Improvements in IVF technologies enable us to incorporate the use of additional techniques and procedures into our daily IVF practice. One such innovation in fertility treatments is Cytoplasmic IVF Treatment, sometimes referred to as the "Three parent Family". While the "Three parent family" has an interesting ring to it, it is more of a catchy phrase rather than being a fully correct statement.
Cytoplasmic IVF Treatment at North Cyprus IVF Centre has been offered since 2012. While it has been almost three years since we have brought this concept into practice, it is important to mention that this treatment is still in its infancy years and the number of cases performed are still far from creating accurate and statistically significant numbers. However, data so far suggests that cytoplasmic transfer is able to increase success rates by 4 to 5 percent compared to standard IVF/ICSI treatments.
What is Cytoplasmic IVF Treatment?
Cytoplasmic IVF Treatment is the treatment option suited for two types of patients:
- Patients with known mitochondria defects
- Patients in older age brackets with likely mitochondria defects due to oocyte aging.
As women age, so do their eggs. Just like any cell, the egg cells is consisted of a nucleus, which contains the genetic material as well as a cytoplasm, which surrounds the nucleus. Within the cytoplasm, there are many other organelles. One of the most important organelles in the the cell is mitochondrion (plural, mitochondria). Mitochondria are responsible for providing the cell with its energy, which facilitates cellular growth and development. As the oocyte (egg cell) ages, so do the mitochondria found within the egg cell. As the mitochondria age, they fail to provide sufficient amount of energy for growth and development, therefore, the egg cells start to lose their viability. This is precisely where cytoplasmic IVF treatment gets in the picture.
With cytoplasmic IVF treatment, a young, healthy and pregnancy proven egg donor is used, very much like an egg donation program. However, it is not the eggs, or the genetic material inside her eggs that we are interested in. Rather, we are interested in the cyoplasm of the donor's eggs. In cytoplasmic IVF treatment, we extract the cytoplasm of the donor's eggs and inject it into the eggs of the recipient. That way, we can provide a healthier cytoplasm (therefore mitochondria) for the growth and development of the recipient's eggs. In a way, we make the recipient's eggs' host environment more friendly for growth. This provides us with a higher chance of IVF success when the own eggs of a patient is used in more advanced age brackets.
However, it should be known that this treatment also has its limits. This is a treatment option which provides a healthier host for the growth and development of your own genetic material. This is not a method that can correct and genetic problems with your eggs that may come with age. If the main reason why you are not able to fall pregnant or experience miscarriages is due to genetic problems associated with oocyte aging, then cytoplasmic IVF treatment is not likely to generate desired results and in such cases, IVF with egg donation should be considered.
IVF with cytoplasmic transfer is mostly recommended for patients with known mitochondrial DNA defects, or patients in more advanced age brackets who still have some ovarian activity, but standard IVF treatments fail to succeed even though the patient has viable oocytes during treatment.
Please check out our "Cytoplasmic IVF Treatment" page for more information.
There are certain things that you can do to help increase the chances of embryo implantation after an embryo transfer. Also, there are things that might hurt your chances of success which you should avoid. In this section, we have gathered information on the things that you should do or you should avoid in order to maximize your chances of success:
Things to do BEFORE embryo transfer:
- You will need to have one final ultrasound scan before your embryo transfer so that your IVF specialist can measure the endometrial thickness and make sure everything is in order for the embryo transfer procedure. Embryo transfer will not require anesthetics; therefore, you may have your normal breakfast on this day.
- Make sure that you have some time to yourself to relax and get rid of any negative thoughts you may have. Stress is our enemy; therefore, anything that will help you relax will help with your embryo transfer.
- Prior to embryo transfer, you may be prescribed a week of antibiotic use. During antibiotic use, it is important that you avoid sun exposure since antibiotics are sun-sensitizing drugs.
- It is strongly recommended that you do not smoke, drink alcoholic beverages or use recreational drugs while preparing for your IVF cycle. These can adversely affect egg and sperm count.
Things to do AFTER embryo transfer:
- On the day of your embryo transfer you will need to have your progesterone level checked. If your progesterone level is low, you may need additional progesterone supplementation in the form of progesterone injections. We will be able to perform the test at our clinic and supplement you with the additional injection if necessary. Progesterone is a naturally occurring hormone which helps maintain the endometrial thickness and provide a favorable environment for embryo implantation. In natural pregnancies, progesterone is released by the corpus luteum after ovulation. In IVF cycles, this needs to be supplemented externally.
- After embryo transfer, you will rest for a few hours at our clinic then you can go back to your normal routine. Once the embryo(s) has/have been transferred, there will be no additional measures to take beyond what we already use.
- Even though we won’t know whether you are pregnant or not until you have your beta hCG pregnancy test 12 days after the embryo transfer, we will need to assume that you are pregnant and take certain precautions for some time until you are in the safer pregnancy period. These include:
* No caffeine for the duration of your pregnancy. If you cannot do without coffee, then we recommend using decaffeinated coffee. You should also be careful about tea consumption as tea also has caffeine. Herbal teas (excluding sage and fennel) can be used. If you have to have caffeine, limit your use of caffeinated drinks to 200 mg per day.
* No fizzy drinks, at least for the first 12 days until your confirmed pregnancy. You should also not be eating gassy foods as fizzy drinks and gassy foods can upset your stomach and we want to avoid stomach cramps and contractions as they may negatively affect embryo implantation.
* No intercourse for 12 days after your embryo transfer, until your confirmed pregnancy.
* Avoid public pools, saunas or any other places that may expose you to chemicals and bacteria until it has been established that you have a healthy progressing pregnancy.
* Avoid smoking, drugs and alcohol altogether after your embryo transfer. Once the embryos have been transferred, drugs, cigarettes and alcohol can have very detrimental effects on your baby’s development.
* No vigorous or high impact exercise until after clinical pregnancy confirmation. Walking and other light aerobic exercises are okay. Avoid heavy lifting greater than 10 pounds for the duration of your pregnancy.
* Minimize your medication use (other than what is prescribed to you by us). Should you require medication use for any condition after your embryo transfer, please consult with us or the doctor who will be following your pregnancy.
* Avoid eating mercury rich fish (tuna and swordfish), unpasteurized cheeses and raw meats .
* 4 mg of folic acid a day is the established dose which needs to be taken during pregnancy. Folic acid is essential for development of your baby. Folic acid deficiency during pregnancy is associated with neural tube defects; therefore, use of a prenatal vitamin complex is essential after your embryo transfer.
* Keep using your progesterone supplements (crinone gel 8%) until the 12th week of your pregnancy. 12th week is when the placenta takes over progesterone secretion, therefore, you will no longer need to externally supplement it. On the 11th week of your pregnancy, you can go down to 1 application per day and continue like that for one week and on the 12th week of your pregnancy, stop using the crinone gel altogether.
* Similarly, you will keep using your estradiol valerate supplements (progynova/estrofem) until the 12th week of your pregnancy which is when the placenta takes over secretion of estrogen. You can half your dose on week 11 and stop altogether on week 12.
* Flying is relatively safe after embryo transfer. Most of our patients fly back home the day after embryo transfer. However, if you have 48 hours to spare, then we recommend flying back home 48 hours after the embryo transfer. The first 24 hours should have more resting and less moving around, but you can enjoy Cyprus and do a bit of sightseeing the next day.
We wish you a successful embryo transfer!
In Vitro Fertilization (IVF) is a fertility treatment options for couples who cannot achieve and/or maintain a successful pregnancy, therefore, need medical assistance. There are various types of fertility treatments depending on whether the couple uses their own egg and sperm cells or require the use of an egg or a sperm donor. Patients in older age brackets have a few alternative options when it comes to a successful IVF treatment. North Cyprus IVF Center is one of the few clinics in the world offering flexible and customizable treatment options for patients based on their specific needs. Due to favorable laws in North Cyprus, our ISO certified and award-winning clinic can quickly adopt new technologies and new treatment methods as they become available while many other clinics may not be able to offer such treatments to their patients due to increase bureaucracy or very high costs of adopting these technologies. At North Cyprus IVF, we are happy to announce that we are one of the few clinics that can offer various options for patients in older age brackets, thus offering high IVF success.
IVF over 45 or even over 50 is possible. However, there are a few considerations that need to be made when offering treatment to women older than 45 years of age. It should be kept in mind that your overall health and well-being is our top priority and we would not be comfortable with offering any treatment that may put your own health at risk. Therefore, before proceeding with treatment, we ask that you have a standard health screening to make sure that you are fit for pregnancy. This screening would include a blood glucose and bloos pressure checks as well as other routine screenings such as complete blood count and liver/kidney function tests. Once we make sure that there are no problems to proceed, we will be able to design the most suitable treatment option for you.
It should be kept in mind that over 45 years of age, your ovarian reserves have highly depleted and the quality of any remaining reserves have been highly compromised. While it may still be possible to obtain and maintain a healthy pregnancy in such age brackets, it is very challenging and requires a careful treatment planning. In 45+ IVF patients, there are two groups of women; women who would like to be pregnant using their own eggs, and women who would like to use donor eggs for a successful pregnancy. Procedures will be different in both cases:
1- Women over 45 who would like to use their own eggs for pregnancy: In this group, the most important step is to make an assessment of the level of fertility. This assessment is made by hormone testing. In this age bracket, the standard FSH/LH testing may not produce accurate results, therefore, on top of the FSH/LH tests, we specifically ask for the Anti-Mullerian Hormne (AMH) test so that we can make an assessment of the ovarian reserves and proceed with treatment planning accordingly. Once we have made an assessment, we will be able to decide whether you have any oocytes in your reserves that can be recruited for ovulation. If there are, then we will be able to offer you a customized treatment program that will aim to maximize your chances of a successful outcome. For instance, if you have an acceptable level of ovarian reserves, but the quality may have been compromised due to oocyte aging, then Mini IVF or IVF with Cytoplasmic Transfer can be ideal treatment types for you. In highly depleted ovarian reserves with compromised oocyte quality, Mini IVF is not recommended but IVF with Cytoplasmic Transfer would still be an option.
2- Women over 45 who would like to use donor eggs for pregnancy: Treatment is much less complicated in this group of women. Since eggs from a young and healthy egg donor are used, pregnancy rates are much higher. Our egg donation program is an exceptional program with exceptionally high success rates due to a number of reasons, which are explained in a previous blog article by Dr. Savas Ozyigit himself. Women seeking IVF treatment with donor eggs would need to undergo the health screening mentioned above as well as a trans-vaginal ultrasound scan to make sure there are no visible problems that can interfere with a successful pregnancy. Hormone testing for ovarian assessment will not be necessary as ovulation induction will not be performed. Please see our donor egg IVF treatment section for more information on this treatment program.
Regardless of whether you are planning on using your own eggs or donor eggs for IVF treatment, a careful assessment and a careful planning are the key factors behind a successful IVF outcome. Feel free to contact our clinic for more information on treatments.
Donor egg IVF treatment (IVF with Egg Donation) is a treatment option for women who are not able to conceive using their own eggs (oocytes). At North Cyprus IVF Centre, overall success rates with donor egg IVF treatment has been announced as 78% while this number can go as high as 96% for age-specific groups. Dr. Savas Ozyigit, director and chief of surgery at North Cyprus IVF Centre explains the high success rates with egg donation as follows:
Uterine fibroids are known to have an impact in a woman's ability to conceive naturally or even with IVF treatments. In this section, we talk about uterine fibroids and their effects on fertility and the specific ways that they can contribute to female infertility. If a woman has fibroids that can potentially impair her fertility, then removal of the fibroid may be necessary in order to achieve pregnancy.
Uterine fibroids are muscular tumors that form in the wall of the womb. The universal medical term used for fibroids is "myoma". Most of these tumor growths are non-cancerous and most women will have fibroids in the uterus without even noticing them.
Fibroids can be a single growth or there can be numerous small tumors in the uterus. The size of a fibroid can be as small as a melon seed or as big as a small melon. The larger the fibroid, the more problems it is likely to cause in the uterus regarding a woman's ability to conceive. It is not only the size of the fibroid that can affect a woman's ability to achieve pregnancy, but also the localization.
Fibroids are classified in three major categories based on their precise locations:
1- Submucosal fibroids: These are the types of fibroids that grow in the uterine cavity
2- Intramural fibroids: These are the fibroids that grow within the wall of the uterus
3- Subserosal fibroids: These are the fibroids that grow on the outside of the uterus.
Fibroids that are in the uterine cavity are the main types of fibroids that have a direct association with infertility. These fibroids can indent the cavity or pressurize the endometrium, therefore, directly affecting embryo implantation. However, other fibroids can also negatively affect chances of conception due to their sizes.
How Do Fibroids Cause Infertility?
- Fibroids located above the cervix can change its position and therefore restrict passage of sperm cells that can travel through the cervix.
- Certain fibroids can block the fallopian tubes, thus restricting oocyte movement and fertilization.
- Some fibroids can restrict the blood flow into the uterine cavity, where the embryo would normally implant and generate a pregnancy.
- Fibroids can also possibly cause changes in the uterine muscle that prevents embryo movement.
How do I know if I have a fibroid?
Fibroids can sometimes have certain symptoms while sometimes they may go unnoticed for years. A proper diagnosis requires a consultation with your gynecologist so that proper diagnosis measures can be used. However, it will be important to know about some of the symptoms of fibroids:
- Heavy bleeding and/or painful menstrual periods
- Feelings of fullness in the pelvic region
- Pain during sex
- Frequent urination
- Lower back pain
- Infertility and/or pregnancy losses
While not all the fibroids will impair your ability to achieve and maintain a healthy pregnancy, it is always a good idea to see your gynecologist at certain time intervals for routine testing and scans so that problems in the uterus do not go unnoticed.
Repeated Miscarriages are one of the most frustrating experiences a couple can have when trying for a baby regardless of whether conception takes place naturally or via assisted reproduction. If miscarriages occur after a natural conception, patients often do not read too much into it and keep trying a few times before they consult their doctors. In IVF treatments, if there are recurrent miscarriages, then the IVF specialist will be able to notice this earlier on and usually after a single miscarriage following treatment, additional tests will be required to rule out certain possibilities. Recurrent miscarriages can be treated in most cases and patients can have a healthy pregnancy to a full term.
One of the first things that needs to be addressed is the time frame in which miscarriages are taking place. The cause and severity of the problem may differ depending on whether your miscarriages are occuring earlier on during your pregnancy (within the first trimester) or later on.
Management of the problem requires an effective testing and diagnosis as well as appropriate measures to make sure the risk of a miscarriage can be minimized based on what the problem might be. (Read More).
Dr. Savas Ozyigit
Egg donation in Cyprus, Gender selection in Cyprus and IVF treatments in North Cyprus in general: you will find information on new advances in IVF technology and latest IVF practices. All the blogs are personally written by Dr. Savas Ozyigit and his expert medical team.