Many couples achieve results within the first 6 months of their attempt to conceive. In 85% of unprotected couples, pregnancy is expected to occur within 1 year. Within the next 36 months, 50% of the remaining couples will conceive.
The main symptom of infertility is the inability to get pregnant. This condition may have no other symptoms.
In some cases, a woman with an infertility problem may have abnormal menstrual bleeding, while a man with an infertility problem may have hormonal problems such as hair growth or some changes in sexual function.

If you haven't been trying to have a baby for more than a year, you don't need to worry too much about infertility. You can contact your doctor in the following situations:
• If you are thinking of getting pregnant, are over 30 years old and have not had menstrual bleeding for 6 months
• If your menstrual periods are irregular or painful; have pelvic pain, endometriosis, or recurrent miscarriage
• If you have a history of low sperm count, testicular, prostate or sexual problems

Before starting infertility tests, you should be aware that this process requires responsibility and commitment. Your doctor may want to know your sexual habits and give you advice about them if necessary. The necessary tests and trial periods can take months. In one-third of couples with infertility problems, no cause can be found. (Infertility of unknown cause)

The evaluation period can be expensive and uncomfortable, and there is no guarantee that you will get pregnant after all the tests and examinations.

Tests for Men to Diagnose Infertility

The testicles of a non-infertile man should produce enough healthy sperm to be able to ejaculate. Tests for men are to understand whether these processes are damaged.

• General Physical Examination: It is about the examination of genital organs, medical history, past diseases, drugs used and sexual habits.

• Sperm Analysis: The most important test in male infertility is sperm analysis. Your doctor may ask you to give a sperm sample one or more times. The sperm sample is obtained by masturbation and examined in the laboratory in terms of quantity, color, presence of infection, sperm count, shape and motility of sperm.

• Hormone Tests: These are blood tests to examine the testosterone level and other male hormones.

• Ultrasound of the Rectum and Testicular Bag: Your doctor may order an ultrasound to diagnose the presence of sexual problems such as retrograde ejaculation.

What is Spermiogram? Why Is It Done?

While it is possible to determine the causes of female infertility with a large number of tests, a single test can inform us about infertility in male patients. Here this test is "Spermiogram (Semen analysis)".

Sperm Test, Sperm Analysis

In male infertility, the most important test that a person should have is the sperm test.

What is Sperm Test?

The purpose of the test is to microscopically examine the fertility potential of the sperm in the patient.

When Should Sperm Test (spermiogram) Be Done?

If couples who have had a regular and unprotected sex life for one year cannot conceive, the first test doctors will ask from male patients is the sperm test. When couples encounter such a situation, they should have a sperm test.

How is the Sperm Test Done?

Before having a sperm test, the person should abstain from sexual intercourse for 3-4 days. There should be no discharge (sleep, etc.) in these 3-4 days. After this 4-day abstinence, the patient is asked to ejaculate into a sterile container by masturbation in the special sperm delivery rooms of the andrology laboratories specialized in this branch. Since the first drops coming out of the penis are very important, they should definitely not be carried out of the container and if they are overflowed, the staff should be informed. In the sperm sample taken from the person, expert technicians perform the sperm examination by considering the main important criteria such as the number, shape, movement and fluidity of the sperm. In order to obtain a healthier result, a sperm sample should be given twice within 3 to four weeks.

Semen (ejaculate, semen, sperm sample)

The fluid that comes from the man as a result of ejaculation is called semen (sperm sample). In the sperm test examination, the number of sperms, the shape of the sperm (morphology), the motility of the sperms and their quantity are examined, as well as the amount of the semen (sperm) sample taken, its pH, color, presence of leukocytes, fructose amount, liquefaction time (Semen solubility) and the evaluation is made.

There are several different criteria in sperm test evaluation. “Kruger criteria” is a microscopic evaluation method that specifically considers deformities in sperm. According to the Kruger order, the sperms are evaluated according to the disorders in the head, middle part and tail structure. By applying a special staining process, the shape (morphology) characteristics of the sperm are examined and the fertility capacity of the sperm sample is determined.

Tests for Women in Diagnosing Infertility

The ovaries of a woman who is not infertile must regularly release an egg each month, allowing the reproductive system to meet the egg and sperm and become an embryo. The reproductive organs of the woman should be healthy and functional.

After asking questions about your medical history, menstrual cycles, sexual habits, your doctor will ask you to undergo a general examination. This is called a gynecological exam and may also require certain tests:

• Ovulation test: A blood test requested to measure hormone levels and check if you are ovulating.

• Hysterosalpinography: It is performed to determine the clarity of the HSG tubes and whether they have the ability to fulfill their duties, to see the formations and anomalies occupying space in the cervical canal and uterus. Cervical insufficiency, tuberculosis, adenomyosis, fibroids and polyps can be identified with HSG. While the HSG is being drawn, an oily x-ray dye (opaque substance) is introduced into the uterus with the help of a cylindrical catheter passing through the cervix (cervix). By looking at the distribution of this opaque substance, it is tried to reveal the problems related to the intrauterine or fallopian tubes.

• Laparoscopy: It is an operation performed under general anesthesia and a thin telescope is inserted into the abdomen through the belly button to view the intra-abdominal organs. With laparoscopy, it is possible to directly observe diseases or problems related to the uterus, ovaries and tubes and to perform surgical intervention with instruments inserted through 3 - 5 mm holes opened in the lower abdomen. Ovarian cysts, ectopic pregnancies, uterine fibroids, tube surgery and endometriosis can be easily treated laparoscopically.

• Hysteroscopy: A way of looking inside the uterus. With the device called hysteroscope, the diagnosis or treatment of the problem related to the uterus can be made. Hysteroscopy can be used to diagnose certain conditions as well as for therapeutic purposes. For example; uterine adhesions, sections or fibroids can be removed by hysteroscopy. Hysteroscopy can be used for diagnostic purposes in cases such as abnormal bleeding, infertility, recurrent miscarriages, adhesions, and abnormal growths.

• Hormone Tests: These are blood tests to look at ovulation hormones, thyroid and pituitary hormones.

• Ovarian Reserve Test: It can be done to determine the potential activity of eggs after ovulation.

• Genetic Tests: It can be done to understand whether there is a genetic condition that causes infertility.

• Pelvic Ultrasound: Ultrasound is performed to examine the uterus and tubes.

The treatment of infertility may vary depending on the cause, how long you have been infertile, the age of the couples and many other personal characteristics. Some causes of infertility cannot be corrected. However, it is still possible to get pregnant with assisted reproductive techniques.

Treatment for Couples These approaches may concern men, women, or both.

Increasing the number of sexual intercourses. Having intercourse 2 or 3 times a week can increase fertility. However, too much ejaculation can also have an effect that reduces the quality of a man's sperm. Sperm can live up to 72 hours in a woman's reproductive system, and the egg can be fertilized up to 24 hours after ovulation.

What are the Treatment Options for Men in Infertility?

General Sexual Problems: Diagnosing impotence or premature ejaculation improves fertility. These can usually be treated with medication or behavioral approaches.

Absence of Sperm: If the absence of sperm is suspected, surgery, hormones or assisted reproductive techniques are used to correct the problem. For example, varicocele condition is usually corrected with surgery. If there is an obstruction that prevents ejaculation or if there is a back ejaculation situation, sperm is taken from the testicles by operation and injected directly into the egg in the laboratory with the microinjection method.

What are the Drug Treatment Options for Women in Infertility?

In infertile women with ovulation problems, fertility drugs are the most commonly used treatment. These drugs regulate or stimulate ovulation. In general, they work similarly to natural hormones such as FSH and LH. Commonly used fertility drugs are:

Clomiphene Citrate: This drug is taken orally and they stimulate ovulation in women with polycystic ovary syndrome or other ovulation problems. They encourage the pituitary gland to release FSH and LH.

Human menopausal gonadotropin (hMG): This drug is given as an injection to women who cannot ovulate spontaneously as a result of a pituitary gland defect. Unlike Clomiphene, which stimulates the pituitary gland, hMG and other gonadotropins stimulate the ovaries directly. This drug contains both FSH and LH.

Follicle Stimulating Hormone or FSH: FSH stimulates the ovaries to mature the ovarian follicles.

Human Chorionic Gonadotropin, (HCG): Used together with Clomiphene, hMG, FSH; stimulates the ovary to release the egg.

Gonadotropin-releasing hormone (Gn-RH) analogues: This treatment is for women whose ovulation function is irregular or who ovulate before the main follicle is mature enough during hMG treatment. Gn-RH analogs continuously send Gn-RH to the pituitary gland.

Aromatase Inhibitors: This class of drugs such as Letrozole (Femara) and Anastrozole (Arimidex) are approved for the treatment of breast cancer. Doctors may sometimes prescribe Letrozole to women who are unable to ovulate spontaneously and do not respond to Clomiphene Citrate therapy.

Metformin (Glucophage): This drug is used to support ovulation. It is used when insulin resistance is known or suspected to be the cause of infertility. Insulin resistance may also play a role in polycystic ovary syndrome.

Bromocriptine (Parlodel): It is used for women whose ovulation cycle is irregular due to high prolactin level. Bromocriptine restricts prolactin production.

Fertility Medicines and Risk of Multiple Pregnancy

Fertility drugs used in the form of injections increase the chance of multiple pregnancy. Oral fertility drugs such as clomiphene also increase the chance of multiple pregnancy, but to a lesser extent than the other. During the use of these drugs, the patient should be carefully monitored with blood tests, hormone tests and ultrasound to determine the follicle size. In general, the greater the number of fetuses, the greater the risk of preterm birth. Babies born prematurely may have health and developmental problems. These risks are most common in triplets.

The risk of multiple pregnancy can be reduced. If a woman needs HCG to trigger ovulation, and the ultrasound shows too many follicles developing, she and her doctor may decide to suspend HCG. Still, for many couples, the desire to become pregnant precludes the possibility of multiple pregnancies.

When there is a multiple pregnancy, the surgical removal of one or more fetuses increases the chance of survival of the remaining babies. There are also some emotional and moral aspects to this for many couples.

Depending on the situation, infertility can be treated with surgery.

Tube Blockages

Blockages and other problems with the tubes can usually be treated with surgery. It is possible to perform delicate operations on tubes with laparoscopic techniques.

Endometriosis (Chocolate Cyst)

Endometriosis-induced infertility is often difficult to treat. Even though it is not used in the treatment of infertility, thanks to the hormones in birth control pills, treatment and pain relief with their use are effective. If you have endometriosis, your doctor may treat you with ovulation therapy, where drugs regulate or stimulate ovulation, or with in vitro fertilization, where the egg and sperm are brought together in the laboratory and fertilized, and the embryo formed is injected into the womb.

However, if endometriosis is a problem with the embryo, then it can be removed laparoscopically or with robotic surgery. The gold standard in endometriosis surgery is to be performed with robotic surgery.

Myoma Treatment

If the size and location of myomas and polyps in the uterus are risky for the embryo, they can be removed with myomectomy surgery. Myomectomy can be performed with hysteroscopy as well as with laparoscopic and robotic surgery. Your doctor will choose which method is more suitable. However, Robotic myomectomy surgery is the gold standard in myomectomy operations as it causes minimal damage to the surrounding tissue.

In Vitro Fertilization (IVF Treatment):

It is the most effective assisted reproductive technique. The eggs of the woman are collected, they are combined with the sperm taken from the man in the laboratory, the fertilized eggs, that is, the embryos, are placed in the uterus within 3-5 days before fertilization. IVF treatment is recommended when both of the woman's tubes are blocked. It is also used in many conditions such as endometriosis, unexplained infertility, cervical infertility, male-induced infertility and ovulation disorders. The chance of multiple pregnancy increases with IVF treatment because more than one embryo is usually transferred to the expectant mother. In addition, blood values and hormone values are frequently checked in this treatment.

Electro or Vibrating Alert for Ejaculation:

This method is used to obtain sperm. This treatment is applied to men who have spinal cord injury and are otherwise unable to produce sperm.

Obtaining Sperm by Operation:

This technique is based on the operation of removing sperm from the testicles. It can be used when the sperm duct is blocked.

Microinjection (ICSI):

It is based on the principle of injecting a sperm into the egg obtained as in normal IVF treatment. Microinjection can be applied to couples who cannot achieve pregnancy with other methods. In men with low sperm count, microinjection is a factor that increases success.

Assisted Hatching:

This technique helps the embryo attach to the uterus. It can be applied in repeated failures.

With IVF treatment, the chance of pregnancy arises for a patient whose both tubes are blocked. IVF treatment is also used in the following situations:

• Endometriosis

• Unexplained infertility

• Infertility conditions related to the cervix

• Male infertility

• Ovulation disorders

With assisted reproductive techniques, there is a greater chance of pregnancy in the following situations:

• Patients who respond to infertility drugs and ovulate naturally

• Patients who have a healthy uterus

There is less chance of pregnancy with assisted reproductive techniques in the following situations:

• Female patients over the age of 40

• Female patients with early menopause and no longer ovulating

• Female patients with incurable uterine scar tissue, fibroids and polyps

In vitro fertilization is the most preferred assisted reproductive technique. The treatment process begins with the woman using infertility drugs to stimulate her ovaries so that she can produce more eggs than normal. There are follicles in the ovaries. These follicles are fluid-filled sacs.

When the eggs are mature enough, they are retrieved from the ovaries. The follicle fluid containing the egg is taken and placed in a container. Eggs are examined under a microscope. After the incubation period in the laboratory, the washed sperm are added to the vessel. Fertilization and early embryo development take place in this vessel. After 2 - 3 days, the fertilized eggs, that is, the embryos, are transferred to the uterus. This procedure is done with the help of a soft and flexible catheter.

The risks associated with IVF treatment are related to the use of medication and the operation to retrieve the eggs.

Some of these risks are:

• Bleeding

• Infection

• Damage to nearby organs

• Ovarian Overstimulation Syndrome

• Multiple pregnancy risk

Studies show that babies born with assisted reproductive techniques do not have more abnormal conditions than babies born normally.

After your initial evaluation by your doctor, you should make another doctor's visit before starting IVF treatment. During this visit, you will discuss with your doctor about your treatment plan. During one of your doctor's visits, your uterus can be measured with the help of a catheter. Catheter; It is a thin, flexible tool that is used to place the embryo in the womb. Since the catheter is first inserted into the cervix and then into the uterus, the size, shape and direction of the uterus can be determined by the measurement. This is beneficial in embryo placement. Blood tests will be done to identify any infections you or your partner may have.

A sperm sample is requested from the man so that it can be analyzed. If an abnormal situation is encountered in the sperm analysis, another sample may be requested for further examinations.

Nurses will tell you about your treatment plan and how you should use your medications.

Stimulating the Eggs:

The IVF treatment process begins in the menstrual cycle, depending on the egg stimulation process. (about a week before the woman's period) During this period, the woman uses GnRH analog drugs to stimulate her eggs. This drug effectively reduces the release of hormones that control the development of eggs in the ovaries. When you have your period, vaginal ultrasound and blood tests are performed to check whether the drug reduces egg development. If it has not decreased, the drug treatment is continued for another week or two. When the function of the ovaries temporarily ceases completely, true stimulation therapy begins. Hormone therapy is applied for about 10 days to stimulate the ovarian follicles. Blood tests and ultrasound will be needed throughout treatment to determine follicle sizes. The use of the drug continues for about 10 - 12 days. When adequate egg stimulation is achieved, another hormone, hCG, is injected. Eggs are collected 36 - 38 hours after hCH injection.
 

Egg Collection and Fertilization of Eggs:

Egg retrieval is performed under anesthesia. Egg retrieval usually takes between 20 and 50 minutes. The fluid taken from the follicles is immediately taken to the embryology laboratory. In the laboratory, eggs are placed in a special solution and placed in the incubator. The length of time the eggs will spend in the incubator depends on how mature they are. On the day of egg collection, the male collects the sperm sample by masturbation and delivers it to the laboratory. The sperm sample can also be collected outside the center in special cases. In particular, couples who may have difficulties in giving sperm samples outside the home by masturbation without a partner can obtain sperm samples at home. After the sperm is obtained, it should be delivered to the embryologists at the center within a maximum of 1 hour. If this period is more than 1 hour; The male sample should obtain in the center. If it is obtained outside the center; The sample should be delivered to the IVF laboratory at room temperature (without exposure to excessive heat or cold), without exposure to light. In rare cases, a second sperm sample may be requested on the same day. The next step is to combine the eggs with the sperm. The fertilization rate of eggs is usually 80%. Eggs are checked 24 hours after retrieval. Fertilization also took place during this time. If deemed necessary, some embryos can be frozen and stored. If pregnancy does not occur after treatment, frozen embryos can be used for the next transfer. In this way, the patient will not repeat the egg stimulation process again. The patient is discharged within 2 - 4 hours after the procedure and is asked to rest at home for 24 hours. It is natural to have pain in the waist, in the groin similar to menstrual pain, red or brown bleeding (from the chamber) in the form of drops within 1-2 days after the egg collection process. Such bleeding does not have a negative effect on the chance of pregnancy as it is not from the uterus.

You may need to inform your doctor if any of the following conditions occur:

a) Fever higher than 38 degrees by measuring

b) Excessive vaginal (from the chamber) bleeding (some bleeding is normal)

c) Very severe and persistent pain (some pain is normal)

d) Weight gain of more than 1 kg in 2 consecutive days

e) Inability to urinate with increasing pain 8-10 hours after the procedure

Embryo Transfer:

Embryo transfer is done within 1-3 days after the eggs are retrieved. The number of embryos to be transferred depends on the quality of the embryo, but the legal limit is three in our country. After the embryo transfer process, you need to rest for 2 days. 12 days after embryo transfer, a blood pregnancy test (blood beta hCG) is performed. Even if there is bleeding that is thought to be compatible with menstruation, a pregnancy test must be performed because sometimes there may be vaginal bleeding due to the embryo being placed in the uterus even though pregnancy occurs. If the test is positive, that is, if there is a pregnancy, the ultrasound is checked after about 3 weeks.

To begin with, the couples are examined and an anamnesis form (information given by the patient about the disease and the environment) is prepared for the couples by listening to the diseases they have experienced and their treatments, if any, the results of pregnancy and birth events, etc. All previous examinations and treatment reports, if available, are reviewed, and additional required analyzes are performed if necessary, and the results are added to this form. If it has not been done, a spermiogram (sperm test) is requested for the male. For this reason, the man should not have had intercourse (ejaculated) for 3 days before coming to the first examination.

Routine tests requested during normal pregnancy for treatment are valid for this treatment. As requested from the couples (complete blood count, blood group, tsh, hepatitis tests, torch...) and in addition to this, ultrasound examination is requested from the expectant mother. Apart from this, if necessary, the uterine film hsg is taken again.

IVF or ICSI, which is the treatment method to be applied in line with the new tests applied, old tests and Gynecological Examination, is decided. Afterwards, all necessary information is given to the patient couple about the treatment and methods that make up the ovulation treatment, which is the continuation of the treatment, and the treatment and methods that make up the IVF process.

Important Note: When you come to your first appointment, please bring with you all the tests you have had about infertility, film results, surgery reports, if any, etc.

Some patients undergoing IVF treatment experience a blockage problem in their tubes. In cases where this obstruction occurs at the ends of the uterus, secretions accumulate in the tubes and these affect the embryos in a toxic way. As a result, the probability of conceiving is reduced by 50%. This problem experienced by the patients in question can be understood with the HSG method.

When the same problem is seen in the ultrasound evaluation, one of the options to remove or connect the tubes is applied. In cases where the removal of the tubes is on the agenda, the procedure is performed by entering the abdomen from the umbilicus using a laparoscopy camera; In cases where the procedure cannot be performed, tubes are tied in order to disconnect it from the uterus.

Removing Tubes

In cases where the obstruction in the patient's tubes is caused by the accumulation of the fluid called "Hydrosalpenx", the tubes are removed by laparoscopy. In patients who have adhesion problems due to previous abdominal surgery and therefore cannot be applied laparoscopy, the tubes are treated by connecting them from the area where they are adjacent to the uterus.

In patients with fluid accumulation in their tubes, the success of achieving pregnancy decreases by 30% to 50%.

Couples with genetic risk have the advantage of giving birth to a healthy baby with this screening method. After the genetic examination of the embryos before the transfer, healthy embryos are transferred and this result can be achieved. PGD, which is a recommended method for older patients with chromosomal anomaly, enables pre-detection of pregnancy disorders such as Mediterranean anemia and sickle cell anemia.

The PGD Method is a diagnostic method that serves the goal of IVF treatments, “To ensure that healthy babies are born into the world, not too many”. Thanks to this method, many couples at risk of having a diseased child can be analyzed before the transfer.

With the PGD method, a diagnosis can be made by revealing the problems of women who have abortion due to a chromosomal disorder problem or who have unsuccessfully tried in vitro fertilization treatments, who have chromosomal anomalies in their eggs at advanced ages and who carry genetic risk.

In simple terms, one cell is taken from the embryos obtained in method applications and these are examined in terms of genetics. In this way, the possibility of transferring unhealthy embryos is prevented from the very beginning.

Contributing to the birth of healthy babies, which is the main purpose of IVF treatments, PGD has become a method that patients can learn and access more easily thanks to the developing opportunities. The application of PGD for Embryo Screening in patients with recurrent miscarriage or unsuccessful attempts and in advancing ages leads to debates in terms of benefits and harms. .

The embryo freezing method, which enables the embryos obtained in IVF treatments to be preserved for later use, increases the probability of success in the treatments, while at the same time brings economic and mental advantages to the patients. Especially for embryos that are thawed for reuse, it is a serious comfort that the patient is not taken to a new process.

In the first years of its application, it was observed that the embryos preserved by freezing were lost in terms of viability and quality when thawed for later transfer, and this problem was prevented with the developed vitrification method.

For the embryo freezing method, the patients' consent is obtained and after that, the embryos are kept in special environments for a certain period of time. The method has a special value for these patients, as patients younger than 35 years of age are allowed to transfer one embryo in the first two trials, within the framework of the law enacted in Turkey. The embryos of the patients who approve the embryo freezing process can be kept for a period of 5 years, provided that the contract is renewed every year. Embryos of patients who do not give consent are destroyed by adhering to the protocols determined by law.

In IVF treatments, it is aimed to prevent multiple pregnancies by transferring a maximum of 2 embryos, and the remaining embryos can be frozen optionally. Thus, if needed, these embryos are thawed and reused, and the patient does not undergo any new treatment. In addition, this kind of convenience ensures that psychological and economic problems can be prevented beforehand. The embryo freezing method, which can also be applied in our country, allows embryos to be stored for 5 years, subject to the consent of the couples.

In the freezing or thawing processes carried out in practice, first of all, balancing and cooling is done with chemical substances called “Cryoprotectant”. Then, storage in -196 degrees liquid nitrogen, and after dissolution, the embryo is taken from the chemical environment and left in special culture solutions. Thus, it is aimed to provide further development.

In classical IVF and microinjection treatments, pregnancy rates of 25% to 40% can be achieved with this method. The patients in whom 40% can be obtained are those who can achieve pregnancy with fresh embryos or whose embryos have been frozen without transfer.

Chip baby is one of the most technological methods of recent times. This is a type of method related to sperm selection. As a result, the better the sperm we can choose among millions of sperm, the higher the success rate will be. There are actually many methods for choosing a good sperm. In the method we call microchip, the sperms are selected with a slightly different method. Sperm race in very thin channels, then healthy sperm accumulate in one place, unhealthy sperm die on the way anyway, especially sperm with DNA damage accumulate in another place. We use the sperm on the side with healthy sperms in IVF. In fact, this is how it is in the natural process. First, the sperm enter a race, they cross the cervix, they cross the uterine cavity, they cross the ovaries, and there is a race in the meantime. The best sperm reach the egg. Microchip technology is actually a technology that imitates this.

Is the chip baby technology applied by the decision of the people?

Chip baby is just one of the techniques applied. We apply many techniques for IVF. We can monitor the division time and division rate of embryos one by one with a camera. We can then look at the retrospective records and select better embryos. Therefore, chip baby technology is a method related to sperm selection. As for when we apply this, if we are successful with a standard IVF placement, it is fine, but if we have failed a few times, we go into the details. We use new techniques. While using these techniques, we present them to our patients. We are talking about choosing the best sperm with the chip baby method, watching the embryo with a camera, and other details.

What is the embryoscopic method?

We store cells, embryos in a device called an incubator. The temperature of the incubator is 37 degrees, that is, the same as body temperature. According to the old technology, we wonder if the egg is fertilized, take it out of the incubator, examine it under the microscope, and put it back, then we take it out of the incubator again and check whether it has split. Of course, at this time, the egg interacts with the environment. Heat or other factors are affecting the egg that leaves the incubator. Of course, it affects productivity. Later, camera methods came to the fore. By observing the embryo completely from the outside with the camera inside the incubator, we can observe when it divides, when it multiplies, how many cells it has. We can even give these records to our patients. We call the embryoscope to watch the embryo inside the incubator.

It is the method used in case of a problem in the case called "implantation".

Implantation is called implantation when the embryo placed in the uterus continues to divide and grows, and after it reaches a certain size, it ruptures the surrounding Zona Pellucida membrane and is embedded in the inner layer of the uterus (Endometrium). If the embryo cannot tear this membrane, pregnancy does not occur. According to studies, more than 50% of women who apply for treatment cannot get pregnant because of this.

With the assisted nesting method, it is aimed to remove the embryo by tearing the membrane around it. For this, before the transfer to be made, a small hole is opened in the dice and the transaction is performed. Mechanical, chemical or laser methods are used in the process.

Some countries, including Turkey, impose restrictions on the number of embryo transfers. Accordingly, legal regulations have been brought in Turkey and 1 embryo transfer has been made mandatory in the first two in vitro fertilization trials of patients younger than 35 years of age. The only chosen method of blastocyst transfer has been a great advantage for patients living in countries where this requirement has been imposed.

The most important feature of single-selected blastocyst transfer is that it has the most similarity to pregnancy obtained by normal means. It is possible to select embryos with high development potential that can be kept in the laboratory for five to six days in application processes. This feature increases the possibility of positive results and eliminates the possibility of facing multiple pregnancy.

After the discovery and implementation of this method, treatment became possible for many men who were considered impossible to have children due to the absence of sperm in the semen. With the introduction of the Micro-TESE Method among the treatment methods, the hope of these patients to become fathers is becoming a reality.

In micro-TESE applications, testicular tissue is examined with the help of a special microscope and the samples taken from here are taken to the laboratory for examination. When the desired result is obtained, that is, when sperm can be obtained, the process of injecting the eggs is applied. In some cases, freezing is done if necessary.

While sperm is obtained in all patients with obstruction in the sperm carrier channels, the same success can be achieved in half of the patients with production disorders due to the discomfort.

These are the methods applied for the purpose of searching sperm in the testicles. It is possible to find sperm in all of the Obstructive Azoospermia patients caused by obstruction and in half of the Nonobstructive Azoospermia patients caused by production disorder.

In the application, a small incision is made and the “Tunica Albuginea” sheath around both testicles and the sac in which the testicles are located is opened. Then, tissue examination is made under the microscope and samples are taken from the large canals and the application is completed by suturing the incisions. In some publications, it has been argued that this application causes less damage to the testicular tissue than other methods.

While the viability rate of frozen sperm after thawing and the potential to create pregnancy provide positive results in Obstructive Azoospermia cases, the same situation has not been certain in Nonobstructive Azoospermia cases. In these cases, where there are problems in freezing and thawing processes due to structurally defected sperms, careful selection of sperm can be made and freezing can be preferred for later use. However, it is more correct to use fresh sperm in cases of Nonobstructive Azoospermia.

-It has been determined that in patients with Obstructive Azoospermia, surgical procedures can be performed up to 7 times, and sperm can be searched and found in all procedures.

- It has been determined that TESE can be applied up to 6 times and sperm can be collected in patients who have nonobstructive azoospermia and who can find sperm in TESE procedures.

- It was determined that 15% of the nonobstructive azoospermia patients who could not obtain sperm in the first TESE application could obtain sperm in the second TESE application.

-The pregnancy rate obtained with the first TESE application and repeated TESE applications is the same.

One of the problems frequently encountered in patients who apply to IVF clinics is the inability to reach a pregnancy result despite the embryo development being achieved. In general, the reason for this problem is that the embryo cannot tear the membrane surrounding it and cannot settle on the uterine wall (endometrium). The method of thinning the embryo membrane is used to solve this problem, and thus, a significant increase in the pregnancy rate achieved by the patients is observed.

One of the chemical, mechanical and laser methods is applied for the treatment of the patients in question. Thus, a small hole is made in the membrane around the embryo or a thinning process is applied and it is possible for the embryo to come out.

It is a method that is beneficial in treatments, but it is not correct to refer to it with terms such as extraordinary or miracle.

The Embryo Bonding Method can increase pregnancy rates in couples who have had repeated unsuccessful attempts and in elderly female patients. An adhesive called “Glue” is used in application processes.

We can recommend this method to our patients because of the positive results we obtained in two studies that we conducted on women older than 39 years who had repeated unsuccessful attempts.

The fact that the embryos have the opportunity to survive in the culture liquids in the laboratories for a long time also positively affects the pregnancy. The use of this method, together with the developments experienced, enables the selection of high quality embryos and reduces the possibility of multiple pregnancy by using fewer embryos in the transfer process. This method lays the groundwork for applications where embryos can be examined for viability.

Another benefit other than these is that it allows biopsy of the inner cell layers of the blastocyst (Trophoectoderm) in clinics that include preimplantation genetics. Thus, this non-embryonic tissue does not cause any ethical discussion.

It is a method used for research purposes today. Although it was brought to the agenda in early 1990 with the claim that the culture mediums were insufficient for the embryos to reach the advanced developmental stage, it was out of preference with the development of sequential culture mediums that allow embryo development until the 5th to 6th day. The Endometrial Co-culture method is based on the development of a small piece taken by endometrial biopsy from the uterus one month before the treatment with cell culture in the laboratory and monitoring the embryos on the formed cell layer.

In the Spandorfer study published in 2003, it was suggested that this method increases pregnancy rates in couples who experience repeated unsuccessful attempts, but this view was not supported by any other research. The factor that makes the study insufficient is that it was not conducted on randomly selected randomized groups and it is not clear whether it has an independent effect from controlled trauma in the uterus on the increase in pregnancy rates.