Embryo transfer on Day 3 or Day 5?

One of the common questions that patients ask about IVF is the difference between doing an embryo transfer on Day 3 or Day 5 following egg pick up. To answer this, we should know a little about the reproduction physiology. When a woman conceives naturally, fertilization occurs in her fallopian tubes. It takes about 3 to 4 days for the fertilized egg to travel through the fallopian tube to the endometrial cavity of the uterus ( mother’s womb). During the transit of the fertilized egg (called a zygote at that stage), the zygote divides into an embryo (by day 2-3) and then further divides to a morula (by day 4) prior to arriving/implanting in the uterus. So, by the time the pregnancy implants in the uterus, it's at a stage of development called a blastocyst on day 5.

Investigations on this field show that blastocyst transfer (day 5) during IVF treatments results in a significantly higher chance of pregnancy compared to an embryo transfer on day 3.

We have routinely been performing blastocyst culture and transfer for many years and observe significantly higher implantation and pregnancy rates as compared to what we see with day 3 embryos. First of all, it could be that longer incubation of embryos in the laboratory allows healthier embryos to grow, while those that are not healthy generally stop growing. This would increase the likelihood that better quality embryos would be chosen and transferred into the patient’s uterus, potentially increasing the chance for pregnancy. Another possible reason is that it more physiologically mimics that which occurs in nature during a spontaneous pregnancy. IVF labs which have poorer techniques and personnel, tend to favour day 3 transfers, as they may not be able to nurture the growing embryos for 5 days. However, if a very limited number of embryos are available on day 3 and no embryo selection is required, then the benefit of a day-5embryo transfer may be limited to the improved synchronization between embryo and endometrium. Because it is obvious that the best conditioned place for the embryos is the mother’s womb itself.

Finally, a clinic’s success with embryo cryopreservation following extended culture should also be carefully considered. We believe that extended culture to day 5 must go hand in hand with an excellent cryopreservation program in order to maximize patient success.

http://turkey-ivf.com/day-3-day-5-ivf-icsi.html

How will IVF treatment be in near future

The goal of all reproductive technologies is the live birth of a healthy singleton baby. To achieve this goal many clinical and laboratory techniques are being used today.

After the start of In Vitro Fertilization (IVF) treatments, it marked a real breakthrough in the field of infertility. At the beginning, IVF was only used to solve the tube (fallopian) problems. Since then, other related technologies such as Intra Cytoplasmic Sperm Injection (ICSI), freezing and storage of the embryos, assisted hatching, sperm selection and preparation methods, genetic evaluation of the embryos before the transfer (PGS/PGD), and others have contributed greatly to fertility treatments.

Today, more recent implementation of advances in reproductive technologies such as blastocyst culture, single embryo transfer and genetic evaluation all the chromosome structure of the baby are enabling physicians to achieve high live birth rates, lower multiple pregnancies and treat the most extreme cases of infertility.
However, sometimes IVF trials may end up with failures repeatedly despite transfer of high-quality embryos. Investigations show us that the fact lying behind the failure of the IVF trial despite high quality embryo transfer, largely originates from the embryo itself. In other words, a very good-looking embryo may be genetically abnormal. The destiny of such an embryo will either be a failure of attachment or end up with a miscarriage. Single euploid (genetically normal) embryo transfer (SEET) possibly at the blastocyst stage to reduce multiple pregnancies, lowering the abnormal pregnancies and abortion rate, and cryopreserve with vitrification of the extra embryos gives us a great chance to be successful with the IVF treatment (1-3).

As advanced fertility diagnosis and treatment technologies continue to develop, possibilities become realities. This will allow more patients to build the families. Despite all these technological advances, however, many who could benefit from their application are not aware of them. Furthermore, many patients cannot afford treatments because they are not covered under their insurance plans.

So, the problem for many couples is only finding the right IVF Centre which will give the high success rate with the possible lowest cost.

Medicana International Istanbul is now offering couples this opportunity.
We have now the technology to evaluate all the embryos genetically with full CGH (comperative genetic hybridisation) method and check for all of 24 chromosomes of the embryo. This gives us excellent success rates with also lowering the miscarriage rates significantly.
For more information, please contact with our clinic by filling our inquiry form in our website.

1. Yang Z. Mol Cytogenet. 2012
2. Sills ES Arch Gynecol Obstet. 2012
3. Keltz MD. J Assist Reprod Genet. 2013

http://turkey-ivf.com/ivf/how-will-ivf-treatment-be-in-near-future.html

Why Turkey ?

• Turkey is the third highest number of JCI accredited hospitals in the world. (As of 1 January 2013)
• Turkey is presently recognized as a competitive and high technology healthcare destination treating thousands of foreign patients from Europe and neighboring countries every month.
• Close to 60 internationally competitive medical faculties training thousands of Turkish and foreign medical students and high certification standards for physicians ensure successful medical results in a wide variety of specialties.
• Culturally vibrant atmosphere in metropolitan Turkish cities provide a friendly and safe environment for patients and spouses to fully recuperate.
• The incredibly central geographical location of Turkey at a crossroad between Europe and Asia allow for easy access and short flying times to every destination in the world.
• Turkey is an EU candidate country currently fulfilling membership criteria ensuring high and consistent standards in healthcare.
• Reliable quotes and consistent prices are the norm.
• All accredited Turkish hospitals are outfitted with world-class infrastructure and modern technology.
• Almost all major pharmaceutical companies such as Pfizer, GlaxoSmithKline, Johnson and Johnson, Sanofi-Aventis, Merck, Novartis, Roche, Astra Zeneca are present in Turkey with regional headquarters and manufacturing facilities as well as many local manufacturers.
• Reliable supply of blood is provided by Kızılay (the Turkish Red Crescent) which is a JCI accredited organization.

Mini IVF

Is mini IVF the same thing as conventional IVF?

The answer is both yes and no. For most part, mini IVF is identical to conventional IVF. However, the two have some differences too.

In mini IVF, also referred as minimal stimulation IVF or micro IVF, fewer eggs are used than conventional IVF. In a typical mini IVF treatment cycle only 2 eggs are used for fertilization, while in a conventional IVF cycle several eggs are retrieved and fertilized. Therefore, in the mini IVF treatment the patient is given weaker ovulation-induction drugs or fewer doses of the usual ovulation-induction drugs. For instance, while in a normal IVF cycle the patient is given gonadotropins to ensure the production of several eggs during ovulation, the patient is given Clomid (a weaker drug in comparison to gonadotropins) or fewer doses of gonadotropins in a mini IVF cycle. 

Another difference between the two lies in the number of embryos (fertilized eggs) implanted inside the uterus. Only one embryo is implanted in mini IVF, whereas in conventional IVF 1 to 3 embryos can be implanted.

In a few cases, the patient may not be administered any ovaries-stimulating drugs during a mini IVF cycle. This usually happens when the couple's infertility is due to male fertility problems. Your doctor may also decide against using any ovulation-stimulating drugs if your fallopian tubes are blocked. However, women who have ovulation problems are most certainly asked to take an ovaries-stimulating medication for a few days. In mini IVF, just like in case of IVF, a patient may be also asked to use Cetrotide or any other GnRH antagonist to regulate ovulation.

The remaining steps, retrieval of eggs, fertilization of eggs, and implantation of embryos (fertilized eggs), are same in both the procedures.

What are the advantages of mini IVF?

Mini IVF has three main advantages:

• It is less costly than conventional IVF. A mini IVF cycle costs anything between $5,000 to $7,000, whereas a conventional IVF costs at least $15,000
• The risk of multiple births in mini IVF is lower than in conventional IVF
• The risk of ovarian hyperstimulation syndrome (OHSS) is less in mini IVF

What are the disadvantages of mini IVF?

The main disadvantages of mini IVF are:

• Mini IVF has a lower success rate than the usual IVF.
• Mini IVF may prove costlier than the usual IVF in the long run. While this statement appears to contradict what has been listed in the first point under the advantages of mini IVF, both statements are absolutely true. One cycle of mini IVF is less expensive than one cycle of usual IVF, as shown above. However, as the success rate of mini IVF is lower than the usual IVF, you may need to undergo many IVF cycles before you are able to conceive.
• Mini IVF is not suitable for someone who wants to store unused embryos for future use, because only 2 eggs are retrieved during the procedure. At the end of a mini IVF cycle, at the best, you will have only one unused embryo. As not all frozen embryos can be used for implantation later, spending money on storing one embryo does not make much sense.

Natural Cycle IVF

What does the term 'natural cycle IVF' means?

IVF, as you may know, stands for in vitro fertilization. In other words, in IVF the fertilization occurs in the laboratory and not inside the female body. In a usual IVF cycle, the female is given ovulation induction drugs to ensure the production of more eggs during ovulation. A natural cycle IVF, on the other hand, is an IVF cycle in which the ovulation is not manipulated. That is, the ovulation occurs normally, resulting in production of only one egg. And it is this egg, produced through normal ovulation, which is fertilized in the laboratory, much like what happens in a usual IVF cycle, by bringing it in contact with sperm.

How can I know for sure if natural cycle IVF is for me?

A natural cycle IVF is a good option for you if you have regular menstruation cycles and ovulate normally and if any of the following holds true for you:

• You cannot take fertility drugs (for example: fertility drugs may not be suitable for cancer patients and women who have an increased risk of ovarian hyper-stimulation)
• You do not want to interfere with the natural ovulation process because of religious or personal beliefs

What are the different steps involved in a natural cycle IVF?

Apart from the ovulation induction step, a natural cycle IVF is identical to the usual IVF cycle. Shared ahead is a brief description of the steps you would go through if you opt for this fertility treatment:

Step 1 - Collection of your egg and sperm

Experts at your clinic will collect your egg during ovulation. At the same time, your male partner will asked to give a sperm sample.

Step 2 - Fertilization

Next, the experts will bring the egg and sperm together to initiate fertilization.

Step 3 - Observing the embryo

The fertilized egg, or embryo, will be observed for a day or two to ascertain everything is going alright.

Step 4 - Implantation of the embryo in your womb

Lastly, the doctors will implant the embryo in your uterus. 

Once the embryo is implanted, there is nothing to do but wait. After 10-15 days, you will have to undergo certain tests-probably a blood test and an ultrasound test-to check if the treatment is successful.

What are the risks associated with a natural cycle IVF?

A natural cycle IVF is safer than the usual IVF on two counts:

• It does not require administration of fertility drugs. Therefore you do not experience the side effects of these drugs; and
• Only one embryo is implanted, so the risk of multiple births is considerably less-almost as low as it is in natural pregnancy.

What are the success rates of natural IVF?

A lot of information is not available about how successful, or unsuccessful, this fertility treatment is. Whatever information is available point towards only one thing-the natural IVF is not as successful as the conventional IVF. This is because in a natural cycle IVF only one egg is used, whereas in a conventional cycle IVF multiple eggs are used.

Egg Freezing

Egg freezing, as the name suggests, is the process of freezing and storing human eggs for use in in vitro fertilization (IVF). As part of an IVF cycle, the patient is given certain hormonal drugs for stimulating the ovaries to produce eggs. The eggs develop within the follicles, which are monitored until they grow large enough. This usually takes around two weeks. The follicles are then emptied carefully and the embryos are identified and separated. The egg retrieval process takes place as the patient under general anesthetic or sedation. At this point, the eggs are either fertilized and prepared for implantation or placed in liquid nitrogen for storage.

Egg freezing and embryo freezing

Embryo freezing has been done for many years now, and thousands of babies around the world have been born from frozen embryos. However, egg freezing is still a rather new technique. The number of babies born from frozen eggs amount to around 900, and the procedure is considered experimental by some clinics.

Why opt for egg freezing and storage?

Egg freezing and storage is done so that it can be used for fertility treatment in the future. It is especially recommended for patients undergoing some forms of cancer treatment or medical treatment that could affect fertility. It is also recommended for patients who are concerned about declining fertility over time, but are not ready to have a child at present.

The procedure for egg freezing

The egg freezing procedure is conducted in six steps given below:

1. Your doctor will first explain the entire egg freezing procedure and the risks involved before you agree to it. Some clinics may also have a specialist counselor who you can consult to know more about the process and whether you should go ahead with it.

2. If you agree to the egg freezing procedure, you will first undergo screening tests to ensure that you do not have infectious diseases like hepatitis B or C or a HIV infection.

3. Once you complete the screening, you need to give written consent for storing your eggs

4. A standard IVF cycle is started and the eggs are collected using the conventional procedure.

5. The eggs are added to a cryoprotectant or freezing solution so that they are protected while they are in a frozen state.

6. The eggs are frozen either by vitrification, which is a fast freezing process, or by cooling them slowly. Once frozen, they are stored in liquid nitrogen storage tanks.

What does the consent form specify?

The consent form that you sign before the egg freezing process gives you certain control over what will happen to your eggs. The specifics of the form may vary with each clinic, but they usually let you specify the following:

• Your consent to the eggs being stored and used later for your IVF treatment
• The period of storage for your eggs, with the usual period being 10 years
• What should be done with the stored eggs in the event of your death or if you are no longer able to make decisions for yourself
• If your eggs may be used for your treatment alone or for training/research or donated for others' treatment

Pre-implantation Genetic Diagnosis (PGD)

Pre-implantation genetic diagnosis or PGD is a technique of preventing certain inherited conditions from being passed on to a couple's child. The process involves a thorough checking of the embryo's genes during an IVF cycle.

When is PGD recommended?

This procedure is recommended under the following conditions:

• The couple has had abortions in the past because the baby was found to have a genetic condition
• The couple has a child or family history of serious genetic conditions

What does PGD test for?

The embryo can be tested for more than 100 genetic conditions using PGD. If the genetic conditions mentioned in the above section are considered sufficiently serious, the clinic may be permitted to check the embryo for that condition.

What clinics can offer PGD?

Clinics offering PGD need to have a specific license to do so. The license lets the clinic test an embryo for any single condition or combination thereof that is considered serious enough. Some clinics may be experienced in testing certain genetic conditions more than others.

Risks of PGD

The risks associated with PGD testing are the same as those of a conventional IVF cycle, but there are some additional risks like those given below:

• The embryos may get damaged during the cell removal process
• The testing may not be fully conclusive or reliable

The procedure

The procedure for Pre-implantation genetic diagnosis usually involves seven steps that are given below:

1. A conventional IVF cycle begins and the eggs are retrieved and fertilized by the male partner's sperm

2. The fertilized eggs are separated and placed in incubation. They develop into embryos, which are place in the lab for 48-72 hours until they reach the eight-cell stage.

3. The embryologist then removes a cell (blastomere) or two from the embryo

4. The cells undergo genetic testing to see if the embryos to which they belong contain the genetic condition(s) in the couple, couple's family, or couple's child.

5. Embryos that do not have the condition are separated. Some are transferred to the uterus for development

6. Other unaffected and separated embryos are cryogenically frozen for later IVF cycles. Embryos that have the genetic condition perish.

7. The woman undergoes a pregnancy test two weeks after the embryos are transferred

In some cases, the embryos may be allowed to grow for five-six days, at which point they will each have 100-150 cells that either form the placenta (trophectoderm) or the fetus (inner cell mass). Cells are removed from the trophectoderm without harming the embryo, which helps in getting more accurate results.

The chances of successful pregnancy after PGD

Lack of data associated with PGD makes it difficult to assess success rates, but most couples using this procedure do it because they want to avoid their child from suffering a genetic disease, and not for any fertility problem. Success, of course, depends on a lot of conditions like the woman's age and the cause of infertility, if any. Sometimes, there may not be any embryos suitable for transfer after PGD because:

• All of them had the genetic disease
• Removal of cells damaged the embryos
• Not enough embryos were available