Frequently Asked Questions (FAQ)
Can my oocytes be prematurely exhausted if I take medication for an IVF treatment?No. This is not true. Oocytes stimulated during ovulation induction are some of the 400.000 follicles, which would undergo atresia and remain unused anyway.
Which ovary ovulates every month?Every month, ovulation is a random event. Ovulation from the left ovary this month doesn’t necessarily mean ovulation from the right ovary next month. The only way to find out which ovary ovulates every month is to have an ultrasonogram approximately 5 days before the expected ovulation, which will show which ovary contains the follicle. Several cases have been reported in international bibliography, showing that an oocyte produced in one ovary can be found and fertilised in the opposite fallopian tube; this is quite rare, though.
I have my period every 28 days exactly. Does this indicate ovulation?Usually, menstruation every 28 days in every cycle proves the existence of ovulation. Women with regular, normal cycles usually ovulate, while women with irregular and extended cycles usually don’t ovulate.
Why are so many sperm cells necessary?One of the animal kingdom rules is the natural selection rule. Among the millions of sperm cells produced, the best and strongest one will prevail. A large number of sperm cells are wasted outside the uterus. Some of them reach the uterus with the aid of cervical mucus. Many sperm cells are destroyed by defensive mechanisms of the female body (phagocytes, antibodies). Finally, only a limited number will reach the fallopian tube at fertilisation. Only few of them will penetrate the outer shell of the oocyte and only one sperm cell will penetrate the oocyte.
For how long after intercourse can fertilisation occur?After normal sperm ejaculation and a few minutes later, sperm will have reached the fallopian tube. Sperm can live there for 2-3 days approximately. However, good quality sperm can remain in the fallopian tube and fertilise the oocyte up to 7 days later.
What happens with men with one or no testicles?These men usually have cryptorchidism. During the embryonic period, testicles are inside the male embryo’s abdomen. Testicles start descending before the embryo is born and move to the scrotum from the inside of the abdomen. Many times, a problem occurs during this normal phenomenon of descent, leading to the child being born with one or both testicles in his abdomen. In those cases, surgery is required and testicles are transferred from the inside of the abdomen to their normal position outside the body. Men with a history of cryptorchidism often have low sperm count, even after a successful surgery.
What is a varicocele?A varicocele is a vein enlargement in the testicle area. A varicocele is a collection of dilated veins around the testicles and slightly higher. It constitutes a quite frequent phenomenon, since 10% of men have a varicocele. These veins aim at sending blood away from testicles. Due to the existing veins, the blood regresses and due to venous blood regression and stasis, local temperature rises. Given that testicles are programmed to function in a slightly lower temperature than body temperature, locally increased temperature leads to reduced sperm production (varicocele drawing).
When must varicocele be operated upon?There is a certain disagreement on whether varicocele must be surgically treated or not. Varicocele must be treated when creating symptoms to the patient, e.g. discomforting dilatation in the scrotum, pain, swelling in the area, aesthetic reasons and slight problem in sperm count and motility. The big question is whether surgical treatment of varicocele will improve fertility. Surgical treatment is relatively easy and can be performed with laparoscopy or with normal surgery through a small section during which dilated vessels are ligated. Surgical treatment of varicocele is not expected to improve male fertility in case of really low sperm count. In these cases, ICSI is the treatment recommended in order to overcome infertility. All factors contributing to infertility must be taken into account before deciding whether varicocele should be surgically treated or not.
What happens when one fallopian tube is blocked and the other is normal?In that case, pregnancy can be achieved, but the period of trying for a pregnancy before consulting a specialist should be limited. Thus, the patient’s age constitutes a significant factor in making the right decisions and treating the problem. Patients under 35 have many possibilities of achieving pregnancy without any problem. However, in patients over 35, for whom time is critical, IVF is recommended. In cases of one fallobian tube being blocked, there is a risk of ectopic pregnancy. Thus, when pregnancy is achieved, the woman must inform her doctor, so that the appropriate ultrasound and hormone examinations are carried out.
What happens if a woman has one ovary and one fallopian tube?In those cases, there is a problem if the ovary and the fallopian tube aren’t on the same side. Then, achieving natural pregnancy is very difficult and IVF is recommended. It is worth noting natural pregnancies have been achieved in such cases, however, they are very few.
Is the IVF procedure painful? At which stage?The entire IVF procedure can be almost totally painless. The only stage during which you might experience mild pain is following oocyte retrieval. The anaesthesiologist administers to you very mild sedation, thus you feel no pain. After the end of oocyte retrieval, you might experience mild pain. In that case, you may take a simple painkiller, e.g. paracetamol. During embryo transfer, you feel absolutely no pain, in fact, the procedure resembles a simple Pap test.
Will medication administered to me during IVF harm me in the long run? I have heard that it might cause cancer…In the past, medication for ovarian stimulation was feared to be correlated with the development of cancer. Recently, an epidemiological study from Denmark has been published, reassuring the medical community, as well as the public, as it definitely and clearly demonstrates that there is no correlation between the use of medication for infertility (ovarian stimulation) and the development of (breast or ovarian) cancer. This study has been recently published in 2 parts (Jensen A et al 2007 Cancer Epidemiol Biomarkers Prev 16(7):1400-7 and Jensen A et al 2009 BMJ 338:b249). Denmark is the country with the highest percentage of children born with the aid of IVF. Within the framework of the study, there have been observed 54.362 patients who have reached assisted reproduction clinics in Denmark, between 1963 and 1998. This is the study with the largest number of participants that has ever been carried out and the only one deemed reliable to give definite and clear answers due to its statistical validity. Namely: Conclusion 1: “There is no significant correlation between the possibility of developing breast cancer and the use of medication for infertility. There is no correlation with the number of cycles or the number of years since the first use of medication”. Researchers have detected 331 cases and note that the group of patients who remain childless must be further studied, due to the limited number of women who constitute it. Conclusion 2: “No increase is recorded in the possibility of developing ovarian cancer after the use of gonadotropins. There is no correlation with medication for infertility, regardless of the number of cycles, time of monitoring or number of children of every patient”. Researchers have found out 156 cases and note that previous studies of that kind couldn’t have given definite and clear answers due to inaccurate statistical analysis (risk factor evaluation) and to comparison being made to the wrong population (patients with infertility who have used medication have been compared to the general population, while they should have been compared with patients with infertility who haven’t used any medication). They conclude that the possibility of developing cancer seems to increase rather due to the patient’s infertility itself than to the use of medication for ovarian stimulation (it has been suggested in the past that endometriosis constitutes a risk factor). They stress that research must now turn towards that direction. Personal opinion of Mr. Evripidis Mantoudis “The study from Denmark confirms my personal clinical experience. Nowadays, too many women are using IVF medication. If it caused cancer, every reproduction gynaecologist who applies IVF treatments would face cases of cancer among his patients on a daily basis. Of course, nothing like that happens. Besides, no large study showing a clear correlation between medication and cancer occurrence has ever been published in the international scientific bibliography. All relevant references concerned studies that involved a limited number of patients, thus their results couldn’t be statistically reliable. In any case, cancer development is multifactorial, which means that many different factors must coexist. Epidemiological studies endorse clinical experience: medication for ovarian stimulation is necessary in order for the infertility treatment to succeed. It is self-evident though that we prescribe the fewest possible medicines, as we achieve in this way the “ideal” ovarian stimulation. Moreover, we thus avoid side effects, such as ovarian hyper-stimulation. Our aim is to achieve a positive result as soon as possible, that is with the fewest possible IVF cycles”.
I have heard that IVF medication has many side effects; is this true?At “gennima”, all medication for ovarian stimulation is administered in personalised doses, i.e we modify the dose depending on the course of every patient’s treatment cycle. As a result, in most cases, there are no side effects. Moreover, during the last years, contrary to the “more drugs= more oocytes= more chances of achieving pregnancy” rationale, Mr. Evripidis Mantoudis has been administering lower doses of medication, with excellent pregnancy achievement results and without the risk of ovarian hyperstimulation. With lower doses of medication, fewer oocytes are produced, having though better fertilisation rates and giving higher quality embryos (better potential of pregnancy achievement). Rarely, the patient’s ovaries may overreact to medication, thus producing too many follicles; this is called “ovarian hyperstimulation”. In that case, the usual symptoms include nausea, vomiting and abdominal pain. “Ovarian Hyperstimulation Syndrome”, as it is called, may have mild, moderate or severe symptoms. The administration of less medication, as applied by Mr. Mantoudis, ensures excellent results and a satisfaction rate of almost 100%, because “disturbance” in the patient’s system is the least possible. Thus, the whole procedure becomes easier, more comfortable and has no complications. In the rare case that too intense OHSS symptoms lead to cancelling the IVF cycle, there is the possibility of embryo cryopreservation and embryo transfer in a future cycle, after symptoms subside.
What is my success rate? How many treatments will be necessary?The success rate of an IVF cycle depends on many factors, such as the woman’s age and hormone profile, anatomical parameters, sperm quality, number and quality of embryos transferred, etc. Statistical data of IVF centres do not depict your individual chances of achieving pregnancy, however, they are indicative of each centre’s quality. After the causes of infertility are diagnosed, we inform you on your personal pregnancy achievement rates, based on the suggested treatment. Unfortunately, even if you have high anticipated possibility of achieving pregnancy, it doesn’t mean that your first IVF cycle will necessarily be successful. At “gennima”, we inform you in detail and with honesty, so that you are fully aware of the situation.
How many times will I have to come to “gennima” during the IVF cycle?After your first appointment at “gennima” and the assessment of the causes of infertility, you will possibly have to undergo some tests. When you start with your IVF protocol, the cycle must be monitored via ultrasonograms (ovaries, endometrium) and blood tests (hormone levels) 3-4 times until oocyte retrieval. Monitoring takes place at “gennima”, unless you live outside Athens. In that case, the cycle can be monitored in your city, as “gennima” cooperates with gynaecologists in all the Greek cities. Oocyte retrieval and subsequent embryo trasfer (2-5 days after oocyte retrieval) are definitely performed at “gennima”. Exactly 14 days after oocyte retrieval, a pregnancy test is carried out.
Does “gennima” cooperate with doctors outside Athens?After the first appointment, couples who live outside Athens are not obliged to come to “gennima” for the IVF cycle monitoring. Monitoring can take place in their city, as “gennima” cooperates with a network of gynaecologists across Greece. The progress of the treatment must be monitored via ultrasonograms (ovaries, endometrium) and blood tests (hormone levels) during ovarian stimulation (before oocyte retrieval). Oocyte retrieval and embryo transfer are performed at “gennima”.
I have heard talking about “embryo quality” at embryo transfer; is this related to the health of the children to be born?Fertilisation and embryo culture until embryo transfer are performed in the embryology laboratory. Throughout embryo culture and until the moment before embryo trabsfer, embryologists assess the embryos based on international IVF regulations. At that time, they inform couples on “embryo quality”, which can be “top”, “good”, “mediocre” or “bad”. This embryo classification is related to the possibility of pregnancy achievement (the patient’s odds of getting pregnant after the specific embryo is transferred) and has absolutely nothing to do with the health of the baby to be born.
Can embryos be frozen at “gennima”? Can one be certain that freezing is safe for the embryos?At “gennima”, there is the possibility to cryopreserve embryos (and blastocysts), as well as sperm and oocytes. You can be informed on the annual cost of cryopreservation at our secretariat. As for safety, a recent (2009) retrospect of relevant clinical studies affirms that embryo cryopreservation is a safe method with regards to the health of children to be born: http://humrep.oxfordjournals.org/cgi/reprint/dep125v1 Researchers have checked pregnancy age, birth weight and congenital abnormality rate and compared children born from “fresh” embryos with those born from “frozen” embryos. They have concluded that no differences are observed between the 2 groups. Thus, cryopreservation doesn’t affect adversely pregnancy or children’s health.
I have heard that with IVF, women get pregnant with twins or even triplets. How can I avoid that?An issue of great interest to couples who need an infertility treatment is the possibility of multiple pregnancy (twins, triplets etc.). Multiple pregnancy constitutes a well known complication of IVF, which may occur when 3 or more embryos are transferred. In Greece, the legislation in force states that up to 3 embryos can be transferred in patients under 40, while up to 4 embryos can be transferred in patients over 40 (the older a woman gets, the fewer her chances of becoming pregnant are). In other European countries, legislation is stricter, e.g. in the UK, no more than 2 embryos are allowed to be transferred in all cases, while in some clinics in Scandinavian countries only one (1) embryo is transferred. This is possible due to the optimal operation of the embryology laboratory, which allows the development of higher quality embryos, i.e. embryos with better chances of implantation. Please read more at www.oneatatime.org.uk. At “gennima”, we try to avoid multiple pregnancy, which is risky for the pregnant woman as well as for the embryos. Thanks to the optimal operation of the embryology laboratory, we have been transferring 2 embryos without pregnancy achievement rates being reduced. Thus, we avoid unpleasant therapeutic options, such as selective embryo reduction.
What is cystic fibrosis? Why should I have this test?At “gennima”, we recommend the cystic fibrosis test as part of prenatal checkup. Unfortunately, insurance funds do not cover the cost of this test; however, we firmly believe that it is worth ruling out the possibility of giving birth to a child with such a severe disease. Cystic Fibrosis or Fibrocystic Disease is the most common hereditary disease of the Caucasian race, leading to death at a young age. Cystic Fibrosis isn’t a contagious disease, however, it is hereditary. To have the disease, one must carry two pathological genes, inherited from both his/ her parents, who are carriers of the disease without knowing it. Today in Greece, carriers of the pathological gene that causes Cystic Fibrosis are estimated to exceed 500.000. The main characteristic of the disease is the production of particularly dense mucus, which clots various organs and pores of the body – mainly the lungs and pancreas -, leading to severe pancreatic insufficiency at a very young age, as well as to severe respiratory infections that gradually destroy the lungs and induce respiratory deficiency and death to the patient. The disease aggravates many other organs of the body, such as: · The liver, by causing cirrhosis, · The sinuses, with the incidence of polyps and sinusitis at a very young age, · The bones and joints, with the development of rheumatoid arthritis, osteopenia and osteoporosis, · The genital system of men, the vast majority of whom face fertility problems, · The bowel, with the induction of ileus, as well as the sweat glands. Due to pancreatic insufficiency, it is difficult for patients to gain weight, while they often suffer from diabetes, too. Patients are extremely sensitive to respiratory infections; to treat them, they undergo physiotherapy and various therapeutic treatments on a daily basis, with the aim to deal with chronic infections of the respiratory system and to restrain damage of the lungs, which leads to the patients’ death. Cystic Fibrosis is a hereditary disease that is due to a mutation of a gene on chromosome 7. To have the disease, one must carry two pathological genes, inherited from both his/ her parents, who are carriers of the disease without knowing it. If 2 carriers of the disease get married, the chance of giving birth to a child with Cystic Fibrosis is 1 out of 4. 25% chances of giving birth to a child with Cystic Fibrosis exist in all births.
I want to talk to a couple that has already had a child with IVF at “gennima”. How can this be arranged?Many of the couples who have overcome their infertility at “gennima” would like to share their experience with you. The have shared their story with us (besides, we have experienced it together!), to help other couples with the same problems overcome their fear and anxiety, giving them hope and courage. The experiences of all these couples are hosted a n o n y m o u s l y on our website. We handle them discretely and in strict confidence, because we have gone through them together, sharing anxiety and joy. If you are interested in a specific story (that couple may have faced the same problems that you are facing today), we can put you in touch with them and you can talk in person. Your communication with them (always a n o n y m o u s l y) is the greatest proof that you can overcome problems and that your dream of a healthy baby will soon come true.
I have heard of the “long” and the “short” IVF protocol. What is their difference?There are 2 basic ovarian stimulation protocols, the “long” one and the “short” one, as well as many variations, selected depending on the hormone profile, the clinical profile and the history of each couple. Medication is administered in the form of subcutaneous injections. In general, the long protocol includes GnRH-agonists, such as ARVEKAP (triptorelin) and DARONDA (leuprorelin) and begins with ovarian suppression in order to regulate the IVF cycle, approximately on the 21st day of the menstrual cycle (when the woman has a 28-day cycle). The first day of the cycle is considered to be the first day of your period. After having your period, you must undergo a transvaginal ultrasound and a blood test to check your hormone levels. This is necessary so as to detect whether suppression has been achieved. Then, the medication for stimulation is administered, helping the ovaries produce many follicles. You must have a blood test and a transvaginal ultrasound 3 – 4 times until oocyte retrieval. With the blood test we monitor hormone levels and with the ultrasound we monitor follicular progress. The short protocol includes GnRH – antagonists, such as ORGALUTRAN (genirelix) and CETROTIDE (cetrorelix) and starts on the 2nd or 3rd day of your menstrual cycle. The first day of the cycle is considered to be the first day of your period. On the 2nd day, you have a transvaginal ultrasound and a hormone blood test. Then, the stimulation drug is administered, while the medication for suppression starts on the 6th or 7th day approximately. As in the long protocol, a transvaginal ultrasound and hormone control must be carried out every 2 or 3 days.
How will I know how many embryos will be transferred at embryo transfer?Embryologists at “gennima” regularly update the couple on the development of the embryos following oocyte retrieval and fertilisation. Right before embryo transfer, the final briefing takes place. At that time, a written report on the entire course of the IVF cycle, as well as pictures of the embryos are given to the couple. The number of embryos to be transferred is thoroughly discussed with the doctor and decision is made based on the legislation in force, the woman’s age, the number and quality of embryos, infertility history etc. Our main aim is to achieve pregnancy without the risk of multiple pregnancy.
What are the main risks of IVF?The main complications of IVF are: · Oocyte retrieval complications, · ovarian hyperstimulation syndrome, · multiple pregnancy · and ectopic pregnancy (embryo implanted outside the uterus). Oocyte retrieval complications Oocyte retrieval usually is a very well tolerated – in fact, almost completely painless – procedure, performed under mild intravenous sedation, so that the patient feels absolutely no pain. However, some women might experience: · Mild or moderate discomfort, usually due to intravenous sedation, · Bleeding from the ovary or the vagina, during or after oocyte retrieval. Usually, bleeding is minimal, totally controlled and may create a problem only in rare cases. Infection is a rare complication, treated with antibiotics. · Injury of the urinary bladder, the bowel or blood vessels during oocyte retrieval is an extremely rare complication. Multiple pregnancy An issue of great interest to couples who need an infertility treatment is the possibility of multiple pregnancy (twins, triplets etc.). Multiple pregnancy constitutes a well known complication of IVF, which may occur when 2 or more embryos are transferred. Twin or triplet birth, though, entails severe problems. These may include complications during pregnancy, preterm labour and low birth weight, disability or increased neonatal death risk (please read below more about risks for the embryos and the mother - from www.oneatatime.org.uk). Risks for the child At least half (50%) of twins are prematurely born (prior to 37 weeks of pregnancy, with full-term pregnancy reaching 40 weeks) and have low weight at birth, which classifies them among “high risk” neonates with regards to severe health problems and neonatal death. Many of them are born before 35 weeks; then, hospitalisation in the neonatal unit is required. Twins weigh at birth 800-1000 gr less than singletons. More than 90% of triplets are born prior to 37 weeks, while some of them are born too prematurely, running a risk of developing severe health problems, which will be tormenting them for many years (if not for life) or even of dying soon after birth. Risks for the mother During pregnancy, a woman who is pregnant with twins or triplets has more chances of facing various problems, such as: · Higher risk of miscarrying throughout pregnancy · 20% of women pregnant with twins develop hypertension (in single pregnancies the percentage is 1-5%) · The risk of pre-eclampsia reaches 30% (usually 2-10%) · Possibility of developing diabetes: 12% (versus 4% in single pregnancies) Namely, concerning diabetes during pregnancy, it must be stressed that, although it doesn’t actually threaten the mother’s health, it increases the risk of embryonic or neonatal death. As for labour and the puerperium, multiple pregnancy increases the risk of maternal bleeding and anaemia, as well as the possibility of developing stress and depression. All the information above is available at www.oneatatime.org.uk. Please read more. In Greece, the law in force states that up to 3 embryos can be transferred in patients under 40, while up to 4 embryos can be transferred in patients over 40 (the older a woman gets, the fewer her chances of becoming pregnant are). In other European countries, legislation is different, e.g. in the UK, no more than 2 embryos are allowed to be transferred in all cases, while in some clinics in Scandinavian countries only one (1) embryo is transferred. This has been made possible by the optimal operation of the embryology laboratory, which allows the development of higher quality embryos, i.e. embryos with better chances of implantation. At “gennima”, we try to avoid multiple pregnancy, which is risky for the pregnant woman as well as for the embryos. Thanks to the optimal operation of the embryology laboratory, we have been transferring 2 embryos in patients under 35, with exceptional pregnancy achievement rates. Thus, we avoid unpleasant therapeutic options, such as selective embryo reduction, during which one or more embryos are being removed. In any case, the couple is fully informed and has a thorough discussion with the doctor concerning the number of embryos to be transferred. Ectopic pregnancy When the embryo implants outside the uterine cavity, an ectopic pregnancy occurs. Ectopic pregnancy is relatively rare and unusual. In most ectopic pregnancies, the embryo stays inside the fallopian tube. Other positions include the ovary and the cervix of the uterus. An embryo growing outside the uterus endangers the mother’s, as well as the embryo’s life. Statistics show that, regardless of the conception method (natural conception or IVF), approximately 1% of total pregnancies are ectopic. This condition must be diagnosed in time and at an early stage. Depending on the severity, ectopic pregnancy is treated with laparoscopic surgery (removal of fallopian tube). If diagnosed early though, it can be treated with medication; thus, surgery can be avoided. Our aim is to verify pregnancy as soon as possible by means of a blood test (b-chorionic hormone /b-HCG). About 2 weeks later, we perform a transvaginal ultrasound, so as to verify that pregnancy evolves inside the uterus. Ovarian Hyperstimulation Syndrome At “gennima”, all medication for ovarian stimulation is administered in personalised doses, i.e we modify the dose depending on the course of every woman’s cycle. As a result, in most cases, there are no side effects. Rarely, the patient’s ovaries may overreact to medication, thus producing too many follicles; this is called “ovarian hyperstimulation”. In that case, the usual symptoms include nausea, vomiting and abdominal pain. “Ovarian Hyperstimulation Syndrome”, as it is called, may have mild, moderate or severe symptoms. How are all those symptoms caused? During a natural cycle, women very often feel pain at ovulation, as well as bloating, swelling, irritability, breast pain or even mild depression before menstruation. When medication is used to stimulate the ovaries, like in IVF, some patients feel all of the above symptoms more intensely, because ovaries produce a large number of oocytes, instead of producing only one, as in the natural cycle. In case all of the above symptoms become too intense and more symptoms occur (intense pain, nausea, vomiting), the patient is diagnosed with Ovarian Hyperstimulation Syndrome. There are 3 categories, depending on the severity of the Syndrom: · Mild Ovarian Hyperstimulation Syndrome – intense pain in the pelvic area. The patient must stay in bed for 1-2 days and modify her diet. Frequency: 1 cycle out of 30. · Moderate Ovarian Hyperstimulation Syndrome – preventive hospitalisation of the patient may be deemed necessary. Frequency: 1 cycle out of 250. · Severe Ovarian Hyperstimulation Syndrome – a great amount of fluid is concentrated in the abdominal area or the chest, which constitutes a very severe medical condition. Frequency: 1 cycle out of 1.000. However, such cases are extremely unusual in reliable IVF centres. Ovarian Hyperstimulation Syndrome is a self-limiting condition and ovaries almost always return to normal. It mainly concerns patients with severe Polycystic Ovary Syndrome. Even then though, when stimulation is properly performed and regularly monitored, with dosage being adjusted as needed, it is unlikely that a problem will occur. At “gennima”, we are proud that high pregnancy achievement rates are combined with particularly low incidence of ovarian hyperstimulation syndrome among our patients. In the rare case that too intense OHSS symptoms lead to cancelling the IVF cycle, there is the possibility of embryo cryopreservation and embryo transfer in a future cycle, after symptoms subside.
Besides IVF, which other medical services are offered at “gennima”?Not only assisted reproduction treatments are offered at “gennima”. Mr. Evripidis Mantoudis and the other doctors at “gennima” perform the entire range of gynaecological clinical and invasive examinations and surgeries: · Gynaecological checkup and Pap test · Transvaginal ultrasound · Breast checkup · Colposcopy – cervical biopsy · Hysteroscopy * · Laparoscopy * · Pregnancy monitoring · Normal labour and caesarean section * * In cooperation with “Iaso” (maternity and gynaecology clinic) www.iaso.gr
How much does IVF cost at “gennima”?At “gennima”, we try hard to combine high quality of medical and laboratory services and personal care with a competitive price list. We understand that assisted reproduction treatments are costly (in combination with all the tests, possible surgeries and medication required) and we try to restrain cost as much as possible. However, each couple is special and has individual needs, depending on the causes of infertility and the examinations, surgeries and treatments required. Please contact us, to be informed on the cost depending on your personal therapeutic needs.
Can sperm analysis be carried out at “gennima” or must we have had the test before our first appointment?It is certainly best for sperm analysis to be carried out in an embryology laboratory specialising in sperm and oocyte evaluation and management within the framework of IVF, instead of being performed in a microbiological – biochemical laboratory. No matter where sperm analysis is carried out though, it must be preceeded by 2 – 4 days of abstinence (neither more nor less); otherwise, results will not be accurate. Sperm analysis can preceed your appointment with Mr. Evripidis Mantoudis or with any of the doctors at “gennima”, otherwise, it can be carried out at the same time with your first appointment. If you have already had the analysis, it must be recent, because in some cases significant variations are observed in sperm samples with the passing of time. If previous test results are conflicting, the test must be repeated. In case you wish to have your sperm analysis at “gennima” you must notify our secretariat, in order for the embryology laboratory to be informed.
I have heard that intra-cytoplasmic sperm injection injures oocytes and affects embryo quality – is this true?ICSI is based on the introduction of a sperm cell in the oocyte by the embryologist with the use of a very thin needle (micro- manipulation enabled by a very powerful microscope). When oocytes are mature and have been retrieved (oocyte retrieval) at the right time, they are not adversely affected by ICSI. Fertilised oocytes develop normally into embryos, just like in classic IVF. ICSI has helped many couples with severe male infertility have children. Thousands of children have already been born in Greece and worldwide with the help of ICSI, often combined with techniques of sperm retrieval from the epididymis or testicles, in order to treat male infertility. These children are healthy and have no difference from the children born following classic IVF. However, there is a marginal increase in abnormalities of the urinary system due to paternal infertility. Finally, as long as mental development is concerned, results in children born with the aid of ICSI and those born following classic IVF are similar. (“A review of ten years experience of ICSI” P.Devroey and A.Van Steirteghem Human Reproduction Update, Vol.10, No.1 pp. 19-28, 2004).
Does blastocyst culture increase IVF success rates?Blastocyst culture is a method with numerous advantages. We could say that it increases total IVF success rates for the following reasons: 1. It allows the selection of the best embryos. During embryo culture until the 5th day, better quality embryos (based on international criteria of embryologists), i.e. those with the best potential of achieving pregnancy, stand out. Thus, there is a possibility of transferring fewer embryos (usually 2), the most appropriate ones for achieving pregnancy. 2. It reduces the risk of multiple pregnancy The fact that fewer embryos (up to 2 blastocysts), with great potential of pregnancy achievement, are transferred, increases success rates, while it also limits multiple pregnancy risk. Thus, chances of giving birth to a healthy baby are increased and the risk of preterm labour and low birth weight is avoided. Sometimes (although not too often) the phenomenon of blastocyst division is observed; then, identical twins develop from 1 blastocyst. In case of blastocyst transfer, with one of the two blastocysts dividing, a triplet pregnancy is achieved. For that reason, a small triplet pregnancy percentage is observed. It is worth noting that division is possible in 3rd – day embryos, too. However, this phenomenon is slightly more frequent when blastocysts are transferred. 3. The endometrium seems to be more receptive on the 5th day after oocyte retrieval. Following oocyte retrieval, uterine contractions are observed due to increased hormone levels. In fact, in some patients, these contractions are quite intense and feel like mild menstrual pain. Contractions tend to subside after the 3rd day from oocyte retrieval. Thus, if blastocyst transfer is performed on the 5th day, less contractions and more favorable conditions are expected at embryo transfer. Moreover, on the 5th day, less cervical discharge (which facilitates embryo transfer) is observed. 4. Embryo culture until the 5th day provides us with more information on embryo quality. With blastocyst culture, the doctor has a more accurate outlook on the couple’s infertility. Sometimes, 3rd – day embryos that seem to be of top quality, develop into mediocre quality embryos. Thus, embryos aren’t of really good quality, which explains the couple’s infertility, but also hinders pregnancy achievement. Of course, this doesn’t mean that pregnancy will not be achieved, but the couple may finally face more difficulties than initially anticipated. 5. It allows preimplantation genetic diagnosis. Embryo biopsy to rule out genetic diseases (e.g. b-thalassemia, cystic fibrosis) or chromosomal abnormalities (e.g. Down syndrome) is performed in 1 of the 3rd- day embryo’s 8 cells. Embryo transfer is performed on the 5th day; by then, embryos have been screened and selected based on test results. However, blastocyst culture isn’t recommended to all couples. If 3rd-day embryos are few, it is deemed preferable to transfer them in the uterus, i.e. their natural environment, where chances of achieving pregnancy are more. Besides, most pregnancies with the aid of IVF have been achieved with 2nd or 3rd-day embryos, as the technique of blastocyst culture is more recent.
In which cases is preimplantation genetic diagnosis required?With preimplantation genetic diagnosis (PGD), embryos are screened before embryo transfer and pregnancy achievement, regarding the following: · Hereditary diseases, such as thalassemia or cystic fibrosis, detected in one (1) gene. · Abnormalities in chromosome number (e.g. Down syndrome) and structure. · Selection of embryo gender in case of gender - linked diseases, such as fragile X chromosome, hemophilia or Duchenne muscular dystrophy. Preimplantation genetic diagnosis has been developed for couples who carry a “defective” gene and run an increased risk of giving birth to children with severe genetic diseases, such as thalassemia or cystic fibrosis, with no coexisting infertility of the couple. In those cases, the man and woman are carriers of the disease, i.e. they are perfectly healthy themselves, but one of their 2 genes is “sick”. However, when 2 carriers of one such disease want to have a child, the latter will possibly have the disease, as she/ he may have inherited the “sick” gene from both parents. Namely, chances of having a child with thalassemia or cystic fibrosis reach 1 out of 4 for each pregnancy. In the past, the only solution for parents with this problem was to diagnose the disease during pregnancy (that is, when the embryo was all grown up) and terminate the pregnancy. Legislation in Greece allows gender selection only for medical reasons, e.g. the transmission of a gender - linked disease (see above). In other countries, there is an intense debate concerning selection via PGD for non-medical reasons (e.g. selection of a female embryo after 3 boys in the family). Also intense is the debate with regards to the selection of an embryo having tissue compatibility with a brother/ sister who has e.g. leukemia, with the aim to save the older brother/ sister with bone marrow transplant. Recurrent miscarriage It has been suggested that PGD in embryos of couples with a history of recurrent miscarriage might prove beneficiary. The argument supporting this is that a percentage of recurrent miscarriage is due to embryonic chromosomal abnormalities, to which bad sperm quality and advanced maternal age contribute. Even today, PGS is recommended in many assisted reproduction centres, with the aim to increase healthy pregnancy achievement rates following recurrent miscarriage or failed IVF cycles. The selection of embryos to be transferred after being screened for chromosomal abnormalities is considered to increase healthy pregnancy achievement rates. According to a recent study, PGS has significantly diminished spontaneous abortions in patients with a history of recurrent miscarriage, especially in patients with 2 or more miscarriages (12.8% miscarried after PGD versus 35.9% who miscarried without PGD). However, there are opposite opinions, too. Other studies show that PGS doesn’t offer any advantages after all. It has been proved that PGD doesn’t improve healthy children birth rate in mothers aged between 35 and 41 with an increased chromosomal abnormality risk rate.