When a patient abroad decides to undergo IVF treatment in Turkey, we will get answers to questions such as how the process works and what is done from Op. Dr. Aret Kamar, an obstetrician and gynecologist from Istanbul Women's Health and IVF Center.
FROM WHICH COUNTRIES DO PATIENTS COME TO TURKEY FOR IVF?
Turkey has a very important place in health tourism in the world, especially in IVF treatment. From which countries do most patients come to Turkey for IVF treatment?
"Many patients from Balkan countries, Northern Iraq, Syria, Iran and Azerbaijan come to Turkey for IVF treatment. There are also patients from Africa, especially from Algeria, Morocco and Tunisia. In other words, there is a very serious demand from countries in the nearby geography. There are also patients coming from America. Because Turkey is a country where this treatment can be done well and at more affordable prices. Today, in Europe, especially in countries in the nearby geography, in vitro fertilization is performed for about twice the price in Turkey. Therefore, they apply to get a good service at more affordable prices and to achieve successful results. The number of couples who have failed in vitro fertilization attempts in their countries and therefore come to Turkey is also considerable."
SUCCESS IN IVF DEPENDS ON THE AGE OF THE WOMAN
So when we compare the success rates of IVF treatment in Turkey with Western countries, what kind of results do we get?
"Actually, we are as successful in IVF as we are in other branches. Of course, the success rate varies. For example, what does it depend on? First of all, it depends on the age of the woman. When embryo transfer is performed in the 40s, a pregnancy rate of around 35-40 percent is mentioned. At the age of 43, this rate can go down to 20 percent. After 43, there is a pregnancy chance of around 10 percent. On the other hand, in younger women, if there are no extra factors, the chance of success can reach 75 percent. The first factor is age and the second is the number of eggs in women. A woman who produces 25-30 eggs at a time does not have the same chance of pregnancy as a woman who produces 2 eggs. Women with fewer eggs have to try a little harder. So, what kind of treatment do we give to these women? In the procedure we do at certain intervals, we collect two or three eggs each time and first make a baby pool in our hands. Then we transfer the good embryos and try to achieve pregnancy. The sperm count of the man is also important in the chance of pregnancy. There are men with plenty of sperm, there are men with very little sperm, even if it is difficult, and there are men who do not have sperm outside but have sperm from the ovary. These are all factors that affect the chances. Also, surgeries performed on the uterus, congenital factors such as the inner layer of the uterus not forming very well, not developing or not thickening affect the chance of pregnancy. However, as I said, the chance of pregnancy at a young age can reach up to 75 percent."
TURKEY STANDS OUT WITH SUCCESS RATES AND AFFORDABLE PRICES IN IVF TREATMENT
Therefore, IVF is more attractive in Turkey than in other countries. It is more attractive both in terms of price and because we are a country that loves to give birth. We are a country that works hard for people to have children. Turkey is a service country. When you go to places in Europe, there is generally a “I paid my money, I bought my service” style of relationship. In other words, when you sit in a restaurant, the waiter just does his duty. Personally, I have not come across such a service like Turkey, “Let's please the customer, let him leave us well, let him leave us well, let him not have any problems.” From this point of view, Turkey is a country of service. When you combine all of these, we are a preferred country among foreign patients due to higher pregnancy rates, more affordable prices, and people who serve with a smiling face."
IT IS IMPORTANT FOR HUSBAND AND WIFE TO COME TOGETHER FOR THE FIRST MEETING
Let's consider a couple coming from Balkan countries, especially Greece, for IVF treatment. Let's assume that they have a problem with their reproductive health. Is it necessary for the man to come with his wife for the first application?
"Ideally, husband and wife should come together for the first time. Couples can come together for one day. First of all, we look for anything that might have a negative impact on this couple having a child. Is there a problem with the husband? Does the man need any previous treatment? Is the sperm coming out or is it enough? Are we going to use the sperm from the sperm coming out, or are we going to take it from the ovary and use it? First of all, we try to understand these things. It is enough for the man to come once and give a sperm test and to have the blood tests we ask for. We ask the woman for an ultrasound. We check whether there are any congenital problems in her uterus and ovaries, and how many eggs her ovaries can give us. We can understand these with an ultrasound examination. Are there things like fibroids, polyps, curtains affecting the inside of the uterus that need to be corrected before treatment? We also look at these. Then we have a uterine X-ray. Uterine films are taken very well in our country. Unfortunately, some of the films coming from abroad are not very satisfactory. In fact, in many places abroad, uterine films are not taken for various reasons. They generally prefer to perform endoscopy, that is, to look inside the uterus with a camera, to look at the tubes or uterus with laparoscopy. This is more expensive and requires anesthesia. On the other hand, we can see very fine details in a well-taken uterine film, and we can determine whether there is a problem that will affect the attachment of the baby when the embryo is transferred into the uterus. Genetic research is also carried out in women who have had previous miscarriages, pregnancy losses or unhealthy babies. Therefore, in the first control, we decide which tests should be done according to what the couple tells us, and we can do everything in one day, such as blood tests, uterine film, blood donation for genetics if necessary, and sperm test.
Patients from abroad return home after this. Afterwards, it is enough for the woman to come alone. Because when a woman comes when she is menstruating, it takes 10-12 days until the time of egg collection. We do not need a man during that time. Since men usually work, they cannot leave their jobs for a long time. Therefore, the woman can stay here. Another alternative is that after the treatment is decided, if there is a gynecologist in their region that they trust and know well, and if they can take estradiol and progesterone hormones, which we do at every control, we can follow the test results of our patients remotely. We also offer the option of “you can stay in your country until the egg collection stage”. As I said before, since we are a service country, we follow the patient and the results very closely. When the result of the blood test does not come out in 2-3 hours, we call the laboratory on the phone and ask, “Why hasn't the result come out yet?” and follow up. In many places abroad, you give the blood today and the result comes out 3-4 days later. Now, when the result comes out 3-4 days later, "What will be done? When will it be collected?" it means that we are 3-4 days behind. Therefore, when you take a blood test in many places abroad, including Germany, you cannot get instant results. However, if these tests can be done and if they work with a center that gives fast results, the husband and wife can be treated in their country and come here directly for egg collection or transfer."
WHICH DISEASES ARE INVESTIGATED BEFORE IN VITRO FERTILIZATION?
So, are there certain diseases that you investigate when you take the history of couples when they first apply?
"Of course, there are genetically inherited diseases. As you know, IVF is not only a treatment to have a child. IVF is also a treatment for women who have previously given birth to a diseased baby to have a healthy birth. Again, let's assume that if the husband and wife are thalassemia carriers, which is common in Mediterranean countries, and they do not want their baby to have thalassemia, IVF is a method where these can be investigated and eliminated before the embryo transfer stage. The same is true for SMA carriers. Therefore, we examine in detail the reasons for not getting pregnant in couples who apply to us. We also investigate the history of undeveloped babies, babies who died during birth or a few years after birth. We conduct a detailed investigation into the genetic diseases carried by the man and the woman. If the man and woman are carriers of the same disease, we can also perform PGD and help to prevent the disease from being passed on to the baby."
STAGES OF IN VITRO FERTILIZATION TREATMENT
Now let's talk a little bit about the stages of “fertilization and embryo transfer” that most people are curious about. Can you tell us about the stages of IVF? How are they done and how much time do they take for couples?
"First of all, tests are done and it is decided what kind of treatment will be done. The first stage of IVF is to enlarge the eggs. Some women have plenty of eggs. In some women, because of a genetic disease, the embryos have to be separated to see if they are healthy. In such cases, needle treatments are performed with the approach “so that both eggs and embryos are abundant so that we have a high chance of distinguishing the healthy ones”. These injections are used to try to multiply the eggs. There are also patients with few eggs. Some of these patients have few eggs despite their young age. On the other hand, there are patients who are older and have fewer eggs. Injection treatment is not given to women in this group. We usually prefer pills to enlarge eggs. So, we do natural treatment. We try to say, “There won't be many eggs, but at least the egg will be good”. Therefore, the process of growing these eggs takes about 10-12 days. As I mentioned before, patients coming from abroad for treatment do not need to wait here. The next stage is egg collection. During the egg collection process, the husband and wife have to be here again. Because after egg collection, the man also gives sperm and we combine those eggs and sperm."
Egg collection is a painless procedure performed under general anesthesia. The patient arrives at the appointed time, her eggs are checked. Then she is taken to the operating room, anesthetized and the eggs are collected and evaluated in the laboratory. At that time, the man also gives his sperm. The extracted and cleaned sperms are combined with the eggs. This is called “micro injection”. After the micro injection, there is a stage called incubation, where these fertilized eggs are waited in the laboratory and their development is monitored. After the development of the embryo, we apply one of two approaches to transfer depending on the patient's condition. In some patients, we prefer to transfer the embryo immediately in the month of egg retrieval. In other women, we freeze the embryos and then transfer them. Embryo transfer is a simple, painless procedure performed without general anesthesia."
PATIENT CAN TRAVEL BY PLANE AFTER EMBRYO TRANSFER
"So, what do we pay attention to during embryo transfer? Is the thickness of the uterus good? Have there been any problems with hormone changes from menstruation until the time of transfer? Are the embryos suitable for transfer? If there are no problems in these three areas and the mother's general health is good, for example, she does not have the flu, she does not have any problems or bleeding, the embryos are transferred into the uterus. After the embryo transfer, patients rest for half an hour. Afterwards, there is no such thing as you should not move, you should not return to your hometown immediately, you should not move from your place. Patients can return to their city. Among our patients living in Turkey, there are even some who take a plane to Van. After all, it is much easier to go to Greece. You can also go to Greece by road or by car. Therefore, there is no problem in traveling after embryo transfer."
Let's imagine that a patient from Greece has undergone IVF treatment in Turkey. The IVF treatment was successful. Does this patient have to give birth in Turkey or can she give birth to her baby in Greece or in her home country?
"The vast majority of patients in Turkey who get pregnant through IVF treatment do not give birth in Turkey. Among the IVF patients we treat, the rate of those who want us to deliver their babies is only 10 percent. The rest of them either go to the city where they live or to their home countries to give birth to their babies. We are a clinic that helps 200-250 patients get pregnant every month. Imagine that 3 people give birth every day among 200-250 people. In such a birth traffic, it is difficult for us to find the time to come here to take care of patients and treat them. Some special things need to be considered in pregnancy follow-ups. We closely follow the examination and test results of expectant mothers who have their pregnancy checks in their city or country, and provide them with the necessary guidance."