New Methods in IVF Treatment | In Vitro Fertilisation in Istanbul | Turkey

New Methods in IVF Treatment

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These days, a variety of novel methods ranging from frozen embryos to genetic diagnosis increase the chances of success in test tube baby treatment (IVF-in vitro fertilisation). These methods make it possible for many infertile couples to have babies. New applications increase the chances of success in IVF.

Ever since its first application, the test tube baby method has helped millions of couples have babies and fulfill their dreams. Nowadays, novel approaches in treatment may increase the chances for success even more

It has been exactly 29 years since the birth of Louis Brown, the first ever test tube baby. Having made sensational headlines all over the world back then, the test tube baby method has been improving day by day and continues to help millions of couples to have babies. In recent years, a variety of methods have emerged which increase the chances for successful treatment even higher. Specialists in this field point out that extended test tube baby and infertility treatments place psychological, physiological and financial burden on the couples. They say that secondary approaches which may speed up the processes result in positive outcomes. We have consulted Associate Professor Cem Demirel on this subject, the specialist in charge of the Test-Tube Baby Unit and Education Centre at Acıbadem Kadıköy Hospital. He says that failure in test tube baby attempts may stem from multi-factorial causes and these are addressed and assessed individually at their centre. Associate Professor Şahin Zeteroğlu who is in charge of the Test-Tube Baby Centre at Acıbadem Bursa Hospital points out to laboratory applications as those factors which increase success in test-tube baby attempts.

What kind of new developments are underway in test-tube baby applications? The head of Acıbadem Kadıköy Hospital Test-Tube Baby Centre, Associate Professor L. Cem Demirel and Associate Professor Şahin Zeteroğlu inform us as follows:"Infertility treatment places significant emotional, physical and financial burden on the couples. In the event of repeated failures in test-tube baby attempts, this also has had an impact on the physicians in charge of the treatment of such couples. This necessitates the application of secondary approaches to shed light on the reasons of failure and ensure more successful outcomes. Here, the failure is either due to the quality of the embryo, a group of cells fertilised in the laboratory and placed in the mother's womb which are in the process of dividing up, or to the inability of the mother's womb to provide a sustainable environment for the embryos placed in it. If repeated inferior embryo quality is identified and observed as the reason for repeated failures in test-tube baby attempts, at Acıbadem Test-Tube Baby Centre we either subject the family to what is called an endometrial co-culture or to natural cycle IVF application. Endometrial co-culture is the name given to the practise of collecting tissue cells from the mother's womb called endometrium, which line the inside of the womb. These cells are then passed through passages in the laboratory and the embryo is developed from these cells prior to its transfer to the mother-to-be. In natural cycle IVF, the eggs of the mother-to-be are collected by either pharmacological stimulation, no stimulation or minimal stimulation. In the event of failure with these methods, we may sometimes recommend egg donation." In the meantime, it is important to identify the role of the sperm and exclude its underlying impact on test-tube baby failures. Dr.Demirel points out that in their unit they also perform the analysis of sperm cells, the male reproductive cells. Dr.Demirel says that they specifically check the DNA breakage ratio of the sperm cells which demonstrate the damage ratio of the DNA that forms the genetic structure of the sperm cells. He indicates that in this way, it possible to take the necessary measures in the presence of high DNA damage.

Sometimes, the anomalies of the womb and of the endometrium layer within the womb where the embryos are placed may be an underlying cause of repeated failures. In the case of certain couples with repeated failures, sometimes the quality of the embryo may be good, but still not result in pregnancy. Then comes the time to examine the uterus bed which may be another important factor influencing successful embryo implantation in a test-tube baby attempt. Here, we identify the presence of any pathology inside the womb which may invade space in the womb or form an abnormal environment in the region and thus prevent the successful implantation of the embryo. These pathologies may be polyps, adhesions, myomas or calcifications. We use an intra-uterine endoscope method called hysteroscopy to remove those pathologies. Hysteroscopy is a method which allows the specialists to directly observe the endometrial cavity lining the inside of the womb and carry out any corrections in the event of encountering any abnormalities. Another underlying reason for repeated failures in repeated test-tube baby attempts is the failure of the endometrial layer lining the inside of the womb to attain an adequate level of thickness for sustaining the embryos, and allowing the development of pregnancy. The reason may be continued exposure of the endometrium to inflammation (endometritis) following miscarriage or abortion, the presence in the womb of a disease called adenomyosis or adhesions remaining in the womb from previous interventions such as abortion or miscarriage. Apart from correcting the underlying condition, vaginal oestrogen support may sometimes have a positive effect on the endometrial thickness of such patients. If the underlying condition is an adhesion, then this has to be removed through hysteroscopy. Again, in some patients, we see the endometrium layer prematurely taking on a shiny appearance and the implantation window closing up prior to the placement of the embryos inside the womb; this results in repeated failures in spite of repeated attempts. Interestingly, some patients may experience this condition repeatedly in every single test-tube attempt. Patients with this condition are advised to have all of their embryos frozen in our centre once they are formed. Once the lining of the womb allows it at some time in the future, the embryos are defrosted and transferred. Associate Professor Şahin Zeteroğlu points out that they have had many successes in their centre with this method.

In women with repeated failures, an investigation is carried out to see whether or not there is any obstruction-related fluid accumulation (hydrosalpenx) in the fallopian tubes, the canals which transport the egg and where the egg and the sperm merge. If the presence of an obstruction is identified, prior to the next test-tube baby attempt, these canals (tubes) need to be either surgically removed or disconnected from the womb. In these patients, the presence of myomas also need to be taken into consideration. It may seem like myomas not extending all the way into the endometrium or not invading the space where the embryos are implanted do not have an effect on the success of test-tube baby attempts. However, in the case of those patients with repeated failures and in the absence of any other explanation, specialists believe that all myomas over 3 cm in size should be removed prior to the following attempt, even if they do not exert any pressure on the endometrial cavity.

Associate Professor Demirel describes another method they try to apply in their clinic on those couples who fail in their test-tube baby attempts. Before placing in the mother's womb those embryos formed in the laboratory environment, they subject them to genetic screening and select the most robust ones to transfer. This method is called pre-implantation aneuploidi screening. The identification of those chromosomes with normal genetic structures and their selective re-implantation in the mother's womb are believed to play an additional role in increasing the chances for a successful pregnancy outcome.

Associate Professor Demirel says there have been dramatic improvements in test-tube baby applications since 1999 which have skyrocketed the rate at which successful pregnancies occur. He continues as follows: "While pregnancy and success rates registered a steady increase until the beginning of the year 2000, there have not been any improvements to top these off over the past 7 years. However, while the success continues at a certain rate, the issue of prevention of side effects has emerged to the foreground. The most important efforts in this regard went into the development of the criteria and the methods which would allow for the selection of the right embryo among many embryos. As such, we are now in a position to be able to transfer fewer embryos, thereby preventing the occurrence of multiple pregnancies. We may now measure the waste substances produced by the embryos in the laboratory or the rate at which they consume the nutrients, monitor their metabolisms, their division rates and blastocytes (5th-6th day embryos), select the best embryo and implant it in the mother's womb. Furthermore, we monitor the development of the embryos on a daily basis and come up with a rating scale. All of these allow us to identify the best embryo for a successful pregnancy outcome; thus, we need to transfer only one or two embryos. As such, multiple pregnancy rates continue to decline."

In Associate Professor Demirel's opinion, another very significant development has been the ever-increasing levels of success attained in the freezing and storage of female eggs containing reproductive cells and embryos developed from fertilised eggs. The most important benefit will be the freezing and the storage of the reproductive cells of those men and women who have been diagnosed with cancer and received chemotherapy. As such, women and men who run the risk of losing their reproductive capacity because of chemotherapy will be able to have children in the future. Even though we have been able to freeze and store the sperm cells for a long time, problems relating to the freezing and the storage of the female reproductive cells (eggs) have only recently been solved. There has been an increase in the number of pregnancies made possible by the defrosting of previously frozen egg cells and their reutilisation. Furthermore, those extra embryos that do not get to be transferred in test-tube baby implantations are frozen and stored for later use, gaining value as a method which increases the success of test-tube baby attempts.

With a significant number of educational centres already underway, Acıbadem Healthcare Group has slowly but surely been assuming the identity of an educational organisation. An illustrative example for this would be the Centre for Test-Tube Baby Education certificate given to the Acıbadem Kadıköy Hospital Test-Tube Baby Centre by the Ministry of Health. This education encompasses all of those processes relating to the training and the certification of all clinicians and laboratory staff who will be working in the field of test-tube baby and assisted reproductive techniques. At the end of a six-month training period, all embryologists who will be working in the laboratories of the Treatment Centre for Test-Tube Baby and Assisted Reproductive Techniques and the obstetricians who will be delivering the clinical applications will be receiving their certificates of competency, entitling them to perform the applications in this field. In charge of Acıbadem Test-Tube Baby Unit and Education Centre, Associate Professor Cem Demirel defines their objective as training competent and qualified professionals in the field of assisted reproductive techniques. He hopes to turn their programme into a successful post-doctoral training programme.

Couples have an important role to play in increasing the likelihood of success in test-tube baby applications. Associate Professor Şahin Zeteroğlu says that first and foremost, the couples have to live a balanced life and continues as follows: If there is smoking and alcohol consumption, both of which interfere with the quality of ovulation or the quality of the egg, or any other bad habits on the side of the father-to-be which may interfere with sperm quality, the parents-to-be have to avoid these. The couple should adhere to a balanced diet. If the mother-to-be is overweight, it would be to the benefit of the process for her to lose some weight and start a new way of life. Emphasising that psychology plays a very significant role in this process, Associate Professor Zeteroğlu remarks that patients are under tremendous psychological burden at the time of their application to the clinic. He says it is up to them to prepare the patients as best as they can so that they can minimise the effect of unidentified factors.

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The Acibadem Health Group  2009-05-05   Articles/Press Releases

Jesse Tino