ICSI (Microinjection)

WHAT IS A MICROINJECTION (ICSI) PROCEDURE? In this system, different from IVF, one single sperm is injected into one single egg and waiting period for the embryos to develop begins. From the developing embryos the optimum ones for the transfer are chosen. Microinjection is usually preferred for men who have very low sperm count and even for men who have no sperm in their semen therefore had to be obtained from their testicles.

Figure 2. Microinjection procedure

WHEN AND HOW IS THE EMBRYO TRANSFER REALISED? Embryo transfer is the last step in test tube baby treatment. 48 to 72 hours after the gathering of the eggs, embryos are placed in the womb when they are of 2 to 8 cellular. This procedure can only be executed between the 2nd and 6th days. Before the embryo transfer the patient must retain their urine. With the help of an ultrasound from the belly, the embryo amount declared beforehand is injected with a thin catheter at the entrance of the womb. The embryo transfer procedure is not painful therefore anesthesia is not required. After the procedure hormone injection, suppository or cream is given to the patient in order to support the tissue layering the womb (endometrium). If pregnancy occurs this treatment continues until the tenth month of pregnancy. In situations where pregnancy does not occur and menstruation starts then the treatment has to be stopped. On the 12th day of the embryo transfer the patient is called in for a pregnancy test. For patients who test positive the blood test is then repeated two days later. After the embryo transfer no difference has been spotted between resting or ongoing with daily activities. However it is recommended that the patient does not perform any heavy duty chores 3-4 days after the procedure. There is a direct relation between the number of embryos transferred and pregnancy rates. Best results are obtained with the transfer of 2 to 4 embryos. When more than two embryos are transferred it is common to encounter multiple pregnancy. Figure 1. 8 Cellular Embryo WHAT IS EMBRYO FREEZING PROCEDURE? For couples who own many embryos and have quality embryos left over from the transfer they can have the rest frozen and in Turkey they can be kept for up to 5 years. If the laboratory environment is good the frozen embryo transfer success rate is quite high. IF THE TEST TUBE BABY TREATMENT IS UNSUCCESSFUL WHAT SHOULD BE THE WAITING PERIOD? Ideally it is best to wait 1.5 to 2 months between the two test tube baby assays. If the financial and psychological factors are convenient a second try could be done. PROBLEMS THAT COULD BE ENCOUNTERED DURING TEST TUBE BABY PROCEDURES Cancellation of the treatment: This usually occurs when the patient does not respond to the treatment and not enough eggs are formed. Usually this ratio is 1 in 7. No eggs are found: This occurs Rarely when there are problems with the ovaries, frequently hatching before the eggs are gathered or no eggs are obtained from the follicle even though the ultrasound and E2 tracking looked normal (Empty follecule syndrome). EFS is seen in 2-7% of all cycles and if the age of the women is advanced then repetition probability will rise up to 20%. Transfer difficulty: Due to the anatomical problems of the woman embryo transfer may be very difficult. Pregnancy rate decreases in these situations. Not finding sperm: In 40% of the patients that TESE is executed, sperm cannot be found and therefore the treatment is cancelled under obligation. Insemination does not occur: It is seen in 5% of the women who undergo the egg gathering process. Even though most of the time the reason could be justified as low sperm count or egg it is not always possible to exhibit the reason. Bleeding before the pregnancy test: Possibility of ectopic pregnancy: The possibility of ectopic pregnancy in test tube baby procedures is between 1-3%. This possibility increases with patients who have a surgery or damaged tubes history. In most of the cases a brown spotting like dispatch from the vagina and groin pains are symptoms but it can be spotted more clearly by a pregnancy serial blood test (beta HCG) along with vaginal ultrasound. When patients menstruate before the test day it does not necessarily mean that pregnancy rate decreases and no pregnancy will occur. Ovarian Hiperstimulation syndrome (OHSS): This situation sometimes takes place on some patients when they are given medication to increase egg production and their ovaries overreact. The specific reason is not known. Some side effects might take place during two weeks following stimulation. This situation can be noticed when abdominal cavity and other body cavities are filled with liquid. The symptoms are swelling, lower abdomen pain, nausea, vomiting an on severe cases respiratory disorder and increase in blood clotting. Some minor effects can be seen in test tube baby patients but on 5% of the patients the situation intensifies and these patients will need to be treated as an inpatient in a hospital. For patients carrying a risk of OHSS the treatment can be cancelled or the embryo transfer could be cancelled to a further date after the eggs have been gathered or the eggs could be frozen or the medication dosage could be decreased.