BASIC PRINCIPLES OF IN VITRO FERTILIZATION (IVF, ICSI)

Stimulation of ovaries to get maximum number of oocytes with COS, triggering the ovulation after reaching  suitable sized follicles , egg collection after 35-36 hours, fertilization of oocytes with sperm , follow-up of developing embryos and transfer of the embryo(s) into the uterus on the second, third or fifth day of embryo according to current conditions.

Although there are various treatment protocols,  Short Protocol  is the most frequently used one worldwide. Transvaginal ultrasonography is performed within first two days of menstruation to see the current ovarian morphology and presence of any  ovarian cyst.  If there is an ovarian cyst above 10 mm, the treatment is either postponed or the cyst is aspirated and treatment is started. The gonadotropin dose is determined according to the patient's age, ovarian reserve and previous stimulation results, if any. In patients in whom the average response is expected, a dose of 150-300 IU Gonadotropin is sufficient. The first evaluation is made after 4-5 days. The thickness of the endometrium is measured. The follicle number and size is evaluated by transvaginal ultrasonography. Gonadotropin dose  is adjusted accordingly. While the follicles continue to grow, Antagonist injection is added to the treatment to prevent premature ovulation around the sixth day of stimulation.  Ovulation is triggered with  hCG injection when the leading 2-3 follicles reach a diameter of 18-20 mm. After 35-36 hours, eggs are collected with sedation anesthesia using a long needle  vaginal ultrasonography. At this time, semen  sample is taken from the patient's husband. Mature eggs are fertilized with sperm on the same day. According to number and quality of embryos; transfer is planned on second, third or fifth day. If there are sufficient number and quality of embryos, the fifth day transfer is preferred. If there are embryos of good quality left , the embryos are frozen by the approval of the couple.

Progesterone support ( Luteal Phase Support) should be given after the embryo transfer. This support is continued until fetal heartbeat is seen or until the 8th gestational week.

11-12 days after embryo transfer,   pregnancy test is carried out in the blood . If the test is positive, ultrasound control is appropriate a week later. Routine pregnancy follow-up is started after the pregnancy sac is seen in the uterus.