For many couples facing fertility problems, IVF is a safe and effective option in order to achieve a pregnancy.

The process of IVF involves fertilising the woman's oocytes by the husband's sperm in the laboratory (instead of inside the fallopian tubes). Fertilization is achieved either by the technique of conventional in vitro fertilization (IVF) or by intra-cytoplasmic sperm injection (ICSI).

Regardless of your age, If you experiencing fertility difficulties, you should contact us, in order to learn more about the factors that affect infertility and how you can increase your chances of conceiving child.

Individualized treatment, combined with the latest techniques and equipment is the most appropriate approach to achieve a pregnancy.

Together we can make dreams come true. You are in the best hands!

in vitro fertilization (IVF)

For many couples with fertility problems, in vitro fertilization (IVF) is the best solution in order to achieve a pregnancy. IVF can overcome many causes of infertility, such as mild semen problems, endometriosis, tubal issues or unknown causes. The oocytes are fertilised by the spermatozoa in the laboratory, either by the technique of conventional in vitro fertilization (IVF) or by intra-cytoplasmic sperm injection (ICSI).

IVF History

Robert G. Edwards, became the most famous biologist of his time, when he announced on the 25^th of July 1978, Louise Brown’s birth, the first “Test-tube baby” in England, together with obstetrician Patrick Steptoe and the midwife Jane Purdie. Since then, developments in the field have been rapid: in 1992 the first successful fertilization with ICSI was announced (Palermo) as well as its variations, MESA (Silber & Asch, 1992) and TESE (Schoyssman, 1993). In Greece, the first birth via IVF was achieved in 1982 and it was the 13^th child was born worldwide.

Stages of IVF treatment- Procedure

Treatment with IVF consists of the following stages:

• Investigation and infertility diagnosis.
• Recommended tests before treatment.
• Ovarian stimulation (12-14 days). We choose the most appropriate protocol based on each woman’s cycle, age and history.
• Monitoring of the cycle with ultrasound and blood tests every 2-3 days in order to optimize the dosage of the drugs.
• Induction of the final oocytes’ maturation. It’s the final drug injection that will induce the final maturation of the oocytes and ovulation.
• Oocyte retrieval (egg collection). It is performed transvaginally, in the presence of an anesthetist. It is short (10-30 minutes) and practically painless due to the light sedation administered.
• Sperm collection. In cases of azoospermia, testicular biopsy is recommended (TESE)
• Egg fertilization from the spermatozoa. In this laboratory stage, the oocytes come into contact with the spermatozoa. When semen has normal parameters, conventional IVF is advised. As the the least invasive method for the eggs. For many couples with poor sperm quality, where spermatozoa are unable to fertilize the oocyte unassisted, intracytoplasmic sperm injection (ICSI) is selected. This method allows successful fertilization even in cases of severe oligoasthenoteratospermia. The following day the embryologist checks and records the percentage of normally fertilized eggs.
• Embryo culture. After fertilization, embryos are cultured in the laboratory for 2 to 6 days, until the blastocyst stage. Proper division of the cells is a basic criterion for their quality.
• Embryo transfer includes the selection and transfer of the best embryos into the uterus. It is performed two to six days after the oocyte retrieval, using a thin catheter. It is a painless procedure that does not require anesthesia.
• Pregnancy test (blood test for the determination of β-chorionic gonadotropin hormone, performed 13 days after the embryo transfer)
• Clinical pregnancy test with a transvaginal ultrasound (4 weeks after embryo transfer).
• Ongoing pregnancy test on the 12^th week of pregnancy, i.e. 10 weeks after embryo transfer.

Optional Procedures (Depending on patient’s history)

• Embryo or egg freezing Freezing allows conservation of oocytes, sperm and embryos for a prolonged period of time (five years or more). With the application of the new freezing method, vitrification, survival rates and pregnancy success rates are higher than the older method of progressively controlled freezing
• EmbryoGlue. It is a specialized culture medium containing hyaluronic acid during the embryo transfer process, which aids in the attachment of the embryo to the endometrium.
• Assisted Hatching is a technique applied in the laboratory and facilitates the hatching of the embryo. It is suggested when the egg’s zona pelucida is thick or hard, in cryopreserved embryos or in women with previous failed attempts

Preimplantation genetic diagnosis (PGD) for the detection of genetic abnormalities and Preimplantation genetic screening (PGS) with the new technique of array CGH or NGS, may be used if considered necessary

Read also:

Success rates in ivf

Fertilisation in Natural cycle

Pre-implatation Genetic diagnosis and screening

Embryo Cryopreservation

Oocyte cryopreservation  

Natural Cycle - Modified Natural Cycle (M.N.C)

During a natural cycle IVF there is no ovarian stimulation with drugs; we monitor the development of the single (predominant) follicle and of the endometrium with a series of ultrasound and hormonal tests. The natural cycle itself is a low cost procedure and carries minimal physical suffering. However, because of the occurrence of a high rate of premature and untimely ovulation and egg collection failure, combined with low success rates and a high probability of the cycle being cancelled, this treatment is rarely advised and has been replaced by the modified natural cycle (MNC).

In a modified natural cycle (MNC) low doses of drugs are administered during a natural ovulation cycle. Our goal is to collect one egg, but with a lower chance of canceling the cycle. The addition of drugs in specific days of the cycle, proper monitoring and measurements of the hormone LH that is responsible for premature ovulation, these are all factors that contribute in avoiding cycle cancellation, which has unpleasant consequences for the woman.

The MNC may include the administration of drugs such as the GnRH antagonist to avoid early surge of LH, gonadotropins and hCG to encourage maturation of the egg and support the corpus luteum.

To apply the MNC, deep knowledge and experience of the Antagonist Protocol are vital prerequisites. In Eugonia, we have published a series of studies in valid international scientific journals regarding this protocol and we have extensive experience in implementing it.

This method is the most common version of a natural cycle in IVF. It is advised to women who do not wish to receive high drug doses, while recent studies indicate that the modified natural cycle is associated with higher success rates in women with poor ovarian response. As such, indications for its application include poor ovarian response (not always related to the woman’s age), previous failed attempts, the desire of avoiding medication and contra-indications in pharmaceutical stimulation.

The advantages of natural cycles include the absence of ovarian stimulation, lack of side effects and complications, short duration of the cycle, low cost etc.

The disadvantages are the availability of only one follicle that we hope will contain one egg, which must be mature in order to be fertilized, it must divide and be able to create a good quality embryo that will be chromosomally normal with good dynamics, capable of being implanted in the uterus and give rise to a pregnancy. Thus, this treatment is considered to be associated with low pregnancy success rates.

Here in Eugonia, the experience and specialization in the MNC have led to considerable pregnancy rates. 

Eugonia’s Contribution

Our team has published a study supporting that the MNC is related to a four-times higher possibility for live birth compared to the conventional protocol and the use of high dosage of gonadotropins in women with poor ovarian response.

Live birth rates after modified natural cycle compared with high-dose FSH stimulation using GnRH antagonists in poor responders.

Lainas TG, Sfontouris IA, Venetis CA, Lainas GT, Zorzovilis IZ, Tarlatzis BC, Kolibianakis EM.
Human Reproduction 2015;30:2321-30. See the publication

In Eugonia, we operate under a rigorous code of ethics, faithfully adhering to the legislation and the strict standards of quality assurance of our services.

In the following pages you can find information on the applicable national legislation regarding IVF, Eugonia’s license by the Greek National Authority of Assisted Reproduction and the quality assurance certifications of our Unit.

In this section you can learn about the core of the legal framework of Medical Assisted Reproduction.

For any further questions, the Legal Advisor of the Unit is at your disposal.

For more information, please visit the Greek National Authority of Assisted Reproduction.

Below you may see the laws, regarding the assisted reproduction (in Greek):

Law 3089| 12/2002

MEDICAL ASSISTANCE IN HUMAN REPRODUCTION

Law 3305| 01/2005

MEDICAL ASSISTED REPRODUCTION APPLIANCE

Law 4272| 07/2014

REGULATION FOR CRYOPRESERVATION- GENETIC MATERIAL DISPOSAL-  ART UNITS/ CRYOPRESERVATION BANKS

Decision 2589| 09/2014

DEFYNING THE NUMBER OF TRANSFERRED EMBRYOS DEPENDIND ON AGE- IUI PRERIQUISITES

Personalization of the treatment is not always provided, and many IVF centers use the same treatment for all couples. Our philosophy in Eugonia is that every couple undergoing IVF is a distinct case, with a specific medical history and cause of infertility. Therefore, the treatment of infertility must not be identical and rigid for everyone.

It is important to design a different treatment for each couple, with flexibility and adjustment during ovarian stimulation, in order to achieve the best result.
It is thus essential to frequently monitor the woman’s cycle with a series of ultrasounds and blood tests. We appreciate that frequent testing might be inconvenient, but it is very helpful in adjusting the protocol selected and determining the right timing for the last injection prior to the oocyte retrieval. These details can make the difference between a successful and a failed attempt.

Dr Lainas is personally involved in assisting all couples who undergo IVF treatment at Eugonia, by tailoring and monitoring the stimulation protocol for each woman with frequent ultrasound scans and blood tests and giving the proper instructions through the midwives via telephone. He is personally carrying out the majority of oocyte retrievals and embryo transfers, ensuring with his experience the best chances for a positive result and avoiding possible complications, for all couples.

This individualized treatment and attention to detail, combined with the deep Knowledge and specialization of our scientific staff, have led Eugonia amongst the top performing clinics not only in Greece, but also internationally.

A couple's wish to have a baby is an important prerequisite in order to undergo IVF treatment. However, the wish is not enough. It very important that the couples choose the IVF Unit based on objective quality criteria. Which may these criteria be? The quality characteristics, as well as the criteria the couple use to select an IVF Unit (see diagram), have been published in journals of scientific societies (ESHRE, ASRM), and have been the topic of international congress lectures. According to the scientific team of Eugonia, the selection criteria must include:

Scientific excellence

• High pregnancy rates
• High quality and range of services
• Research activity and published studies in international scientific journals of high impact
• Continuous update on recent developments and use of modern methods based on the principles of evidence-based medicine
• Reduction of physical burden by using new protocols of short duration

State of the art infrastructure of staff and equipment

• Scientific staff with deep knowledge and experience,
• Embryology laboratory with modern equipment, adherence to strict cleaning procedures, detailed protocols, and certification by a government authority.
• Creation and constant update of a database
• Quality management certification ISO 9001

Human-centered approach

• Individualized treatment
• Direct communication
• Friendly and warm approach
• Psychological support
• Reduction of stress associated with IVF treatment
• Rapid review of the patient's history and initiation of a new treatment cycle in case of a negative result

Reduction of the cost of IVF treatment

At Eugonia, our attempt to adhere to all the above criteria reflects our high pregnancy rates.

The IVF treatment cycle includes the following stages:

• Investigation and diagnosis of infertility
• Preliminary tests
• Stimulation of the ovary with drugs (12-14 days) for the development of multiple follicles
• Monitoring using a series of ultrasounds and hormone tests
• Induction of final oocyte maturation (a single evening injection)
• Egg collection
• Fertilization and culture outside the woman's body (2-6 days)
• Embryo transfer
• Pregnancy test (13 days after the embryo transfer, measurement of blood levels of β-human chorionic gonadotrophin (β-hCG)
• Test of clinical pregnancy using transvaginal ultrasound (4 weeks after embryo transfer)
• Test of ongoing pregnancy on 12th week of gestation (10 weeks after embryo transfer).

What must I do first?

You must first book an appointment either yourselves or via one of our collaborating doctors who referred you to our unit. It is also useful that you gather any previous related tests (semen analysis, hysterosalpingography, blood tests, hormone levels, photographs or videos from previous hysteroscopies or laparoscopies), reports from previous IVF attempts, operations, laparoscopies etc.

What tests are necessary?

The preliminary tests before the onset of an IVF program include:

• Sperm tests (semen analysis, sperm preparation, semen culture)
• Hormone profiling and transvaginal ultrasound on the 3rd day of the cycle
• Blood tests for hepatitis, HIV I-II, VDRL (necessary)
• Pap-test, breast examination in women over 35, heart check up
• Special examinations, such as laparoscopy or hysteroscopy, which may be recommended by the Medical Director of the unit, based on the assessment of the medical history and other tests (information on laparoscopy-hysteroscopy can be found in a following section).

The tests of prenatal diagnosis are also recommended. These tests usually include haemoglobin electrophoresis (helpful for diagnosis of haemoglobin disorders), blood group, Rhesus factor, rubella, toxoplasm and cytomegalovirus antibodies, complete blood count, complete urine testing, blood urea and sugar, cystic fibrosis etc.

Coloured karyotype (Mr Pagkalos archive)

Although these tests are usually performed in the first weeks of pregnancy, it is preferable to complete them prior to embarking on in vitro fertilization treatment.

In very rare circumstances, a karyotype may be requested, along with a check for thrombophilia and special immunological testing.

Where can I have my tests?

Eugonia covers the entire spectrum of the necessary examinations and collaborates with many national insurance organisations.

It is necessary that the ultrasound, hormone tests and sperm tests are performed in our unit so that the results can be assessed by the scientific team of Eugonia and be compared with similar other cases. This provides an additional level of quality control of the whole process.

However, if this is not possible, these tests can be performed elsewhere and be brought or delivered to our unit. It is preferable that all the tests have been completed before the start of the treatment program.

Monitoring

Ultrasound unit, ADARA type by Siemens.

The monitoring is performed in our unit and involves a series of ultrasounds and hormone tests. You may find a detailed description in the section: Treatment course.

Your first visit at Eugonia

At your first appointment, you will be welcomed by the coordinator of the unit (sister or midwife). The interview will be conducted in three phases:

First, the midwife will take a detailed record of your medical history and information from any previous attempts.

Then, you will meet the Medical Director of the unit, with whom you will discuss extensively the diagnostic and therapeutic strategy recommended. The Doctor will note in your history sheet all the necessary tests that need to be done, the treatment protocol, doses of drugs and details about the treatment program you will follow.

In a third phase, the midwife will explain and give you written instructions for any further tests, if necessary, as well as details about when and how these will be conducted. You will also be given the prescriptions for the necessary drugs, instructions about the treatment protocol, dosage, time and manner to take your drugs, and also medical notes, forms and instructions about your next appointment with us.

You must remember that this first appointment may last a while, depending on the information that need to be recorded and the extent to which you wish to discuss your treatment with the Doctor (usually 1-2 hours).

Finally, you will be given official information brochures and consent forms required by the law, so you have enough time to peruse them. Consent forms must have been signed and filed in your medical folder before the onset of the treatment.

Your visits to the unit during the treatment program

You will be informed about your visits to the unit during the treatment for hormone tests and ultrasounds. Should you have any questions or problems feel free to contact the units midwife, who, in turn, will inform the Doctor.

In each phase of the program, the results of your tests will be assessed by the Medical Director and his colleagues, aiming to decide on the way forward regarding your drug dosage and treatment continuation. Each organism responds differently to the treatment so each case is judged on its own merits. Perhaps it may be possible to re-assess the dosage of the drugs, or modify some timing aspects of the program. Our principle in your monitoring is always the best outcome of your attempt and your final success.

- A couple is described as “infertile” when systematically attempting to conceive for over a year without success, while being at reproductive age.

- IVF is safe and efficient solution,  that has given the joy of parenthood to thousands of infertile couples.

- IVF is the fertilization outside the body (fertilization in the glass as the term describes). Therefore, the interaction of eggs and sperm and subsequent fertilization are achieved in the laboratory instead of taking place naturally in the fallopian tubes. This is a deviation which overcomes certain barriers that prevent fertilization from occurring naturally within the body. However, in most cases, the eggs are the woman’s and the sperm are the man’s, so the resulting embryos are genetically theirs.

- Fertilization takes place in the embryology laboratory by clinical embryologists and the embryos are transferred back to the uterus by a specialized gynecologist. If pregnancy occurs, its course is identical as after natural conception, and the children born are similarly healthy.

- The use of ICSI (intracytoplasmic sperm injection) gives a solution to nearly all cases of male infertility.

Thanks to ICSI, men with severe problems in sperm numbers and motility can become fathers, while in the past they had no hope of fatherhood. All that is required is a few motile spermatozoa for the fertilization of an equal number of eggs.

- Laser laparoscopic and   hysteroscopic surgery is the method of choice for infertility-related conditions, but is also a modern safe and effective method to treat the majority of benign gynecological conditions.

- The rapid developments that occur daily in the physiology of reproduction, embryology, reproductive endocrinology, laparoscopic and   hysteroscopic surgery offer new means to treat infertility. At the same time, the evolution of technological equipment and the groundbreaking progress in their application have lead to a dramatic increase of pregnancy rates worldwide in state-of-the-art IVF Units.

• What is In Vitro Fertilization
• Pregnancy rates in IVF
• How is IVF done;
• When to choose IVF
• Is IVF something unnatural?
• Will my child be healthy?
• In Vitro Fertilization risks

What is In Vitro Fertilization

In vitro fertilization (IVF) is the most commonly used ART method. It was first successfully used in the human in 1978.

Detail of a microscope in the IVF laboratory (EUGONIA archive).

IVF is the fertilization outside the body (fertilization in the glass as the term describes). Therefore, the interaction of eggs and sperm and subsequent fertilization are achieved in the laboratory instead of taking place naturally in the fallopian tubes.

This is a deviation which overcomes certain barriers that prevent fertilization from occurring naturally within the body. However, in most cases, the eggs are the woman's and the sperm are the man's, so the resulting embryos are genetically theirs.

 

Pregnancy rates in IVF

Eugonia is an ART Unit with stable and top pregnancy rates.

See more:  Pregnancy rates at Eugonia

How is IVF done

The eggs are recovered from the follicles that have developed in the woman's ovaries by the procedure of egg collection. In the laboratory, the eggs come in contact with the sperm inside special dishes with culture medium, in order for fertilization to occur. The fertilized eggs (zygotes) are placed inside an incubator and are cultured under special conditions for 2-6 days, so that the embryos can achieve their first stages of development.

Instead of reaching the uterus naturally, i.e. via the fallopian tube, the embryos are transferred to the uterus by a specialise gynecologist using a thin catheter into which the embryos have been previously loaded by the embryologist. The embryos implant in the endometrium by themselves just like in natural conception. If implantation occurs then a pregnancy will follow.

When to choose IVF

There are absolute and relative indications concerning one or both partners.

Absolute indications are:

• Lack (following removal) or obstruction of fallopian tubes centrally or peripherally (hydrosalpinges).
• Lack of spermatozoa (azoospermia) requiring surgical retrieval.
• Very low number of motile normal spermatozoa (severe oligo-asteno-teratozoospermia).

Relative indications include:

• Long period of infertility
• Age
• Severe sperm-related problems (severe oligo-asteno-teratozoospermia)
• Unexplained infertility
• Failure of other methods (i.e. ovulation induction for timed intercourse or IUI)
• Severe endometriosis
• Preimplantation genetic diagnosis (PGD) for β-thalassaemia, sex-linked diseases, special inheritable diseases*
• Prior to chemotherapy*
• Donation of eggs, sperm or embryos*
• Surrogacy *

* Rare indications

When in vitro fertilization is undertaken for the first time, especially in cases of unexplained infertility, it can also be used as a diagnostic tool: i.e. a detailed record of gamete behavior, fertilization, embryo development and other parameters is kept. This means that following treatment, the reason of infertility can be established from all these details recorded.

Is IVF something unnatural?

Conventional IVF does not violate the laws of natural conception. Despite certain phobias of the public, IVF takes place in the laboratory without further intervention in the interaction of the gametes, while embryo implantation occurs unaided.

Other versions of conventional IVF, such as ICSI, are indeed intrusive methods, but are used to overcome certain problems, most often related to sperm.

In all cases however, if a pregnancy is achieved, it progresses in exactly the same way as following a natural conception.

Will my child be healthy?

IVF children are as healthy and normal as children conceived naturally, and do not present a significant increase in related and chromosome abnormalities, as shown by several large scale epidemiological studies.

This is confirmed by the fact that more than 1.5 million children have been born to date following IVF, and some of them have already had children of their own.

In Vitro Fertilization risks

In general, in vitro fertilization is a risk free and effective method for a subfertile couple to have their own baby. The worries of the public, especially for those that are not aware, although understood, are almost without any basis.

The risk of pharmaceutical stimulation of ovarian function which is called ovarian hyperstimulation syndrome (OHSS), is thought to appear in its severe form in about 1% of all the women that undertake in vitro fertilization treatments. It is a side-effect that can nowadays be prevented in the majority of cases and can also be effectively managed. The scientific team of Eugonia has already published five original studies for the management of established severe OHSS in internationally renowned scientific journals.

The risk of analgesia/light sedation that is administered during egg collection is comparable to any other risk of a simple surgical procedure.

The risk of developing ovarian, uterine or breast cancer is exactly the same as in the general population, as all large international epidemiological studies show. However, breasts should always be examined, especially in women above 35 years of age.

At your first appointment, you will be welcomed by the coordinator of the unit (sister or midwife). The consultation/interview will be conducted in three phases:

First, the midwife will take a detailed record of your medical history and information from any previous attempts.

Then, you will meet the Medical Director of the unit, with whom you will discuss extensively the diagnostic and therapeutic strategy recommended.

The Doctor will note in your history sheet all the necessary tests that need to be done, the
treatment protocol, doses of drugs and details about the treatment program you will follow.

In a third phase, the midwife will explain and give you written instructions for any further tests, if necessary, as well as details about when and how these will be conducted. You will also be given the prescriptions for the necessary drugs, instructions about the treatment protocol, dosage, time and manner to take your drugs, and also medical notes, forms and instructions  about your next appointment with us.

You must remember that this first appointment may last a while, depending on the information that need to be recorded and the extent to which you wish to discuss your treatment  with the Doctor (usually 1 - 2 hours).

Finally, you will be given official information brochures and consent forms required by the law, so you have enough time to peruse them.

Consent forms must have been signed and filed in your medical folder before the onset of the treatment.