In vitro fertilization (IVF) is one of the most preferred and successful assisted reproductive methods used for infertility treatments for many years. In this article, I will address the topic of “What Should Be Considered in IVF Treatment?”
In IVF treatment, the eggs obtained from the woman and the sperm from the man are combined in a laboratory environment. As a result of fertilization between the eggs and sperm, the first human cells called embryos are formed. The development of the embryos is monitored in an incubator in the laboratory, and after 2 to 5 days, they are placed into the woman’s uterus.
The couples are evaluated through examination, ultrasound, and necessary tests, and preparations for IVF treatment are started. The most suitable treatment protocol is determined.
On the 2nd or 3rd day of the menstrual cycle, ovarian stimulation begins with daily hormonal medications and injections. Ultrasound follow-ups are done at regular intervals to monitor the growth of fluid sacs called follicles that contain the eggs. When the follicles have grown sufficiently, a trigger shot is given, and egg retrieval is performed via transvaginal ultrasound under light anesthesia, typically 35 to 36 hours later.
The egg obtained from the woman is fertilized with sperm in the laboratory environment (ICSI – Intracytoplasmic Sperm Injection),and embryos are obtained. The resulting embryos are placed into the woman’s uterus through a fine catheter.
Taking good care of yourself before starting IVF treatment will increase your chances of pregnancy. When you hold your beautiful baby in your arms, you will be happy knowing that you have done your best to create healthy eggs and sperm, and that you have prepared your body in the best possible condition for this process with your partner.
The ideal preparation period for IVF treatment is three to six months. The reason for this is that the maturation of an egg takes three months or longer. The quality of your eggs is a direct reflection of the healthy environment you have been in for the previous few months. Similarly, since today's sperm was produced 72 days ago, this is also valid for obtaining healthy sperm.
In IVF patients, it has been shown that various modifiable risk factors such as high body mass index, obesity, diabetes, smoking, overeating, micronutrient deficiencies, and high lipids negatively affect success.
Negative lifestyle factors in IVF treatment lead to chronic low-grade oxidative stress, which:
In Women:
In Men:
As a result of IVF treatment:
Maintain an ideal weight: Being at an ideal weight has a positive effect on treatment success. Being overweight or underweight can negatively impact your chances of becoming pregnant. Too much or too little body fat can lead to irregular menstrual cycles or even complete cessation, which can affect fertility. A recent study found that women who were overweight and undergoing IVF had significantly lower pregnancy rates compared to those of normal weight.
Protect your sperm health: It takes about 3 months for a sperm stem cell in the testes to mature into a fully developed sperm. Generally, maintaining a healthy weight, taking multivitamins, staying physically active, and eating a balanced diet can improve sperm quality. Excessive alcohol and smoking can reduce testosterone production, cause erectile dysfunction, and decrease sperm count/quality. Increased scrotal temperature can reduce sperm production and harm sperm quality. Men should avoid very hot environments at least 3 months before IVF treatment. While not fully proven, using boxers instead of briefs, reducing sitting time, avoiding saunas and hot tubs, and limiting scrotum exposure to hot objects like laptops can help improve sperm quality. Vitamins and antioxidants in men can improve sperm count and quality, having a beneficial impact on IVF outcomes.
Use of vitamins: If adequate intake cannot be achieved through diet, selenium, vitamin E, vitamin D, magnesium, folic acid, zinc, coenzyme Q10, and Omega-3 can positively affect egg and sperm quality. Since it takes three months for egg and sperm maturation, it is better to start supplements ideally 3 to 6 months before trying to conceive.
Quit smoking and drinking: Smoking or chewing tobacco, drugs, alcohol, and excessive caffeine consumption reduce the chances of becoming pregnant. Nicotine is ten times more concentrated in the uterine fluid than other parts of the body. Nicotine negatively affects ovarian reserve, aging the ovaries and making eggs resistant to fertilization, which reduces fertilization rates of eggs exposed to cigarette smoke.
Men who smoke are more likely to experience decreased sperm count and motility. Studies have shown that smoking men experience increased DNA damage in sperm. DNA-damaged sperm negatively affects fertilization, embryo development, embryo implantation, and increases the risk of miscarriage. Research has shown a correlation between alcohol consumption and reduced IVF success rates and live birth rates. Heavy alcohol use can reduce testosterone and sperm production.
Eat foods that can help you get pregnant: Foods rich in antioxidants like folic acid and zinc can increase pregnancy chances in both men and women by neutralizing free radicals that can damage sperm and egg cells. A healthy diet consisting of fresh vegetables and fruits, and consuming walnuts, almonds, and peanuts is beneficial.
Low-carb diets can help regulate menstrual cycles, maintain a healthy weight, lower insulin levels, and speed up fat loss. Reducing carbohydrate intake is particularly helpful for women with polycystic ovary syndrome (PCOS) as it facilitates pregnancy.
The type of carbohydrates is also important. Refined carbohydrates, such as sugary foods and drinks and processed grains like white pasta, bread, and rice, are quickly absorbed and cause rapid spikes in blood sugar and insulin levels. Refined carbohydrates have a high glycemic index. The glycemic index measures how quickly a carbohydrate food raises blood sugar and insulin levels. Consistently high insulin levels in the blood can negatively affect egg maturation and cause a reduction in reproductive hormones responsible for ovulation.
Dairy products and lactose may affect ovulation functions and reduce fertility. Adequate water intake should be ensured, with at least 2 liters of water consumed daily.
Exercise: Recent studies show that women with an active lifestyle and exercise index have a higher chance of clinical pregnancy, while women who exercise more than 4 hours a week tend to have lower live birth rates. If your physical activity is low and you are overweight, daily exercise can help you get pregnant. Moderate physical activity can increase the levels of strong antioxidant enzymes that protect eggs and sperm. Light exercise can reduce stress. It is recommended to avoid intense cardiovascular exercise and not exceed 4 hours of exercise per week. In certain stages of IVF treatment, exercise should be completely stopped.
Reduce your stress: Stress is a significant factor in IVF treatment. Deciding to undergo IVF and the treatment process itself can be exciting, but it is also emotionally stressful and overwhelming. Avoiding stress during IVF, staying in a calm and peaceful environment, having trust, and feeling relaxed can positively influence the outcome. Studies on stress and IVF success show that stress reduces the chances of live birth by 7% and that reducing stress increases pregnancy rates. Research supports that lower physiological stress levels lead to higher IVF success and that feeling relaxed facilitates conception. Reducing stress is essential when preparing for IVF. During this period, couples should maintain communication and understanding. Couples undergoing IVF should be in harmony and trust each other, which will help them avoid stress. Slowing down the pace of life, engaging in stress-reducing activities such as meditation, yoga, acupuncture, journaling, stress-free hobbies, awareness exercises, walking, and similar activities can help reduce stress. Talk therapy can also be helpful for resolving emotions and learning how to cope with them healthily. Avoiding anxiety-inducing thoughts or discussions and focusing on enjoyable activities can alleviate stress. Your doctor, who values experience and success, will make you feel comfortable and supported during this emotional and challenging process.
Breathing exercises: Breathing exercises can be used to reduce stress. Deep breathing sends a message to your brain to relax and calm down. Your brain then sends this message back to your body. When stressed, your heart rate, breathing rate, and blood pressure increase. Breathing exercises are an excellent way to relax, reduce tension, and lower stress. They are easy to learn, can be done anytime, and don’t require any special equipment. Deep breathing can eliminate stress hormones from your body faster than any medication, and you can do it anytime and anywhere. For example, you can use it during doctor appointments, ovarian stimulation, egg retrieval, or embryo transfer.
Regulate your sleep: Sleep is essential for both physical and mental health and for maintaining a generally healthy lifestyle. Sleep and fertility are intricately connected. Sleep quality and duration affect sex hormones, sperm production, and ovulation. Studies show that those who sleep 7 to 8 hours per night have significantly higher pregnancy rates than those who sleep either shorter or longer durations. Our sleep cycle is regulated by our circadian rhythm, which is controlled by a part of the brain called the suprachiasmatic nucleus in the hypothalamus. This circadian rhythm can be influenced by various environmental and personal factors, such as light exposure, exercise, and temperature. Sticking to a routine and trying to go to bed and wake up at the same time each day, avoiding alcohol and caffeine, and maintaining a healthy sleep cycle can help you fall asleep more easily. Keeping your bedroom temperature between 15 and 19ºC can significantly improve your sleep quality. Try to keep your bedroom as quiet as possible to block out external noise. If you enjoy reading before bed, make sure the lighting in your bedroom is as dim as possible. A warm shower or bath before bedtime can help promote relaxation.
Pay attention to your lifestyle: The success rates of IVF treatment can be influenced by physical, behavioral, genetic, socio-economic, environmental, or occupational factors. Exposure to various toxic agents such as heavy metals, chlorine compounds, polychlorinated biphenyls, dioxins, particulate pollutants in the air, and chemicals released from storage areas can negatively affect IVF success. Exposure to pesticides, lead, and other toxins can affect sperm quantity and quality. If there is occupational exposure, protect yourself by wearing protective clothing and equipment and avoiding skin contact with chemicals.
Check your medications: Certain medications such as calcium channel blockers, tricyclic antidepressants, anti-androgens, and anabolic steroids may affect the medications used in ovulation treatment, cause hormonal imbalances, and reduce IVF success. To avoid negative interactions, provide your doctor with a full list of all medications and dietary supplements you are taking.
It is important for both the mother and father candidates to fully disclose all information about previous treatments or existing medical conditions to their doctors to help ensure the success of the treatment.
Before starting the treatment, couples should be fully informed about all the stages of IVF so they can approach the process with patience, knowing what to expect and accepting any potential side effects or negative results.
Once IVF treatment begins, being well-informed about the procedures, including egg stimulation and the use of injection medications, paying attention to medication dosages, injection schedules, following appointments, and following the doctor’s recommendations carefully can all contribute to increasing treatment success.
The male partner must abstain from sexual intercourse and ejaculation for the last 3 days before providing the sperm sample on the egg retrieval day.
Is bed rest necessary after embryo transfer?
Embryo transfer does not require anesthesia, so you can return home shortly after the embryos are placed in the uterus. The embryo usually implants in the uterine wall either on the day of transfer or the following day, so resting and taking care of yourself during these two days is crucial.
It is advisable not to take long journeys during the first few days after the transfer and to rest at home. Bed rest is not necessary.
During the 10-12 days before the pregnancy test, normal daily activities can continue, but heavy sports should be avoided. If you are working, you may return to your job. Sneezing or coughing does not affect embryo implantation. You can take a shower, but hot tubs or saunas are not recommended.
Are there any medications to take after the embryo transfer?
During your initial IVF consultation, you will be asked about any medications you are currently taking, and the doctor will advise you on whether any of these medications might affect the IVF process, pregnancy, or fertility.
Any medications or supplements not prescribed by your doctor should be discontinued. Certain medications and supplements may interact with the treatment drugs and negatively affect the process.
In IVF, success includes the post-treatment phase. Do not neglect to take the prescribed medications after IVF. Medications prescribed after the procedure should be used regularly and as directed. Do not take any medications, including simple painkillers, without your doctor’s approval.
To increase the chances of embryo implantation and to support a potential pregnancy, luteal support medications, especially progesterone, should continue during the first few weeks following embryo transfer. Progesterone is critical for maintaining pregnancy, which is why it is often used in IVF.
Certain side effects may appear after the transfer, so it is important to monitor any symptoms and stay in touch with your doctor.
Women taking ovulation drugs may develop a condition called ovarian hyperstimulation syndrome (OHSS),where the ovaries produce too many eggs.
Symptoms of OHSS may include:
These symptoms can be mild or, in rare cases, become severe. If you experience sudden weight gain or severe abdominal pain, contact your doctor immediately for assistance.
Generally, it is recommended to avoid sexual intercourse during the two-week period after embryo transfer. While there are differing opinions, vaginal intercourse is advised against because it may trigger uterine contractions at this stage.
There is no evidence to suggest that any specific sleep position is better for embryo implantation. The embryo is transferred when the uterine wall is ideal for implantation, with the necessary thickness and structure.
If all goes as planned, your body will host a little one for the next 9 months. As mentioned in the section “Eat foods that help you get pregnant,” continue eating a diet rich in various fruits and vegetables, calcium, proteins, B vitamins, and iron.
During pregnancy, folic acid helps prevent neural tube defects, congenital heart defects, and cleft lip or palate. Folic acid is a B vitamin, and 400 mcg should be taken daily. If you had a child with a neural tube defect in a previous pregnancy, you may need a higher dose.
Pregnancy tests can be done on the 12th day after a 3-day embryo transfer or on the 10th day after a 5-day embryo transfer. To be sure, follow your doctor’s instructions about when to take the pregnancy test. At home tests are acceptable but will yield more accurate results in a medical setting.
Some women who are pregnant may experience spotting, while others may not. Some women may have cramps, while others may not.
Some women experience breast tenderness, mood swings, and more, while others feel nothing at all. Therefore, continue taking your medications and perform the pregnancy test at the time recommended by your doctor.
Prof. Dr. Nilgün TurhanGynecology, Obstetrics and IVF Treatment Specialist
PROF. DR. NILGÜN TURHAN
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