How Is IVF Performed? In its simplest definition, IVF is the process of achieving pregnancy by fertilizing the egg and sperm cells obtained from the prospective mother and father in a laboratory environment and transferring the resulting embryos into the mother’s uterus.
IVF treatment has become more commonly used in recent years. Factors such as advanced-age marriages, postponement of having children, the increasing prevalence of conditions such as endometriosis in women, rising male infertility, and infertility problems in couples who previously had children all contribute to this trend.

Today, the most significant issue in infertility is advanced maternal age. Therefore, when a woman is over 35, it is very important to consider treatment options and try to conceive as soon as possible. For women who are unmarried or not planning immediate pregnancy, increasing awareness about egg freezing is also crucial.

The key point is knowing that this condition can be treated.

Prof. Dr. Banu Kumbak Aygün

To achieve success in IVF treatment, the first and most important factor is the evaluation by an experienced physician and identifying the cause of infertility.

After evaluation and testing, an IVF treatment plan is established, and certain procedures are implemented to increase success. Proper use of medications, fertilization of the obtained gametes (sperm and egg) in a laboratory environment by an experienced team, and selecting and transferring the best embryo immediately or after 1–2 months are factors that positively affect treatment success. Maintaining a positive outlook and trusting the physician will help couples feel more comfortable during the treatment process. Recommendations regarding activity, nutrition, and stress management remain similar to daily life: staying cautious, eating a balanced diet, consuming plenty of fluids, avoiding smoking, taking short walks, not sharing the process with everyone, and adopting a positive mindset will especially help the woman feel more relaxed and support the treatment process.

Medical History (Initial Consultation)

Before starting IVF treatment, a detailed evaluation and initial consultation with the couple provide valuable insights that positively influence treatment. This consultation can take place on any day of the menstrual cycle. If immediate treatment is planned, it is appropriate to visit on the 2nd or 3rd day of menstruation. A detailed medical history is taken prior to IVF treatment. Past treatments, surgeries, medications, and test results for both partners are reviewed. Any gynecological complaints are noted. Smoking habits and body weight are also important, as they affect egg and sperm quality. After taking a detailed medical history, a gynecological examination, vaginal ultrasonography, and necessary blood tests are performed.

A uterine imaging test is usually requested to obtain information about the uterus and fallopian tubes. If suspicious findings are detected on ultrasound or uterine imaging, or if issues such as polyps or tubal blockage are identified, these problems should be resolved through endoscopic procedures such as hysteroscopy and/or laparoscopy. In some cases, pregnancy may occur naturally after these procedures without the need for IVF. Similarly, if pathologies such as ovarian cysts, uterine anomalies, endometriosis, or fibroids are detected, they should first be treated through endoscopic methods. It is known that pregnancies may also occur after such treatments.

Additionally, IVF success rates improve following treatment of these conditions. Blood tests in women typically include evaluation of ovarian reserve using AMH, thyroid function tests, and prolactin (milk hormone) levels.
Certain tests are also requested for men during the initial consultation. A sperm analysis should be performed after 3–4 days of sexual abstinence. If abnormalities are detected, consultation with a urologist may be recommended.

In particular, in cases of azoospermia (absence of sperm in semen), surgery may be required, and preoperative medications may be beneficial. In such cases, patients are evaluated jointly with a urologist, and IVF treatment timing is planned accordingly.
After completing the evaluation and tests for both partners, an individualized treatment plan is created for each couple. This plan varies depending on the woman’s age, ovarian reserve, previous treatments, and sperm parameters.

Therefore, there is no standard treatment applied to every couple; even medication types and dosages may differ. Sometimes, different treatment attempts for the same couple may also vary. Each treatment cycle is unique, and rather than making comparisons, obtaining accurate information from the physician helps reduce stress and provides psychological comfort. Comparisons may increase stress and create a pessimistic outlook, negatively affecting the treatment process. Negative energy during this period may particularly contribute to depression in women.

Ovarian Stimulation and Follicle Monitoring

On the 2nd or 3rd day of menstruation, ultrasound and blood hormone levels such as estrogen and progesterone are evaluated to determine whether it is appropriate to start treatment. If there is no contraindication, the ovaries are stimulated with small subcutaneous injections to promote the development of multiple eggs. This process lasts approximately 10–15 days. During this period, ultrasound is performed 3–4 times to evaluate the body’s response to medications, and estrogen levels in the blood provide additional information about developing follicles. Sexual intercourse is not recommended during the last 5 days of this process. Adequate fluid intake, balanced nutrition, and avoiding smoking are also advised. As a result of this process, follicles reach approximately 17–20 mm in size, and an HCG trigger injection is administered. Egg retrieval (OPU) is then performed 35–36 hours later.

Egg Retrieval (Opu)

Egg retrieval is a 15–20 minute procedure performed vaginally under anesthesia. It is not a surgical operation. On the day of egg retrieval, mature eggs are fertilized with high-quality sperm selected from the partner’s semen sample using microinjection (ICSI). Sperm selection is important and may be performed using methods such as IMSI, microchip technology, or PICSI to ensure the best sperm is injected into each mature egg. The following day, the number of fertilized eggs that have developed into embryos is determined.

The resulting embryos are preserved in special incubators and monitored daily in the laboratory to identify the best embryo. Modern laboratories use embryoscopes, allowing continuous 24/7 monitoring of embryo development. Embryo development is typically monitored for 3–5 days. An embryo that reaches day 5 is called a blastocyst and represents the highest-quality stage. A good blastocyst transferred into the uterus may result in pregnancy rates approaching 80%.

If multiple embryos reach the blastocyst stage, one or two are selected for transfer, and the remaining high-quality embryos can be frozen for future use. This allows for a second pregnancy in the future without repeating ovarian stimulation and egg retrieval. If pregnancy is not achieved, frozen embryos can be thawed and transferred after two months without repeating stimulation and retrieval.

Embryo Transfer (Et)

Embryo transfer is performed 3–5 days after egg retrieval in a painless procedure lasting 5–10 minutes in the gynecological position. One or two embryos are transferred into the uterus using a thin catheter under ultrasound guidance. A full bladder is required to obtain a clear ultrasound image.

After embryo transfer, certain medications are used to support implantation. Three days of rest at home is recommended. Patients traveling from other cities or countries may return home by plane 2–3 days later. A pregnancy test is performed 10–12 days after transfer.

Intercourse should be avoided during this period. Mild symptoms such as gas, spotting, or abdominal discomfort may occur. Continuous bed rest is not necessary. Adequate fluid intake and avoiding constipation are beneficial. Any bleeding should be reported to the physician, and medication instructions should be followed carefully.

In summary, IVF treatment begins on the 2nd–3rd day of menstruation and is completed within 15–20 days, requiring approximately 5–6 clinic visits for examination and follow-up.