IVF

There is not enough scientific evidence that although it should work as the other vaccinations such as flu vaccinations. The best approach is to postpone any non-emergency treatments during this pandemic. However, if you feel that you cannot postpone your treatment any longer, I recommend that you should complete your vaccine program before starting IVF. If you are pregnant, you should avoid vaccination in the first 3 months of the pregnancy because of a lack of evidence. According to the recent evidence, pregnant women are at increased risk of severe illness from COVID 19. Additionally, pregnant women with COVID are at increased risk for other adverse outcomes, such as preterm birth. If you think that your risk of COVID is high, you may get the vaccination. I believe the benefit is more than the risk.

Many patients ask the same question. Some find it very pleasant. However, we take multiple pregnancies as a complication of IVF, and we do our best to avoid it. On the other hand, the risk of multiple pregnancies in infertility treatment is higher than in nature. We may need to transfer 2 embryos in patients over 35 or after a few unsuccessful IVF trials. The idea is to increase the pregnancy chance, but a twin pregnancy may happen.

There are several factors to make the right decision. First of all, you and your partner should go through an infertility consultation. Some couples may need IVF even if their tubes are open due to severe sperm problems or age, or other reasons. Therefore, a tubal reversal would be useless.

The method of tubal ligation is also important. Some ligation techniques are difficult to repair. You should ask yourself how long you can wait for getting pregnant after tubal reversal. You may need at least one year to see if you can get pregnant, and then you may need IVF. If you are already 39 years old, you do not have that much time since it will jeopardize your IVF chance. However, it may be wise to do a reversal and starting an IVF treatment too.

It is also important to plan about the number of children you want after the reversal. If you want to have only one child, then IVF may be a better and even cheaper option. Again if you desire to choose the gender of your next child, then you should consider IVF.

Unfortunately, some patients may not respond to drugs as we hope. These are some of the reasons for cancellation.

• No follicle response and consequently low estrogen levels after many days of drug usage.
• Risk of ovarian hyperstimulation. This is one of the most serious risks in IVF treatment. Although we have some tools to prevent this, we have to cancel treatment in some special circumstances.
• Sometimes, we do not retrieve any oocytes, although the ovulation induction drugs' response is satisfactory. In some cases, we can get eggs, but none of them are suitable for IVF. Finally, you may not have any good embryos.

Therefore, your embryo transfer may not happen.

We refer to the egg collection day as fertilization day or day 0. We can transfer embryos on any day after fertilization—however, the idea in IVF treatment to choose the best embryo among many embryos. We have several tools to do so. One of the best method is to watch embryos for 5 days and select the best developing ones. However, you may have a better chance of pregnancy if you get the embryos early if you have only a few embryos, and you will get them all in that cycle. Now, the culture media and the incubators are better than those before. Therefore, it may be wise to wait for day 5 to see the embryos' progress, even if you have a single one. This may give us an insight into your overall pregnancy chance. If you fail to get pregnant in the first cycle, you may not need to wait for a blastocyst transfer in another cycle. If you are coming from abroad for IVF treatment, you can save time and money with the early embryo transfer without changing your pregnancy chance if not improving it.

Although most clinics forbid intercourse during IVF treatment until the pregnancy test, there is no scientific evidence to support this. Therefore, we do not ask our patients to refrain from intercourse during any part of IVF except on the day of embryo transfer. However, it is essential not to have intercourse during ovulation induction until the day of embryo transfer when we do IVF for single-gene disorders or gender selection. Although it is not very common, some patients can get pregnant spontaneously happening embryos during IVF. We do not want to take any risk of an unhealthy embryo being implanted.

We need to see you a few times during ovulation induction for IVF. After the first visit, we may not see you for 7-8 days again. So you can travel during your free time as long as you come to the clinic when you have an appointment. Besides this, it may be possible to organize some of your scans in a different city with a sister clinic. This way, you may have a holiday as well during your treatment.

This does not harm during IVF and pregnancy. However, it would be best if you did nail polish or paint in a well-ventilated area. The respiration of the fumes may not be very healthy.

Although most modern hair products are claimed to be safe during pregnancy, I would not take any risks. Therefore, I do not recommend this during IVF treatment and the first 3 months of the pregnancy.

Although some clinics advise patients to rest after egg collection and embryo transfer for days, there is no scientific evidence to prove that. We never ask patients to stay in bed or decrease their activities. Of course, it may not be possible to do heavy exercises or do contact sports such as basketball, boxing, wrestling after egg collection, especially if the ovaries are very enlarged due to ovulation induction. It is also safe to fly to your home country right after embryo transfer. Carrying normal size baggage is also fine. Your doctor may tell you differently if you have a special condition.

Most patients can learn to use public transportation, buses, and our underground system. They are cheap and always available. The taxis in Istanbul are not expensive. However, it is possible to provide you a private driver and a rental car at your own expense.

Yes, we can help you to find accommodation if you request. Some patients prefer to find their own places and turn this visit into an opportunity to have a holiday. Since we see patients only 3-5 times during the entire treatment, our patients will have plenty of free time and enjoy the city. Istanbul has countless opportunities to enjoy yourself as a tourist.

We are specialized in offering treatment for foreign patients. We speak English, which is satisfactory for most of our patients, but we can provide translators. You can reach your doctors or the clinic coordinator by phone, email, or text messages during and after treatment. We prefer Whatsapp text messages unless there is an emergency.

We do not have a waiting list. As soon as you complete your initial examination or consultation, you can start your treatment if the treatment protocol is planned. Most IVF cycles start on cycle day 2. So you may need to wait for day 2 of the period.

Our own system normally produces these hormones in those drugs. However, due to multiple follicular growth and enlarged ovaries, and a high amount of estrogen in your system may cause bloating, headache, abdominal tenderness, and mastalgia. Mild Injection site reactions may also occur frequently. Please be well hydrated during treatment.

The length of treatment depends on the protocol and your response level to the drugs. Most of the patients need about 10-12 days of injections. After the egg collection, the majority of patients use vaginal pessaries to support ovulation. This takes 4 more weeks after the positive pregnancy test. In frozen-thaw cycles, we usually prepare endometrium artificially. In this case, patients may need to use vaginal pessaries for 10 more weeks.

It depends on the individuals. However, most patients require to visit the clinic 3-5 times during the entire treatment after the initial examination. The initial examination and consultation usually take the longest time. It is important to spare some time in that visit because making a good plan saves you time and money in the future. Although there are clinics where patients have scans and blood tests almost every day, this is unnecessary and does not add any value to your treatment. On the other hand, a tiny group of patients with special problems may require more frequent visits.

Most of the previous tests will not be repeated. However, your physician will decide which tests can still be valid and which tests should be repeated. Several factors make this decision, such as age, the nature of the test, the planned treatment, etc.

In most cases, patients already have many hormone tests. Your doctor may need more recent tests, or your previous tests may be sufficient. An experienced doctor rarely needs hormone tests during ovulation induction. If patients want to start their ovulation induction before seeing us before having a scan here before starting ovulation induction, an AMH (Anti-mullerian Hormone) test will be beneficial. You can have this hormone test on any day of the cycle. It has a great value to estimate the response level to the drugs.

Yes, it is possible to have female doctors do your initial consultation and your examinations. There is always a female chaperone in the room during the examination.

It is best to see both partners in our visits. However, patients may need to try several cycles before getting pregnant, and this may cause stress between couples. Therefore, it is best to support each other but use time efficiently. If both partners are working, it may not be easy to make the time for each visit. Although it is crucial to be together on decision-making steps, it is unnecessary to come to the clinic at every appointment. After the treatment starts, we only need the female partner. It may be very stressful to organize the visiting hours for both partners.

We do not have a waiting list. The patients can start IVF as soon as they have the initial evaluation and provide drugs. We make a tailored program for each couple. If possible, they can start their drugs on cycle day 2.

We have to evaluate both partners since infertility is not a problem for males or females. The infertility evaluation is not complete without the examination of both partners. Every IVF clinic should be able to do that.

We will evaluate female patients attempting pregnancy from the age of 18 years old to 50 years old. However, we seldom offer IVF after the age of 44. A patient after the age of 44 should have an extreme egg reserve and exceptionally good for her age to try IVF. Otherwise, the couple should be directed to egg donation programs.

The first phase of the treatment is the evaluation of the patients. We can do this in two ways. You can come here a few days before menstruation and have an initial examination. We encourage our patients to do this on the internet, especially if they tried IVF before. We can do this initial evaluation on the internet. If you plan to have an infertility treatment abroad, the only feasible option is IVF due to the high travel and accommodation cost. It is not only the medical cost you should consider. Therefore, the most important question is to decide if you are eligible for IVF. It is also important to assess your pregnancy chance and the best ovulation induction in your case.

For local patients, an initial ultrasound scan and a meeting in our office help us determine the possible reasons for fertility problems.
For most patients, the treatment can start right away because the majority of patients have several tests and treatments before applying to us. It may be possible to start treatment even before seeing the patients in our clinic. We do video conferences and examine the existing data over the internet. This saves time and money for our patients. Making a good plan before treatment is crucial in IVF treatment We can simplify IVF for elected patients to decrease the cost and the stress level of the patients. We offer special programs to do so.

You can exercise during treatment. However, ovaries are more extensive due to ovulation induction drugs, and some sports may not be appropriate, such as contact sports, boxing, basketball, football. If you are used to doing exercise, you can continue to do so with ease by decreasing the workout's intensity. Especially after egg collection, your ovaries will be more fragile and bigger than usual. Under normal circumstances, you do not need any bed rest after embryo transfer. We allow moderate exercise and even intercourse after embryo transfer.

The number of visits will depend on your response to the drugs. Usually, after an initial evaluation, we see patients 4-5 times, including egg collection and embryo transfer.

The drugs are not included in the IVF price. The amount of drugs depends on your age, your egg reserve, history, and infertility reason. Therefore, it may be different for every patient. However, we may estimate the cost of the drugs after we evaluate the patients.

It is straightforward to do the injections. We will teach you how to do injections by yourself. A family member, your partner, can help you too. We prepared instruction videos. Injections are all subcutaneously done, and the needles you will use are tiny and painless.

Side effects vary from patient to patient. Reactions to the drugs may include skin irritation at the injection site, abdominal bloating, headaches, breast tenderness, and nausea, especially if patients have a high response to the drugs. The ovaries will be bigger than usual due to ovulation induction drugs. The most important complication of drugs is the OHSS (Ovarian Hyperstimulation Syndrome). Ovaries are more extensive, and a few patients may have fluid in the abdominal cavity. It may be very uncomfortable. However, your doctor will take necessary precautions to prevent it.

Several factors can affect the pregnancy chance. Your doctor may estimate your probability after a complete evaluation. However, we can do the best estimation after seeing your response to the drugs and your embryos' quality. Your history is also significant. Patients frequently ask this question because of two purposes. Some want to know the average pregnancy rates to choose a good clinic with a reasonable rate. Some others want to know their chances to make plans for the future. The average rate does not mean anything. Some clinics may deal with difficult patients, and they may have a low average rate, although they do excellent jobs.

In general, the success of frozen-thawed embryo transfer procedures depends on three factors:

• The quality and survival of the frozen-thawed embryos. In general, we only freeze good quality embryos, so the current survival rate is greater than 90%.
• The age of the woman who produced the eggs. In patients, younger than 37, the chances of pregnancy with frozen-thawed embryos are similar to pregnancy with fresh embryos.
• In patients 37 years or older, pregnancy chances with frozen-thawed embryos decline in conjunction with declining fertility in general but still can be quite useful. As always, it is best to discuss a woman's situation with their physician.
• The status of the uterus in the woman receiving the frozen embryos. A healthy endometrial lining free of any fibroids or polyps provides a favorable environment for embryo implantation.
• Once an embryo survives after freezing and thawing, this embryo was a good one before freezing. It may work as a second step embryo selection, and these healthy embryos may have a better potential. In selected cases, the frozen-thaw embryos may have higher success rates than the fresh ones.
• Frozen-thawed cycles are straightforward. No injectable drugs and no frequent follow-up scans like the ovulation induction cycles. In most cases, patients can come to the clinic for only 2 hours to get the embryo transfer.

Ovaries contain hundreds of potential eggs. Each month, only one egg from a pool of 100-1,000 is selected during the natural ovulation cycle. Those eggs which are not set undergo a natural cell death process called atresia. Hormonal drugs may stimulate as many as 20 eggs in one cycle. Thus we do not use more eggs than otherwise disappearing eggs in a given natural cycle.

There is no scientific evidence about it in the literature. Unless there is a high risk of ovarian hyperstimulation, most of our out of town patients return home even on the day after the embryo transfer. There is no medical reason to stay in İstanbul after IVF treatment. Patients can leave the clinic by walking in 20 minutes following embryo transfer and take all types of traveling to their home towns. Sitting for an extended period, or walking, or even having moderate exercise will not affect pregnancy chances. We recommend that patients traveling for a long-distance, move their legs frequently to avoid any thrombophebitis, drink plenty of fluids, and dehydration should be avoided.

Many of our patients at Jinepol Women’s Health and IVF Clinic come from other parts of the country and worldwide. We are very aware of the needs of our patients. We do our best to decrease the total cost of IVF by careful planning. If possible, we do most of the consultations by phone on the internet. Most patients can provide us enough information about their tests, hormones. Therefore, we can even start ovulation induction before actually seeing patients in person. Sometimes, we organize the stimulation programs and scans with the help of a local Ob/Gyn. Those who have started stimulation treatment at home will travel to our clinic about 5-7 days later. Most patients need to be in İstanbul for 7-10 days. We are always available to help out of town patients throughout treatment, via telephone or internet.

It is not painful but uncomfortable. We always do our egg retrieval under sedation. Patients feel nothing and remember nothing during and after the procedure. Egg retrieval is a minor surgery. We insert a long needle under ultrasound guidance through the vaginal wall and into the ovaries and aspirate the content of each follicle into a tube with the help of gentle suction. Drugs wear off quickly, and most patients can leave the clinic in less than one hour. Some patients may feel slight pain after the procedure, and we may administer strong pain-killers.

Daily injections can be overwhelming. However, these injections are all subcutaneous injections and are done with a small hypodermic needle. These needles are the same as the diabetic people use all their lives. You will mostly take them for 8-10 days. No drugs are used intramuscularly in our programs. After egg retrieval, patients have been prescribed progesterone hormones. At the beginning of IVF history, these drugs used to be painful intramuscular injections. Now, they are replaced by pills or intravaginal suppositories. These drugs are as effective as intramuscular injections.

According to some epidemiologic studies, women who have never get pregnant have a higher risk of ovarian cancer (the Odds ratio is 1.6).
At first, some scientists claimed that this was due to the use of fertility medications in 1992. Since then, several studies have shown no association between fertility drugs and ovarian, uterine, or breast cancer.
This link may be due to the fact of infertility. Findings suggest that pregnancy and childbirth, and breastfeeding have some protection against reproductive organ cancers.

Some research shows that there is a slightly increased incidence of congenital disabilities in IVF babies. This difference may be due to infertility reasons other than IVF treatment itself (4-5% vs 3%)

This slightly increased risk is also reported for children born after IUI treatments. Therefore, it is very like that this increased risk is due to the infertile couples' intrinsic factors, not in the technique used in IVF or in vitro culturing of embryos.

On the other hand, some research indicates that IVF babies are more successful academically than non-IVF babies. It seems that the answer to that question requires more studies..

Doctors normally recommend that you continue using your drugs until after positive pregnancy test result. The duration varies depending on the patient and the drug protocol. In the standard protocol using agonists, our patients continue using progesterone for 15 days following the embryo transfer. Some clinics may ask patients to continue using the drugs for three months, however there are studies showing that this is not necessary.

One or two cells (blastomeres) are taken out and special genetic tests are performed on them. Embryos that are shown to be genetically normal are selected and transferred back to the uterus.

You can have sexual intercourse two days after the embryo transfer. Some people recommend longer periods of sexual abstinence, but studies show that intercourse on the day of the transfer does not affect the pregnancy rate.

You can bathe a few hours after the procedure. We do not recommend extreme heat as is found in Turkish baths, saunas or solariums. Also we recommend that you refrain from physical therapy using ultrasound for a few days after the procedure. There is no scientific proof backing this restriction.

You can go away right after the procedure as long as you do not walk.

Resting fifteen or twenty minutes after the transfer is usually sufficient. We do not recommend heavy exercise and walking for long distances. Women who work at a desk can work the next day resume daily activities. Sexual intercourse is allowed two days after the transfer. Although there is no scientific proof in this area, we recommend that women refrain from hard exercise or beginning a new sport.

A good quality embryo has a higher potential to be genetically normal, but perceived quality is not the absolute criteria. There are other unknown factors influencing the pregnancy rate such as endometrial receptivity.

Use of frozen embryos is easier psychologically and less costly. But the pregnancy rates for fresh embryos are better than frozen.

Embryos can be frozen on any day starting from the day after it is fertilized until the 6th day of culture. We at our clinic, prefer to fertilize on day 1, 3 and 5 (blastocyst stage).

Some couples who have had IVF done, wish to donate their embryos to other childless couples. Embryo donation is legal in North Cyprus and is performed in our clinic.

A menopausal woman can get pregnant regardless of her age. A donor’s eggs can be fertilized with her husband’s sperm. Even if the woman is healthy, IVF on women of advanced age is ethically controversial. Although there are no legal age limits, we do not perform the procedure on women over the age of 50. If we determine upon evaluation that the couple is incapable of educating and caring for the child, then we can refuse treatment.

Yes, it is possible, donor eggs can be inseminated with her partner’s sperm as is done in a regular IVF procedure. It can be done if requested but some countries have made it illegal.

The average fertilization rate is 65% while some couples have a higher fertilization rate, there are instances of total fertilization failure.

The procedure is the same as in regular IVF and the success rates are the same as regular IVF procedures. Donor sperm samples are taken from donors that have been tested and matched prior to the procedure.

After trying the various procedures available for azoospermic men, sperm is still not found, then sperm donation should be considered as the next available option.

There are procedures available to men who do not have sperm in their semen. These procedures involve taking tissue samples directly from the testes in various ways depending on the situation. If sperm is found in those tissue samples, then microinjection (ICSI) can be used to inseminate the eggs.

Your husband will be asked to provide a semen sample on the day of egg collection. You will have to come to the clinic together on the day of the procedure. Please tell your doctor if your husband will have trouble providing the sample in a clinic atmosphere. He can collect the sample at home and bring it to the clinic. There are special condoms that are non toxic for sperm or if necessary sperm can be frozen in advance for use on the egg collection day.

Drowsiness is the most commonly seen side effect of the anesthesia. Patients report aches in the groin area near the bladder. Because the ovaries are enlarged, patients usually feel this ache before the egg collection procedure.

The procedure is not painful but can cause mild discomfort. At our clinic, we use mild anesthesia administered through an IV line which relieves the discomfort. A patient rarely will need a heavy dose of anesthetic drugs.

The duration of the procedure depends on the number of follicles that need to be aspirated. Normally it takes about 5-10 minutes. You should assume that the preparations, procedure and recovery time will take roughly 2 hours total.

This method requires a highly trained staff and latest technology in equipment. The equipment and materials used in an IVF lab are all imported and costly. Also most of the materials used are disposable and in single use format. In the United States the cost of one cycle is $6,500 excluding the cost of the drugs used to stimulate the ovaries.

A couple can try as many times as they wish provided they can handle the costs.

We usually recommend a three month break after an IVF attempt. In the donor egg program if there are suitable donors available, a recipient can try every month. A natural IVF cycle can also be done every month.

If you have not had any other procedures done after your last HSG, and if the results are not older than three years, you do not need to redo the procedure. Normally hysteroscopy is the more preferred procedure to evaluate the endometrium.

Providing that we are in close contact with the clinician having your tests at a clinic close to you is feasible. We also have colleagues located in many cities.

Your doctor will explain the best time to start treatment after the initial consultation, exam and blood tests. Your clinician may start your treatment on the 2nd or 3rd day of your period, concurrent with your initial work-up if he/she

There are no limits to the number of attempts of Artificial Insemination. It is recommended however, that patients consider more advanced methods of ART after 2-3 failed attempts.

Intrauterine Insemination (IUI) or more commonly known as Artificial Insemination is the term used when semen is washed to increase the concentration of progressive motile sperm and injected into the uterus on ovulation day. This is done to increase the couple’s chances of getting pregnant.

Women are evaluated for infertility on the second or third day of menstruation and semen analysis is done after 3-5 days of sexual abstinence. During this period, various tests like hormone levels, pelvic exam, ultrasonography, semen analysis and for infectious diseases can be done. If required, inside of the uterus is best examined after menstruation. Doctors can decide the best form of treatment after the consulting the results of these tests.

In addition to poor quality eggs or blocked tubes, endometriosis is also attributed to causing infertility in females. Poor sperm quality or count is usually the cause of male fertility.

Infertility is the term used when a couple fails to conceive after 1 year of regular intercourse. Infertility is seen among 10-15% of the couples throughout the world.