How Previously Unsuccessful IVF Trials Can Be Successful?
How Previously Unsuccessful IVF Trials Can Be Successful?
Before taking the patients, who were unsuccessful in two or more IVF application previously, to the next treatment, previous trials of the patient should be taken into consideration and a different treatment protocol should be applied to the patient.
1- Methods to be applied if pregnancy is not achieved although the quality of the obtained embryo is good or very good
A- Office Hysteroscopy: If pregnancy does not occur although at least two embryos were given, it is possible to diagnose diseases which prevent holding embryo such as 20% polype, adehesive, myoma and intrauterine parts and at the same time to treat and remove during the same operation. With Prof Dr Recai PABUÇCU, who is among the pioneers of this operation in Turkey and trained many doctors, and his team, this operation is applied to our patients successfully at our clinic without need to anaesthesia and pain.
B- Opening or Removing Diseased Tubes (Channels) with Laparoscopy Method: If there is adhesiveness, occlusion in tubes or liquid is accumulated in tubes due to the occlusion (hydrosalphinx), it was proved that the liquid which occurs as a result of this occlusion, adhesiveness and hydrosalphinx prevents that embryos are held certainly as a result of leaking into the utero. AS a result of opening, removing the tubes of these patients or blocking the area where tubes go out of the womb with laparoscopic (closed) method, this problem which causes that the embryo falls is removed.
C- PGD (Preimplantation Genetic Diagnosis) (Genetic Monitoring of Embryo): A blastomer (cell) of a 8-cell embryo can be taken and biopsy can be performed and chromosome structure and some gene defects of the embryo can be determined before implanting in the womb. Recently, in parallel with the development in the gene technologies, these techniques, which were used restrictedly only in research centers, can be used more commonly and practically. Although the area develops quite rapidly, it should be applied to a limited number of patients at the clinic (risk of inherited disorder based on gender- muscle dystrophies, hemophilia etc. translocations, chromosome count disorders, some known gene defects, etc.)
These techniques never claim 100% healthy child. In fact, most of the experienced clinics recommend classical antenatal diagnosis methods, amniocenteses and chronionic villus biops, in pregnancies obtained after using these methods. Preimplentation genetic diagnosis method is also applied at our clinic successfully and especially when embryo is transferred after genetic diagnosis in women over 38 with more than three embryos, pregnancy is obtained closer to the young age group. In addition, it is useful if there are more than two unsuccessful IVF trials. Since there may be genetically defected embryo as a result of insemination in males with sperm count defect, it must be used to select healthy embryos.
D- I.M.S.I. (intracytoplasmic morphologically selected sperm injection): It is a method which increases success especially in males with low sperm count and activity. Very special microscopes eqruipped with advanced technology are used for this operation. In operations using IMSI technique, intracellular structure, cell nucleus of the sperms which are magnified 16.000 times more than an ordinary microscope can be examined in detail and thus the best sperms can be selected without being degenerated. Later, the success is increased with microinjection operation carried out with these sperms.
E- HLA-G5: Identifying the HLAG5 protein produced by embryos with high holding ability and using it in embryo selection will increase pregnancy rate. This method is used at our clinic.
F- P.I.C.S.I.: It is method used for selecting mature sperms and separating genetically defective ones during microinjection. A special protein on the cell membrane of the genetically normal sperms enables that these sperms stick to the plaques prepared in laboratuary. Sperms which do not have this protein cannot pass the plaque and success is increased with this method that enables using it outside.
G-Assisted Hatching (AHA): It is a technique developed to increase the attachment rates of embryo to the womb. In this technique, the sheath surrounding the embryo (zona pellucida) is thinned with laser, acid or mechanical methods. These methods do not have superiority over each other and one of them can be used according to the experience of the clinic. On the transfer day, embryos are evaluated together with the age and story of the patient and it is decided whether this operation can be implemented or not. This operation can be used in transfer of frozen embryos. Pregnancy rates can be increased in inseminated cells with this method. However, it is not clarified yet.
2- Methods Which Will Increase Success in Phenomena in Which Bad Embryo is Obtained
A- I.V.M. (In Vitro Maturation): The groups in which this method, which is also known as drug-free in vitro fertilization treatment, will be tried are patients in which mature ovum is not obtained despite stimulation with drug; patients with bad quality embryo that cannot be explained with any reason; patients with polycystic ovary syndrome and the risk of ascites and in which mature ovum cannot be obtained and patients who take chemotherapy or will be desexualized. Mostly ova are collected early without need to drugs. They are grown, matured with special methods in the laboratory environment and then microinjection is applied. In addition to obtaining more quality embryos in above patient groups with this method, overstimulation risk will be eliminated. However, remember that this method is suitable only 5 – 15% of all IUF cases.
B- DEFRAGMANTATION (Cleaning Hazardous Fragments in the Embryo): While some embryos are developed, some unwanted fragments occur in addition to cell division. These fragments reduce the success of the treatment. For that reason, experienced teams clean these fragments with special techniques and special micro-pipettes under the microscope and increase the pregnancy rate with the fragment free embryo.
C- Endometrial Co-Culture (Co-culture/Artificial Womb): It is method used in patients with Recurrent unsuccessful IVF experience and bad quality embryo. A small piece taken from the intrauterine tissue (endometrium) of the patients is combined with mother serum and some special matters and a new medium is prepared. The ova are grown in this medium after microinjection and better quality embryos are obtained. This method is applied to appropriate patients successfully at our clinic.
D- Differentiating Medication for Success: Experienced gynecologic endocrinologists can obtain better quality ova by changing the ovulation programs applied to the patients and the success of the treatment is increased by arranging it individually to the patient. For example, better quality ova are created in patients with PCO by implementing special programs which are called as patient friendly programs and the success is increased. Prof Dr Recai PABUÇCU is quite experienced on this subject