Back in 1978, in Bourn Hall of England, the collaboration of the scientists Patrick Steptoe and Robert Edwards led to the birth of the first IVF child, giving hope to millions of people all around the world.
Almost 40 years later, the diagnosis of the problem of infertility, the development of the IVF method, while society gradually began to accept it, led to its wide dissemination.
In particular, the In-Vitro Fertilization (IVF) is a procedure performed in the laboratory, outside the human body, in order to fertilize a mature oocyte by a sperm and create a fertilized egg or zygote. The method has been proved highly effective and helped thousands of mothers to give birth to healthy children.
In-Vitro Fertilization (IVF) is indicated in cases of:
- 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
- unexplained infertility where no cause was found, despite thorough testing in both partners.
Couples attending an IVF treatment in our clinic, are submitted to the following tests:
The female partner
- Gynecological test
- Vagina culture test
- PAP test
- 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 specialized tests are required, such as:
- Thrombophilia screening
- Immunology tests
- Genetic testing (e.g. karyotype analysis, cystic fibrosis test, etc.)
THE STAGES OF IVF
1. Ovary stimulation
The start date of treatment, the type and dosage of medicines to be used, and the day of the medical review is agreed upon by all parts. At each examination, the E2 hormone is measured, and an ultrasound scan is performed to check the thickness of the endometrium and the number and diameter of the follicles growing in the ovaries. The continuation of treatment is decided based on these results. On average, women are examined 3 to 5 times during an IVF program, up to and including ovulation. Ovarian stimulation lasts for about 9 to 12 days.
2. Egg Retrieval
The oocytes are obtained by transvaginal puncture, using a special needle under ultrasound monitoring. The procedure is performed under light anesthesia. Shortly after the end of the egg retrieval, the woman can return home.
The oocytes taken from the woman as well as the male spermatozoa are placed together – after proper processing- in special culture material and stay incubated for 24 hours. The day after the egg collection, the number of fertilized eggs is determined.
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 the first IVF cycle, may be maintained in liquid nitrogen (-196 ºC) in order to be used in the next cycle if required.
THE IVF PROCEDURE
After the full clinical and lab screening of the couple, who decided to proceed with an IVF treatment, a protocol is followed for the stimulation of ovaries depending on the woman’s age, the hormonological test results and/or the outcome of previous ovaries stimulations. Then, a medical prescription is given, the cost of which remains quite high. However, social health insurance covers a large percentage of such costs, if the couple submits all relevant documents and certificates.
Find out more
about all the IVF methods
1. IVF IN NATURAL CYCLE
This is an IVF procedure, that doesn’t include 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.
- 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 for consecutive months
- Oocytes of very good quality most of the time
- 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 to be fertilized by a spermatozoid.
- The oocyte might not be fertilized.
Medimall’s partners are highly specialized in IVF in a natural cycle, having for 12 years, very satisfactory results. At the 1st International Convention of Natural Cycle IVF in December 2006, we were the first to publish our case series, as well as their success rate.
2. CLASSIC 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.
3. INTRACYTOPLASMIC SPERM INJECTION - 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.
4. TESTICLE BIOPSY – TESE
It is recommended in cases of azoospermia.
After spermatozoa are collected directly from testicles, the procedure of ICSI is then performed.
5. 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.
6. EMBRYO TRANSFER IN THE BLASTOCYST STAGE OF DEVELOPMENT
- if no pregnancy is achieved after two IVF attempts, in which good quality embryos were transferred
- in cases of an adequate number of good quality, embryos are available, but still, the couple wishes to have only one embryo transferred.
- if there are special needs, which will be judged by the IVF doctor.
7. MICROFERTILIZATION IMSI
A method of selecting spermatozoa using a special electron microscope which provides much higher magnification and allows detailed visualization of the sperm head and assessment of any damage to its DNA. In this way, healthy sperm can be preselected before microfertilisation, in order to avoid sperm with abnormalities that could compromise the success of IVF.
WHAT YOU NEED TO KNOW
- The chances of success after completing an IVF program depend on a combination of factors such as the age of the woman, the quality of the embryos, the causes of infertility of the couple. It is worth noting that in 90% of couples who start an IVF program, embryo transfer is eventually carried out.
- The law defines the maximum number of embryos that can be transferred, always in relation to the age of the woman. When the couple wishes to avoid a possible multiple pregnancy, fewer embryos can be transferred than allowed.
- After ovulation, the woman is given some medication, mainly oral, but also transvaginal. This creates a friendly endometrium, which can better accommodate the implantation of the embryos.
- The scientific team at the IVF clinic and the doctor provide the couple with detailed information so that they can decide on the fate of the remaining embryos. The embryos remaining after the first embryo transfer can be cryopreserved for 5 years unless an application for an extension (under certain conditions) is requested and approved by the National Authority for Medically Assisted Reproduction (ANA).
- The number of IVF attempts to which a couple undergoes to achieve pregnancy is not specific. Usually, however, if it is more than 6 attempts, the chances of success are low.
- According to Law 3305/2005, adults who have given their written consent and undergone the indicated laboratory testing may undergo an IVF procedure.
- The maximum number of embryos transferred, according to the law, is two (2), depending on the age and history of each woman.
- Women over 50 years of age cannot undergo IVF.
- The legal framework makes clear the length of time for which eggs, sperm and embryos may be kept in cryopreservation, and under what conditions the cryopreservation period may be extended.
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