Stages of IVF Treatment

What Is IVF (In Vitro Fertilization) Treatment?

IVF treatment, medically known as in vitro fertilization (IVF),is a process in which female and male reproductive cells are combined in a laboratory environment to achieve fertilization, and the resulting embryo is then transferred into the uterus. This method is an advanced assisted reproductive technology developed for couples who are unable to conceive naturally.

The stages of IVF treatment generally include hormonal stimulation of the ovaries, retrieval of the eggs, fertilization with sperm in a laboratory setting, and monitoring embryo development before transferring the embryo into the uterus at the appropriate time. Hormonal medications are used to obtain multiple eggs, thereby increasing the chance of success. Fertilized eggs are monitored for 3 to 5 days under laboratory conditions, after which high-quality embryos are selected and transferred to the uterus.

Who Is IVF Treatment Suitable For?

IVF treatment is recommended for couples with a low chance of natural conception or for those who have not achieved success with other treatment methods. The most common indications include:

• Female factor infertility: Conditions such as blocked or removed fallopian tubes, decreased ovarian reserve due to advanced maternal age, endometriosis, and ovulation disorders (e.g., polycystic ovary syndrome – PCOS).
• Male factor infertility: When there are significant abnormalities in sperm count, motility, or morphology (e.g., azoospermia or oligozoospermia),fertilization can be achieved using intracytoplasmic sperm injection (ICSI).
• Unexplained infertility: IVF is an effective option for couples who are unable to conceive despite normal test results.
• Recurrent miscarriages or failed intrauterine insemination (IUI) treatments: If pregnancies fail to progress or embryos do not implant properly, IVF allows for a more detailed evaluation of embryo quality.
• Genetic disease carriers: Through preimplantation genetic testing (PGT),embryos can be screened and only healthy ones selected for transfer.

What Are the Stages of IVF Treatment?

1. Initial Consultation
2. Ovarian Stimulation
3. Egg Retrieval (OPU – Ovum Pick-Up)
4. Sperm Collection
5. Intracytoplasmic Sperm Injection (ICSI)
6. Embryo Transfer
7. Luteal Phase Support (Supportive Hormonal Therapy)
8. Pregnancy Test and Evaluation of Results

1. Initial Consultation

The initial consultation is a crucial step in IVF treatment. During this visit, the patient’s age, duration of infertility, menstrual cycle regularity, previous surgeries, and current medications are reviewed. Any previous tests performed for the patient and her partner are carefully evaluated. A physical examination is conducted to assess ovarian reserve and the uterus. Based on the examination and test results, an individualized diagnostic and treatment plan is created for the couple.

As part of the routine gynecological evaluation, cervical cancer screening tests (Pap smear and HPV testing) and breast cancer screening with baseline breast ultrasound are recommended; for women over the age of 40, mammography should also be performed. While focusing on IVF treatment, general health evaluations should not be neglected.

2. Ovarian Stimulation

The start day of treatment varies depending on the selected IVF protocol. In the most commonly used short protocol, treatment begins on the 2nd or 3rd day of the menstrual cycle. Appropriate medication doses are determined based on ultrasound assessment of ovarian reserve, the patient’s body mass index, and age. Patients administer the prescribed doses daily via subcutaneous injections.

At appropriate intervals, ultrasound examinations are performed to monitor follicle growth and endometrial thickness, while blood tests are used to assess hormone levels and treatment response. Approximately 10–12 days after the start of treatment, the follicles reach the desired size. When at least three follicles measure 17 mm or larger, a trigger injection is administered and the egg retrieval procedure is scheduled. Optimal timing is individualized according to the patient’s history and previous treatment responses to maximize the number of mature eggs.

3. Egg Retrieval (OPU – Ovum Pick-Up)

When at least three follicles reach a diameter of 17 mm or more following ovarian stimulation, a trigger (maturation) injection is given, and eggs are collected 34–36 hours later. Egg retrieval is performed under mild sedation anesthesia using a needle guided by transvaginal ultrasound. The needle is inserted into the follicles, and the follicular fluid containing the eggs is aspirated using gentle suction.

The collected fluid is transferred into tubes and examined under a microscope by an embryologist, who identifies and isolates the egg cells and places them into culture dishes. The egg retrieval procedure typically takes about 15 minutes. After a few hours of rest, patients can be discharged and resume their daily activities. Medications required for post-procedure care and preparation for embryo transfer are prescribed.

4. Sperm Collection

On the day of egg retrieval, the male partner provides a sperm sample through masturbation. After undergoing specific washing and preparation procedures, the selected sperm are injected into mature eggs using the intracytoplasmic sperm injection (ICSI) technique to achieve fertilization.

In patients with azoospermia (absence of sperm in semen) or in those with erectile or ejaculatory dysfunction, sperm can be obtained directly from the testes using surgical procedures such as TESE or TESA.

5. Intracytoplasmic Sperm Injection (ICSI)

In IVF treatment, fertilization can be achieved in two ways. The first is conventional in vitro fertilization, in which sperm cells are placed around the egg and fertilization occurs naturally. The second—and most commonly used—method is intracytoplasmic sperm injection (ICSI),where a single sperm cell is injected directly into a mature egg using specialized needles under a high-powered microscope. Because fertilization rates are higher with ICSI, it is the most preferred method today.

After fertilization, the eggs are placed in special culture media and kept in incubators that mimic the natural conditions of the human body. Fertilization is assessed 16–18 hours later. With the ICSI technique, the fertilization rate is approximately 80%.

The resulting embryos are removed from the incubators and evaluated for quality and developmental progress on the 3rd and 5th days after egg retrieval. When time-lapse incubators are used, embryo development and cleavage patterns can be monitored continuously without removing the embryos from the incubator.

6. Embryo Transfer

Embryos formed after fertilization are evaluated on days 3 and 5 based on cell number and fragmentation rate, which reflect embryo quality. When multiple embryos are available, extending culture to day 5 is preferred in order to select the highest-quality embryos. However, if only a limited number of embryos are obtained, transfer may be planned without waiting until day 5. Due to advances in laboratory conditions, blastocyst (day 5 embryo) transfer—which has a higher implantation potential—is preferred in suitable patients.

Embryo transfer is a simple procedure that does not require anesthesia and is performed with a moderately full bladder. Under transabdominal ultrasound guidance, a catheter containing the embryo is gently passed through the cervix, and the embryos are placed near the upper part of the uterus. Embryo transfer is one of the most critical stages of IVF treatment and must be performed carefully and delicately. The number of embryos to be transferred is determined based on the patient’s age and the number of previous attempts. Patients over the age of 35 or those with two or more unsuccessful IVF cycles are allowed the transfer of two embryos.

7. Luteal Phase Support (Supportive Hormonal Therapy)

After embryo transfer, progesterone support is provided to help the uterine lining accept and maintain the embryo. This support may be administered as a vaginal gel, oral tablet, or injection. Hormonal support typically continues for 10–14 days after transfer. A stable and supportive uterine environment increases the chances of embryo implantation. Stress management and adequate physical rest are also recommended during this period.

8. Pregnancy Test and Evaluation of Results

Following embryo transfer, the waiting period for pregnancy begins. A pregnancy test is performed on day 10 after blastocyst transfer and on day 12 after day-3 embryo transfer. During this time, prescribed uterine-supportive hormonal medications should be taken regularly. In cases of low beta-hCG levels, conditions such as biochemical pregnancy or ectopic pregnancy should also be considered.

Success Rates in IVF Treatment

The success rate of IVF treatment depends on many factors and varies from person to person. In general, success rates are influenced by parameters such as the woman’s age, ovarian reserve, sperm quality, the uterine environment, laboratory conditions, and the experience of the clinic.

It should be remembered that IVF treatment is not merely a “last resort,” but a powerful option offered by modern medicine. With proper patient selection, individualized treatment planning, and a multidisciplinary approach, success rates can reach high levels.