Treatments

 

Egg Donation

Egg donation in Greece is based on the existing legal framework (Law 3305 | 01/2005). By now it has been clear to everyone that we are talking about a scientific medical method, which makes the couples’ hitherto impossible dreams come true.

Egg donation is the method we use to offer them this opportunity, as the mother may take the egg from the donor, but she is pregnant with the fetus herself, which grows, eats and breathes through her.

The donor’s reproductive ability is not affected at all by the whole process of egg donation.

Choosing the donor

According to the legal framework (Law 3305 | 01/2005) the donor must:

  • be less than 35 years old
  • have a normal medical history
  • have normal physical tests results

Moreover she undergoes a series of tests such as:

  • Ultrasound examination to exclude gynecological pathological situations (fibroids, cysts, polyps, etc.)
  • Control of chromosomes to exclude chromosomal abnormalities (caryotyping)
  • Screening for cystic fibrosis
  •  Screening for hepatitis, HIV, syphilis, Rh group

If it is confirmed that she is an appropriate donor, we move to the phase of the pharmaceutical controlled ovarian stimulation, like in a natural IVF cycle, to produce sufficient numbers of ova. The day of the scheduled eggs retrieval from the donor, the male partner gives the semen sample in the laboratory.

Subsequently, the fertilization of the eggs with the sperm of the male partner takes place inside the lab. The next day we know how many eggs have been fertilized, after 3-5 days the embryo transfer occurs, while the rest of the embryos are cryopreserved. At the same time medicines are administered to support the implant.

About ten days after the egg retrieval, we examine the b-HCG to determine if pregnancy has been achieved.

Egg donation is an established scientific process, with more and more supporters and with excellent results at international level.

In Vitro Fertilisation

IVF is a process by which an egg is fertilised by sperm in the laboratory, outside the body: in vitro (“in glass”), in order to obtain fertilized embryos for transfer to the mother’s uterus.

The fertilisation of the ova can be carried out by means of the conventional IVF method or by Intracytoplasmic Sperm Injection (ICSI).

IVF using semen from the couple is recommended for:

  •             Couples for whom simple methods such as Intrauterine Insemination (IUI), have failed.
  •             Women with complete absence of or lesions on the fallopian tubes.
  •             Women suffering from advanced endometriosis with probable repercussions on the fallopian tubes and on oocyte quality.
  •             Situations in which there is a limited number of oocytes.
  •             Cases of severe male factor infertility.

IVF using semen from a donor is recommended for:

  •             Serious cases of male factor infertility with poor sperm quality.
  •             Previous failed fertilization using semen from the couple.
  •             Cases of poor quality embryos or repeated implantation failures, mainly due to male factor.
  •             Men who are carriers of a genetic disease that can not be studied in embryos.
  •             Women without a partner.

It is the most widespread method of Medical Assisted Reproduction in the world, with extremely high success rates and concrete scientific assurances that it is a safe medical procedure.

Ovarian Stimulation

The ovaries are stimulated with daily administration of injections in order to develop several eggs rather than a single egg as it occurs in a natural cycle. This way a large number of embryos can be created after the fertilization of the oocytes. This treatment usually takes from 10 to 20 days, depending on the treatment protocol used and on each woman’s response.

During the treatment, usually 3-4 ultrasounds take place as well as blood sampling for hormone measurement (estradiol, etc.), in order to monitor the development of the ova.

Egg Retrieval

When the follicles are mature, we plan the egg retrieval about 36 hours after the administration of HCG, which promotes the final egg maturation exactly as it occurs in the natural cycle. Oocyte retrieval takes place in the operating room under light anesthesia (sedation) so that the patient does not feel any discomfort or pain during the process, which typically takes 10-15 minutes. The oocytes are aspirated transvaginally with a sonographically guided needle.

Fertilization

After the egg retrieval, semen is provided by the male partner so as to proceed with the fertilization of the ova. The process of fertilization is carried out either via classical IVF, during which a few thousand spermatozoa are placed around an egg or via ICSI, in which a single live sperm cell is selected and inserted into the egg by the embryologist.

Embryotransfer

The day after the fertilization, the embryos are “graded” depending on their morphological characteristics and their ability to divide. Some may not have evolved and get discarded because they are considered unsustainable.

The best embryos are selected for transfer into the uterus of the mother 2- 5 days after the retrieval. Embryo transfer is performed with a special catheter. The whole process takes place in the operating room, no kind of anesthesia is needed, it is painless and does not last long.

The remaining good quality embryos are cryopreserved by the vitrification technique and may be used in the future without the need of ovarian stimulation or drug therapy.

Microfertility – ICSI

Microferma or intracytoplasmic sperm injection ICSI, Intracytoplasmic sperm injection, revolutionized IVF in the 1990s. The successful application of the method, worldwide, for more than three decades, as well as the development of oocyte micromanipulation techniques, solves fertility problems.

What is Microfertility?

Microfertility (ICSI) is a method of assisted reproduction that is mainly used to treat fertility problems associated with sperm quality.

For many couples unable to apply “classical fertilization” due to serious sperm problems (oligoestherospermia, obstructive azoospermia, etc.), the application of Microfertility may be the solution to the problem.

How is microfertility done?

When applied, the embryologist selects the appropriate sperm and injects it into the egg. In this way good or bad quality eggs can be fertilized by a weak sperm.

In case of obstructive azoospermia, surgical removal of spermatozoa from the testis after biopsy (TESE)

Common reasons for applying Microgeneration

One of the most common reasons for choosing the Microfertility method is male infertility due to severe sperm disorders. In particular, oligospermia, low sperm motility, very poor sperm morphology, failure to fertilize oocytes in previous attempts, are a series of fertility problems in which microencapsulation could solve.

Microgeneity may also be the appropriate method for couples with a low number of eggs in an oocyte.

In this scenario, Microfermatization (ICSI) is used to fertilize as many ova as possible than with the classic method where ova and sperm are placed together and mixed.

Ovulation induction

Ovulation induction is a method of assisted reproduction which is appropriate for the treatment of fertility problems in women who do not have normal ovulation or have no ovulation at all because of hormonal disorders or because of Polycystic Ovary Syndrome.

What is ovulation induction?

Ovulation induction is a simple procedure to help ovulate. In women who have no ovulation at all, this drug therapy aims at releasing a mature egg.

Ovulation induction is usually followed by sexual intercourse but is often part of other therapies such as intrauterine insemination or IVF.

Drug administration stimulates ovarian stimulation in order to increase the number of eggs to be released per cycle so as to maximize chances of conception during sexual intercourse, IUI, or IVF.

Treatment procedure

Initially, the physician will recommend specific blood tests to measure hormone levels at specific stages of the woman’s cycle. Then, transvaginal ultrasounds will be made to examine the development of the follicles, the thickness and the image of the endometrium.

The ovulation induction usually follows the following procedure:

During the first 2-3 days of the menstrual cycle, blood tests and an ultrasound can be performed to check if the right conditions are in place to initiate the challenge. The next day, the woman begins to receive medication. Depending on the method of inducing ovulation, follicular development is monitored by 2-4 transvaginal ultrasounds and possibly by measuring levels of hormones in the blood.

The process of producing eggs may be delayed in women with unstable menstrual cycles.

When the follicles have reached a satisfactory size, the day of onset ovulation may either be predicted by the sudden increase in LL levels in the blood or may be determined earlier by the administration of choriogonadotropin in the form of an injection causing the Final maturation of the follicles and ovulation. At about 32-36 hours from LH elevation or chorionic gonadotropin injection is an ideal time for the couple to have sexual intercourse or intrauterine insemination.

Duration of treatment

The treatment lasts from 10 to 20 days depending on the treatment protocol used and depending on the response of each woman to the particular method.

Usual medication

The drug most commonly used as the first choice for ovulation induction is clomiphene citrate which causes gentle ovarian stimulation and has no serious side effects. It is given in the form of oral pills for 5 consecutive days at the beginning of the woman’s cycle.

Another way to stimulate the ovaries to induce ovulation is to administer medications called gonadotrophins (such as follicle stimulating hormone-FSH), substances produced by the woman’s own pituitary gland and acting on their follicles, causing them to grow and mature.

Stimulation by this method is applied to women who have no ovulation due to lack of their own pituitary gonadotrophins and to women in whom ovulation induction with clomiphene has not produced satisfactory results.

Gonadotrophins are given daily in the form of injections in small doses beginning on the 2nd or 3rd day of the cycle.When using gonadotropins to cause ovulation, monitoring the woman with successive ultrasounds and measuring the estrogen in the blood should be particularly meticulous in order to avoid the risk of ovarian hyperstimulation syndrome and multiple pregnancies.

 

 

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