The IVF Process
IVF involves controlled ovarian stimulation to produce multiple oocytes (eggs), laboratory fertilisation, embryo culture to blastocyst stage, and transfer of the highest quality embryo into the uterus.
Step 1 - Initial investigation and protocol planning:
- Baseline bloods: AMH (ovarian reserve), FSH/LH/E2 (Day 2-3), TSH, prolactin, full blood count, infectious disease screening
- Antral follicle count (AFC) by transvaginal ultrasound
- Semen analysis: concentration, motility, morphology (Kruger strict criteria); DNA fragmentation (SDF) if indicated
- Fertility specialist consultation: diagnosis, stimulation protocol selection, realistic outcome discussion
Step 2 - Ovarian stimulation (Days 1-12 approximately):
- Gonadotrophin injections (FSH/LH) - recombinant or urinary; self-administered subcutaneously
- Protocol tailored to ovarian reserve: low-AMH patients use gentle minimal stimulation or mini-IVF; high-responders use antagonist protocols to reduce OHSS risk
- Monitoring: serial transvaginal ultrasound and serum E2 every 2-3 days to assess follicular development
- Trigger injection (hCG or GnRH agonist) when follicles reach 17-18 mm
Step 3 - Oocyte retrieval (Egg Collection):
- Trans-vaginal ultrasound-guided follicle aspiration under IV sedation or general anaesthesia - typically 15-30 minutes
- Day case: 2-4 hours total; discharge same day
- Oocytes graded by embryologist in the laboratory immediately
Step 4 - Fertilisation:
- Standard IVF (sperm placed with oocyte in culture) or ICSI (intracytoplasmic sperm injection) for male factor or poor previous fertilisation
- Fertilisation confirmed at 16-18 hours (2 pronuclei = zygote)
Step 5 - Embryo culture (Days 1-5/6):
- Embryos cultured in individual time-lapse incubators (EmbryoScope) - continuous monitoring without disturbance
- Cleavage stage (Day 3) or blastocyst stage (Day 5/6) assessment
- Blastocyst culture preferred: higher implantation rates; allows PGT-A biopsy; better selection
- Blastocyst morphology grading: ICM grade A/B/C + TE grade A/B/C (Gardner grading)
Step 6 - PGT-A (optional, recommended for age >37 or recurrent failure):
- Trophectoderm biopsy of 5-8 cells from blastocyst - NGS analysis
- Identifies euploid (chromosomally normal) embryos - single euploid embryo transfer (SET) - significantly reduced miscarriage rates (from ~25% to ~5% per transfer)
- Results in 7-10 days; embryos vitrified while awaiting results
Step 7 - Embryo transfer:
- Fresh transfer: Day 3 (cleavage) or Day 5 (blastocyst) - same stimulation cycle
- Frozen embryo transfer (FET): cryopreserved embryo thawed and transferred in a prepared cycle - equal or higher success rates vs. fresh for most patients
- Ultrasound-guided transfer under mild sedation; 5-minute procedure; bed rest 15-30 minutes
- Luteal support: progesterone pessaries/injections - oestrogen until 12 weeks if positive
Step 8 - Pregnancy test:
- Blood beta-hCG: 10-14 days post-transfer
- Positive: confirmatory scan at 6-7 weeks; handover to obstetric care
Success Rates and Laboratory Technology
Realistic success rates per embryo transfer:
| Age Group | Blastocyst SET (own eggs) | With PGT-A (euploid SET) |
|---|---|---|
| Under 35 | 45-55% | 60-70% |
| 35-37 | 35-45% | 55-65% |
| 38-40 | 25-35% | 50-60% |
| 41-42 | 15-25% | 45-55% |
| 43+ | 10-18% | 40-50% (with donor egg if euploid unavailable) |
Success rates are per embryo transfer (not per cycle started) with blastocyst graded ?BB by Gardner criteria. Clinic-specific SART-equivalent data provided on request.
Laboratory technology at partner clinics:
- EmbryoScope+ (Timelapse incubation): Continuous non-invasive embryo monitoring - time-lapse photography every 5 minutes documents cell division patterns; AI-assisted embryo selection algorithms
- Vitrification cryopreservation: Ultra-rapid freezing - survival rates >98% vs. 60-70% with slow-freeze; all surplus blastocysts vitrified
- Next-generation sequencing (NGS) PGT-A: 24-chromosome analysis - identifies all aneuploidies (both numerical and structural)
- ERA (Endometrial Receptivity Analysis): Gene expression test for personalised window of implantation - recommended for recurrent implantation failure (?3 failed transfers)
- IMSI (Intracytoplasmic Morphologically Selected Sperm Injection): High-magnification sperm selection (6,600- vs 400- standard ICSI) for severe male factor
Who is IVF most suitable for:
- Bilateral tubal occlusion or tubal damage
- Severe male factor infertility (combined with ICSI)
- Advanced reproductive age (?37 years)
- Unexplained infertility unresponsive to IUI
- Ovulatory dysfunction (PCOS) not responding to oral induction
- Same-sex female couples
- Single women using donor sperm
IVF Costs in Turkey
Base IVF package (own eggs + own sperm): -2,500-4,500 per cycle - typically includes stimulation monitoring (ultrasounds + bloods), egg collection, standard fertilisation, embryo culture to blastocyst, fresh or frozen transfer, luteal support, and UK/EU patient coordination.
Optional additions (priced separately):
- ICSI: +-400-600
- PGT-A (per blastocyst biopsied): +-200-400 per embryo; minimum panel fees apply
- ERA test: +-600-900
- Vitrification (embryo freezing): +-500
- FET (frozen transfer) cycle: +-800-1,200 (not including medications)
Comparison with UK:
| Procedure | Turkey | UK Private |
|---|---|---|
| IVF with ICSI (own eggs) | -2,500-4,500 | -5,000-8,000 |
| IVF + PGT-A | -4,000-7,000 | -8,000-15,000 |
| Egg donation IVF | -5,000-9,000 | -12,000-20,000 |
| Frozen embryo transfer | -800-1,200 | -2,000-3,500 |
Medications are not included in the above - gonadotrophin medications cost approximately -500-1,200 in Turkey (vs. -1,500-3,000+ in the UK).
What the package covers: All clinical fees, embryology laboratory, ultrasound monitoring, egg collection procedure, anaesthesia, embryo culture, transfer - and BB Global Health coordination including airport transfers, hotel recommendations, interpreter service, and home clinic handover documentation.