In this world of ever-evolving medicinal techniques, we have many emerging front runners. The problems which were once cursed and lamented as incurable afflictions are now being treated with utmost convenience. It is no secret that with the passage of time, the only strides we will ever take will be in the forward direction. The giant leaps promise us solutions that were once unfathomable to say the least.
One of such problems has a lot of social stigma attached to it which makes it specifically harder to tackle. Infertility, is a very real problem which affects over millions of couples worldwide. In many cultures, the inability to conceive bears this flag of obloquy. In closed social groups, a degree of rejection or a sense of being rejected by the couple may cause considerable anxiety and disappointment. Some unfortunately respond by actively avoiding the issue altogether; middle-class men are the most likely to respond in this way. Infertility may have psychological effects. Partners may become more anxious to conceive, increasing sexual dysfunction. Marital discord often develops, especially when they are under pressure to make medical decisions. Women trying to conceive often have depression rates similar to women who have heart disease or cancer. Emotional stress and marital difficulties are greater in couples where the infertility lies with the man. Fortunately, not all is lost as a beacon of hope for couples inflicted with this unfortunate condition is in-vitro Fertilization: a complex series of procedures that treat fertility, genetic problems and aid in conception.
IVF is rudimentarily a process of fertilization where an egg is combined with sperm outside the body, in vitro (in glass). The underlying principle of IVF revolves primarily around ovulation induction, which essentially involves taking fertility medications for months to help a patient’s ovaries produce eggs that are suitable for fertilization. The next step in the process is a minor surgical procedure that involves egg retrieval, where a medical professional extracts eggs from the patient’s ovaries. Once that is successfully done, the eggs are mixed with sperm cells of your partner and the fertilization process commences. The cells in the fertilized eggs divide and form embryos. The embryos are then implanted in the same or another woman’s uterus, with the intention of establishing a successful pregnancy. If the embryos attach to the lining of the uterus, pregnancy commences.
Conventional IVF is one of the many options available under the flag of assisted reproductive technology (ART). Assisted reproductive technology (ART) constitutes medical procedures which are used primarily to address infertility. When used to address infertility, it may also be referred to as fertility treatment. ART mainly belongs to the field of reproductive endocrinology and infertility. Some forms of ART are also used with regard to fertile couples for genetic reasons (preimplantation genetic diagnosis). ART may also be used in surrogacy arrangements, although not all surrogacy arrangements involve ART.
Basically, the procedure has 4 salient stages:
i) The patient is injected with certain drugs that aim to improve the fertility of the person by mimicking the action of sex hormones in the female. The levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) are meticulously regulated. The patient is also monitored on regular intervals via ultrasounds so that the best time for retrieving the egg is estimated. The egg is most commonly retrieved right after it is released by the follicles.
ii) Once the exact time is estimated, the eggs are given a hormonal drug called Human Chorionic Gonadotropin (HCG) so that the egg is prepared for fertilization. A hollow needle is then used to extract the egg which is then used.
iii) If the male has an abnormally low sperm count or the sperms are not as motile as they should be, instead of risking the fusion, the doctors inject the sperms directly into the egg so that there’s minimal chance of failure.
iv) The fertilized embryo is then set aside and for about five days it is subjected to incubation, until it becomes ready for implantation. It is then implanted in the uterus by the use of a catheter. If multiple embryos are available, they are frozen and stored so that they might be used in the future.
IVF has many different forms and the most popular and effective of those are delineated below:
i) Intra-Uterine Insemination (IUI): It is a fertility treatment that involves placing sperm inside a woman’s uterus to facilitate fertilization. The goal of IUI is to increase the number of sperms that reach the fallopian tubes and subsequently increase the chance of fertilization. It is used primarily in the cases of idiopathic infertility.
ii) Intra-Cytoplasmic Sperm Injection (ICSI): Intracytoplasmic sperm injection is an in vitro fertilization procedure in which a single sperm cell is injected directly into the cytoplasm of an egg. This technique is used in order to prepare the gametes for the obtention of embryos that may be transferred to a maternal uterus. It is usually considered in cases of severe male infertility. It is used foremostly after IVF has proven to be unsuccessful.
iii) Intra-Cytoplasmic Morphological Sperm Injection (IMSI): The intracytoplasmic morphologically selected sperm injection (IMSI) is a laboratory technique used for In Vitro Fertilization treatments and involves inserting morphologically selected sperm into the egg. A prior sperm sorting is conducted and those with abnormalities that could hinder pregnancy are discarded. This treatment is considered for males with an abnormally low sperm count.
iv) Minimal Stimulation IVF: Minimal stimulation IVF is a relatively new ART technique in the United States that offers a gentler version of ovarian stimulation compared to traditional In Vitro Fertilization. It involves the administration of less potent fertility drugs to increase the chances of conception. Low Stimulation IVF allows patients at risk of Hyperstimulation to reduce the chances of multiple births, beginning with the lowest drug doses possible.
v) Natural Cycle IVF: Natural cycle IVF is a treatment similar to traditional, or stimulated, IVF, but without the use of medications to stimulate the ovaries to produce multiple eggs. It might sound appealing to those who dislike medications. The problem, though, is that these ‘natural cycles’ still require all the other costly and demanding aspects of traditional IVF. The frequent appointments, injections to trigger ovulation, surgical egg retrievals, and embryo development in the lab are all present in natural cycle IVF. Yet, this treatment has unequivocally demonstrated a significantly lower rate of pregnancy than traditional IVF.
If infertility is caused by one of the following problems, IVF is highly recommended:
i) Genetic abnormalities
ii) Damaged, clogged or removed fallopian tubes
iii) Abnormally low sperm count
iv) Impaired motility of sperms
v) Premature Ovarian Failure
vi) Idiopathic infertility
vii) Uterine fibroids, disorders in ovulation period or endometriosis
It is pleasing to see how such severe plights have a very viable treatment now as modern IVF can very conveniently be used to treat such cases.
Infertility points to a problem in the fertilization process. The fertilization is the very first step of pregnancy. It is a process that requires the combination of the egg with the sperm. Fertilization is expected to happen 18-20 hours after the sperm gets into the egg. Generally, infertility can be diagnosed if the couple is trying to have a baby but cannot get into fertilization phase in over a year. However, for women over 35, the time period for an expected fertilization gets reduced to 6 months. After the period is observed accordingly, the couple can consider IVF as a solution for this impaired fertilization. Although the female is generally held accountable for most cases infertility, it is actually not that true. Both the male and female can have certain conditions which can predispose them to infertility. According to statistical data, in 30% of the cases, the male is to blame while similarly in 30% of the cases, the female may be the reason of infertility. The remaining 40% is split into two parts again; the first 20% indicates the situations where both male and female are the unwilling culprits while the last 20% are the situations that cannot be diagnosed and are therefore classified as cases of ‘unexplained infertility’.
Turkey is one country that has suffered from this affliction of infertility herself. Turkey is a country that lays particular emphasis on the issue of infertility, especially after experiencing a dramatic fertility decline over the last two decades. A study that was recently carried out suggested that the prevalence of infertility decreased markedly from 1993 to 2013 in Turkey. This decline was the result of improvements in maternal health care services in Turkey, as well as an increase in the use of Assisted Reproductive Technology (ART), from 1.9% in 2008 to 4.1% in 2013. The results of the final logistic regression model suggested that the risk of infertility was significantly higher among women aged between 35 and 49, uneducated women, women whose age at first marriage was over 30, women defined as overweight and women whose age at menarche was less than 12 years.
However, ever since, Turkey has come a long way and as of late, it has broken into the list of the top countries that health tourists go to for IVF treatments. The latest statistical data shows that there are more than 8 million babies that born from IVF method since the world’s first IVF baby in 1978. IVF is being applied for 50 years now and the technology and the success rate is getting better and better. With highly trained health care professionals and lucrative rates, Turkey is growing in popularity as a destination for IVF treatment abroad. There are over 140 IVF clinics and what makes Turkey attractive for fertility treatment is the low cost and the exotic scenery. Unlike the other countries that offer the aforementioned treatment, the laws in Turkey do not allow egg, sperm or embryo donation. Therefore, only IVF treatment using the couple’s own eggs and sperm is allowed. Whilst this might come off as a little restrictive, the cost of the IVF treatment can be almost the half of that in the United Kingdom and this makes Turkey a very attractive option.
Since the cost factor is a huge bargaining point for such treatments in Turkey, it would be wise not to delve into its details. Generally, a single IVF cycle costs around 2000 Euros. This price does not include medications which may be around an additional 300-500 Euros. Programs with ICSI are available from around the 2500 Euro mark. It is common practice that the initial consultation is free of charge but one should calculate any additional visits, blood tests, procedures while planning their full budget. Furthermore, the initial visit cost averages around 200 Euros while the bare IVF ICSI cycle, excluding the medications, starts from 2250 Euros at the least. Basic IVF with egg donation may cost around 4500 Euros, and coupled with Pre-implantation Genetic Diagnosis aka PGD; 6000 Euros. And if the services of a donor agency are used, the cost could go all the way up to 9000 to 10,000 Euros. However, as mentioned before, compared to the other countries in Europe, the law in Turkey is quite stringent about who is allowed to be treated and which treatments are allowed. Egg, sperm and embryo donation treatments are strictly prohibited in Turkey, as is surrogacy. Moreover, it is against the law to treat single women and lesbian couples. Therefore, the egg donation treatment is off the charts when it comes to Turkey which brings the cost of basic IVF treatment there down to a meek 2000 Euros.
All in all, Turkey has definitely revolutionized its medical methodology and is reaping the results now. Consequently, they have state of the art medical centres offering top quality health care which is so irresistible that they have people from all over the world coming to avail those services. If it keeps on going like this, a very promising future awaits Turkey.