IVF and ICSI in Turkey
In natural pregnancy, a man’s sperm penetrates and fertilizes a woman’s egg inside her body after ovulation, when a mature egg is released from the ovaries. The fertilized egg then implants in the uterine wall. In other words, the new cell (zygote) formed from the union of sperm and egg after intercourse settles in the mother’s uterus, where it divides, multiplies, and develops into an embryo.

When pregnancy is desired but does not occur naturally, in-vitro fertilization (IVF) can provide a solution. IVF is generally preferred after more than a year of unprotected intercourse without conception. Depending on ovarian stimulation, IVF is performed either by conventional insemination in the lab or by intracytoplasmic sperm injection (ICSI).

With conventional IVF, mature eggs are retrieved from the ovaries and fertilized with sperm in the laboratory. The fertilized egg(s) (embryo[s]) are then transferred to the uterus. One IVF cycle takes about three weeks; sometimes steps are split, so the process may take longer. With ICSI, a single sperm cell obtained from the father is injected into the egg obtained from the mother under a microscope with a fine needle to ensure fertilization. Especially in male-factor infertility, ICSI increases the chance of fertilization and pregnancy.

IVF, one of the methods that enable individuals with different fertility problems to have children, has been the most effective form of assisted reproductive technology since the late 1970s. Louise Brown, the first IVF baby, was born on July 25, 1978; Robert Edwards and Patrick Steptoe, who collaborated on IVF, are considered pioneers. When a woman cannot conceive naturally, IVF includes many approaches, especially insemination (IUI).

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Step-by-Step IVF Process

In general terms, IVF involves fertilizing egg cells taken from the woman with sperm cells taken from the man in a laboratory environment and transferring the resulting embryo to the woman’s uterus. Since the first successful IVF procedure in 1978, the method has advanced greatly.

Step 1: Ovarian stimulation with hormones

Normally, one egg grows, matures, and ovulates monthly. If only a single egg is retrieved in IVF, it may not fertilize or may fail to form a healthy embryo. Therefore, ovarian stimulation medications are used to obtain multiple eggs. Treatment begins based on day-2 vaginal ultrasound and blood hormone tests. Drug doses are set individually (by BMI, ovarian reserve, prior IVF response, doses used, and number of eggs previously collected). Protocols are personalized.

Common medications:

• To stimulate the ovaries: injectable FSH, LH, or a combination.
• To mature eggs: hCG or other triggers when follicles are ready.
• To prevent premature ovulation: medications that stop early egg release.
• To prepare the uterine lining: progesterone supplements on egg-retrieval day or at transfer.

Stimulation typically lasts about 10–12 days. Follicle growth is monitored every 2–3 days by transvaginal ultrasound, and blood hormones are checked. When follicles reach a certain size, an rhCG or GnRH-agonist trigger is given for final maturation. Proper timing and technique are critical; if mistimed, eggs may not mature and the cycle can fail. About 36 hours after the trigger, egg retrieval begins.

Step 2: Egg retrieval

A sedative or light anesthesia is given. Using a transvaginal ultrasound probe with a fine hollow needle, the physician aspirates eggs from the ovaries—about 12–30 minutes. Samples are sent immediately to the lab. If transvaginal access isn’t possible, transabdominal ultrasound may guide the needle. Eggs are removed from follicles with suction. Cramping, fullness, or pressure can occur afterward.

Step 3: Sperm collection

Semen obtained by masturbation is sent to the lab immediately. In men with no sperm in the ejaculate, sperm can be surgically retrieved from the testes. Sperm are separated from seminal fluid in the lab.

Step 4: Fertilization

In conventional IVF, sperm and eggs are placed together in a culture medium and left to fertilize. The lab monitors signs of fertilization and embryo development. In ICSI, a single sperm is injected into each mature egg—typically used after prior fertilization failure or when sperm quality/number is low.

Step 5: Embryo transfer

After fertilization, embryo development is followed and transfer is scheduled on the appropriate day. Transfer timing varies by clinic strategy, number of eggs, and embryo quality. The number of embryos to transfer is chosen based on embryo quality and stage, and with consideration of the woman’s age and IVF history. On transfer day, a thin catheter is used to place the embryo(s) into the uterus. Daily progesterone or hCG may be recommended to support implantation. Most women feel minimal discomfort. About 30 minutes of rest after transfer is sufficient.

Typical post-transfer effects:

• A small amount of clear or blood-tinged discharge shortly after (from cervical swabbing).
• Breast tenderness (estrogen).
• Mild bloating, light cramps, constipation.
• Low back/groin aches similar to menstrual pain.

Until the pregnancy test: avoid intercourse, smoking, and any medications without consulting your doctor (take painkillers only if necessary). Normal activities like cooking, using stairs, and walking are fine, but avoid strenuous exercise, heavy lifting, or physically demanding work until the test.

Bathroom use and showering are allowed; do not douche because it alters the vaginal environment and may cause infection.

Note: If moderate or severe pain occurs after transfer, contact your doctor to evaluate for complications such as infection, ovarian torsion, or severe OHSS.

Step 6: Pregnancy test

About two weeks after embryo transfer, a pregnancy test determines whether pregnancy occurred. If positive, an ultrasound is performed about 10 days later to check the gestational sac.

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IVF/ICSI in Turkey — When is it preferred?

Reasons include:

• Tubal damage/blockage: impedes fertilization or embryo transport.
• Ovulation disorders / low ovarian reserve: anovulation accounts for 5–25% of infertility.
• Endometriosis: can affect ovaries, uterus, and tubes.
• Uterine fibroids: common in 30s–40s; may interfere with implantation.
• Prior tubal ligation/removal: IVF is an alternative to reversal.
• Male-factor issues: low count, poor motility, morphology defects, survival issues.
• Unexplained infertility: no identified cause despite evaluation.
• Genetic disorders: Preimplantation genetic testing (PGT/PGD) can screen embryos for certain conditions to avoid transmission.
• Fertility preservation: prior to chemo/radiation; eggs/embryos can be frozen.

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Factors affecting IVF success

• Maternal age: younger age → higher success with own eggs.
• Embryo quality: not all embryos survive; poor early development predicts later arrest.
• Previous birth: women who’ve delivered before have higher IVF success.
• Cause of infertility: normal egg supply improves chances; severe endometriosis lowers them compared to unexplained infertility.
• Lifestyle: smoking halves success; obesity reduces chances; alcohol/drug excess can harm outcomes.

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Risks of IVF/ICSI

• Multiple pregnancy: transferring more than one embryo increases multiples (about 1 in 4 successful cycles). Higher risks of prematurity and low birth weight.
• Preterm birth / low birth weight: slightly increased risk.
• Ovarian hyperstimulation syndrome (OHSS): from strong response to FSH; usually mild (abdominal pain/bloat, nausea/vomiting/diarrhea). Rarely severe with rapid weight gain and shortness of breath.
• Miscarriage: overall risk reflects the infertile population’s higher genetic anomaly risk, not the IVF method itself.
• Egg retrieval complications: bleeding, infection, injury to bowel/bladder/vessels; anesthesia risks.
• Ectopic pregnancy: ~2–5% after IVF.
• Birth defects: maternal age is the main factor; more research is needed to determine any IVF-specific increase.
• Cancer: modern studies do not show a significant increase in breast, endometrial, cervical, or ovarian cancer from IVF medications.
• Stress: IVF can be physically and emotionally taxing.

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FAQs

What is infertility?
Failure to conceive after ≥1 year of regular unprotected intercourse (also includes couples unable to carry to term).

IVF vs. ICSI—what’s the difference?
IVF: eggs and sperm co-incubated in the lab.
ICSI: a single sperm is injected into the egg—especially helpful in male-factor infertility.

What affects female fertility?
Genetics, age at marriage/first birth, menstrual regularity, STIs, excess weight/insulin resistance, smoking, alcohol, stress.

Does IVF deplete a woman’s egg reserve?
No. Eggs retrieved are those recruited in that month; new cohorts are recruited the next month.

Does IVF cause early menopause?
No. Menopause timing is genetically determined.

Does every developed egg fertilize?
No. Growth rates differ; some eggs/embryos fail to fertilize or arrest. Egg/sperm quality and embryo genetics are key factors.

Age limits and effect on success?
Any woman with eggs can attempt IVF. After 40, success and live-birth rates decline; after 45, pregnancy rates are ~1–5% even if eggs are present.

Do blocked tubes prevent pregnancy?
They prevent natural conception, but not IVF (fertilization occurs outside). However, hydrosalpinx fluid can impair implantation; tubes may need to be clipped/removed.

Do fibroids reduce pregnancy chances?
Submucosal fibroids (distorting the cavity) can impair implantation and increase miscarriage/preterm risk. Evaluation by HSG and/or hysteroscopy may be needed.

Do IVF drugs increase cancer risk or weight?
No proven cancer link. Temporary weight gain may occur (fluid retention, appetite). Mood changes can also affect eating.

Side effects at injection sites?
Itching, mild pain/burning/irritation, small bruises. Other possible effects: breast tenderness, hot flashes, emotional lability, groin bloating, constipation, frequent urination.

Hair dye during IVF/pregnancy?
Generally safe; prefer ammonia-free organic dyes.

When can I return to work?
Usually the day after embryo transfer; bed rest does not improve success.

Travel by car/plane during treatment?
No restriction after transfer.

How many embryos can be transferred?
Restricted by Ministry of Health to reduce multiples (e.g., under 35: typically 1 embryo; over 35: up to 2; allowances after failed attempts).

What about surplus embryos?
With consent, they can be frozen for future use. Pregnancy rates with frozen transfers are comparable to fresh; sometimes better.

Unexplained infertility—what then?
These couples often have among the highest IVF success; sometimes the problem becomes apparent during treatment (e.g., egg quality or fertilization issues).

How long does a cycle take?
Starts on day 2–3 of menses; completes in ~16–17 days. Pregnancy test 10–12 days after transfer.

Is miscarriage risk higher with IVF?
Monitored like natural pregnancies; higher genetic anomaly risk stems from the infertile population, not the method.

Should I rest after transfer?
No prolonged rest needed. Rest ~20 minutes, then resume normal light activities; limit intercourse and heavy exertion.

Gender selection?
Genetic testing can identify sex, but non-medical sex selection is legally prohibited in Turkey. PGT is allowed only for preventing serious sex-linked diseases.

Differences between IVF and natural-conception babies?
No difference.

When to test after IVF—urine vs. blood?
Urine tests can be falsely negative early. A blood hCG test 10–12 days after transfer is most accurate; in healthy early pregnancy, blood hCG roughly doubles every 48 hours.

Diet before IVF?
Healthy body supports success. Stop smoking; aim for ideal weight. Eat protein regularly (≈3x/week), drink 2–3 L water/day, increase legumes, limit tea/coffee (2–3 cups/day), avoid sodas, take folic acid and folate-rich foods, and address thyroid/insulin issues.

Do prior miscarriages reduce future IVF chances?
Not necessarily, unless complications occurred. After recurrent early loss, consider genetic testing of both partners before another attempt.

Timing of pre-IVF tests?
Some hormones (FSH, LH, estrogen, progesterone) need specific cycle days (day 2–3 or day 21). Others have no timing limits; some require fasting.

Do protocols change treatment length?
Yes. “Long” protocols start around day 21 of the prior cycle; “short/antagonist” protocols start day 2–3 and often last 10–12 days. Embryos can be transferred fresh or frozen for later transfer, depending on the case.

Very low/absent sperm—what then?
Repeat semen analysis in ~3 weeks; do genetic/hormonal tests and testicular ultrasound if needed; consult andrology/urology. If azoospermia, micro-TESE can retrieve sperm. Sperm may be retrieved first and frozen, or coordinated with the partner’s stimulation.

Painful periods and desire for children?
Painful menses may suggest endometriosis—see a specialist to evaluate ovarian reserve and endometriosis.

Frozen vs. fresh transfer success?
No significant difference; frozen transfers may sometimes improve outcomes.

Male morphology problems—treatment plan?
In conventional IVF, significant morphology defects can reduce fertilization. With ICSI, embryologists select the best-looking sperm, mitigating morphology issues (except rare conditions like globozoospermia).

When to check AMH?
Any time; no fasting needed. A specialist should interpret AMH alongside ultrasound assessment of ovarian reserve.

Interval between IVF attempts?
If β-hCG is negative, the next cycle can usually start after the next period (about one-month break), as your doctor advises.

Improving egg quality at advanced age?
Antioxidant vitamins exist, but there’s no definitive evidence they improve egg quality.

IVM (in-vitro maturation) without meds?
In IVM, immature eggs are collected and matured in the lab, used when stimulation drugs may be harmful. Thanks to newer protocols, IVM is needed less frequently today.

Dating pregnancy after transfer?
Count back 14 days from embryo transfer to assign an “LMP” date for ultrasound records; pregnancy week = embryo age + 2 weeks.

Swimming/sauna after retrieval/transfer?
Avoid very hot/humid places (sauna, Turkish bath) and swimming pools/sea soon after.

Is missed period always menopause?
No. Stress, diet, exercise, or endocrine issues can cause amenorrhea. True menopause requires clinical assessment and hormone testing.

Does cancer treatment prevent future fertility?
Chemo/radiation can damage fertility. Fertility preservation (egg/sperm freezing) before treatment is key.

Do surgeries prevent fertility?
Fertility can be protected by freezing eggs/sperm before procedures. If the uterus is removed, only surrogacy (currently prohibited by law in Turkey) would allow genetic motherhood.

I’m single and not planning marriage soon—can I preserve fertility?
Under Turkish ÜYTE regulations, single women may freeze eggs if they meet criteria (low ovarian reserve, family history of early menopause, no prior children), after specialist evaluation (including AMH).

What to bring to the IVF center?
Bring prior tests/records (HSG, semen analysis, hormone tests) for complete evaluation.

Do polyps/septum/adhesions prevent pregnancy or reduce IVF success?
Depends on location and size. Not all require treatment; hysteroscopy may be recommended.

What is laparoscopy and when is it advised?
A minimally invasive surgery to visualize the abdomen—gold standard for tubal problems, and used for ovarian cysts, fibroids, or ectopic pregnancy.

What is insemination (IUI) and its success?
Mild stimulation to produce 1–2 follicles, then prepared sperm are placed in the uterus—success similar to timed intercourse, ~15–20% per attempt.

Who is advised IUI and how many times?
Requires at least one open tube, normal uterine cavity, and ≥5 million motile sperm after wash. Typically 2–3 attempts are reasonable.

How long to wait after ectopic pregnancy?
After treatment of early ectopic (within first 1–2 months), a new attempt can be made after 3 cycles. If surgery was required, a 2-cycle wait may suffice.

Drug doses and time off work?
Patient-friendly, low-dose regimens are common; most women need time off only on egg-retrieval and embryo-transfer days.

Does season affect IVF success?
No evidence of seasonal differences.

Does obesity affect conception?
Yes. BMI >30 and central obesity/insulin resistance can reduce ovarian response and pregnancy rates. Weight loss with medical/nutritional guidance improves outcomes and reduces pregnancy risks.

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