Wednesday, May 22, 2024

IVF-ICSI Questions

IVF/ICSI Related Frequently Asked Questions

In-Vitro Fertilization is a fertility treatment option suitable for patients who are unable to achieve or maintain pregnancy naturally.

Traveling abroad for IVF treatments can be stressful. We are here to make sure that every step of your treatment is well-organized and well monitored so that you spend a minimum amount of time in Cyprus, have a short holiday and go home with your baby!

For any questions that may have remained unanswered, please check our Frequently Asked Questions below:

1- What are my chances of success with IVF+ICSI treatment?
The chances of success will depend on a number of factors. These include your age, your hormone levels and general level of fertility as well as your husband’s semen characteristics and other factors like the equipment used, doctors’ experience and choice of medication. So it is really misleading to quote a success statistics in general or based on just your age. However, the age based statistics we publish on our website more or less provide an idea of what you will be looking at. However, your individual hormone profile and your ovarian reserves are the most important determinant of how likely you are to achieve success. Patients up till mid-30s usually have a very good chance of getting pregnant on the first attempt as long as they have an ovarian reserve and a hormone profile in line with their age. Above the age of 35, the level of fertility declines and the chances of success start to diminish.

In some cases, when we are able to obtain a good count and quality of eggs, we end up having multiple embryos and if there are more embryos than required for the given transfer cycle, we are able to preserve the ones that will not be used in the current cycle. This gives you a chance to use these preserved embryos at a future date without having to go through the entire treatment again. Should your current cycle fail, the preserved embryos will give you a chance to have another go. In the case your current cycle is successful, the preserved embryos will give you a chance to have a sibling for your child in the future.

2- Why do I need to use medication before IVF treatment?
This is one of the most commonly asked questions from patients undergoing treatment. Whether you are able to conceive naturally or not, in any IVF treatment, we will need to obtain multiple eggs and therefore multiple embryos so that we can maximize your chances of success. Without any use of fertility medication, your ovaries are likely to release only one egg in a given menstrual cycle. This single egg may or may not be of optimal quality.
Not all the eggs will fertilize into good quality embryos and not all the fertilized embryos will survive until the day of embryo transfer, and not all the embryos that have survived will turn out to be healthy. This is why we need to administer a custom prepared medication protocol which will optimize the number of eggs to be harvested so that we can offer you the highest chance of success possible.

3- What is the age limit for IVF treatment?
There is an age limit for IVF treatment. This is in relation to how likely you are to achieve success. If not using a donor, then we will want to make sure your eggs are viable and we have a shot at pregnancy with your own eggs. This is one of the reasons why we ask that patients undergo a series of testing for assessment of their fertility levels prior to proceeding with treatment. Based on these test results, we are able to form an opinion of how likely we are to obtain a good count and quality of eggs in an IVF cycle and how likely these eggs are to produce a healthy pregnancy. We try to emphasize that over the age of 35, the level of fertility tends to decline for female patients and that affects the chances of success with treatment. Over the age of 40, pregnancy rates drop dramatically and unless the patients have a satisfactory level of hormone profile that provides them with some chance of success, we recommend against treatment with own eggs. Usually, we observe that patients older than 43 will not have a satisfactory chance of success.

4- Which tests will you require for IVF treatment?
We require a series of tests for fertility assessment / fitness for pregnancy as well as infectious disease screening. Each and every test that we order serves a different purpose and each one of these tests will have an implication for your treatment.
For assessment of fertility, we ask each female patient to have the following testing done on day 2 or day 3 of their menstrual cycle: FSH, LH, Estradiol, Prolactin, TSH and AMH hormone tests. The AMH test is independent from your menstrual cycle and can be done at any time, but our patients find it easier to have all the tests done on the same day during their visit to their doctor. It will also be important to have a base line pelvic ultrasound scan during this visit for antral follicle count in the ovaries and to check that there are no major visible problems in the uterus that can interfere with a successful pregnancy.
The male patient is required to have a semen analysis done. Especially if he has not had a child in the near past, it will be important to observe sperm parameters such as count/volume/motility/morphology/pH level and round cell count. In some cases, a small infection in sperm can compromise the whole process, therefore, it is important to be prepared for possible precautions that we may need to take.
All patients undergoing treatment at our practice are required to undergo infectious disease screening. This includes patients undergoing donor treatments as well. There are three main reasons for infectious disease screening:

1- To protect the spread of infectious diseases at our lab and to avoid exposing other patients to these diseases.
2- To avoid exposing embryos to infectious diseases that might come from their parents.
3- To protect lab personnel from exposure to infectious diseases when handling egg and sperm cells.

The validity of infectious disease testing is six (6) months. As long as patients have their testing done within the 6 month period prior to their treatment time, we do not require a repeat test. However, if patients do not have current test results, then we will administer these tests here at our practice prior to handling any samples.
Only the test results from reputable clinics and hospitals will be accepted, and original test results will need to be presented at the time of your first visit. Photocopies and scanned email attachments are only accepted as temporary proof of testing until we see the originals.
The infectious disease tests required by our practice are as follows:
For female patient: Anti-HIV, Anti-HCV, HbsAg, VDRL, Rubella IgG, CMV IgG, and Toxoplasmosis IgG
For male patient: Anti-HIV, Anti-HCV, HbsAg, VDRL.

5- Would you recommend HSG or Hysteroscopy for Filming the Uterus and the fallopian tubes?
Around thirty percent of infertile couples suffer from tubal dysfunction. Diagnostic imaging to observe possible fallopian tube damage is an important part of the infertility workup. Patency of the fallopian tubes can be assessed by two main methods. These are Hysterosalpingo-contrast-sonography and Hysterosalpingography. Hysterosalpingo-contrast-sonography, abbreviated as HyCoSy, is a variation of ultrasonography, which involves using a contrast agent for better visualization of possible leakages in the fallopian tubes. A leakage would indicate patent tube where there is no blockage while the opposite would indicate damaged or blocked tubes.

However, problems with fallopian tubes are not the only factor of infertility other than oocyte/sperm related problems. Uterine conditions are also a major factor that can possibly lead to infertility. When it comes to observing uterine and intra-uterine conditions, Hysteroscopy is the gold standard of all imaging technologies. Hysteroscopy allows for panoramic visualization of the uterine cavity as well as direct biopsy of possible lesions observed during the procedure, thus increasing the accuracy in diagnosis and assessment of intra-uterine problems. Nevertheless; hysteroscopy is not a method to analyze the anatomy of fallopian tubes and is limited to the investigation of the uterus and uterine factors of infertility.

An alternative imaging technology, which still remains number one diagnostic tool in infertility assessment is hysterosalpingography (HSG). For a long time HSG was the sole procedure providing important details about the presence of intrauterine anomalies and tubal patency. An HSG is more complex compared to the ultrasonography methods. During a hysterosalpingogram, a dye (contrast material) is injected into the uterus. Because of the anatomy of the uterus and the fallopian tubes, the dye flows into the fallopian tubes. As the dye progresses into the uterus and the fallopian tubes, intermittent pictures are taken using a steady beam of X-ray. The pictures can show problems such as an injury or abnormal structure of the uterus or fallopian tubes. An HSG can also point to possible problems related to embryo implantation.

The use of X-ray beams during the HSG procedure suggests that there is radiation involved. Even though the adult effective dose estimate is between 0.1 to 1 mSv, it makes sense to carefully assess the need for HSG so that the patient is not exposed to unnecessary levels of radiation as we know that radiation does not only have deterministic effects, but also stochastic effects. It is known that HyCoSy can be a better indicator of uterine pathology compared to a standard ultrasonography, though it falls short of HSG. However, HyCoSy does not use any radiation or iodinated contrast material, which is a clear advantage over HSG. Hysteroscopy; on the other hand, can be used in tubal patency evaluation if combined with ultrasonography, which would eliminate the necessity of an HSG film. Furthermore, an HSG is often accompanied by laparoscopy, which is very invasive. Even if one finds evidence of peritubal disease by performing laparoscopy, in most cases IVF will be more successful than treating significant tubal disease through the laparoscope. According to a 2014 study with 64 infertile women, office hysteroscopy combined with ultrasonography can be used as an alternative to HSG, as an effective, easy, safe and minimal invasive procedure without subjecting the patients to any radiative procedures.

6- How do I begin treatment?
The first step in treatment is to gather all the necessary information, i.e. the test results mentioned above. One we have all the test results, we are able to identify the right treatment protocol as well as the precise dose of medication to be administered. Once you send us your test results, we will be able to provide our feedback and lay down all the options based on your unique fertility assessment.
At this point, we are able to map out your treatment calendar and issue your prescription. We work with an international pharmacy in the UK which delivers worldwide, so you will be able to order your medication online and receive them at your door. There are clear instructions on how to administer the medication as well as daily instructions of what you need to do on your treatment calendar.
Once you begin with the preliminary treatment, you will begin using your medication locally and you will need to visit your local gynecologist in order to observe your response to medication and reassess the dose of medication if necessary. These local scans can be done at your local gynecologist or scanning clinic. We work with a number of places in the United States, United Kingdom, Sweden, Turkey, Germany, France, Holland and Spain for scans. Therefore, should you not have a local doctor, we may be able to recommend a place or two.

7- How do I administer the medication?
Administering medication is relatively easy given that the injections to be used are sub-cutaneous injections and are administered right under the skin. These injections are painless and easy to self-administer. Please refer to the link which will be provided to you on your treatment calendar for a complete explanation on how to mix and arrange the dose of your medication as well as how to administer it. Once you watch this video, please contact us for any questions you may have.
You will notice that once you retrieve the necessary amount of medication from the vial, you will have some left over medication in the vial. You will store this in a refrigerator and use the next day. For instance, a vial of Gonal-F 450 iu will give you 600 units of medication once mixed. If your daily dose is, say, 300 iu, you will use half of it and store the other half for the next day.

8- How long will I need to be in Cyprus for?
We try to minimize then length of stay for our traveling patients as we realize how difficult it can be to take time off work, family or other commitments. This is precisely why we have established links with reputable clinics abroad for preliminary testing and monitoring so that you are not required to come to Cyprus for the entire treatment. Given that you are able to carry out the preliminary work locally, you will only need to visit us for a total of six (6) days. This will be the amount of time required for your final scan, trigger injection, egg retrieval, ICSI for fertilization and the final embryo transfer.

9- Where will we stay while in Cyprus?
We try to make your stay in Cyprus as pleasant as possible. For this end, we have agreements with a few hotels where you can stay on a discounted price. We offer three alternatives that cater to different budgets. Please refer to our Accommodation section.

10- How soon after the embryo transfer will I know whether I am pregnant or not?
A beta hCG test will be administered 12 days after your embryo transfer to detect hCG hormone in blood. This is a specific hormone released immediately after pregnancy occurs. This is the soonest that pregnancy can be detected. We do not recommend using a home pregnancy test as they are not very accurate too early into your pregnancy and they may not be able to detect anything until 15/16 days after your embryo transfer. Therefore, a home pregnancy test done too early is likely to indicate a negative result as it is unable to detect pregnancy and will cause disappointment. Please schedule you beta hCG test 12 days after your embryo transfer at your local doctor for most accurate results.

11- Is there anything I need to do after the embryo transfer to help become pregnant?
There will be specific guidelines handed to you after your embryo transfer. In this document, you will find information on what to do and what not to do to help the process. Once the embryo transfer has been performed, there is not much to do to assist with conception. However, there are things that can be done in order not to jeopardize the process and to make sure you don’t do things that can negatively impact embryo’s ability to implant. These have to do with your diet and physical activities that require strength. Otherwise, you will be able to continue your daily chores without any interruption, but will simply take it down a notch.

12- How much does IVF treatment cost at North Cyprus IVF Center?
The cost of IVF/ICSI treatment at North Cyprus IVF Clinic is 3,000 Euros. This is the cost of medical aspects of your IVF treatment in Cyprus. The cost is inclusive of your scans and consults while you are in Cyprus at our clinic. However, the cost of preliminary testing, IVF medication, flights and accommodation are not included in this cost. For more information on accommodation options and their pricing, please visit “Accommodation Options” page.

For more Questions and Answers on our other treatment types, please see the links below.