In Vitro Fertilization

The first private In Vitro Fertilization Center of İzmir: İRENBE

İRENBE is the first private in vitro fertilization center of the Aegean Region and İZMİR, pearl of this region. We are following the latest technology and developments being aware of the responsibility we undertake with this feature.

We provide opportunity for any kind of examination and treatment related to infertility for the couples longing for a baby from different regions of our country and the world who applied to İRENBE.

In this field, the applications all hormone analyses, ovulation follow-ups, sperm analyses, HSG (hysterosalpingography) with or without anesthesia, office hysteroscopy, laparoscopy, in our embryo laboratories; sperm washing methods, selection techniques for the best quality sperms with micro-chip, oocyte, sperm and embryo freezing techniques, Microinjection (ICSI), Assisted Hatching, embryo biopsies, TIME-LAPSE.

It is our main purpose for couples coming to our center to have a baby to take reason-based treatment and concluding the treatment in a brief time with the highest achievement possible. The treatment process must be planned by taking the age of the couple, infertility period and previous treatments into consideration. The treatment methods special for couples are applied by our specialist and experienced staff in our laboratories in the world class in our center.

The Process in the In Vitro Fertilization

PRELIMINARY EVALUATION

İRENBE is a "Women's Health Center" at the same time. Every woman applying to out clinic is evaluated in terms of her general and gynecological situation. Complete blood count, blood type, preprandial blood glucose, lipid profile, level of some vitamins in the blood, thyroid function tests, cervix swab evaluation (pap smear), breast examination - ultrasonography andmammography are conducted on women. Necessary consultations are requested towards your diagnosed diseases. Your ovary reserve and possible gynecological problems are studied with the examination conducted in the 2. or 3. day of the menstruation. If necessary, it might be asked for some hormone analyses. Cervix roentgen might be required for determining the situation of the cervix cavity and the tubes right after the menstruation finishes. If the patient is male, he gives a sperm sample with a sexual abstinence for 3-5 days. A new sample, if necessary urological examination, hormone analysis and genetic analysis might be requested in the patients with negative sperm analysis results. It might be necessary to conduct hysteroscopy (monitoring the uterus cavity with a camera) and laparoscopy (monitoring the abdominal cavity with a camera, performing the necessary medical intervention=closed surgery) under anesthesia towards the problems identified by examinations and analyses. It might be necessary to fix the health problems of the applicant couples, if there are, (diabetes, goiter, anemia, heart disease), for those patients with high body mass index to lose weight and to stop smoking before starting to the treatment. If it is regarded necessary, reinforcement of insufficient vitamins and antioxidant can also be done.

STARTING TO THE TREATMENT

Even though the reason is man factor, the woman takes treatment in the in vitro fertilization. In order to have an efficient treatment, it is essential to have sufficient amount of egg and sperm of good quality. In this sense, there are many egg stimulation protocols being applied. It is decided which of these treatments are suitable in the light of personal data (age, egg count, body mass index, smoking, procedure features-PGD etc.). In this sense, the treatments and medicines are as follows; 1) Long protocol For the patients with sufficient egg reserve, it generally starts in the 21. day of the menstruation cycle before the month that the treatment will start. Contraceptive pills can also be prescribed in advance. Your body's own control system is suppressed by injecting certain doses of GnRH-analogs. The purpose here is to prevent your ovaries to work beyond our control. These medicines are used until egg is collected. When you have your menstruation, the medicines adjusted suitably for you are applied to you for 10-12 days. 2) Short protocol (antagonist) The egg-stimulant medicines are started to be applied after the examination in the 2. or 3. day of the menstruation. GnRH-antagonist medicines are added for your eggs not to crack on its own in certain days of the treatment depending on your response to the treatment. This treatment is mainly applied to the patients with insufficient egg reserve as much as it can be applied to any patient groups. 3) Co-flare and microdoseprotocol This treatment is mainly applied to the patients whose egg reserve has decreased. The treatment in Co-flare protocol is applied by starting to use GnRH agonist in the 1. or 2. day of the menstruation and by adding egg-stimulant medicines. 4) Modified protocol where Co-fare and antagonist protocol are applied together (ultra short agonist + antagonist protocol) 5) Clomiphene citrate or letrozole in antagonist protocol 6) Consecutive stimulation Double stimulation in the same cycle (this kind of application gives result in cases with insufficient egg reserve.)

MAINTENANCE OF THE TREATMENT

A follow-up period for 10-12 days starts after the selection of the suitable protocol. In this period, your response to the treatment is checked by conducting ultrasonographic examination and if necessary hormone analysis (estradiol, LH, progesterone) coming to the clinic 3-4 times. Addition or reduction for medicine is applied according to the results. The size of the vesicles filled with liquid containing egg cells called FOLLICLE is approximately 18 mm. It is very important to maintain the treatment meticulously in this phase.

FINAL PHASE (EGG MATUREMENT OR CRACKING)

When the size of your follicles becomes 18 mm, it is ensured that your eggs are matured and obtainable by gibing the suitable injections, the procedure to gather the eggs are carried out under anesthesia from the vaginal route and by the help of ultrasound 34-36 after the application of the medicine.

Egg Retrieval

Intravenous anesthesia was performed. In a customized needle and pump line, the round vesicles (follicles) are sucked in and taken into the tube. Chemicalized eggs in the laboratory are separated from this liquid.

LABORATORYPHASE

The eggs are put in specially-prepared devices called incubator 3-4 hours after gathering the eggs. Purification from the sustenacular cell mass (Cumulusoophorus-granülozacells) around themprocedure starts following this.It is identified whether it is matured or not under microscope. The conventional method, also known as classical method, applied in a way that 100 thousand sperms will be surrounding each egg might be applied for patients with sperm count of 15 million and above, sufficient mobility (40% and above) and normal morphology.The successful clinics around the world apply this method for 25% of their suitable patients. On the other hand, 1 sperm is injected into each egg in microinjection. This method can generally be applied in patient groups whose egg reserve has decreased, from whom few amount of egg can be obtained, with small sperm count or from whom sperm can be obtained by surgery as much as in other patient groups. Impregnation rate in microinjection is around 70-80%. Whether impregnation is successful is generally checked 16-17 hours after the impregnation procedure (the following morning). If the impregnation is successful, cell division controls are conducted (CLEAVAGE PERIOD). These processes are carried out automatically in the incubator for embryos in the video follow-up. Fertilized eggs (embryos) stay in special liquids and special environments (incubator=devices of which the heat and gas features are adjusted) imitating the mother's womb until they return to the uterus.

EMBRYO TRANSFER

The embryo transfer is generally made in the 2.-3. day in fresh embryo transfer procedures. It can also be done in the 5. day (blast) in suitable patients (if there are high number of embryos of good quality). Transfer procedure is pain-free and it is applied without anesthesia when you feel the need of urinating.It is not different than examination. Embryos put in a special catheter are transferred to theuterus by the help of ultrasound. Progesterone and the derivative medicines started to be used in the day of egg gathering procedureshould be used until the pregnancy test. It is also used in order to accumulate embryo for unexpected endometrium problems, infection, allergy, liquid in endometrium, PGD.

EMBRYO FREEZING

If you have embryos of good quality, they are stored by freezing for 3. or 5. days depending on their days. This method reduces the cost for future attempts and therefore, also increases your chance for pregnancy. Moreover, your embryos can be stored for 5 years as stated in the law with embryo freezing method. Embryo freezing has become a reason for preference in cases with no time problem since the possibility to trasnfer recently frozen and deiced embryo is higher compared to the fresh cycles and also risk for ectopic pregnancy is less.

PREGNANCY TEST

Pregnancy test is conducted in the blood (b-HCG) after 12 days following the egg gathering procedure. Another test is carried out 2 fays later for the patients with positive result to follow whether the process of pregnancy is healthy.The patients with regular increase are called for ultrasound control 10-12 days after the last test. Medicines continue to be used in the stated order for the first 3 months of the pregnancy.

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