IVF

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IVF 2017-10-03T11:37:07+00:00

INTRODUCTION TO IVF TECHNIQUES

Back in 1978, in Bourn Hall of England, the first IVF child was born by scientists Patrick Steptoe and Robert Edwards, giving hope to millions of couples all around the world.

Almost 40 years later, the detection of infertility problems, the evolution of IVF methods and the improvement of the results thereof, along with the evolution of the society which gradually began accepting it, led to a large expansion of the implementation of IVF.

In particular, the in-vitro Fertilization (IVF) is a procedure performed in the laboratory, i.e. outside the human body, to fertilize a mature oocyte by a sperm and create a fertilized egg or zygote.

The method was proved highly effective and helped thousands of healthy children be brought to the world.

In-vitro Fertilization (IVF) is advised in the following cases:

  • Destroyed or obstructed fallopian tubes;
  • Ovulation disorders;
  • Possible endometriosis;
  • Sperm disorders (small number of spermatozoa, restricted semen motility and increased percentage of morphological abnormalities);
  • Immunological factors related to the endometrium and the sperm;
  • Advanced reproductive age
  • Cases of unexplained infertility where no cause of infertility was found, despite thorough testing in both man and woman.

MEDICAL EXAMINATIONS

Couples following an IVF treatment at Medimall IVF Clinic in Athens, Greece, are submitted to the following tests:

The female partner:

  • Gynecological test;
  • Vagina culture test;
  • PAP test;
  • Hysterosalpingography;
  • Full range hormonological tests;
  • Mammography, when older than 35 years old.

The male partner:

  • Sperm culture
  • Sperm analysis

According to the results of the tests and the medical background of the couple, the doctor shall decide whether more specialized tests are required, such as:

  • Thrombophilia screening
  • Immunology tests
  • Genetic testing (e.g. karyotype analysis, cystic fibrosis test, etc.)
  • Laparoscopy

PHASES OF IVF

1. Ovary stimulation

The day of the beginning of the treatment is agreed, as well as the type and dosage of medication to be administered and the day of the re-examination. At every visit,  the levels of E2 are measured and an ultrasound screening is performed to establish the thickness of the endometrium and the number and  diameter of the ovarian follicles developed in the ovaries. Depending on these results, the doctor shall determine whether to continue the treatment or not. On average, women are examined 3 to 5 times during an IVF cycle and until egg retrieval. The stimulation of ovaries lasts 9 to 12 days approximately.

2. Egg Retrieval

The oocytes are taken by a transvaginal puncture with the use of a special needle under ultrasound monitoring. Light anesthesia is administered. Just a little after the end of the egg retrieval procedure, the woman may return to her everyday activities.

3. Fertilization

Following a certain procedure, the collected oocytes and spermatozoa are put together in culture material and are incubated for 24 hours. The day following the egg retrieval, we would know the exact number of fertilized eggs.

4. Embryo transfer

It is a simple and painless procedure. Two, three or six days after the egg retrieval, the embryos are transferred into the cavity of the uterus using a tiny catheter. Anesthesia is not required. The pregnancy test, namely the measurement of b-hCG, is performed 14 days after the egg retrieval.

5. Embryo freezing

Embryos of good quality, not used in a certain IVF cycle, may be maintained in liquid nitrogen (-196 ºC) to be potentially used in a next cycle, if required.

PHASES OF IVF

1. Ovary stimulation

The day of the beginning of the treatment is agreed, as well as the type and dosage of medication to be administered and the day of the re-examination. At every visit,  the levels of E2 are measured and an ultrasound screening is performed to establish the thickness of the endometrium and the number and  diameter of the ovarian follicles developed in the ovaries. Depending on these results, the doctor shall determine whether to continue the treatment or not. On average, women are examined 3 to 5 times during an IVF cycle and until egg retrieval. The stimulation of ovaries lasts 9 to 12 days approximately.

2. Egg Retrieval

The oocytes are taken by a transvaginal puncture with the use of a special needle under ultrasound monitoring. Light anesthesia is administered. Just a little after the end of the egg retrieval procedure, the woman may return to her everyday activities.

3. Fertilization

Following a certain procedure, the collected oocytes and spermatozoa are put together in culture material and are incubated for 24 hours. The day following the egg retrieval, we would know the exact number of fertilized eggs.

4. Embryo transfer

It is a simple and painless procedure. Two, three or six days after the egg retrieval, the embryos are transferred into the cavity of the uterus using a tiny catheter. Anesthesia is not required. The pregnancy test, namely the measurement of b-hCG, is performed 14 days after the egg retrieval.

5. Embryo freezing

Embryos of good quality, not used in a certain IVF cycle, may be maintained in liquid nitrogen (-196 ºC) to be potentially used in a next cycle, if required.

IVF PROCEDURE

After a full clinical and lab screening of the couple, who decided to proceed to an IVF procedure, a protocol is followed for the stimulation of ovaries depending on the woman’s age, the hormonological tests or the results of previous ovaries stimulation. Then, a medical prescription is given, the cost of which remains quite high. However, health funds cover a large percentage of such costs, as long as the couple submits all relevant documents and certificates, and the fund committee approves the same.

Ovary stimulation protocols are largely distinguished in long and short, with the administration of similar medication, and in protocols with the administration of antagonists.

IVF METHODS

IVF in natural cycle

This is an IVF procedure, which does not apply ovaries stimulation through medication. Instead, ultrasound monitoring is performed until an ovarian follicle reaches the ideal diameter and the hormonological measurement shows that a mature oocyte can be collected.

This method is recommended in cases of women:

  • Whose ovaries do not correspond adequately to medication for their stimulation;
  • Who repeatedly experienced failed IVF attempts using ovarian stimulation medication in the past;
  • Who do not wish to or it is not recommended to undergo ovarian stimulation because of their medical background.

Advantages of natural cycle IVF:

  • Avoidance of medication;
  • Possibility to repeat the procedure month after month;
  • Collection of oocytes usually of very good quality;
  • Smallest possible psychological impact on the couple.

Disadvantages of natural cycle IVF:

  • During the scheduled egg retrieval, ovulation might possibly occur, making egg retrieval impossible to be performed.
  • The oocyte might not be mature enough o be able to be fertilized by a spermatozoon.
  • The oocyte might not be fertilized.

At Μedimall IVF Clinic we have a great level of expertise in natural cycle IVF and very satisfactory results. We are considered to be pioneers as we first published series of our cases and their success rates in the 1st International Convention of Natural Cycle IVF in December 2006.

Typical IVF

It is recommended in cases of obstructed or destroyed fallopian tubes and possibly in cases of endometriosis. A basic prerequisite is that the semen shows normal parameters (number, motility and morphology).

With this method, the gametes (oocytes – spermatozoa) are incubated in a culture material for 16-18 hours.

ICSI

It is recommended in cases of male infertility, namely in cases where semen parameters (number, motility and morphology) are found abnormal.

According to this method, an immobilized spermatozoon is directly injected into the oocyte by means of a special needle.

Testicle biopsy – TESE

It is recommended in cases of azoospermia.

After spermatozoa are directly collected from testicles, the procedure of ICSI is then performed.

Assisted Hatching

It applies in cases where the membrane that encloses embryos is harder or thicker than normal.

This method makes the membrane thinner, through mechanical or chemical means.

Embryo transfer in the phase of blastocysts

It applies:

  • when no pregnancy is achieved after two IVF attempts, in which good quality embryos were transferred;
  • in cases where an adequate number of good quality embryos is available, still the couple wishes to have only one embryo transferred;
  • under specific circumstances, as considered by the IVF-specialist.

The transfer of embryos is performed five to six days after egg retrieval.

Please take note of the following:

  • The chances of a successful outcome after the completion of the IVF treatment is a combination of various parameters: the age of the woman, the quality of embryos, as well as the cause of the couple’s infertility. It is worth noting that 90% of couples starting an IVF treatment, finally manage to reach the stage of embryo transfer.
  • The existing legislation provides for the largest number of embryos which may be transferred, in relation to the age of the woman. When the couple wishes to avoid a possible multiple pregnancy, less embryos may be transferred than the number permitted.
  • Following an egg retrieval, medication is administered, mainly by mouth and/or a vaginal cream. In this way, a friendly environment is created in the endometrium to better accept the implantation of embryos.
  • The scientific team of the Clinic where the IVF procedure is held and the treating doctor shall inform the couple in detail to help them decide on the future of remaining embryos. Embryos left unused may be cryopreserved for five years, unless an extension is given by the National Authority of Assisted Reproduction, under particular circumstances.
  • The maximum number of IVF attempts is not determined. However, when a couple has had more that six attempts, they usually have little chance to achieve pregnancy through IVF in the future.

LEGAL ISSUES – IVF

According to Greek law no. 3305/2011, adults who have given their consent in writing and have been submitted to all lab tests as required, may undergo an IVF treatment. Moreover, the law provides for a maximum number of transferred embryos, namely three (3) for women up to 40 years old and four (4) for women older than 40 years of age. Women older than 50 years of age cannot be submitted to an IVF procedure.  Finally, the legal framework clearly determines the maximum period for which oocytes, spermatozoa and embryos can be cryopreserved, as well as the conditions under which an extension of such cryopreservation may be provided.