MEET DR. BASTU

Ovulation induction is one of the first treatments recommended to couples that face fertility issues.

In ovulation induction, fertility medications are utilized to induce ovulation and stimulate the development of egg production in women dealing with fertility issues.

Patients can respond differently to ovulation induction. Hence, there must be a balance between increasing the number of eggs to improve the chance of pregnancy and not producing excess amount to create ovarian hyper stimulation.

We monitor closely with bloodwork and ultrasounds to ensure the response is appropriate.

To achieve pregnancy, ovulation induction is to be followed by a fertility treatment technique that brings the egg and the semen together. This is usually achieved via intrauterine insemination (IUI) and in vitro fertilization (IVF).

Intrauterine insemination (IUI) is a relatively safe procedure and usually the first fertility treatment for couples who wish to become pregnant.

IUI heavily relies on the sperm’s natural ability to fertilize an egg in the woman’s fallopian tube. Studies show that IUI will not be effective in couples where the male partner’s semen analysis is not normal.

IUI is a very quick, office procedure. It takes a few minutes, no anesthesia is utilized, and is similar to a Pap smear.

The timing of IUI is based on a woman’s ovulation for the highest chance of achieving pregnancy.

For individuals and couples who face fertility issues despite the common first-line treatments such as IUI, in vitro fertilization (IVF) is the next step.

Worldwide, IVF is the most effective fertility treatment. It is the most common form of fertility treatment and is particularly helpful for women of advanced age, women with damaged fallopian tubes, male factor infertility, and many other factors.

I work in the IVF Center of Acibadem Fulya Hospital (Istanbul, Turkey). Our center specializes in IVF and has built a reputation as a respected source for this treatment. We try to offer a variety of modifications to the standard IVF process to help patients with specific disorders. Our ability to treat both routine and complicated cases is a testament to the IVF team, including myself, other fertility doctors, nurses, scientists, embryologists, and lab technicians who together provide you with individualized care, valuable insight and world-class care that maximizes your success.

Basics of IVF

Firstly, eggs are collected from the woman’s ovaries in a surgical procedure and fertilized by the male partner’s sperm in our embryology lab. If the male partner has an abnormal semen analysis, then fertilization is achieved by injecting a single sperm into each egg, which is called Intra-Cytoplasmic Sperm Injection (ICSI).

If the fertilized eggs, which are called embryos, develop normally, they are implanted into the woman’s uterus three to five days after fertilization. They may also be frozen to use in a future IVF cycle.

Before implantation, embryos can also be tested genetically. Preimplantation genetic screening (PGT-A) and preimplantation genetic diagnosis (PGT-M). These tests enable us to detect genetic or chromosomal defects in an embryo prior implantation.

Genetic Testing

PGT-A and PGT-M have been shown to increase success rates, reduce miscarriage, identify the cause of recurrent pregnancy losses or unsuccessful fertility cycles and avoid the passing of inherited genetic conditions on to children. These tests were formerly named, preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS).

I work closely with each couple to determine an individualized and appropriate approach to help achieve the couple’s goals in creating or growing their family.

Each individual treatment is called an “IVF cycle.” One IVF cycle is usually around 2-3 weeks.

Some patients undergo several unsuccessful IVF cycles in seemingly optimal conditions: high quality eggs at retrieval, an appearance of a healthy uterine lining and a successful transfer. However, they do not get pregnant. For such patients, Endometrial Receptivity Analysis (ERA) might be viable option.

ERA is a genetic test that evaluates a sample of a woman’s endometrial lining to determine if the endometrium is prepared to accept an embryo. The test requires a tissue sample, which is taken by endometrial biopsy. When the endometrial lining is receptive, the genetic material of the endometrial cells has a unique “expression.” Advanced computer technology utilizes algorithms to look for patterns until they can classify the biopsy sample as “Receptive” or “Non-Receptive” according to its specific “expression.”

ERA testing offers the ability to identify whether a woman’s uterus is receptive (known as “implantation window”) to receive an embryo to increase the chance of getting pregnant.

Platelet Rich Plasma (PRP) injections is a treatment in which blood is taken from the forearm of the patient and centrifuged to isolate the platelet-rich plasma. The centrifuged plasma is then injected back into the ovary of the patient. It is a minimally invasive procedure. The goal is to activate ovarian stem cells to produce eggs.

PPR injections may be useful in patients with:

• Women with premature ovarian insufficiency (POI), also known as premature ovarian failure (POF). Such women are usually younger than 40 years old.
• Women with early peri-menopause.
• Women who have a low ovarian reserve.
• Women who have low Anti-Mullerian hormone (AMH) levels

Since women always have eggs inside their ovaries that are dormant, patients that suffer from early menopause or other conditions which limit fertility may still conceive using their own eggs with the aid of stem cell therapy. This is still an experimental and newly pioneered therapy intended to re-awake egg maturation and development within the ovary.
Women that are either postmenopausal or perimenopausal for less than 5 years, or young women that have a low reserve of eggs may potentially benefit from this therapy. The aim of the therapy is to stimulate ovaries, allowing for the creation and release of eggs.
Stem cell therapy is minimally invasive. Firstly, bone marrow aspiration is performed under local anesthesia. In the stem cell laboratory, separation of the bone marrow derived stem cell fraction is performed. Finally, the derived stem cell fraction is instilled to the ovaries laparoscopically under general anesthesia. The aspiration and instillation are carried out on the same day.

Infertility affects both men and women equally. I would like to repeat this fact because there is a common misconception that infertility is only a female-partner issue.

The reality is that about half of all infertility cases are due to male-factor infertility. Hence, male infertility testing is vital in order to ensure every couple’s treatment is as effective as possible.

In the IVF Center of Acibadem Fulya Hospital, we successfully diagnose numerous male infertility cases every year and develop individualized treatment plans that lead to successful outcomes.

For women who experience unexplained infertility or recurrent pregnancy loss, chromosomal abnormalities in an embryo may be a potential factor.

Nearly 70% of all embryos created naturally are low-grade and do not survive the first months of pregnancy. During IVF, many embryos are unable to successfully implant due to these abnormalities or certain genetic conditions.

Preimplantation genetic testing allows the clinicians to identify genetic or chromosomal defects in an embryo prior to being utilized in an IVF cycle.

The high-quality, chromosomally-normal embryos that are selected vial genetic testing will have the best chance of implanting successfully in the uterus and later developing into a healthy baby.

IVF Center of Acibadem Fulya Hospital offers two different types of genetic tests for embryo evaluation: preimplantation genetic screening (PGT-A) and preimplantation genetic diagnosis (PGT-M). These tests were formerly named, preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS). PGT-A enables to identify the cause of recurrent pregnancy losses or unsuccessful fertility cycles, select the very the best embryos prior to implantation, and increase the couple’s IVF success rate. PGT-M can identify whether the couples is at risk of having a baby with various genetic conditions and eliminate the chance.

Polycystic Ovary Syndrome (PCOS) is the most common ovulatory disorder for women.

PCOS often affects a woman’s menstrual cycle. In women with PCOS, ovulation does not occur properly and an egg is not released. The follicles don’t break down as they should. Instead, follicles are filled with fluid and turned into cysts on the ovaries, which is why it is called “poly-cystic” ovarian syndrome. The cysts are not harmful, but lead to hormone imbalances that can cause infertility if left untreated. However, it is treatable and most women who seek care can get pregnant through lifestyle changes, weight loss, basic infertility treatments and medication.

Endometriosis is a common, treatable disease that is known to be present in 30% of women with infertility.

Aside from infertility, women may seek medical or surgical treatment because of painful periods, pain during sexual intercourse, pain during bowel movements or urination and heavy menstrual periods or excessive bleeding between periods.

I specialize in the diagnosis and treatment of all stages of endometriosis and perform surgery on several cases a year. In Acibadem Fulya Hospital, we have a well-established Endometriosis Center and I am part of this team that provide a multidisciplinary approach to this complex disease.

In some fertility cases, reproductive surgery is required to achieve the optimal fertility success. In addition, women that do not want to get pregnant but have gynecologic conditions like endometriosis that affect their quality of life may need surgical approach.

Whether due to fertility issues or other gynecologic conditions, my surgical goal is to treat the condition with the least invasive procedure possible. Such conditions include, but not limited to:

• Endometriosis
• Chronic pelvic pain
• Ovarian cysts
• Pelvic and/or intrauterine adhesions
• Uterine fibroids
• Myomas
• Endometrial polyps
• Fallopian tube disease and obstruction
• Congenital anomalies of the pelvic organs, such as a uterine or vaginal septum