Laparoscopy can be used to directly examine the issues or diseases associated with the uterus, ovaries, and the tubes by inserting instruments into the lower abdominal cavity through 3 - 5-mm holes. If required, surgery can be performed using laparoscopy.Laparoscopy is performed for the following conditions: Intra-abdominal adhesions Opening of the tubes Removal of damaged tubes Fibroid surgery Chocolate cyst surgery Hysteroscopy Hysteroscope is a device, which allows for visualizing the intrauterine cavity and making the diagnosis of uterine fibroids, polyps, and intrauterine membranes. The method also allows for providing treatment in the same session. The hysteroscope is in the form of a tube with a camera at its end. It is extended from the neck (cervix) of the uterus to the intrauterine cavity to examine and identify intrauterine problems. Your doctor may collect a small sample of tissue during the procedure if necessary. Hysteroscopy is performed in the following conditions: Intrauterine adhesions Excision of intrauterine mass lesions including fibroids/polyps Intrauterine membranes (uterine septum) Correction of uterine deformities Examination of the intrauterine cavity How is hysteroscopy performed? Hysteroscopy involves using a small telescopic camera system, which is proceeded through the cervix (neck of the uterus) and the intrauterine cavity. No incisions are required to perform the procedure. During the hysteroscopy procedure, the inner walls of the uterus is visualized after injecting a sterile solution into the uterus. The telescopic camera is used during the procedure, which helps to find out uterine fibroids, polyps, adhesions, and septum. Biopsy samples can be collected during the procedure, too, if necessary.After the diagnostic procedure, a surgical hysteroscopy is also possible in the same session to treat the identified problems. General anesthesia is used for surgery most commonly; however, the procedure can also be performed under local anesthesia and sedation. You can return home on the same day of the surgery unless you do not undergo surgery for the excision of large uterine fibroids. In this case, an adult should accompany you 24 hours a day. Hysteroscopy is not performed during menstrual bleeding or it is not used in the patients who can conceive potentially because it may cause a miscarriage. Sexual intercourse should be avoided for a menstrual cycle after hysteroscopy unless a reliable contraception method is used. After hysteroscopy, there may be mild vaginal bleeding and some pain similar to that experienced during menstruation. Simple painkillers can be used for pain relief. The bleeding will diminish gradually and stop in a few days. The bleeding will not be problematic unless it becomes severe or turns into a discharge with a foul odor. Tampons should not be used and sexual intercourse should be avoided for 1 week.Myomectomy - Fibroid SurgeryMyomectomy is the removal of uterine fibroids, which may prevent conception. Myomectomy can be performed either as open or closed surgery. Before undergoing IVF, a series of diagnostic examinations and tests will be carried out to identify the factors which may interfere with the implantation of the embryo, hindering conception. These examinations will help find out whether there are fibroids or polyps in the reproductive system of the prospective mother. Surgical treatment of uterine fibroids requires administration of general anesthesia to patients and uterine fibroids are removed one by one during the procedure. These operations are usually performed by open surgery in the abdominal region. Also, they can be performed using laparoscopic or hysteroscopic methods. A high number of uterine fibroids may make treatment processes difficult. In some cases, patients may need to repeat surgery.Not all uterine fibroids impose great risks for pregnancy; therefore, treatment should be planned at the physician's discretion.During pregnancy, fibroids may develop in the internal or external walls of the uterus. When these fibroids show growth and proliferation, they may block the intrauterine cavity. They may adversely affect the fetal development or they may even cause a preterm labor.Surgery will be scheduled based on the complaints making the patient suffer. In one out of

Ovarian hyperstimulation syndrome (OHSS) is a disease of women receiving follicle stimulating hormone (FSH) to have mature egg cells during the IVF process. During the IVF procedures, some patients may develop reactions to the medications they receive. If more than a few egg cells develop during these procedures, the ovaries will be enlarged in size and side effects may occur within 15 days because of the high levels of hormones secreted from these ovaries. The constellation of these side effects are called ovarian hyperstimulation syndrome (OHSS). OHSS is usually encountered in female patients undergoing IVF because this procedure requires stimulation of the ovaries with medication to increase the number of mature egg cells. This syndrome can be seen in women undergoing ovulation induction and artificial insemination after obtaining the mature egg cells. But hyperstimulation syndrome is usually seen in women undergoing in vitro fertilization (IVF). All patients receiving IVF-associated medication experience minor symptoms of OHSS. The majority of symptoms in most patients can be controlled sufficiently enough not to interfere with the daily life. How Does Hyperstimulation Occur?  The exact underlying mechanisms causing hyperstimulation syndrome in women with extremely low or high egg counts have not been established yet. However, a considerable number of eggs should be formed in order to see a full-fledged syndrome. The higher the number of maturing eggs, the greater will be the risk to develop the syndrome. In the female body, ovarian hormones and other hormones secreted in the body affect the permeability of small blood cells. For this reason, some fluid accumulation may occur at spaces, where it should not be. The abberrant accumulation of fluid causes bloating and discomfort. At the same time, the fluid accumulation will reduce the volume of fluid drained in the kidneys, consequently leading to a lower urine output and disordered sodium - potassium balance. What are the  OHSS symptoms? OHHS symptoms include the following: Pain in the lower abdomen due to enlarged ovaries; nausea, vomiting, diarrhea and rapid weight gain; in severe disease, shortness of breath due to fluid collection in the lungs and a predisposition to thrombosis; changes in the fluid and electrolyte balance, and dehydration meaning that the body cannot get enough water.  What are the severity categories of the ovarian hyperstimulation syndrome? OHSS is categorized as mild, moderate, and severe. Mild and Moderate OHSS: In mild and moderate OHSS,the symptoms include bloating in the abdomen, ovarian enlargement, feeling of discomfort, excessive weight gain, and nausea. These categories of severity account for 10% of OHSS cases. Severe OHSS: In severe OHSS; the abdomen swells more compared to the milder forms of the syndrome; the abdominal pain is severe, and the weight gain is excessive. Patients suffer from shortness of breath, nausea, vomiting; and they have reduced urine volume. The incidence of the severe category is lower than 2%. Patients suffering from a severe form of the syndrome usually require inpatient hospital care so that they can be followed up closely during the treatment. This group of patients is usually encountered when they first achieved conception. Resolution of symptoms may take longer compared to a natural recovery process. What determines the severity of Ovarian Hyperstimulation Syndrome (OHSS)? The severity of OHSS depends directly on the maturing follicle count and  the excess estradiol levels in the serum. If OHHS is severe or moderate and if it has a progressing disease course, inpatient treatment is necessary. Fluid replacement should be definitely performed. Nausea and vomiting should be treated with medications or injections under the supervision of a physician. As a precaution against the risk of thrombosis, heparin injection is recommended. Paracentesis is another treatment method; which is performed by withdrawing the excess fluid in the abdominal cavity. It is one of the most beneficial treatment methods in severe and progressive disease grades. If OHSS does not occur with pregnancy, it will generally disappear gradually within 10 days. If the patient is pregnant, the symptoms will remain to be apparent for 15 or 20 days. If this clinical picture is not severe, the manifestations will resolve spontaneously and will not act on pregnancy negatively.

Individuals older than 40 years of age Patients over 35 years of age with a low egg count determined in the ultrasound examination. Regardless of age, having AMH levels of less than 1. Patients with blocked, deformed or swollen uterine tubes on both sides (hydrosalpinx). (In these patients, the tubes should be closed with a laparoscopic intervention and IVF should be scheduled). When there are no sperms in the spermiogram, the condition is called azoospermia: (The MicroTESE - TESE procedure will be carried out in these patients to retrieve sperms. Then, these sperms will be examined and frozen.) A severely reduced sperm count or motility in the spermiogram. A high rate of deformity especially in the sperm heads. Family history of sex-linked genetic diseases. Genetic testing should be performed in embryos (a preimplantation genetic diagnosis - PGD -) should be performed and appropriate embryos should be selected. Either the man or the woman in the couple is a hereditary carrier of a genetic disorder. (Embryo sorting based on genes needs to be performed). Patients with a history of failed infertility treatments Couples having difficulties with sexual intercourse due to vaginismus, erectile dysfunction or ejaculation problems. Additionally, IVF can be attempted directly without performing any other treatment options in couples, in whom no underlying cause is found and with unexplained infertility. Especially in young patients and in patients with ovulation problems despite the appropriate number of eggs (polycystic ovary syndrome - PCOS-), intrauterine insemination can be attempted before in vitro fertilization (IVF).

Do medications used in the IVF procedure cause cancer?Studies have shown that these medications do not increase the risk of cancer because they are prescribed for short-term use and their use is controlled. However, the drugs to be used during IVF will be different in patients with a history of breast cancer. Does IVF treatment cause weight gain?Drugs may cause some water retention. However, when the treatment is over, the retained water will be excreted as the urine, so that the treatment will not cause a permanent weight gain.Is the type of diet important during IVF treatment?Diet content is directly associated with female fertility. Another critical point is to maintain a healthy body weight. Especially adoption of Mediterranean diet is important for both achieving the treatment targets and for the well-being of the individual as it promotes consumption of fresh fruits and vegetables.Is sexual intercourse prohibited during treatment?Engaging in sexual intercourse is not forbidden unless your doctor advises otherwise. Is the risk of miscarriages high in IVF pregnancies?The risk of miscarriage and preterm deliveries and the rates of caesarean section are high in IVF pregnancies.How many years can frozen embryos be stored?Our country allows for the storage of frozen embryos for 5 years. At the end of five years, they can be stored for one more year upon the request of the couple.What are the side effects of the drugs used in the procedure?These may include bloating, nausea, mild abdominal pain, and mild constipation.

Advanced female age Poor ovarian reserve History of uterine and ovarian surgery Infertility duration of longer than 2 years History of previously failed attempts