Who Should Seek Assisted Reproductive Technologies?
Assisted reproductive technologies should be sought in cases where conception has not occurred despite regular, unprotected sexual intercourse 2-3 times a week for 1 year in women under 35, and for 6 months in women over 35.
These assisted reproductive technology procedures encompass fertility treatments that utilize both female eggs and male sperm.
Which Tests Should Be Performed Prior?
Women: Should undergo hormone tests and ultrasound on the 3rd day of menstruation, and a hysterosalpingography (HSG) within the first 10 days of menstruation.
Men: Should undergo semen analysis after 3 days of sexual abstinence.
Despite all these tests, sometimes no cause may be found in approximately 15-20% of patients.
Following these investigations, cause-specific treatments such as ovulation induction (with pills or injections), follicular monitoring, intrauterine insemination, or in vitro fertilization methods may be applied. In cases of abnormalities in sperm count or morphology, appropriate medical or surgical treatments are administered.
In Vitro Fertilization Procedures
In vitro fertilization treatments begin with ovulation induction injections/pills on days 3-5 of the menstrual cycle and typically last 12-15 days. At the end of this period, once an adequate number and size of oocytes are obtained, an oocyte retrieval procedure is performed vaginally under anesthesia with the aid of a small needle under ultrasound guidance. This procedure typically takes 15-25 minutes, and the patient can resume daily activities after 2 hours.
On the day of oocyte retrieval, a sperm sample is collected from the male partner and combined with the oocytes in the embryology laboratory. Suitable oocytes fertilized by appropriate sperm then lead to the formation of embryos. Embryos are monitored under optimal laboratory conditions and transferred into the uterus on day 3 or day 5.
In some cases, the uterine lining may not be ready for embryo implantation. In such a situation, embryos can be cryopreserved under suitable laboratory conditions and stored for many years. Frozen embryos can be transferred after appropriate uterine preparation. Depending on the embryo's age, a blood pregnancy test (B-hCG) can be performed 9-12 days after transfer to determine the pregnancy outcome.
What is the Success Rate?
The success rate of in vitro fertilization treatment depends on numerous factors:
- Maternal age (success rates significantly increase, especially under 35 years of age)
- Oocyte count and quality
- Sperm count and quality
- Embryo quality
- Uterine endometrial pathologies
- Endometriomas (chocolate cysts) and uterine structure
- Tubal abnormalities
- Coexisting diseases and undiagnosed immune system/genetic disorders
As the maternal age advances, the number and quality of oocytes decrease, and they respond less to hormone-stimulating medications.
Does In Vitro Fertilization Treatment Accelerate Menopause?
During oocyte stimulation treatment in an IVF procedure, oocytes that would naturally be lost in that menstrual cycle participate in a selection competition under equal conditions with externally administered hormonal support. All oocytes reach almost the same size, resulting in the development of multiple oocytes.
Consequently, assisted reproductive treatments do not accelerate menopause. Oocytes that would otherwise be lost are rescued, thereby increasing the chance of pregnancy.
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