When is IVF Recommended? Conditions and Stages

In vitro fertilisation (IVF) treatment is typically recommended when a couple cannot achieve pregnancy despite a year of regular, unprotected intercourse, or when there are underlying issues such as blocked fallopian tubes in women or insufficient sperm parameters in men. Based on fertilising an egg in a laboratory setting and transferring the healthy embryo to the mother's uterus, this method offers hope to many couples diagnosed with infertility who cannot conceive naturally. The answer to when IVF is recommended varies depending on the couple's age, general health, and the root cause of the infertility.

• IVF is considered after 1 year of unprotected intercourse for couples under 35, and after 6 months for those over 35.
• Advanced maternal age, chocolate cysts (endometriosis), blocked tubes, and low ovarian reserve are primary reasons for women to seek treatment.
• For men, it is preferred in cases of low sperm count (oligospermia), poor motility, or a complete absence of sperm (azoospermia).
• The treatment process takes an average of 15-20 days and begins on the second or third day of the woman's menstrual cycle.
• IVF cannot be performed on women who have entered menopause or have had their uterus surgically removed.

What is In Vitro Fertilisation (IVF)?

In Vitro Fertilisation (IVF) is an advanced assisted reproductive technology where eggs retrieved from the expectant mother and sperm from the expectant father are brought together outside the body, in specialised laboratory conditions, to achieve fertilisation. The resulting embryos are monitored for development over a few days in the lab, and the healthiest ones are selected and transferred to the mother's womb. The main goal of the treatment is to overcome anatomical, hormonal, or genetic barriers that prevent natural conception, ultimately achieving a healthy pregnancy.

First successfully performed in 1978, this method has reached much higher success rates with the advancement of medical technologies. In particular, the inclusion of techniques like microinjection (ICSI) ensures successful outcomes even in cases of severe male infertility. The treatment offers the possibility of healthy embryo selection (PGT) not only to couples experiencing infertility but also to those who are carriers of genetic diseases and wish to avoid passing them on to their babies.

What Are the Necessary Conditions?

To begin IVF treatment, couples are expected to meet specific medical criteria. The most fundamental condition is that the couple has not been able to achieve pregnancy despite regular and unprotected intercourse for a certain period. While this period is considered at least 1 year for women under 35, the waiting time is reduced to 6 months for women aged 35 and older due to the risk of a more rapid decline in ovarian reserve. For women aged 40 and above, moving directly to IVF after a 3-month trial period may be recommended to avoid losing precious time.

Besides the time criterion, the expectant mother must have a healthy uterine structure capable of carrying a pregnancy, and it must be possible to retrieve sperm from the expectant father, at least through surgical methods (TESE/TESA). Before starting treatment, the couple's general health, hormone levels, and the presence of any infectious diseases are checked through detailed blood tests. The exact answer to who is a suitable candidate for IVF is clarified by the physician following these comprehensive evaluations.

When is IVF Recommended for Women?

In cases of female-factor infertility, IVF comes into play in several different scenarios. One of the most common situations is when both fallopian tubes are blocked or damaged. Previous pelvic infections, inflammation of the ovaries (salpingitis), a history of ectopic pregnancy, or abdominal surgeries can cause adhesions in the tubes, preventing the egg and sperm from meeting naturally.

Additionally, conditions where the ovarian reserve is significantly diminished, advanced age, and severe cases of chocolate cysts (endometriosis) are direct indications for IVF. For conditions that cause ovulation irregularities, such as Polycystic Ovary Syndrome (PCOS), IVF is initiated when simple ovulation induction and intrauterine insemination (IUI) methods fail to yield results. Furthermore, IVF remains the most effective option for women diagnosed with unexplained infertility who have exhausted other treatment steps.

What Are the Indications for IVF in Men?

IVF offers revolutionary solutions for overcoming male-factor infertility. Severe abnormalities in sperm parameters are the leading conditions requiring IVF in men. When the sperm count is insufficient to cause pregnancy (oligospermia), sperm forward motility is weak (asthenospermia), or sperm have severe structural deformities (teratospermia), direct recourse is taken to IVF and the microinjection (ICSI) method.

IVF can also be performed in cases of azoospermia, a condition where there is no sperm in the semen. In these patients, sperm is surgically sought from the testicles (Micro TESE), and the retrieved live sperm are used to fertilise the egg. Previous surgeries for undescended testicles, testicular trauma, a history of cancer treatment (chemotherapy/radiotherapy), genetic diseases, or the congenital absence of sperm ducts are the main factors that make IVF necessary for men.

Who Cannot Receive This Treatment?

Although IVF is a highly advanced method, it unfortunately cannot be applied to every patient. The clearest answer to who cannot undergo IVF is women who have entered menopause and have no remaining egg cells in their ovaries. Under legal regulations in Türkiye, IVF cannot be performed on these patients as they have no chance of achieving pregnancy with their own eggs.

Furthermore, women whose uterus has been completely removed surgically (hysterectomy) due to various medical reasons (cancer, severe fibroids, birth complications) cannot undergo this treatment as there is no organ left for the embryo to attach to. For men, IVF cannot be performed on patients who have no sperm in their semen (azoospermia) and from whom no live sperm cells can be retrieved from the testicular tissue despite a Micro TESE operation. The treatment is also not recommended in cases of systemic diseases such as severe heart, liver, or kidney failure, where carrying a pregnancy poses a life-threatening risk to the expectant mother.

Stages of Treatment

The stages of IVF treatment consist of sequential steps meticulously planned and tailored to the couple's specific situation. The process is usually initiated in sync with the woman's menstrual cycle and takes an average of 2.5 to 3 weeks.

Doctor Consultation and Planning

The medical history of the couple seeking treatment is listened to in detail. Previous illnesses, surgeries, medications used, and prior pregnancy losses are evaluated. An ultrasound is performed on the woman to examine the condition of the uterus and ovaries, and the man's sperm analysis (spermiogram) results are reviewed. The most suitable treatment protocol and medication dosages for the couple's needs are determined at this stage.

Ovarian Stimulation and Egg Development

The expectant mother is given egg-stimulating hormone medications (injections), starting on the 2nd or 3rd day of her menstrual bleeding. While usually only a single egg matures each month in a natural cycle, these medications aim to grow multiple eggs simultaneously. This process takes an average of 8-12 days. Egg development is closely monitored through regular ultrasound examinations and blood oestrogen hormone measurements.

Egg Retrieval (OPU) and Sperm Collection

When the eggs reach the desired size (approximately 18-20 mm), a 'trigger shot' is administered to complete their maturation. Exactly 34-36 hours after this injection, the egg retrieval (OPU) procedure is performed under mild general anaesthesia. It is a painless procedure that takes about 15-20 minutes. A sperm sample is also collected from the expectant father on the same day. If there is no sperm in the semen, sperm is simultaneously obtained from the testicles using the Micro TESE method.

Laboratory Fertilisation (ICSI/IVF)

The collected mature eggs and the prepared highest-quality sperm are brought together in the laboratory. Today, the Microinjection (ICSI) method is generally preferred; meaning, a single selected healthy sperm is injected directly into the egg under a special microscope. The fertilised eggs (embryos) are kept in special incubators that mimic the mother's womb for 3 to 5 days to monitor their development.

Embryo Transfer and the Waiting Period

The highest quality embryo or embryos that continue to develop healthily are placed into the mother's uterus under ultrasound guidance using a thin, soft catheter. It is a simple procedure that does not require anaesthesia and takes about 10 minutes. The remaining high-quality embryos can be frozen and stored for possible future attempts. A Beta-hCG blood test is performed 12 days after the transfer to check if pregnancy has occurred.

Factors Affecting Success Rates

The most critical factor determining success in IVF treatment is the age of the expectant mother. Egg quality and quantity begin to decline, especially after the age of 35, and this decline accelerates after 40. Besides age, embryo quality, the capacity of the uterine lining (endometrium) to accept the embryo, and the sperm DNA damage rate of the expectant father also directly affect success.

Couples' lifestyle habits also play a major role in the treatment outcome. Factors such as smoking, excess weight (obesity), intense stress, and an unhealthy diet can negatively impact both egg and sperm quality, reducing the chances of success. Strictly following the physician's recommendations during the treatment process and, when necessary, planning the treatment process correctly increases the success rate.

When to See a Doctor?

It is crucial for couples planning to have children to take the right steps without losing time. If you are under 35 and have not achieved pregnancy despite 1 year of unprotected intercourse, you should definitely consult a reproductive health specialist. If you are over 35, you should limit this period to 6 months, and if you are 40 or older, you should seek direct medical support without waiting.

There are also situations where you should consult a doctor immediately without waiting for the time criteria. If the woman has severe menstrual cramps (suspicion of chocolate cysts), irregular periods, a history of pelvic infection, or a previous ectopic pregnancy, no time should be lost. For men, if there is a history of undescended testicle surgery, sexual dysfunction, or a family history of early menopause or genetic diseases, a specialist should be consulted for necessary tests regardless of the waiting period.

The Process and Multidisciplinary Approach at BHT CLINIC

At the BHT CLINIC İstanbul Tema Hastanesi Obstetrics and Gynaecology department and our IVF Centre, we apply personalised treatment protocols to turn your dream of having a child into reality. We are by your side at every stage of the process with our advanced embryology laboratory and experienced medical staff. If either partner has an infectious disease such as Hepatitis or HIV, your treatment is carried out in coordination with our Infectious Diseases department, using a multidisciplinary approach under high safety standards.

It is our priority that you feel safe not only medically but also psychologically during the treatment process. Following a successful pregnancy, we continue to support you on your journey to birth with our Pregnancy School classes within our hospital. To take a step towards a healthy future and create the most suitable treatment plan for your situation, you can book an appointment with our specialist physicians.

Frequently Asked Questions

How long does IVF treatment take?

IVF treatment begins on the 2nd or 3rd day of the expectant mother's menstrual cycle and takes an average of 15-20 days until the embryo transfer. The outcome of the process is revealed with a pregnancy test performed 12 days after the transfer.

Is there an age limit for IVF?

Although there is no strict upper age limit legally specified for IVF treatment, it is medically required that the woman's ovarian reserve is not depleted (she has not entered menopause). Generally, the treatment may not be recommended after the age of 45, as the chance of achieving pregnancy with one's own eggs drops significantly.

Is IVF a painful procedure?

The egg-stimulating injections used during the treatment process have fine needles and do not cause significant pain. Since the egg retrieval (OPU) procedure is performed under mild general anaesthesia, no pain is felt. Embryo transfer is a painless procedure similar to a gynaecological examination that does not require anaesthesia.

Does IVF work on the first try?

The probability of IVF succeeding on the first attempt varies depending on the expectant mother's age, embryo quality, and the cause of infertility. While the success rate on the first try is quite high in young patients, this rate can decrease at advanced ages, and repeated attempts may be necessary.

What should be considered after the transfer?

For the first few days after embryo transfer, heavy physical activities should be avoided, and one should rest. However, continuous bed rest is not recommended. Sexual intercourse should be avoided until the pregnancy test day, medications prescribed by the doctor (such as progesterone) should be used without interruption, and stress should be avoided.

This article is for informational purposes only; please consult your physician for diagnosis and treatment.