One of the doctors who started the first IVF application in the country in the 90s (who performed the 3rd IVF application), Prof. Cihat Ünlü, M.D., President of Turkish German Gynecological Education and Research Foundation (TAJEV) said, “After the last 30 years, the point we have reached in assisted reproductive techniques and infertility treatments in our country and our success rates are above that of many European countries.”
“In the 90s, we could do very little, especially in cases of severe male infertility, and we were sending most of our patients to European countries. In fact, some IVF and Microinjection centers in Belgium held meetings in our big cities and patients were sent to these centers. Today, this statement is completely reversed. Almost no infertile patients from Turkey go abroad, on the contrary, many infertile patients from Europe, the Middle East and Africa come to successful IVF Centers in Turkey.”
Infertility is a growing problem
Prof. Dr. Cihat Ünlü stated that the rate of pregnancy was 85.2% at the end of 1 year and 90% at the end of the year in healthy couples who are regularly together, and said, “Infertility is the inability to get pregnant for 1 year without using any birth control method, despite regular intercourse. About 30% of families with infertility problems have problems in men, 30% in women, and 30% in both men and women. In 10% of the families, there is no problem preventing pregnancy and the patients in this group are called ‘unexplained infertility’. Approximately one million couples in our country have infertility problems. We think this number is increasing. There are many reasons for this: Our women are getting married at an older age, or career and so on.
It is an important factor that they always postpone childbearing due to various reasons. In addition, the sperm count in men is gradually decreasing. To give an example; When we looked at the WHO (World Health Organization) data in the 1960s, 200 million/ml sperm in a man was considered normal. Today, this value has decreased to 20 million. The main reasons for this are pesticides that we are constantly exposed to, hormones and other toxic substances used unconsciously in agriculture, radiation, stressful life, plastic waste that even enters our waters, cigarettes, Covid 19 infection, etc…”
Declaring that all these negative factors affect the ovaries and testicles in the first place in women and men, they both cause premature aging of the ovaries and disrupt the production of sperm in the testicles, Dr. Ünlü added, “Our recommendation to couples is if the woman’s age is under 35, for 1 year, if over 35, for 6-9 months, if pregnancy has not occurred despite regular intercourse, they should go to an infertility center and have their basic examinations done. Here, first of all, sperm analysis of the man should be performed and if there is a disorder that can be corrected, it should be treated. We recommend taking a medicated uterine film (HSG) to control the permeability of both the uterus and the tubes, following the simultaneous examination of the woman, ultrasound and, if necessary, hormone tests, and examination of the ovaries and uterus.
Thanks to today’s advanced technological methods, we can treat many disorders. For example, intrauterine fibroids, the septum in the uterus, as well as the treatment of adhesions formed in the uterus as a result of some interventions and infections can be treated with the method we call hysteroscopy, by entering only the natural cavities of the body (vagina) without cutting or stitching any part of the body. Likewise, chocolate cyst, which we call endometriosis, which develops in the ovaries, etc. We can also treat cystic formations, adhesions and obstructions in the tubes with the laparoscopy method and ensure that the patient becomes pregnant spontaneously without the need for any assisted reproductive technique (in vitro fertilization, etc.). We apply IVF and other assisted reproductive techniques in our patients for whom these methods are insufficient.”
There are promising developments
Expressing that many techniques that increase success in IVF are applied today, Prof. Dr. Ünlü said, “These are Sperm Chip Application, IMSI, endometrial co -culture, Blastocyst transfer, selection of healthy embryos by embryo biopsy etc. We usually apply the methods I mentioned above after an unsuccessful IVF attempt, to address the source of the problem. We also have a patient group whose egg reserves are rapidly decreasing due to advancing age or some systemic diseases and cancer. There are many promising developments in these patients. We know that with age, the ovarian reserve decreases rapidly in women. This decrease is especially greater after 37 years of age.
For this reason, we recommend our women who are not married yet and/or who are not planning to have children yet, to freeze eggs before the age of 40. These eggs dissolve when our patient plans to have a child in the following years, and an extremely high rate of pregnancies can be obtained. Another method is to freeze and store ovarian tissue. Unfortunately, the ovaries of a patient who will undergo chemotherapy or radiotherapy due to cancer (bone cancer, lymphoma, hematological cancers such as leukemia, etc.) during childhood and youth are often irreversibly damaged due to these treatments.
Before these treatments, some of the ovarian tissue is taken in small pieces and frozen, and when it is transplanted on the existing ovary years later, that ovary can start working again and produce eggs. In fact, this method is used in some countries to delay menopause or to maintain fertility even at advanced ages. In addition to these, there are some new applications that increase the success in IVF treatments (especially in women with very low egg reserve). Among these, PRP and stem cell applications are promising in patients who have entered menopause much earlier than expected or whose ovarian reserve is very low.”
