The journey toward having a child is different for every couple, and the process may sometimes take longer or be more challenging than expected. In vitro fertilization (IVF) is one of the scientifically established methods used in the treatment of infertility. Before starting treatment, it is natural to have many questions: “What happens during the first consultation?”, “What is the difference between IUI and IVF?”, “How does treatment work, and are there any risks?”

In this section, we answer some of the most frequently asked questions about IVF and infertility in clear and accessible language. The information provided here is for general informational purposes. For advice regarding your individual health circumstances, you should consult your doctor.

👩‍⚕️ 1. General Definitions and Initial Assessment

What is infertility?

  • ✅ Short answer: Infertility is the inability to achieve pregnancy after a defined period of regular, unprotected sexual intercourse.
  • 📖 Detailed explanation:

Evaluation is generally recommended after 12 months for women under 35 and after 6 months for women aged 35 or older.

Earlier evaluation may be appropriate in the presence of irregular menstrual cycles, ovulatory disorders, endometriosis, known tubal problems or male-factor infertility.

Infertility is a common health condition affecting many couples worldwide.

👩‍⚕️ Who evaluates infertility? Obstetricians and gynecologists are involved in female fertility assessment, while urologists with expertise in andrology may be involved in male fertility assessment when appropriate.

What causes infertility?

  • ✅ Short answer: Causes may include ovulatory disorders, blocked or damaged fallopian tubes, sperm-related factors, age, uterine conditions, endometriosis and unexplained infertility.
  • 📖 Detailed explanation:

Ovulatory factors: Absent or irregular ovulation.

Tubal factors: Blockage or damage affecting the fallopian tubes.

Male factors: Abnormalities in sperm count, motility or morphology.

Age-related factors: The number and reproductive potential of eggs may decline with age.

Uterine/cervical factors: Polyps, fibroids, adhesions or cervical conditions.

Endometriosis: May affect the ovaries, fallopian tubes and pelvic anatomy.

Unexplained infertility: In some couples, no specific cause is identified despite appropriate evaluation.

What happens at the first consultation?

  • ✅ Short answer: Fertility assessment involves evaluating both partners. During the first consultation, the doctor reviews the medical history and plans any necessary investigations.
  • 📖 Detailed explanation:

For the woman: Menstrual history, pain, abnormal discharge or bleeding, previous infections or surgery, pregnancies and miscarriages.

For the man: Previous surgery, infections, reproductive health issues, smoking, alcohol and medication use, and previous pregnancies.

For both partners: Duration of attempts to conceive and other factors that may affect reproductive health.

Initial tests: Ultrasound and hormonal tests may be planned for the woman and semen analysis for the man when appropriate.

💡 Note: Whenever possible, evaluating both partners allows fertility-related factors to be considered together.

👩‍⚕️ 2. Treatment Options

What is intrauterine insemination (IUI)?

  • ✅ Short answer: IUI involves placing a laboratory-prepared sperm sample directly into the uterus through a thin catheter around the time of ovulation.
  • 📖 Detailed explanation:

Purpose: To facilitate the sperm's passage toward the egg.

Who may be considered for IUI?

Women with certain ovulatory disorders,

Certain cervical factors,

Couples with mild male-factor infertility,

Certain cases involving erectile or ejaculatory difficulties.

How is it performed?

The sperm sample is prepared in the laboratory.

Ovulation is monitored.

The prepared sperm is placed into the uterus through a thin catheter.

Success: Outcomes vary according to factors including female age, the cause of infertility and sperm characteristics.

What is IVF?

  • ✅ Short answer: IVF involves retrieving eggs from the ovaries, fertilizing them with sperm in the laboratory and transferring a developing embryo into the uterus.
  • 📖 Detailed explanation:

Ovarian stimulation and monitoring.

Egg retrieval.

Fertilization using conventional IVF or ICSI.

Monitoring embryo development in the laboratory.

Embryo transfer.

Success: Treatment outcomes vary according to factors including female age, ovarian reserve, egg and sperm characteristics, embryo development and the underlying cause of infertility.

IUI or IVF: which is the appropriate treatment?

IUI:

May be considered as a first-line treatment in certain causes of infertility.

Involves fewer treatment steps than IVF but is not appropriate for every patient.

IVF:

May be considered for certain causes of infertility or when previous treatments have not resulted in pregnancy.

Involves more treatment stages than IUI.

💡 Summary: Your doctor will consider factors such as age, ovarian reserve, sperm characteristics, tubal status and the cause of infertility when determining the appropriate approach.

👩‍⚕️ 3. The IVF Process

How is IVF performed?

  • ✅ Short answer: IVF involves fertilizing eggs with sperm in the laboratory and transferring a developing embryo into the uterus.
  • 📖 Detailed explanation:

Ovarian stimulation: Hormonal medications are used to stimulate the ovaries, with the aim of supporting the development of multiple follicles during the treatment cycle.

Egg retrieval (OPU): Eggs are generally retrieved using a thin needle under transvaginal ultrasound guidance. The procedure is usually performed under sedation or anesthesia.

Fertilization: Eggs and sperm may be combined in the laboratory using conventional IVF. When indicated, a selected sperm may be injected directly into the egg using ICSI.

Embryo development: Developing embryos are monitored in the laboratory. Embryos considered appropriate for transfer are determined following embryological assessment.

Embryo transfer: The selected embryo is placed into the uterus using a thin catheter. The procedure generally does not require anesthesia.

What is intracytoplasmic sperm injection (ICSI)?

  • ✅ Short answer: ICSI involves injecting a selected sperm directly into an egg using a fine needle under microscopic guidance.
  • 📖 Detailed explanation:
    During natural fertilization, sperm must reach and penetrate the outer layers of the egg. This process may be affected in certain cases of male-factor infertility.

With ICSI, a selected sperm is injected directly into the egg by an embryologist. If fertilization occurs, embryo development is monitored in the laboratory.

🔎 Note: ICSI may be used particularly in certain cases of male-factor infertility and other appropriate clinical circumstances. ICSI does not guarantee pregnancy.

👩‍⚕️ 4. Success, Risks and Expectations

What is the success rate of IVF?

  • ✅ Short answer: IVF outcomes vary between individuals and cannot be represented by a single success rate.
  • 📖 Detailed explanation:

Female age is an important factor.

Ovarian reserve, egg and sperm characteristics and embryo development may influence outcomes.

The cause of infertility, uterine and endometrial factors and previous treatment history are also relevant.

How does age affect IVF success?

  • ✅ Short answer: Female age is one of the important factors affecting reproductive potential and IVF outcomes.
  • 📖 Detailed explanation:

Female fertility begins to decline particularly from the mid-30s.

With increasing age, both the number of eggs and the likelihood of an egg being chromosomally normal may decline.

The likelihood of chromosomal abnormalities also increases with maternal age.

What should I do after embryo transfer?

  • ✅ Short answer: Prolonged bed rest is generally not required following embryo transfer.
  • 📖 Detailed explanation:

Most patients can return to normal daily activities following transfer.

Bed rest has not been shown to increase the likelihood of pregnancy.

Recommendations regarding physical activity may vary according to the individual treatment plan.

Medication prescribed by your doctor should be used as directed.

Is there a risk of multiple pregnancy?

  • ✅ Short answer: Yes. The likelihood of multiple pregnancy may increase when more than one embryo is transferred.
  • 📖 Detailed explanation:
    Multiple pregnancies are associated with increased risks of preterm birth, low birth weight and certain pregnancy-related complications.

The number of embryos transferred is determined according to the patient's clinical circumstances and applicable regulations.

What are the possible side effects and risks of IVF?

  • 📖 Detailed explanation:

Medication-related effects: Pain or swelling at injection sites and, rarely, allergic reactions.

Ovarian hyperstimulation syndrome (OHSS): May occur when the ovaries respond excessively to treatment. Severity can vary.

Risks associated with egg retrieval: Complications such as bleeding, infection or injury to surrounding organs may rarely occur.

Psychological effects: The treatment process and uncertainty may cause stress and anxiety for some couples.

🧪 5. Experimental and Emerging Treatments

What is the ERA (Endometrial Receptivity Analysis) test?

  • ✅ Short answer: ERA is a molecular test designed to assess the timing of endometrial receptivity in relation to embryo transfer.
  • 📖 Detailed explanation:
    A biopsy of the endometrium is obtained at a specific stage of the menstrual cycle and gene expression is assessed. The aim is to identify the period during which the endometrium is considered receptive to embryo transfer.

🔎 Realistic note: Evidence that routine ERA testing improves pregnancy or live-birth outcomes is limited. It is not routinely recommended for every patient.

What is Embryo Glue, and does it work?

  • ✅ Short answer: Embryo Glue is a hyaluronan-containing transfer medium used during embryo transfer.
  • 📖 Detailed explanation:
    This culture medium is used during embryo transfer and is intended to support the transfer environment through its hyaluronan content.

🔎 Realistic note: Studies have reported varying results, and benefit cannot be assumed for every patient.

What is microfluidic IVF?

  • ✅ Short answer: Microfluidic sperm selection is a laboratory technique that uses specially designed microchannels to separate sperm according to certain characteristics.
  • 📖 Detailed explanation:
    As sperm move through specially designed microchannels, they may be separated according to characteristics such as motility. The technique is intended to assist sperm selection for IVF or ICSI.

🔎 Realistic note: Evidence regarding its effect on pregnancy and live-birth outcomes is still being evaluated, and it is not routinely used for every patient.

What is exosome treatment?

  • ✅ Short answer: Potential applications of exosomes in reproductive medicine are being investigated and remain experimental.
  • 📖 Detailed explanation:
    Exosomes are small vesicles released by cells that can carry proteins, RNA and other biological molecules. Their possible roles and applications in reproductive biology are being investigated.

🔎 Realistic note: Exosome applications are not a standard infertility treatment. Sufficient clinical evidence regarding their safety and effectiveness in humans is not currently available.

What is endometrial scratching, and is it beneficial?

  • ✅ Short answer: Endometrial scratching involves controlled mechanical stimulation of the endometrium before embryo transfer.
  • 📖 Detailed explanation:
    The approach is based on the hypothesis that a controlled mechanical effect on the endometrium may influence the implantation process.

🔎 Realistic note: Current evidence does not conclusively demonstrate that routine endometrial scratching improves pregnancy outcomes. It is therefore not routinely recommended.

What is stem cell treatment?

  • ✅ Short answer: The potential effects of stem cells on ovarian and endometrial function are being investigated, and these applications remain experimental.
  • 📖 Detailed explanation:

In women with diminished ovarian reserve: Potential effects on ovarian function are being investigated.

For thin endometrium: Potential effects on the endometrium remain an area of research.

🔎 Realistic note: Stem cell applications are not standard infertility treatments. Clinical evidence regarding safety and effectiveness remains insufficient.

What is ROSI (Round Spermatid Injection)?

  • ✅ Short answer: ROSI is an experimental technique involving injection of immature round spermatids into an egg instead of mature sperm.
  • 📖 Detailed explanation:
    In certain circumstances where mature sperm cannot be identified, injection of round spermatids obtained from testicular tissue has been investigated.

🔎 Realistic note: ROSI is not a standard infertility treatment. Clinical evidence remains limited, and the technique is considered experimental.

What is PRP (Platelet-Rich Plasma) treatment?

  • ✅ Short answer: PRP is an experimental approach in which platelet-rich plasma prepared from a person's own blood is being investigated for potential applications in reproductive medicine.
  • 📖 Detailed explanation:

Endometrium: Potential effects have been studied in patients with thin endometrium.

Ovaries: Studies have investigated possible effects in women with diminished ovarian reserve.

🔎 Realistic note: Scientific evidence regarding the effectiveness of PRP in infertility treatment remains limited, and it is not considered a standard treatment.

What is PICSI, and how does it differ from conventional ICSI?

  • ✅ Short answer: PICSI is a laboratory technique designed to select sperm according to their ability to bind to hyaluronan before ICSI.
  • 📖 Detailed explanation:
    In conventional ICSI, sperm is selected following microscopic assessment. PICSI additionally uses the sperm's ability to bind to hyaluronan as part of the selection process.

🔎 Realistic note: An effect of PICSI on pregnancy and live-birth outcomes has not been conclusively demonstrated, and it is not routinely used for every patient.

What is calcium ionophore, and why is it used?

  • ✅ Short answer: Calcium ionophore is a laboratory agent used in selected circumstances to support oocyte activation.
  • 📖 Detailed explanation:
    During normal fertilization, changes in intracellular calcium occur after sperm entry and contribute to oocyte activation.

In certain circumstances involving previous failed or very low fertilization following ICSI, calcium ionophore may be considered for artificial oocyte activation.

🔎 Realistic note: Calcium ionophore is not routinely used for every patient. Its use is considered in specific clinical and laboratory circumstances.