Which Methods Increase Success in Treatment of Infertility?

In addition to the scientific approach adopted at In Vitro Fertilization Center of Yeditepe University, following methods are used to achieve healthy pregnancies and allow birth of healthy newborn infants.

Assisted Hatching

The term is defined as thinning or opening a certain part of the membrane that surrounds embryos (the zona pellucida) mechanically or using acidified Tyrode’s solution or laser. This technique aims to facilitate implantation of embryos into the uterine wall (endometrium).

Embryos need to implant into endometrium to ensure pregnancy along with nourishment and development of embryos (fertilized egg). If the membrane that surrounds the embryo is unusually thick, pregnancy may fail, as embryo may not implant into the uterine wall. The membrane is thinned or a very small hole is created in a certain part of the membrane through various methods to prevent this adverse event and facilitate implantation of embryo.

Although various chemical substances and enzymes were used in the past, laser systems are recently utilized for this procedure. Laser is used in women at or older than 35 who failed pregnancy in past in vitro fertilization attempts. Moreover, it is considered for embryos that will be biopsied for genetic diagnosis, embryos that are frozen and thawed and for women with failure of pregnancy in previous attempts despite high-quality embryo as well as women with high or borderline FSH.

Endometrial co-culture

Endometrial co-culture is a new hope for couples, who cannot achieve pregnancy despite multiple ART (assisted reproductive techniques) attempts or have poorly or slowly growing embryos. A tiny tissue piece is biopsied from endometrium on Day 21 of the period and an artificial endometrial tissue is obtained by growing the biopsy specimen at laboratory settings. Embryos are implanted into this tissue. Since native endometrial cells of the women are used for this practice, risky conditions are eliminated, such as jaundice, AIDS and others. Endometrial cells are not hazardous for development of embryo and even, they increase chance of growth by maintaining the development.

Blastocyst culture

Blastocyst is the term that refers to embryo on day five of fertilization. In assisted reproductive technologies, generally acknowledged practice is to transfer embryos three days after fertilization. Transfer of embryos in blastocyst phase yields certain significant gains. For example, embryos that can survive until this phase are more likely to implant. These embryos have higher capability of survival until day five relative to other embryos.

Pre-implantation Genetic Diagnosis

Numerous hereditary diseases can be diagnosed even at embryonic phase. This technique, called Preimplantation Genetic Diagnosis (PGD), allows selection of only healthy embryos that will be transferred into the uterus. In this method, 1 or 2 blastomer cells are biopsied from each embryo and the genetic locus that is responsible for the disease is amplified through single-cell PCR, when embryos with normal development reach 7- to 8-cell stage following the fertilization.

Embryo Freezing

Embryos are frozen due to absolute indications that are linked to female factors. For example, all embryos are frozen, when a certain condition, such as ovarian hyperstimulation syndrome, occurs during hormone therapy at the phase of embryo transfer. Posing a life threatening risk for the woman, this clinical picture should be regressed and embryo should be thawed and transferred in a safer time. However, embryos can also be frozen and stored, if the thickness of innermost lining of the uterus (endometrium) is not suitable for pregnancy, and embryos are transferred when intrauterine cavity is better prepared.

Removal of Fallopian Tubes

Hydrosalpinx implies total block of Fallopian tubes at the ovarian end and the condition is a major barrier against pregnancy. The condition that affects implantation of embryo adversely can be diagnosed with ultrasound and it is among most critical and common problems that decrease chance of in vitro fertilization. Accumulating in lumen of Fallopian tubes, the fluid flows into uterine cavity and thus, embryos cannot implant or pregnancy results in miscarriage in early phases. After intrauterine cavity is imaged to determine severity of hydrosalpinx more clearly, a laparoscopic surgery can eliminate this problem. In this case, laparoscopic removal of tubes or ligation of tubes at the junction of the tube and the uterine cavity increases the success rate significantly.

Micro-dissection TESE

Micro-TESE is a surgical method that is used for treatment of severe male infertility. In case of azospermia that is not associated with blockage of reproductive channels, Micro-TESE is considered to harvest sperm under microscope. Sperms can actually be obtained in twenty percent of cases without obstruction in reproductive channels in conventional testicular biopsy (TESE), while the figure is 45 percent for micro-TESE.

Opening new horizons for couples who plan pregnancy, micro-TESE is an outpatient procedure that is performed under local or general anesthesia and it lasts for 1 to 4 hours depending on complexity of the case. If the procedure is carried out under local anesthesia, patients can very soon engage in daily routines. In case of general anesthesia patients are mobilized within 1 to 2 hours and they can return to activities of daily life in several days.