starting the drug application, you will be called back to our IVF center after 4-5 days to evaluate the effectiveness of the drugs in the treatment. When you come for the second control, the treatment course, drug doses and what will be done in the process will be planned after the ultrasound and hormone evaluation. The treatment of stimulating the ovaries takes an average of 7-12 days. In the follow-ups, when it is foreseen that the eggs have reached sufficient size, it is planned to make the egg cracking injection to our patients. 34-36 hours after the egg cracking injection, eggs are collected from the follicles in the ovaries under anesthesia. Since the egg collection procedure requires anesthesia, all our patients will be given anesthesia, so you should not eat and drink on the day of egg collection. The same day, micro-injection is applied with the sperm taken from your spouse or if the sperm is frozen, it is dissolved on the same day and our experienced embryologists apply micro-injection.
One day after the egg collection procedure, our patients are informed by our embryologists about the fertilized eggs and embryos. Patients are informed by phone daily. Your embryo transfer is planned on the day deemed appropriate by your doctor and embryologist, and you are called by phone one day before or in the morning of that day for the transfer procedure.
Support Conditions for Treatments from SSI
Support is provided for your treatment under the conditions determined by the laws below.
The insemination procedure requires that the couple does not have a child registered on them from their current marriage.
For IVF procedure
- The female spouse must be between the ages of 23-40
- The couple does not have a child registered on them from their current marriage,
- One of the couple had an SSI entry 5 years ago and has paid 900 working days premium
- It is provable that the woman has low ovarian reserve, her tubes are closed,
- It is proven that the result of 3 different spermiograms made at least 15 days apart by the man is an obstacle to pregnancy.
If no problem is detected in the tests of the couple (unexplained infertility), the presence of at least 3 years of official marriage, having been inseminated twice in an SSI-contracted center is required.
Some High Technologies Used in IVF
Our IVF laboratory follows all the innovations in its field to provide a service at world standards to its patients and to achieve a continuously increasing success rate and implement them.
PGT (Preimplantation Genetic Diagnosis)
Sometimes in couples who have difficulty having children, and sometimes in those who get pregnant spontaneously but have recurrent miscarriages, the reason for not being able to have a healthy baby maybe not being able to form an embryo with normal genetics. Sometimes, couples who have a genetic disease themselves, in their families, or their previous children may want to reach embryos that have been proven not to have this genetic disease in order not to experience such a problem again. Therefore, nowadays, we can examine the genetics of the embryos we obtain as a result of IVF treatment, select embryos with genetics that are largely normal, and achieve healthier and higher rates of pregnancies.
Time Lapse (
Embryoscope)
After the egg collection from the woman and the sperm taken from the man are combined with microinjection in the laboratory, they are stored in incubators, which mimic the environments inside the body, to continue their development and are examined every day. The aim at the end of the approximately 5 days that the embryos spend in the IVF laboratories is to distinguish between normally and abnormally fertilized eggs, to monitor the division stages of the embryo, to follow fast or slow developing embryos, and thus to select the best embryos for transfer and increase the chance of pregnancy. However, embryos are taken out of incubators with fixed temperature, carbon dioxide, oxygen, and nitrogen levels at certain intervals and evaluated under a microscope in a very short time without affecting the culture conditions. Due to the rapid and dynamic nature of embryo development, it is not possible to observe all the developmental stages of the embryos in detail, and the evaluation of the embryos is made based on the information obtained from instant images.
In the high-tech incubator device called Embryoscope, the embryo can be observed with a camera for 24 hours without being exposed to the external environment, and all development stages can be examined in detail. In addition, by minimizing exposure to the external environment, better development of embryos can be ensured.
Microchip
In classical sperm selection methods, there are concerns that different chemicals and physical processes used may harm sperm, these negative effects may cause sperm to release some substances that damage sperm DNA. Microchips are technologies produced to mimic the environment that sperms naturally have to pass through in the female body and to select sperms in the most natural ways by imitating this environment in microchannels.
Piezoelectric
Piezoelectric, can be used to increase the fertilization potential of sperm and oocyte by giving a special electric current immediately after the sperm is placed into the oocyte with microinjection in patients with fertilization problems after sperm and oocyte (oocyte) are combined.
Ca-ionophore
In intracytoplasmic sperm injection, the absence of fertilization in any egg is seen in approximately 1-3% of couples who have undergone microinjection. In these patients, that is, in patients with no or low fertilization (less than 30-35% of mature eggs are fertilized), the fertilization rates can be increased by providing egg activation in laboratory conditions.
Ca-ionophore is a promising new procedure for couples who have no fertilization or low fertilization rates, such as patients with all sperms being globose (sperms without the part called acrosome that provides fertilization). When IVF applications performed with this technique are evaluated, it has been observed that fertilization occurs in those with no fertilization or that the fertilization rates of those with low fertilization increase.
IMSI (Intracytoplasmic Morphologically - Selected Sperm Injection - High Microscopic Magnification Selected Sperm Microinjection)
Intracytoplasmic morphologically selected sperm injection (IMSI) is a method that allows the selection of sperm using special magnification techniques compared to conventional IVF microscopes. With this method, magnifications exceeding 6000 allow the selection of sperms with the best morphology. Thanks to this advanced method, it is possible to detect some intracellular structures such as vacuoles (surrounded by membranes) that are known to disrupt genetic stabilization in sperm cells, and microinjection (ICSI) is performed with sperms that show the least or no defects, thus increasing implantation and pregnancy rates and early It is possible to reduce the risk of miscarriage.
The contribution of sperm to embryo development increases from the second or third day in humans. Because the genome of the embryo, that is, the new genetic structure formed by the combination of sperm and egg, becomes fully active after this period. Therefore, the fact that the embryos formed by the sperms selected with the IMSI method reach the blastocyst stage is an indirect indicator of the healthy functioning of the genome. Therefore, it has been shown that the rates of reaching the blastocyst stage of embryos formed by sperms selected with IMSI are higher than those formed by sperms selected without IMSI. Especially in couples with severe male factors, it is used in our clinic as a method that can increase pregnancy rates.
Customized Culture Media
After the egg is combined with the sperm taken from the man in the laboratory with microinjection, they are placed in small containers containing nourishing fluids to continue their lives. These fluids are prepared by imitating the fluids found in the woman's tubes. The eggs placed in the container are preserved in devices called incubators that carry the temperature and characteristics of the woman's body. Then the eggs are prepared for microinjection by special processes.
In our patients who have had repeated unsuccessful IVF attempts, one of the techniques that we can use in our patients with low embryo
quality and baby attachment rate (implant) are customized mediums. These customized mediums can contribute to the formation, development, and implantation rates of embryos with the special substances they contain.
Egg Collection (OPU) Procedure
Egg collection is performed under sedation (mild anesthesia) guided by transvaginal ultrasound.
- Since the procedure is performed under anesthesia, no pain is felt, and it takes about 10-15 minutes. There is no need to stay in the hospital after the procedure, it is a day procedure. You are discharged after resting for 1 hour after the procedure. When you receive anesthesia, it is recommended to rest and not do things that require attention (driving, doing something related to your account, etc.).
- The complications that may develop due to this procedure are bleeding and infection.
- However, since the procedures are performed in sterile conditions and by experienced people, both risks are very low.
- The collected eggs are placed in small containers containing nourishing fluids. These fluids are prepared by imitating the fluids found in the woman's tubes.
- The eggs in the container are preserved in devices called incubators that carry the temperature and characteristics of the woman's body. Then the eggs are prepared for microinjection by special processes.
- The same day, microinjection is applied with the sperm taken from your spouse, or if the sperm is frozen, it is dissolved on the same day and applied by our experienced embryologists.
One day after the egg collection procedure, our patients are informed by our embryologists by phone about the fertilized eggs and embryos. Patients are informed by phone daily. Your embryo transfer is planned on the day deemed appropriate by your doctor and embryologist, and you are called by phone one day before or in the morning of that day for the transfer procedure.
Microinjection
It is the combination of the most suitable eggs and sperms by selecting them under a microscope and injecting the sperm into the egg by microinjection. This way, fertilization is expected at a rate of about 60-85%.
According to your treatment management, you can proceed to the transfer of your suitable embryo. In some treatment processes or to avoid possible complications in your treatment process, all your embryos can be frozen and the transfer processes can be left to later processes.
Embryo Freezing
In the IVF treatment process of our patients, sometimes due to the lack of embryos and sometimes due to the excess of embryos, it may be necessary to freeze and store the embryos. When embryos are transferred, if there are good and medium-quality embryos left, the option of freezing the remaining embryos is offered to our patients, and in later periods, the same pregnancy rates can be given with the remaining embryos with a much more comfortable treatment. Embryos are stored in our special tanks at -70 degrees.
In patients with very low egg reserves, an egg pooling treatment strategy, which requires collecting and freezing many embryos as soon as possible, may be required. In the vast majority of our patients, however, our goal is to reach as many embryos as possible in a single go, which is the most troublesome part of the process, where injections are made, eggs are tried to be enlarged, and then collected, rather than repeating it, and to have the biggest desire, pregnancy in the first transfer, and in later periods, to continue your treatment with a much easier process. If pregnancy is not achieved at the first time, we can continue your treatment with a much easier process with the ready-made embryos we have obtained for further trials.
Embryo Transfer
In fresh cycles, microinjection is applied in our laboratory after the egg collection procedure and your embryo selected by your doctor and embryologist is transferred to your uterus without anesthesia, under ultrasonography, with a full bladder, on the day deemed most suitable for you, with a thin special catheter.
In the transfer of frozen embryos, the transfer process is carried out after the preparation of the inner lining of the uterus for your embryos with a relatively less troublesome treatment. This special moment is painless. After a short rest period, you can leave our center, continue all your daily work, and return to your normal life.