One of the most important stages that determine the success of IVF is the adhesion and embed- ment capability of implanted embryo. Embryo and intrauterine membrane interact via their mu- tual secretions, and if they get along intrauterine membrane accepts embryo and embryo gets embedded in membrane. With help of a number
of techniques applied before and during the treatment, the uterine is prepared for embryos and intrauterine immunity balance is maintained. Thus, it is targetted to maximize adhesion capacity of the embryo.
Hysteroscopic Injury
Some problems related to intrauterine membrane may cause embedment failure for quality embryo. During preceeding months to transfer any potetial threats to pregnancy are inspected with heteros- copy method and small incisions are performed. After these incisions uterus is left for a kind of fal- low. In this way, the intrauterine cells are activated and the chance of embedment of transferred embryo is increased. This method increases preg- nancy rate, and at the same time the chance of miscarriage is decreased.
Supported / Combined Fallow Technique: In this technique, in addition to above mentioned fallow technique, a special fluid that enhances and stimulates G-CSF- embedment support cells is injected into the uterus. With this application, it is targetted to thicken the intrauterine membrane with help of immunity cells, and ensuring interaction between the most healthy embryo and immunity cells, thus increasing pregnancy.
Fallow 2 Application: It is understood that medications for egg development may decrease int- rauterine embedment ability. For this reason in some cases, it is recommended to freeze the high quality embryos during medication therapy and transfer these embryos in subsequent months, after egg improvement therapy.
This technique, also known as Freeze All Technique, is applied to PCOS, endometriosis cases, immune system disorders, intrauterine blood supply conditions.
Era Test (endometrium receptivity assay)
In order to have a healthy pregnancy, the endo- metrial ability to accept the embryos as well as the quality of the embryo will be important. When patients who experienced recurrent IVF failure examined, it was found that in some women the period of endometrial receptivity was different.
This problem can be solved by an advanced molecular biology-based test, which is known as the endometrium receptivity assay (ERA), which determines the optimal time for the uterus to accept the embryo.
The tissue taken from the intrauterine membrane of the patient is genetically analyzed on a given day, in a natural menstrual cycle, or in a hormo- ne-stimulated treatment process. With this anal- yze, it is possible to determine whether the uterus is suitable for embryo transplantation.
Microorganism Balancing (Emma/Alice)
It has been determined by the recent studies that the system of burial, which allows the intrauterine membrane to accept the embryo, is also regulated by various microbes in the uterus. Reduction of these beneficial microbes called
Lactobacillus can significantly reduce pregnancy rates despite good embryo transfer.
Therefore, especially in recurrent IVF failures and pregnancy losses, investigation of microbes that affect uterus positive and negative effects can be done with Alice and Emma tests or some other tests that are developed in our country.
In cases where beneficial microorganisms are less, it is observed that success rates of IVF treatment significantly increase after getting a treatment to support intrauterine. These tests and treatments are applied individually in our
clinic.
Intrauterine Detox: G-CSF Application (Intrauterine Immune Support)
It is known that the immune system’s role is crucial for embedment of embryo in endometrium. For enhancement of the positive changes of endometrium during the adhesion and embedment process of embryo, the immune
system has to be balanced.
G-CSF applied into the uterus via a special catheter during last cycle before IVF treatment supports embryo’s healthy embedment into the uterus thus increasing pregnancy probability. This application can prevent early miscarriages
and those who have difficulties to get pregnant, also known as biochemical pregnancy.
Fertility Vaccine: (Balancing immune system of uterus membrane)
The aim of fertility vaccine is to produce necessary materials for embedment of embryo out of female’s own blood cells. On the day of egg collection, a blood sample is taken and monocytes are separated from this sample. Then these cells are reproduced in special culture solutions.
CRH – a hormone secreted by brain and HCG – auterine membrane strenghtening hormone are added to this solution to ensure the proper and continuous reproduction and sufficient secretion of necessary materials.
After a two-day culture cytokine and growth hormones, which assist embedment, are secreted by monocytic cells and accumulated in reproduction fluid. This laboratory generated fluid – so called “fertility vaccine” is usually
applied into the uterus two days before the implantation, but condition of patient can affect timing. This procedure prepares the uterus for embryo implantation, or for pregnancy, in other words.
Our studies showed an easier acceptance of embryo and increased support for pregnancy by endometrium prepared with this method. Besides, miscarriages can be prevented with this method, as pregnancy becomes healthier. A 40% pregnancy rate has been achieved with this method since 2009, in women who have been given high quality embryos but have not succeeded. Moreover, this method improved miscarriage cases after IVF by 30%.
GÜRGAN CLINIC
IVF centre applies this method in cases such as:
• Unsuccessful IVF trials despite high quality embryo implantations
• Having difficulties with endometrium thickening
• Embedment problems revealed by various tests, PCOS, endometrioma, immune system disorders and observing serious increase in pregnancy rates.
Serum Treatment
There are a group of cells kknown as “natural killer” cells and some secretions from vessels such as cytokin, interferoni etc which attack supporting cells in endometrium and limit and even prevent embedment.
If the cells which secrete these substances are dominant by number and activation, embryo embedment is interrupted and ther may be no pregnancy. This is one of the causes of repetitive IVF treatments and detected by special tests. Under this circumstance, special serums are developed to eliminate these cells and their negative effects, and increase pregnancy probability.
Our aim is, either to augment the types of cells and their secretions which boost embedment by fertility serum, or to suppress cells with negative effects when necessary in order to achieve high chance of success. This serum intervenes immune system which prevents embedment, and maintains intrauterine balance. The intravenous application takes place on day of implantation, as well as after implantation, in a periodical pattern.
Operative Endoscopic Applications
There are two main approaches for endoscopic applications. In laparoscopy, reproductive organs such as uterus, ovaries, fallopian tubes are accessed and evaluated through a small incision in lower abdomen. In this way potential problems and conditions for success of IVF are studied. Conglutination caused by inflamations or other reasons, myomas, fluid accumulations due to obstruction of fallopian tubes, chocolate and ovary cysts and several other are defined and operated without completely opening the abdomen.
In this manner, abiding by microsur- gery rules, internal organ damages and conglutinations are prevented. After these operations the patient is treated with medications and put on hold for a while to verify or eliminate the spontaneous pregnancy option. These operations contribute IVF success if performed by ex-perienced specialists, under proper conditions and timed adequately.
Another approach is hysteroscopy, in which the access is performed through cervix. In hysteroscopic method, following observation of uterus, revealed polips, myomas, conglutinations uterus development disorders, unidentified bleeding are detected and treated. IVF treatments are more successful once these conditions and problems are eliminated. Hysteroscopic application is also used in Fallow1 and Fallow2 procedures to boost intrauterine immune system and intrauterine blood supply.
Combined Treatments
According to Balancing Concept, a new application and treatment is added to list of treatments and applications if it contributes to couple’s problems. In this manner the couple will have the chance to learn about every innovation, discuss its benefits and take advantage of it if necessary.
Another important subject of this concept is preventing unnecessary teatments and having healthy babies through the most financially efficient way. The above mentioned applications can be applied simultaneously, chosen over the others or substituted. These approac hes are called combined therapies.
It must be remembered that the best of everything is the closest to the natural. In some cases over treatment can be harmful, whereas a limited one can be sufficient.
Alternative Treatment Applications
Acupuncture
Acupuncture treatment adjusts limbic system, thus increases resistance against stress and giving opportunity to reduce anxiety of future mothers and fathers. Supports the embedment by affecting thinner endometrium.
Contributes to hormonal and egg quality which is regulated by autonomic nervous system. There are several studies comparing rates of successful pregnancy and continuous pregnancy in women that have received acupuncture treatment and those who have not before transfer. These studies also emphasise stress reduction and relaxation effect of acupuncture.
Ozone Treatment
Ozone treatment is a supportive treatment that has been used for a long time to eliminate circulation disorders, increase circulation and reviving organic functions.
It is used to increase the adhesion probability in IVF by decontaminating toxins and eliminating circulation
disorders, and as a result restorng intrauterine blood circulation.
Periodic application of ozone into the uterus with special equipments, as well as intravenous application ofozone improves embedment capability of endometrium.
