Frequently Asked Questions About In Vitro Fertilization Treatment

The success of in vitro fertilization treatment is closely related to the selection of the right center and physician and fulfillment of all requirements of the process by the candidates. There are numerous questions that couples intending to have a baby may ask about the process. The success of treatment is conditional upon following the rules of the IVF team and avoiding common but wrong practices.  

Assoc. Prof. Özkan Özdamar from IVF Center of Memorial Bahçelievler Hospital answered the frequently asked questions about IVF treatment.

• What is infertility?

Infertility is defined as the inability to conceive within 1 year or more of regular unprotected sexual intercourse. The definition also includes pregnancy loss.

• What is IVF & Microinjection? What are differences between these procedures?

“In vitro fertilization” is a process of fertilization where an egg is combined with sperm in a laboratory dish.

Microinjection is a method in which the sperm cell is taken into a needle and injected into the center of the egg cell to induce fertilization. Therefore, especially in male infertility, microinjection metod increases chances for fertilization and pregnancy.

• What are the factors affecting fertility of women?

Genetic traits, advanced maternal age, regularity of menstrual cycles, sexually transmitted diseases, excess weight and insulin resistance, smoking- consumption of alcohol- excessive caffeine and stress are among the factors that affect fertility.

• What are the stages of in vitro fertilization treatment?

After the initial consult, examination of tests and subsequent decision stages, the process of medication administration will start according to the protocol determined by your doctor. Medication administration is usually started on the 2nd or 3rd day of menstruation (short preparation protocol). Your doctor will determine the frequency of your egg follow-ups. An ultrasound check will be performed to check the size and count of your eggs as well as the endometrial thickness. This is the process of monitoring ovulation and will take approximately 10 days.

The next stage is egg collection. Eggs are collected 2 days after maturation.  Sperm will be collected from the male partner while the female partner is having US-guided vaginal egg collection process performed under general anesthesia; fertilization will be achieved by microinjection procedure. Embryo transfer will take place 2-3 or 5 days after selection of the best quality embryos from those on follow-up in the last process.

• Does IVF reduce ovarian reserve?

No, female babies are born with a fixed number of eggs inside their ovaries. A part of this reserve is lost until adolescence. Later, starting from puberty, the ovaries will produce and release the eggs into the female reproductive tract, within the week before menstruation begins, to grow in the subsequent period. Only 1 or 2 of the eggs develop and reach ovulatory maturity, prepare the uterus for potential pregnancy. If pregnancy does not occur, the same cycle will be repeated in the next period. Eggs collected in an IVF treatment are those produced for that month; new eggs will develop from the egg reserve within the next month.

• Does IVF lead to an early menopause?

No, women are born with a certain reserve of eggs. In an IVF treatment, the eggs available in the ovary within the month of procedure will be developed and collected. The age at which a woman reaches menopause is genetically determined, regardless of IVF treatment.

• Are all developed eggs fertilized?

No. When medications are started for egg development, not all eggs show the same rate of development. Moreover, fertilization and cell division do not occur at an identical rate following egg collection and microinjection procedures. Some may even show no improvement or cease to develop at any stage. Studies carried out so far have revealed that the most important factor underlying such developmental differences of embryos may be related to the genetic traits of the egg-sperm, and consequently, of the embryo.  

• Is there an upper age limit for IVF treatment? Does age affect the chances of pregnancy?

Any woman with an egg reserve can have an IVF treatment. After the age of 40, chances of fertility, pregnancy and delivery will be lower. After the age of 45, the probability of a successful pregnancy can be as low as 1-5% even for women with an egg reserve. The pregnancy rates will decrease progressively with increasing age. Thanks to our experience, we have achieved cases of successful pregnancy and delivery at the age of 45-46 with patients’ own eggs.

• Do blocked fallopian tubes prevent pregnancy? Does a tubal blockage reduce success in an IVF treatment?

If fallopian tubes are blocked, this will negatively affect the normal process of pregnancy. In the process of a spontaneous pregnancy, the union of a human egg and sperm usually occurs in the fallopian tubes. The preimplantation development for the first 5 days and the subsequent transport of the embryo take place within the fallopian tubes. Since fertilization in an IVF treatment takes place outside the body, the chances of pregnancy will not be affected by tubal blockage. However, in some cases where the probability of embryo implantation may decrease due to fluid buildup in the tubes, laparoscopic surgery may be necessary for closing or removal of one or both of the tubes. In such case, you will be informed in detail by your doctor.

• Do fibroids decrease the chances of getting pregnant?

Fibroids extending into the uterine cavity may prevent successful embryo implantation or development, or cause a miscarriage- preterm birth. If the embryo implantation occurs within or nearby the area where the fibroid is located, this may lead to flawed blood supply and eventually a miscarriage. In the advanced stages of pregnancy, fibroids may degenerate or rotate around its own axis, causing significant pain or even preterm labor. The simplest test showing the presence of fibroids in the uterus is Hysterosalpingography, which is an x-ray examination of the uterus. Further examination is performed by a minor operation called Hysteroscopy, in which a viewing scope is used to examine the interior of the uterus.

• Does the presence of fibroids reduce egg reserve?

No, the presence of fibroids does not reduce the egg reserve. The ovaries and fibroids are separately located. Fibroids are located in the uterus. In presence of fibroids, the doctor will examine the patient and provide details about whether the fibroid may prevent pregnancy, and also inform the patient about available treatment options including surgical intervention, if required.

• Do fertility drugs increase risk of cancer?

No, there is no evidence that drugs used in an IVF treatment increase the risk of cancer. Numerous studies conducted on the subject show no direct relationship between such type of drugs and ovarian, uterus or breast cancer.

• Do IVF drugs cause weight gain?

The drugs used in an IVF treatment may cause weight gain due to edema in the body and increase in appetite. As the function of such drugs is to produce normal hormonal effects in the body, side effects related to weight gain may be observed. The administration of such drugs do not cause an irreversible weight gain. Furthermore, female patients enduring the distress of the situation may develop depressive-like behaviors, which will eventually result in changes in eating and drinking habits and in weight.

• Do hormone drugs have any side effects?

Depending on the level of sensitivity, female patients may have complaints such as itching, mild pain, burning and irritation as well as bruising on the injection sites. Additionally, breast tenderness, hot flashes, emotional distress, and pain in the groin area- bloating, constipation, and frequent urination may also be observed during an IVF treatment.

• Is it safe to get hair colored whilst on IFV treatment?

Hair dyes are not dangerously toxic, so patients can color their hair during IVF treatment and pregnancy. A small amount of hair dye may be absorbed by the skin during the hair coloring process. As the absorbed amount of dye is insignificant, it will have no harmful effects on the development of the fetus. Patients should prefer only ammonia-free organic hair dyes during pregnancy.

• When can I return to work after IVF treatment?

There is no need to keep patients at bed rest after IVF treatment. You can go back to work the day after the embryo transfer. Bed rest is not proven to be effective in increasing the chances of pregnancy. During the treatment, patients can take time off only for the days of egg collection and embryo transfer (2 days in total).

• What are the success factors to consider when going through IVF?

The factors which have an effect on the success of IVF include the female patient’s age, amount and quality of egg reserve, stress, weight management - starting treatment at a healthy weight, presence of structural problems (e.g. fibroids, uterine anomalies), sperm count and quality, smoking and alcohol consumption, thickness and structure of the endometrial lining to enable a fertilized egg to implant, and genetic problems of the couples.

• Is it safe to fly or drive after embryo transfer and during IVF treatment?

Yes, it is safe to drive and fly after receiving IVF treatment.

• How many embryos can be transferred at a time?

For prevention of multiple pregnancies, a restriction is imposed by the Ministry of Health on the number of embryos to be transferred to patients. Maximum 2 transfers can be performed to patients over the age of 35 and maximum 1 transfer to those under the age of 35. For patients under the age of 35, 2 transfers are allowed after the first 2 unsuccessful attempts.

• What happens to extra embryos after IVF?

Any excess embryos can be cryopreserved by obtaining informed consent of the couples. Following a failed IVF treatment, the cryopreserved embryos can be used for later attempts or another pregnancy. There is no difference in pregnancy rates between the transfer of cryopreserved embryos and the first transfer.

• What procedure is followed when pregnancy is not achieved in couples with no medical problem?

Some couples are diagnosed with unexplained infertility when no unknown cause of infertility is detected. The highest rate of pregnancy with IVF treatment is achieved in this group of patients. In some of the cases, the cause of problem is detected during the treatment. It is possible that low quality eggs or fertilization problems can only be detected during and after egg collection and microinjection.

• Does IVF treatment take long?

The treatment starts on the 2nd or 3rd day of menstruation and ends after approximately 16 or 17 days. Following a waiting period of 10-12 days after the embryo transfer, blood test will be done to check pregnancy.

• Is there a higher risk of miscarriage after conception with IVF treatment as compared to normal pregnancy?

Today, pregnancies achieved by the IVF method are followed up like normal pregnancies. This may be considered as a risk only in case of multiple pregnancies. Additionally, a general fact is that infertile couples have a higher risk of genetic anomaly as compared to other members of the society. Regardless of how pregnancy is achieved, such couples are more likely to experience genetic problems in pregnancy, and consequently, miscarriage.

• Is bed rest prescribed after the embryo transfer?

A strict bed rest is not recommended after embryo transfer. There is no evidence that bed rest increases the chances of pregnancy. Patients can return to routine daily work following a 20- minute bed rest after the embryo transfer. It is appropriate to restrict sexual intercourse and tasks involving a lot of effort.

• Is ectopic pregnancy observed after IVF treatment?

The risk of ectopic pregnancy is observed in 2 out of 100 normal pregnancies. This risk is slightly higher in IVF treatments. The increased risk of ectopic pregnancy in such couples is caused by the factors leading to infertility such as damaged fallopian tubes.

• Is sex selection possible with IVF treatment?

Yes, sex selection is possible through genetic testing which is usually performed after the IVF treatment. Yet, sex selection is legally prohibited in Turkey as specified in the IVF Regulation. Therefore, genetic testing cannot be performed for sex selection. In Turkey, sex selection is allowed only in presence of inherited chromosomal disorders.

• Who should get genetic testing?

Preimplantation genetic diagnosis (PGD) is a diagnostic method recommended for parents at known risk of passing on serious genetic disorders to their children. PGD is used to identify certain gene defects in the embryos of couples with genetic diseases such as cystic fibrosis and thalassemia, and eliminate embryos with defects before pregnancy occurs, without need to terminate pregnancy. Preimplantation genetic diagnosis offers an alternative for couples who are at risk for such genetic diseases or unable to achieve a healthy pregnancy due to recurrent miscarriages caused by structural chromosomal abnormalities (e.g. translocation, inversion, etc.).

• Is there a difference between babies conceived via IVF or naturally?

No, there is no difference between pregnancies achieved via IVF and normal pregnancies.

• When can I take a pregnancy test after IVF? Can I take a urine test?

Urine tests may not detect pregnancy until HCG has risen to a certain level, so they may give false negative results in early pregnancy. (For example, if the test is sensitive up to a value of 100, it will cause a false negative result when the value is 25 in early pregnancy). Also, visual results may sometimes be misinterpreted. Therefore, a blood test to be done approximately 10-12 days after the embryo transfer will provide the most accurate result. In normal pregnancy, HCG in the blood cannot be detected earlier than 2 weeks after the intercourse.

It is also important that: In a healthy pregnancy, HCG in the blood will nearly double at 2 day intervals. When this value reaches a value of 2000, pregnancy can be monitored via ultrasound scan.    

• Should a special diet be applied before IVF treatment?

It is highly important to stick to a healthy diet in the IVF assisted reproduction. The success of the treatment depends on a good physical health. If the couples have smoking habit, the primary measure should be smoking cessation. Maintaining the ideal weight before pregnancy is among the success factors. Protein-rich foods should be consumed regularly (3 times a week). Daily water intake of around 2-3 lt is recommended. Legumes such as chickpeas and beans should be consumed in higher amounts. Tea and coffee consumption may be reduced (2-3 cups a day). Carbonated drinks should be avoided. Folic acid supplements and foods rich in folic acid should be consumed.

Before starting the IVF treatment, other metabolic problems (thyroid, insulin resistance, diabetes ..) should be eliminated to increase the chances of success and healthy pregnancy.

• Will pregnancy loss and abortion reduce chances of pregnancy in subsequent IVF attempts?

Termination of pregnancy with abortion will not cause problems with the ability to conceive again unless there is any complication during or after the procedure (such as remaining tissue, infection, adhesion).

Yet, especially after an early pregnancy loss, it may sometimes be necessary to perform a genetic testing of the couple before a new attempt. It should be noted that the result of a genetic test can be obtained in 2-3 weeks.

• Are there certain dates for the tests required before IVF treatment?

Certain hormone tests (FSH, LH, estrogen, progesterone) should be performed on certain days (Day 2 - 3 or 21) of menstruation. There are no time restrictions for other tests. Some of the tests should be performed on empty stomach.

• Does the duration of treatment vary depending on the protocol selected in IVF treatment?

The first step in the IVF is to prepare the female patient for the treatment. The preparation can be in two ways; the first one is the long protocol starting on Day 21 of the menstruation, with egg collection performed approximately in 3- 3.5 weeks; and, the second one is the antagonist protocol starting on Day 2-3 of the menstruation, with egg collection performed approximately in 10-12 days. 

Embryos collected via the mentioned protocols are transferred into the uterus either by using fresh embryos (in the same period with egg collection) or by freezing - thawing procedure (embryos are initially cryopreserved and later implanted in another period deemed appropriate by the physician) depending on the patient’s special conditions and the physician’s habits.

• What should be done if the sperm count is low or zero in the semen analysis?

In such case, a single analysis alone will not be enough for a final decision. The findings should be confirmed by a second analysis 3 weeks later. If the results of the second analysis is identical or similar to the first one, necessary data should be obtained primarily by conducting genetic and hormone tests or testicular ultrasound scan. Later, the patient should be consulted by an andrologist-urologist if necessary.  

If the specimen contains no sperm, it is possible to obtain sperm from the testicle by using the surgical method known as Micro TESE.  Preferably, TESE procedure is planned concurrently with the egg maturation process; the IVF is performed by egg collection after the sperm is obtained. However, the microTESE operation may sometimes be performed for diagnostic purposes before the female partner is prepared. Sperm, if detected, may be cryopreserved and then the female patient may be prepared.

• My periods are painful. I want to have a baby. What should I do?

Menstrual pain is especially observed with a disease called endometriosis. If you have menstrual pain and cramps, and want to have a baby, we recommend you to be checked by a specialist immediately for egg reserve and endometriosis problem.

• How is an embryo transfer performed?

After the patient is prepared on the gynecological examination table, as in the examination position, the speculum will be placed. The cervix will be cleaned. Later, the embryos brought from the laboratory by the embryologist will be placed inside the uterus by using a thin catheter. The procedure is not painful. For the US monitoring of the progression of the catheter in the uterus on the abdomen during insertion, the woman is expected to have full bladder.

• How is an egg collection procedure performed?

An egg collection procedure is vaginally performed under mild sedation. Firstly, vaginal secretions are cleared out. Later, a needle is placed on the vaginal US probe which is advanced like an injection through the vagina into follicles; fluids are aspired and egg cells are obtained. Mild pain and vaginal bleeding may occur after the procedure.

• When will the embryo implant after the transfer?

Following the embryo transfer, the 5 day blastocyst implantation will take place within 1-5 days. Considering the egg collection day; it can be said that the implantation will occur in the next 6-10 days. In other words, the embryo will have attached to the endometrium no later than on the 10th day after egg collection if the procedure is successful. 

• May bleeding occur after embryo transfer?

Following an embryo transfer, vaginal bleeding may occur due to 2 main reasons: The first reason is a trauma during embryo transfer, that is, the irritation caused by the catheter passing through the cervix (especially in complicated transfers). The second reason is bleeding during the attachment of the fertilized egg, medically known as implantation bleeding. However, both are temporary and in small amounts and in form of swab - spotting bleeding.

• Is there any difference in pregnancy rates between the transfer of cryopreserved embryos and of fresh embryos?

There is no difference in pregnancy rates between the transfer of cryopreserved embryos and fresh embryos. Even in some cases, embryo transfer through freezing-thawing may have positive effects on pregnancy success rates. 

• What are the risks of IVF treatment?

There are some minor risks and side effects at every stage of the IVF treatment. Side effects of the applied drugs are tolerable and temporary. Pelvic infection after egg collection is possible, though very rare. This problem can also be eliminated by antibiotic treatment. Ovarian bleeding may occur. Yet, such bleeding is in a small amount. In very rare cases, management of the bleeding may be necessary. However, it is not a serious risk.

The problem of hyperstimulation (exaggerated ovarian response to excess hormones), which is the most critical risk known, almost never occurs thanks to new treatment protocols and experienced physicians.  

• What is polycystic ovary syndrome (PCOS)?

Polycystic Ovary Syndrome is a common ovulation problem. Patients with PCOS may refer to the doctor with various complaints. In the mildest forms, the patient may refer only with the complaint of inability to conceive without any menstrual or cosmetic-metabolic problems. On the other end of the spectrum, there are overweight women with excessive hair growth in male pattern, and occasionally without menstruation for years. The group of female patients only with the mentioned problem, gives the most successful results in the treatments.

The most important considerations for patients with PCOS are that elimination of insulin resistance, diabetes or other metabolic problems, if any, before the treatment is directly linked to chances of success and health of the female patient and pregnancy. Also, these patients should be very carefully followed up by the physician in terms of the risk of hyperstimulation.  

• How should the treatment be planned in case male patients have morphological abnormalities?

Studies conducted on in vitro fertilization - IVF, in which sperms of a certain number and motility can be used efficiently, that is, selected motile sperms are placed in the same environment with egg cells, and the natural fertilization process is used, revealed a relationship between the fertilization success of sperm and severity of sperm deformities. Since embryologists who perform sperm processing (ICSI) method select the sperms with the most appropriate form and structure by using special methods, morphological evaluation will not have such negative impact as in the IVF treatment, except in certain special cases.

It is of course necessary to exclude special deformities such as Globozoospermia, in which the abnormality in the sperm causes low fertilization.

• When should I take the AMH (anti-mullerian hormone) test to check my egg reserves?

The AMH (Anti-Mullerian Hormone) test is a blood test performed to check the egg reserve. The test has no prerequisite, such as a special time interval or fasting. Nevertheless, the test result should be interpreted by a specialized physician after US-guided examination of the egg reserve; findings should not be interpreted alone.  

• How long of a wait is recommended between a failed IVF cycle and trying again?

If the BetaHCG result is negative after the first IVF attempt, the patient’s next menstruation will be awaited. After a 1 month waiting period from the next menstruation, the treatment can be started again in the next menstruation date. However, the final decision should be made by the doctor.

• Is there a method applied to improve egg quality in advanced maternal age in an IVF treatment?

The egg reserve and consequently the chances of fertilization and pregnancy decrease with the age. Although there are some vitamin-antioxidant preparations commercially available to improve egg quality, there is no clear data to prove their effectiveness.

• Is an IVF treatment possible without drugs?

The IVF treatment involves collection of the matured eggs and fertilization by microinjection. In an IVF treatment without drugs, the eggs are collected before they are fully matured, and this maturation process is performed in a laboratory environment. The purpose of this treatment is to ensure patients, who may be affected by the medication used for maturation of eggs, to continue their treatment without administering such medication. The eggs will be monitored for their development, collected when they reach the desired size and expected to mature for 24 hours in the laboratory environment. Subsequently, the sperm collected from the patient's partner will be injected into the eggs by microinjection method; the embryos obtained will be frozen and then transferred within subsequent month. Especially thanks to new treatment protocols available today, IVM methods are less needed.

• How is the gestational week calculated according to the embryo transfer date?

The last menstrual date will be considered as 14 days before embryo transfer. Or the embryo transfer date will be written on the last menstruation field on the ultrasonography device. The gestational week is calculated by adding 2 weeks to the determined date.

• Is it safe to swim and take a bath after egg collection and embryo transfer?

Patients are generally recommended to avoid extremely hot and humid places such as sauna, Turkish bath, etc. and swimming in the pool or the sea.

• Do I need to make a change in my life during and after treatment?

No, you can return to normal work and social life. Smoking and alcohol consumption, if any, should be restricted. Apart from this, no restrictive change is recommended after the egg collection process, except avoiding sexual intercourse and heavy efforts. Yet, most importantly, patients need to administer the drugs recommended by the physician fully and regularly, and avoid making any change in the medication or dosage without referring to the physician.

• How many rounds of IVF is safe?

It is usually considered that, after 5 failed IVF attempts, the pregnancy rates will not increase any higher. However, we have a couple who referred to us after 15 failed IVF attempts in 11 years; we performed their 16th and 17th attempts. We achieved live birth of twin children in their 17th attempt. But these figures are surely quite exceptional. Usually a limit of around 5 attempts is advised.

• Are missed periods always a sign of menopause? Can a woman get pregnant without having a period?

Menopause is a phase. Occasionally, women may stop menstruating due to sudden mental traumas, excessive stress, diet, physical exercise; such events do not mean menopause. Generally, findings such as irregular menstrual bleeding, hot flashes and increased stress after the age of 40 are signs of the perimenopause. The symptoms will increasingly continue. Absence of menstruation for 6 months and symptoms such as stress - sweating - hot flash - vaginal dryness may also be signs of menopause. Yet, menopause is diagnosed by checking FSH hormone and evaluating other symptoms in absence of menstruation for longer than 6 months. Missed and irregular periods are not always a sign of menopause. For a definitive diagnosis, patients should consult a physician and have their examination and ultrasound findings evaluated. In women with PCO (polycystic ovaries) or with very low levels of hormones regulating ovulation, there may be menstrual irregularities or absence of menstruation. Patients should consult a specialist for a definitive diagnosis.

• Does cancer treatment affect fertility? How can I protect my reproductive health?

Chemotherapy and radiotherapy may lead to loss of female reproductive functions. As such treatments may have a toxic effect on the reproductive cells and ovaries, female patients may lose their reproductive potential. Cancer treatment does not always prevent pregnancy. Before a cancer treatment, the female patient's eggs can be collected and cryopreserved. The same procedure can be applied for the male sperm cells. Especially when a young male or female patient is diagnosed with cancer, collection of his/her reproductive cells before chemotherapy and/or radiotherapy and preservation of the cells will be the primary measure to be taken for future plans to have children.

• Do surgical interventions affect fertility? How can I protect my reproductive health?

Cryopreservation of egg/sperm cells before surgical interventions e.g. for cancer, etc. will enable the patient to maintain future chances of having children. In case of surgical removal of her uterus, a female patient may refer to a surrogate to have her own child; however, this practice is currently prohibited under the laws of our country.

• I don't have plans to get married yet. How can I maintain my reproductive health? Can I preserve my eggs and my chances of becoming a mother?

In Turkey, single women are legally allowed to have their eggs cryopreserved within the framework of the rules set out as per the ART regulations. For this purpose, the patient is examined by a specialist to have her egg reserve checked, and she takes an AMH (Anti-mullerian hormone) test; the evaluation of these 2 data will help decide whether the egg cryopreservation process can be performed. Women with a legally low ovarian reserve, a family history of early menopause and no child can have their eggs cryopreserved.

• What should you bring with you when you refer to an IVF center?

When you visit an IVF center for the initial consult, it is very important for you to take all your medical documents including your previous examinations and follow-ups with you, so that the physician will evaluate those data and ask you to take the remaining tests needed. X-ray of the uterus, semen analysis and hormone testing results, if available, must be viewed and assessed by your physician.

• Do disorders such as uterine polyp, septum, synechia (adhesion) prevent pregnancy? Do they reduce the pregnancy rate in IVF treatment?

Disorders such as septum, polyp or adhesion observed in the uterus are evaluated according to their location. Not every polyp or septum-like formation prevents pregnancy. Your doctor will give you detailed information about the hysteroscopy to be performed if necessary, depending on the location and size of the formations in the uterus.

• What is laparoscopy? When is it recommended?

Laparoscopy is an endoscopic surgery to examine the organs inside the abdomen. It is the gold standard for diagnosing tubal damage and problems. The procedure is usually performed under general anesthesia within one week after the menstruation. Laparoscopy surgery is recommended in cases where there are serious problems with the tubes, such as hydrosalpinx which refers to a fallopian tube that is blocked with a watery fluid. 
Laparoscopy can also be performed to diagnose problems such as ovarian cysts, fibroids or ectopic pregnancy.

• What is Intrauterine Insemination (IUI)? What are the success rates?

The procedure called Intrauterine Insemination is a fertility treatment in which development 1-2 follicles is induced by medication (pills or injections), and then the male partner’s sperm is collected, prepared and fed into the uterus with a catheter before the follicles break open. Chances of pregnancy with insemination are approximately the same as sexual intercourse; the success rates are around 15-20%.

• Who should get IUI treatment? How many times should you attempt IUI?

IUI can be applied to a patient only if both tubes of the female partner are open, her uterus is normal, and the post-wash total motile sperm count is no less than 5 million in the male partner’s sperm sample. In other words, insemination cannot be performed with very low sperm counts or blocked tubes. The number of IUI attempts will be decided according to the individual characteristics of the couples (e.g. age, economic situation, etc.). However, 2 or 3 attempts may be considered adequate to evaluate success.

• How long does it take to start a new attempt after recovering from ectopic pregnancy?

If an ectopic pregnancy has occurred, a new attempt can be started after 3 menstrual periods, assuming that the ectopic pregnancy was diagnosed and treated in the first 2 months. If a surgical operation is planned after ectopic pregnancy (laparoscopy), the new attempt can be started after 2 menstrual periods.

• How is the dosage of IVF drug determined? For which days should I take a leave during the treatment?

Current IVF options are patient-friendly. Treatments involve low dosage medication that the woman can administer on her own, with no harm to the health of the woman or her baby in the long term.

Female patients will not need too many days off during the treatment. During the treatment, they can take time off only for the days of egg collection and embryo transfer (2 days in total). They will not need any more time off after the transfer as there is no other rule than regular use of medication. However, the female patients may sometimes psychologically tend to believe that the chances of pregnancy may be higher if they have bed rest especially after the embryo transfer. In such case, the patient’s request should be respected by taking her comfort and psychological situation into account.

• What is the success rate of IVF treatment in unexplained infertility?

Male and female partners are evaluated together in an IVF treatment. Nearly 20% of the couples applying to the IVF center are not diagnosed with any problems, which is called as "unexplained infertility". During treatment of unexplained infertility, the problem which is not found in examinations and tests may later arise during studies on the egg and sperm cells at the laboratory stage; or sometimes pregnancy is not achieved even though there is no obvious problem at the laboratory stage. The female partner's age and ovarian reserve will definitely have a significant effect on the chances of pregnancy.

Prepared by Memorial Medical Editorial Board.