IVF and ICSI
In vitro fertilisation (IVF) is used when the sperm is normal in concentration, motility and morphology. Approximately 300,000 sperm cells are mixed with one egg in a drop of insemination medium and incubated at 37 o C with 5-6% CO2, until the next day. The sperm cells are left to penetrate the outer membrane of the egg, on their own, to fertilize the egg. Fertilization is determined 17-19 hours after insemination.
Sperm cells are mixed in a drop of insemination medium with one egg.
ICSI (Intracytoplasmic Sperm Injection)
The method of ICSI is mainly used when the semen analysis is abnormal, i.e. when the sperm count is low, when there is low motility or severe morphological defects. This method is also applied in cases where classic IVF has been tried multiple times and failed, in the presence of sperm antibodies and occasionally in patients with a small number of retrieved oocytes. It is also applied in cases of idiopathic infertility.
During ICSI, the embryologist manually selects the normal looking spermatozoa and injects each egg with a spermatozoon, using special equipment and micro tools. Fertilization is confirmed the following morning.
1. Consultation & Fertility Assessment
At Pedieos IVF Center we believe that every patient has their own personal story with a unique background, so we strive at creating a personalized treatment plan for each of our patients. The first step on your fertility journey will be to book an appointment to discuss your unique situation and needs. Please bring along any past related medical reports so our doctor can review. During your consultation with our doctors, some initial routine examinations may be performed on site to evaluate your fertility status.
If further diagnostics are necessary, such as Fallopian Tube Patency test, (Hysterosalpingography – HSG) or Genetic Testing for infertility, these will be performed during a second phase of testing. After an in-depth discussion you will be presented with a unique IVF or ICSI treatment plan that is customized for your situation. Should you require further information regarding either egg or sperm donation treatment, one of our clinical coordinators will guide you through the entire process.
2. Ovarian Stimulation
During IVF treatment you will take medication in order to produce more eggs in your cycle. These hormonal injections are given by subcutaneous injection (just under the skin) for 9-12 days. These injections help you to produce more follicles in order to succeed in producing embryos. Each program is suited to the requirements of the patient and adjusted according to her response to the medication.
You can be taught to give yourself the injections or have someone else do it for you. It is also possible to have your injections done at our clinic. Your progress is monitored by ultrasound and blood hormone tests.
It is very important to carefully follow instructions regarding your medication. Do not hesitate to contact the clinic should you have any queries regarding your medication.
3. Egg & Sperm Collection
Based on the size and development of the follicles, the doctor will decide the date of the egg collection. On the morning of the egg collection, the male partner will need to provide a semen sample.
- Based on the size and development of the follicles, the doctor will decide the date of the egg collection. When your eggs are ready to be retrieved, you will be instructed to take an injection which triggers ovulation.
- This injection is given approximately 36 hours before egg collection, also known as Ovum Pickup (OPU). It is very important to administer the injection at the proper time. The OPU will take place 36 hours later, usually in the morning. From midnight until the time of OPU which is scheduled in the morning, you must not eat or drink anything. This is extremely important since the OPU will have to be cancelled if something is eaten.
- You will be told the exact time to be at the clinic for your OPU. The procedure only takes about 10-15 minutes and the anesthesiologist will give you light sedation so you will feel no discomfort. After the procedure, you will be able to rest for an hour until you feel well enough to go home.
- Before you leave, we will provide you with a detailed written plan of what medications to take. It is very important not to stop any medication until you are advised by the doctor.
- On the morning of the egg collection, the male partner will need to provide a semen sample. In order to produce the best quality of sperm possible, sexual abstinence of 2-5 days is required. If the sample is produced off the premises of our center, the sample must be kept next to the body to keep it at body temperature and delivered within an hour of production. Alternatively, a frozen sperm sample of the partner or a pre-selected donor can be used.
- Undergoing an IVF treatment can cause stress and anxiety to women and their partners; especially, if the couple has already undergone multiple previous fertility treatments. This is why we make sure that a nurse or coordinator is always available to discuss or to answer any questions you may have. All our nurses and coordinators are highly qualified and trained to provide you with the psychological support during your treatment.
4. Fertilization & Embryo Culture
Depending on the concentration, motility and morphology of the sperm, the doctor will decide whether to go with classic IVF or ICSI. Either methods chosen does not affect the price of the treatment.
After the eggs are inseminated, they are incubated overnight and fertilization is assessed the following morning. Your dedicated coordinator will contact you the next morning to inform you about the progress and fertilization rate. Over the next few days the embryos will be incubated and allowed to develop. Depending on their development, the embryologists and the doctor will inform you when it is best to perform the embryo transfer, it could be on day-3 or day-5.
If the cycle involves pre-implantation genetic testing (PGT), the embryos are cultured to day-5 and any blastocysts that develop are biopsied and frozen. For more information on PGT, please refer to our PGT page where we have recently updated our methodology.
5. Embryo Transfer
This is an exciting day for you! You will arrive at the clinic 30-60 minutes before your appointment so that you can be prepared for the Embryo Transfer (ET). Your bladder must be full for the ET as this will provide a better view of the uterus and allow the doctor to place the embryo/embryos in the exact position that will give them the best chance for implantation. The ET is done under ultrasound guidance which does not require sedation so you can eat and drink as you like before the ET.
On arrival, one of the embryologists will give you an update as to how many developing embryos you have and their quality. We will then discuss how many embryos will be transferred. Normally, we transfer 1 or 2 embryos, and only in special cases 3 (only women over 39 years of age are allowed by law to transfer 3 embryos).
After the ET you will rest for 30-60 minutes and we suggest you take it easy for the remainder of the day. From the following day onwards, you can continue your normal routine, although you will be given specific guidelines from the doctor for certain things to avoid. It is very important to continue all medication until your doctor advises you on how and when to stop the medication.
6. Freezing Embryos
In some cases, additional embryos are created than what is needed for the embryo transfer. As mentioned in the previous step we usually transfer 1-2 embryos to your womb. When we have additional embryos, they can be cryopreserved (frozen) and used for another cycle.
- Sometimes embryos must be cryopreserved for medical reasons so that an embryo biopsy is done.
- In addition, all embryos will be cryopreserved if the embryo transfer has to be postponed due to inadequate endometrium, inappropriate serum progesterone or serious hyperstimulation of the ovaries.
- There is an extra charge for embryo freezing. Our clinic will provide you with the details related to freezing.
7. Pregnancy Test
A βhCG blood test is performed 11 days after your embryo transfer and then again 2 days later, to establish the outcome of the embryo transfer. If positive, this is repeated once more 7 days later. At this point a urine test for pregnancy may not be sensitive enough to give accurate results, so always choose to do the blood test wherever possible.
If the βhCG blood test is negative or dropping. Your doctor will advise you as to when and how to stop the medication. You will experience bleeding after a few days from stopping medication. At this stage you will discuss with the doctor about your options to either try again or use one of your frozen embryos. You must remember that there are always options on how to proceed that we are happy to discuss with you.
If the βhCG blood test is positive and rising. It is important to continue the medication exactly as prescribed for the first 10 weeks of gestation. Your hormones are already artificially raised and so you must maintain that level until the placenta is strong enough to support the baby on its own. At week 6 of gestation, you can have an ultrasound scan to confirm how many embryos have implanted and to check for the fetal heartbeat.