Memorial Hospital IVF and Genetics Center is the largest IVF Center in Turkey and has been providing fertility services since 2000. Around 4,800 couples are accepted for IVF every year. Throughout their treatment they receive care from a team of specialists who closely coordinate to achieve optimum results. All of our IVF doctors are highly trained and board certified in Reproductive Endocrinology and Infertility.

Success rates differ depending on various factors. Among these, women’s age and previous failed IVF cycles are the main two factors. The pregnancy rate in young couples with a good prognosis is approximately 55%, whereas in couples with a poor prognosis, such as those with a maternal age of over 40y, or with more than three previous failed IVF cycles, the pregnancy rate is significantly lower, decreasing up to 15-20%. After 43 years pregnancy rate is about 3-5 %.

• The most important factor is women’s age. After 43y, the success rate decreases dramatically. 
• Having more than three previous failed IVF cycles despite good quality embrios in a successful clinic is also a negative prognostic factor. 
• Sperm samples dominantly containing sperms with severe morphological defects can cause lower fertilization and pregnancy rates.
• Endometrium, the inner layer of the uterus that accepts the embryos, plays an important role in implantation. A thinner endometrium decreases the chance of being pregnant.
• Hydrosalpinx can negatively affect implantation. These are swollen fallopian tubes filled with fluid. This fluid flows back into the uterus and be toxic to embryos, increasing the risk of implantation failure, abortion and also ectopic pregnancy rate. These pathological tubes must be removed or blocked before an IVF attempt. 

• Age: A woman's fertility begins to decrease after the age of 35 and decreases rapidly after the age of 40. Male fertility progressively decreases after the age of 50.
• Smoking and Alcohol Consumption: There is ample evidence that excessive smoking and excessive alcohol consumption are detrimental to general health. It is also clear that they can negatively affect fertility potential .
• Obesity: Obese women are more likely to have irregular periods, chronic oligo-anovulation and infertility. It also increases the risk of miscarriage and reduces the chances of successful IVF. In men, obesity is associated with low testosterone levels. The frequency of erectile dysfunction increases with increasing body mass index.
• hose sexually transmitted diseases which may block the fallopian tubes.

Unlike men, who continue to produce sperm throughout their lives, a woman is born with all the egg-containing follicles in her ovaries that she will ever have. At birth there are about one million follicles. By puberty that number will have dropped to about 300,000. During the fetal period sex hormones are produced in the placenta. This results in a high estrogen level in the blood of the mother and of the fetus. This gives rise to a considerable maturation of the primordial follicles in the female fetus. When the sex hormone level in the fetus significantly decreases after birth, all of the previously matured follicles become atretic.  From the time you reach puberty, with your eggs numbering between 300.000 and 400.000, you'll lose about 13.000 eggs a year.  Of the follicles remaining at puberty, only about 300 will be ovulated during the reproductive years.

From the age of 35, fertility starts to decline. The greatest drops are seen at age 40 and 42, when it becomes extremely difficult to conceive.  A healthy, fertile 30-year-old woman has a 20% chance of getting pregnant each month. That means that for every 100 fertile 30-year-old women trying to get pregnant in 1 cycle, 20 will be successful and the other 80 will have to try it again. By age 40, a woman’s chance is less than 5% per cycle, so fewer than 5 out of every 100 women are expected to be successful each month. The chances of getting pregnant naturally after the age of 40 significantly drop. It is very common for women over 40 to have fertility treatment, after 45 it is very rare that a woman will get pregnant with her own eggs.

The chance of having a baby per IVF cycle in women 40-42 years can be around 15%. It is around 5-10% for women between 43-44. After 44 years, it reduces to less than 5%. 

If you are over 40 you have a one in twenty chance of conceiving each cycle. This means that it could take up to 20 months for conception to occur. It is rare that women in their 40s naturally conceive, women 40-45 have about a 30 percent chance of getting pregnant over a one-year period naturally. Miscarriage rates are high: a 40-year-old has a 33 percent chance of miscarriage and women over 45 have a miscarriage rate as high as 50 percent or more.

It is highly recommended that if you are over the age of 40, begin trying to conceive under the care of your physician. Another reason to see a doctor as soon as possible is that fertility treatments are less effective for women over 40. For example, IUI treatment success rates are as low as 5% for women in their 40s. IVF treatment has slight better success rates – 15% per cycle – but that’s still not as good as it is for younger women. This rate quickly falls as the years go by as well. 

Women over 45 have less than a 5 percent chance of conceiving naturally. For women age 43, the percentage of live births per IVF cycle is just 6.2% according to the most recent statistics, and only a little more than 1% after age 44.

After 45, it's almost impossible to get pregnant using your own eggs.

In the pregnancies of cases with advanced maternal age, there is a heightened chance of chromosomal problems like Down's Syndrome, birth defects and miscarriages. There are also additional problems for the mother like heart disease or high blood pressure that should be initially checked by your GP before you start to try to conceive.

Although a successful pregnancy is possible in advanced maternal age, but egg quality declines. An important change in egg quality is the frequency of genetic abnormalities called aneuploidy (too many or too few chromosomes in the egg). At fertilization, a normal egg should have 23 chromosomes, so that when it is fertilized by a sperm also having 23 chromosomes, the resulting embryo will have the normal total of 46 chromosomes. As a woman gets older, more and more of her eggs have either too few or too many chromosomes. That means that if fertilization occurs, the embryo also will have too many or too few chromosomes. Most people are familiar with Down syndrome, a condition that results when the embryo has an extra chromosome 21. Most embryos with too many or too few chromosomes do not result in pregnancy at all or result in miscarriage. This helps explain the lower chance of pregnancy and higher chance of miscarriage in older women.  Women aged 35-45 have a 20-35 % chance of miscarriage. 

 Since women are born with all of the follicles they will ever have, the pool of waiting follicles is gradually used up. As ovarian reserve declines, the follicles become less and less sensitive to FSH stimulation, so that they require more stimulation for an egg to mature and ovulate. 

The older a woman gets, the longer it may take. A woman who is 35 years old may take twice as long as a woman in her twenties to conceive. 

A woman's chronological age is the single most important factor in predicting her reproductive potential however, age alone doesn't tell the whole story

The term "ovarian reserve" refers to a woman's current supply of eggs, and is closely associated with reproductive potential. In general, the greater the number of remaining eggs, the better the chance for conception. Conversely, low ovarian reserve greatly diminishes a patient's chances for conception. A vaginal ultrasound can be performed to count the number of follicles in the ovaries. While this testing provides some insight into the ovarian reserve, some of the more sophisticated tools for assessing fertility potential include the measurement of anti-mullerian hormone (AMH), FSH LH, estradiol, and inhibin-B should be combined with antral follicle count.

The true test of ovarian reserve is a stimulated cycle where the woman takes injections of FSH.

Because infertility is more likely after 40, and because with every year that passes your chances are lower, it’s important you seek help as soon as possible if you experience trouble conceiving. If after six months you’re still not pregnant, it’s time for an evaluationIt is highly recommended that if you are over the age of 40, begin trying to conceive under the care of your physician. Another reason to see a doctor as soon as possible is that fertility treatments are less effective for women over 40. For example, IUI treatment success rates are as low as 5% for women in their 40s. IVF treatment has slight better success rates – 15% per cycle – but that’s still not as good as it is for younger women. This rate quickly falls as the years go by as well. 

Our advise for the women at their late 3o's and 40's is not being late for By age 40, a woman’s chance is less than 5% per cycle, so fewer than 5 out of every 100 women are expected to be successful each month. The chances of getting pregnant naturally after the age of 40 significantly drop. It is very common for women over 40 to have fertility treatment, after 45 it is very rare that a woman will get pregnant with her own eggs.

IVF has slight better success rates – 15% per cycle – but that’s still not as good as it is for younger women. This rate quickly falls as the years go by as well. For women age 43, the percentage of live births per IVF cycle is just 6.2% according to the most recent statistics, and only a little more than 1% after age 44.

Assisted reproductive technologies may help couples to have children, that is true however we are unable to prevent menopause and therefore we cannot stop the decrease in the quantity and quality of the eggs. Therefore ART cannot do any miracles.

Whenever possible, it is best for both partners to come to the clinic for a thorough evaluation before treatment is started. If a  couple wish to start treatment during the initial visit, then it is essential that the woman should come on day two or three of her period. It is preferable for her husband to have abstained from intercourse for three to four days before the visit so that sperm analysis can be carried out.

One cycle of treatment takes approximately sixteen to seventeen  days.

COH begins on the second or third day of the menstruation period. Generally it takes seven to ten days, depending on whether it is a short or a long protocol.

After that, hCG; the drug that stimulates final oocyte maturation, is given, and thirty-six hours later OPU is performed.

Three to five days after OPU, embryos are transferred. Transfer day depends upon the number and quality of the embryos.

Day one is calculated as the first full day of your period, with heavy bleeding that starts before midday; so for timing purposes, you can ignore spotting or light premenstrual bleeding.

The first step of treatment is a complete evaluation of both partners and a range of tests are needed. 

Karyotyping

In cases of severe male infertility, repeated pregnancy losses or repeated IVF failure, both male and female karyotypes are useful to exclude the possibility chromosomal abnormalities.

Hysterosalpingography (HSG)

This may be helpful if there is a history of pelvic infection, abdominal surgery, endometriosis or intrauterine adhesion in order to diagnose possible tubal or uterine cavity abnormalities.

Hysteroscopy

This procedure is helpful if there is a suspicion of a uterine cavity problem.

Laparoscopy

This procedure is helpful if there is a suspicion of tubal damage, hydrosalpingistis or the signs of severe endometritis. Both diagnosis and treatment can be carried out during a laparoscopy.

It is possible to send and receive samples of blood, DNA, sperm or even embryonic tissues for analysis from abroad. Please contact our genetic laboratory for further information.

A  raised  basal  FSH  level  means  that  the  number  of  eggs  remaining  in  the  ovary  is  reduced. Some of the eggs may  be  sub-optimal  in  quality. If  the  level  is in  the  menopausal  range,  this  indicates  that  there  are  no  eggs left  in  the  ovary. In this case, IVF is not an option. 

This is  a  fluid  filled  structure  in which  the  egg (oocyte) developed. Follicles  contains cells (granulosa cells)  which  produce  the  female  hormone  (estrogen).

AMH is directly secreted from small follicles and so the level of AMH indicates the number of follicles in the ovaries. A low level of AMH (<1ng/ml) means that the number of eggs in the ovaries is low.

Mild stimulation means the usage of lower doses of gonadotrophines. It improves oocyte and thus embryo quality. Additionally by giving low doses, cost of the treatment and side effects, especially ovarian hyper stimulation occurrence and severity can be reduced.

Our treatement protocols are basically long ang short protocols.

Treatement protocol is individualised

Side effects are uncommon.

Usually IVF teratement itself does not lead to the formation of malignancies. Drugs effects disepears during the following month. But in the case of malignancies we prefer special stimulation protocols related to the type of the disease.

During the treatement drugs enlarges the ovaries and oocyte pick up is done. So in order to wait the healing period generally waiting at least two months before starting a new treatement is prefered.

IVF babies are not diffrent than others. However in severe male infertility cases some minör congenital abnormalities may be seen more frequently.

All injectable medications and the progesterone pessaries need to be kept refrigerated whenever possible during the course of your treatment.

It is advisable to have your injections at approximately the same time each day.  If you are going to the clinic for a scan, do not have your stimulating injection before the scan and blood tests results as your injection dose may be changed.

Paracetamol used according to the normal dosage instructions is safe, even in pregnancy.

Most colds or upper respiratory infections will not be a problem. Most over the counter medications and antibiotics are safe to use with fertility drugs.

Herbal supplements are not recommended as they may have unknown effects.  If you are currently on such supplements, please inform us during your initial visit.

Yes. There is no evidence that any of these activities can be harmful. You should live your life as normally as possible during your treatment. It is important that you are relaxed and comfortable with yourself at this time and during any resulting pregnancy.

There is no indication that stress negatively affects the chance of pregnancy with IVF. But the more stressed you are the more difficult the experience of IVF is likely to be. Remember our nurses and counsellors are here to help you during this time.

No. Follicles are encouraged to mature during stimulation, but this happens during a normal cycle too. The only difference is that, during a normal cycle, most of the follicles die. Ovarian stimulation helps many eggs which would otherwise be lost, develop.

Women with mutations in the BRCA1 gene are predisposed to breast cancer have a high risk of developing tumors. The mutation test is available upon request and performed by sequencing of the entire gene.

Firstly, drink plenty of water. Stone fruits, such as and high fibre cereals can help. Failing that, pharmacy products that are not absorbed are also fine.

Currently, we are able to offer a fertility treatment to patients up to the age of 45.

No. Many women have undergone egg retrieval several times.

We do our egg retrievals under anesthesia. You will be asleep during the procedure. You will feel absolutely nothing, remember absolutely nothing, and will have few of or none of the typical side effects of anesthesia such as nausea and vomiting.

Not necessarily. Although we will usually take an egg from most mature sized follicles, most women will have  differently  sized follicles after ovulation induction. Some of those follicles will have mature eggs, while others may have immature or post mature eggs. This cannot be predicted by ultrasonographic monitoring.

Vaginal bleeding is not common after egg retrieval. If it does occur, it is usually from the needle puncture sites in the vaginal wall. It is usually minor and similar to, or less heavy than, a period.

The clinic is open 7 days a week for the active treatment of IVF patients.

Embryo transfer does not require anesthesia. It is performed using a speculum that allows the doctor to see the cervix, (like a Pap smear) and is very similar in technique to an intrauterine insemination (IUI).

Bleeding may be due to implantation or early menses. It is advised that you do the pregnancy test at the designated time in order to show the cause of bleeding.

You spend some time resting in a recovery room, lying on your back and are discharged 30 minutes to 1 hour after the procedure.

Bed rest makes no difference to the chances of becoming pregnant. However, it is advisable not to do strenuous activity. Bed rest after embryo transfer does not increase the chance of pregnancy. You may resume daily activities. However we recommend avoiding high impact physical activity in the first 24 hours. Also avoiding sports, demanding physical tasks and the lifting of heavy objects until the day of the pregnancy test is recommended.

After the embryo transfer, you continue with your progesterone ampule injection or your gel until instructed otherwise. Progesterone ampule sometimes make too much pain because of its oily structure, so if you can not tolerate it well, gel form can be used. You will continue progesterone and daily 5 mg tablet of folic acid until 12th weeks of pregnancy.

On 14th day following oocyte pick-up, a blood pregnancy test( beta HCG) will be done.

To follow the increasing pattern; please 2 days after a positive pregnancy test, do your second test. Normally we expect doubling of the test in two days time. Any abnormal rising may reflect an ectopic pregnancy or abortion. Please call or e-mail us for your test results on same day.

If the second pregnancy test is doubled,  you may change the progesterone ampule to a vaginal progesterone gel. This drug supports the endometrium and helps the implantation of a fertilized egg. It is easy to apply once a day in the morning. You will continue using it for up to the 12th week of gestation. Also continue taking daily 5 mg. tablet of folic acid until 12th weeks.

In order to see the fetus, 3 weeks after the first pregnancy test, we offer you to have an ultrasound scan. It should be possible to see the baby’s heartbeat in this early scan and exclude an ectopic pregnancy or abortion.

Yes. Please call or e-mail us your scan results on the same day.

When you experience vaginal bleeding or spotting, if you have already taking coraspin, please stop using it and start progesterone injection instead of vaginal gel. However, when bleeding or spotting stops, you may start to use the vaginal form again.

Although there is no objection to car and air travel, we recommend that you do not fly on the day of the transfer, but wait until the next day.

It  has  not  been  proven  that  avoiding   coitus  during  the  two  weeks  after  embryo  transfer  makes  any  difference  to  the  chance  of  pregnancy. However you will be required not to have any sexual intercourse till the result of the pregnancy test is obtained.

IVF is cancelled if

• follicular development is insufficient.
• follicles rupture before oocyte pick-up
• no normal embryos are diagnosed by preimplantation genetic diagnosis
• no spermatocytes are found during micro-TESE
• there is fertilization failure after intracytoplasmic sperm injection (ICSI)
• cleavage arrest occurs in the embryos
• ovarian hyperstimulation syndrome (OHSS) occurs

Generally little abdominal discomfort may occur after stimulation. 

In hyper responder patients who have too much eggs in their ovaries, signs of ovarian hyper stimulation syndrome may occur. These are:

• Abdominal bloating 
• Mild to moderate abdominal pain 
• Mild nausea 
• Decreased urinary frequency 
• Shortness of breath 
• Severe nausea or vomiting 

If any of the above symptoms occur, promptly report them by calling 0212 314 66 66

If your pregnancy test is negative after IVF, stop taking all medications

Please contact with your doctor by writing an e-mail.

We would recommend waiting for at least two menstrual cycles before undergoing IVF a second time.

There is no upper limit, but the chances of achieving pregnancy decrease after three failed cycles. In this case, a detailed investigation into the possible causes of failure is needed.

Our center follows very strict and highly reliable procedures to identify eggs, sperm and embryos. In our laboratory, the precise source identities of all eggs, sperm and embryos are carefully checked by two people, independent of each other. Also, during treatment, we keep checking your name.

• IVF is not the only way to achieve pregnancy. Treatment depends on the cause of the infertility.
• If the infertility is unexplained or of short duration (approximately one to three years), treatment starts with the simplest procedure: timed intercourse and ovulation induction using oral medications (clomiphene citrate, aromatase inhibitors) or injections (rFSH, hMG).
• If this fails, the next step is intrauterine insemination (IUI). This is a procedure in which motile sperms are placed directly into the uterine cavity, via a thin catheter. Before the sperms are placed, the ovaries are stimulated by hormonal pills or injections. This is a painless procedure and anesthesia is not needed. It is also less costly than IVF.
• If IUI fails despite two or three attempts, the next step is IVF.
• In cases of severe male infertility, tubal pathology or ovarian insufficiency, treatment starts directly with IVF.

A woman who becomes pregnant naturally has a one percent chance of an ectopic pregnancy. The chances are no higher in an IVF pregnancy unless the woman already has a damaged tube or tubes.

The miscarriage rate is about the same for ART patients as for the general population. In advanced maternal age patients undergoing ART the rate of miscarriage is higher.

It is thought that about 15-20 percent of pregnancies end in miscarriage before the 20th week of pregnancy. Having more than two consecutive such miscarriages including biochemical abortion  is described as recurrent, spontaneous abortion.

The reason why you are experiencing repeated pregnancy losses could be due either to abnormalities in the chromosomes of your babies, or  to several other physical and thrombophilical factors. If a cytogenetic test reveals any chromosomal abnormality in the miscarriage materials, both parents should have a chromosomal test to exclude any chromosomal abnormalities, such as inversion or translocation. Unfortunately, no genetic therapy is available for genetic disorders. However, current technology enables the selection of disease-free or chromosomally normal embryos before achieving pregnancy.Also hydrosalpixes and trombophilia may be a reason for reccurent miscarriages.

Here are two types of chromosomal translocation, Robertsonian and reciprocal. Both types of translocation carriers may have problems of repeated pregnancy losses and may have children with mental and physical abnormalities. Robertsonian translocations have a better chance of having a healthy child than reciprocal carriers due to innate mechanisms of producing gametes during oogenesis and spermatogenesis. Prenatal genetic diagnosis and preimplantation genetic diagnosis can overcome these problems.

Under some circumstances IVF can increase the chances of multiple pregnancy. For example, a woman under the age of thirty-seven having IVF treatment has a twenty-five to thirty per cent chance of having twins if two embryos are transferred. Because multiple pregnancies increase the risk of miscarriage, premature births and other medical problems, a limit is placed on the number of embryos transferred in an IVF treatment. Under Turkish law, the maximum number of embryos that can be transferred is dependent on the age of the woman and the number of previous treatments.

Abnormalities are found in around three percent of the children, which corresponds with the general population of children born following natural fertilization.

This is the failure to achieve pregnancy in three consecutive IVF cycles, despite the transfer of good quality embryos.

The problem may be because of the embryo quality especially genetic structure or because of the uterus and endometrium (the inner lining of the uterus) that accepts the baby. Also some tubal problems may have a role in repeated ımplantation failure.

Embryo quality:

1. Usage of lower doses of gonadotrophine during stimulation decreases aneuploidy risk, and in turn improves the oocyte and embryo quality. Also in severe sperm problems, IMSI technique-that is selecting sperms under high magnification microscope, may help improving the quality of embryos.
2. Continual monitoring of the developing embryos using embryoscope can be used to select the best embryo.
3. Karyotype should be carried out for both partners. If there is a genetic problem in one of the partners, abnormal embryo development and in turn implantation failure may occur. To eliminate the possibility of using embryos with chromosomal abnormalities, the peripheric karyotypes of both partners are needed. If any pathologies are present, preimplantation genetic diagnosis of the embryos is advised.

Tuba, uterus and endometrium

The inner layer of the uterus (endometrium) and tubas is examined by hysterosalpingography to rule out pathologies such as myomas, adhesions or polyps.

If this genetic disorder is already diagnosed and confirmed by mutation tests, couples who are carriers of genetic disorders can apply for preimplantation genetic diagnosis in which disease-free embryos are selected before transferring them into the mother’s uterus. Preimplantation genetic diagnosis can be applied for any single gene disorder with known mutations.

Peripheral karyotype analysis and Y-chromosome microdeletion tests are available for non-obstructive azoospermic or oligozoospermic males. The reasons for low sperm count could be structural or numerical abnormalities in the chromosomes or could be deletions in the Y-chromosomal regions where azoospermia factor (AZF) genes reside. Approximately 10 % of azoospermic patients have microdeletions in the Y-chromosome lowering the sperm count. According to the results of these tests, it is decided whether to advise a testical biopsy.  If a chromosomal analysis reveals any structural abnormality, such as translocation or numerical abnormality such as Klinefelter’s syndrome, preimplantation genetic diagnosis can be offered.

Sperm FISH provides a good estimate of normal or balanced sperms in the ejaculate.This information is valuable for the planning of ART and stimulation protocols, as it gives the physician a guide to approximately how many transferable embryos can be produced in one IVF cycle.

Hematopoietic stem cell transplantation is the only cure for thalassemia major. If no HLA matched donor is available, preimplantation genetic diagnosis with preimplantation HLA typing can  be performed for the selection of both disease-free and HLA identical embryos. The treatment and complete recovery of many children with beta-thalassemia and other bone marrow failure disorders has been made possible through stem cell transplanation using either the cord blood or bone marrow of matched, healthy siblings.. Our center is proud to report the successful recovery of 39 children through the use of these techniques, one of the highest number of successful treatments in a single centre, worldwide.

Spinal muscular atrophy (SMA) is one of the most common hereditary muscle disorders. It is a progressive and lethal recessively inherited genetic disorder. When both partners carry a duplication/deletion mutation in the SMA gene, there is a 25% risk of having a child with this disorder. The use of preimplantation genetic diagnosis (PGD) can enable couples carrying the mutation to have healthy children by excluding embryos with the disorder.

Numerical and structural chromosomal screening could be performed for all of the chromosomes. The first results of numerical analysis are completed within 3-5 working days and structural analysis is completed within 15 working days.

Compared to the general population, there is an increased risk of having a child with genetic disorder among families where couples are first or second degree relatives.  If there is a known genetic disorder among the families of either partner, the partners can be screened for this disorder. Otherwise, screening couples for the more than 3000 known genetic disorders has not been possible. Recently, however, with the progress of new techniques such as next generation sequencing, it is possible to sequence all genes within a week. Couples can then be advised in the light of the results of these screening tests.