PCOS, Infertility and IVF Treatment
Polycystic ovarian syndrome, abbreviated as PCOS, is one of the main causes of ovulatory problems and female infertility for women at the childbearing age. PCOS is a very common problem. It has been estimated that 1 in 10 women (approximately 10% of women) at the childbearing age is affected.
It has been suggested that the main factor contributing to PCOS and its symptoms is insulin resistance. People who are resistant to insulin have an ineffective transport of glucose from blood to the cells and muscles where the glucose is used for energy. Instead, it is built up in blood, causing the body to produce higher and higher levles of insulin in an attempt to lower the level of glucose accumulated. Excess insulin production does not only lead to storage of fat, causing weight gain and obesity, it can also interfere with the reproductive pathways.
Some experts believe that insulin resistance is not to blame for PCOS but rather we should focus on hormonal dysregulation of the hypothalamus of the brain. This is the region responsible for production of hormones and stimulation of the pituitary gland, which has a substantial amount of influence in the female reproductive system.
Symptoms of polycystic ovarian syndrome
The following symptoms are the most frequently observed sympotms by women who have polycystic ovarian syndrome (PCOS):
-Oligomenorrhea, which is defined as having irregular menstrual cycles. Some PCOS patients may also experience amenorrhea, which corresponds to having no menstrual cycles. In such cases, patients are often prescribed appropriate medication so that their cycles can be regulated.
-Some patients with PCOS will also experience an onset of excess hair growth, which is known as hirsutism. Excess growth of hair can be on the face, on breasts or on other parts of the body.
-Patients whose PCOS may have been contrinbuted by insulin resistance are also likely to experience weight gain and difficulty in managing their weight even though various weight loss plans may have been attempted.
Symptoms can vary across women depending on how polycystic the ovaries are and many other factors that might be at interplay.
What is the relationship between PCOS and Infertility?
Patients affected by PCOS are highly likely to have infertility problems. This is due to the ovulatory problems that are associated with PCOS. While some women are still able to ovulate despite having PCOS, some women will not ovulate at all, making it impossible for natural conception to occur. In order for natural conception to take place, an egg should mature and should be released from the ovaries so that fertilization with sperm can take place. However, if there is no ovulation, the eggs will not receive maturity.
It is possible that some patients with PCOS will have naturally regular menstrual cycles and will conceive without any problems, and may not even realize that they have the condition. On the other hand, some patients will exhibit eveyr single symptom in the book and will have a very difficult time achieving pregnancy. This means that PCOS is not a condition that can be managed with a single prescription. Each case will require a unique approach and attention for effective management.
Can I conceive with PCOS?
Absolutely! While PCOS is a condition which is closely associated with female infertility, the chance of achieving and maintaining a successful pregnancy with women who have polycystic ovarian syndrome using fertility treatments is very high. Majority of women with PCOS will be able to achieve and carry a pregnancy to a full term with the use of fertility treatments.
However, it is important that the fertility treatment program of a woman with PCOS is very carefully planned by an IVF specialist. Designing a suitable treatment program will necessitate that your IVF specialist is informed about your hormone levels and your antral follicle count (AFC) so that the dosage of your medication can be adjusted accordingly. For more information on these tests, please visit our “Infertility Testing” Section. The good news is, women with PCOS respond very well to ovarian stimulation medication, therefore, even mild doses of medication will allow us to obtain many oocytes from your ovaries. The bad news is, if you are receiving assistance from an inexperienced clinic, you will be running the risk of a severe case of ovarian hyperstimulation, which can be a very unpleasant side-effect of controlled ovarian hyperstimulation (COH).
At North Cyprus IVF Centre, we make sure that our IVF specialists work with specialist endocrinologists in optimal management of your PCOS.
There are various reasons why people travel abroad for treatment. One of the most popular treatments for which patients travel abroad is In Vitro Fertilization (IVF). Several factors play a crucial role in patients' decision to travel abroad for treatment of infertility:
-Low cost treatment options: At North Cyprus IVF Clinic, we offer a variety of fertility treatments at a cost which is fraction of the costs offered in the UK or the US. However, this does not come with a sacrifice of quality. At North Cyprus IVF, we are able to keep our costs much lower compared to our US and UK competitors as a result of lower licence fees, lower general wage rate, less bureaucratic requirements, considerably lower cost of donor compensation, and the use of advanced technology to keep our overall costs down.
-Flexibility of IVF laws which allow treatment for older women as well as availabilty of many treatment options which are not locally available. At North Cyprus IVF Centre, while we have a "recommended" age limit for treatments, it is at the initiative of our IVF specialists to offer treatment to women above the age of 50 in consideration with the patient's overall health and fitness for pregnancy. Also, at North Cyprus IVF Centre, our favorable laws allow us to adopt treatments and research practices that may not be permitted due to bureaucracy in countries where laws are very rigid.
-Long waiting lines at local clinics for receiving treatment under the NHS or at private clinics. This is especially true when patients are hoping to recieve treatment with donor eggs. Also, when it comes to using egg donors, our award-winning clinic has very strict criteria, allowing us to achieve very high levels of success.
-Practice makes perfect! Our clinic was established by Dr. Savas Ozyigit, an IVF pioneer, in 1998. Our clinic has treated over 10,000 patients within the 17 years of its existence.
This is not a complete list of advantages a couple will benefit from when receiving IVF treatment at North Cyprus IVF Centre. There are numerous advantages that are treatment-specific, which can be listed under a specific treatment. For various treatment options at our clinic in Cyprus, please visit our "Treatments" page.
From time to time, we all hear about new advancements in IVF technologies. Some of these lose their popularity over time when they cannot contribute positively to the existing technologies in practice while other innovations remain with us and become an integral part of IVF treatments. Time-lapse imaging technology (also referred to as embryoscope due to its commercial name) is one such innovation in the field of IVF that is here to stay for a long time.
Time-lapse imaging system is a technological breakthrough which allows the embryologist to monitor embryos in the incubator with a 24/7 surveillance system. With this ability, embryos are watched and observed continuously, allowing the embryologist to see the whole pattern of embryo growth and development through a built-in camera system. This is not possible with standard incubators, and the only way to check the development of embryos is by physically opening the doors of the incubator to look at the embryos. This puts embryos in contact with the air outside the incubator and may possibly increase the risk of embryo fragmentation. An embryoscope allows the embryologist to observe all embryos in the incubator without any interruption.
At North Cyprus IVF Centre, we are proud to offer you this latest IVF technology with a small additional cost also giving you a DVD of your embryos' initial stages of development - what a perfect gift to give your child when (s)he grows up! Please visit our "Embryoscope" page for more information.
Gender selection, or sex selection refers to selecting the sex of your unborn baby prior to pregnancy. At North Cyprus IVF Centre, this option is offered to two groups of patients:
1- Couples who would like to select the sex of their child due to a known genetic predisposition to a sex-linked (X-linked) condition. X-linked diseases are single gene disorders that point to the presence of gene mutations or gene defects on the X chromosome. Since males only acquire one copy of the X chromosome from the mother, only one mutated allele is sufficient to cause a sex-linked disease on males. This suggests that males are more prone to the majority of X-linked diseases compared to females.
2- Couples who already have children and would like to balance their family by having another child of the opposite sex. This group of patients usually have no fertility issues and are able to have healthy children via natural conception methods. However, natural conception may not always produce “balanced” offspring, therefore, assisted reproductive technologies come into play.
Regardless of your reasoning, gender selection can be legally offered at North Cyprus IVF Centre to both groups of patients. There are two alternative methods in practice at North Cyprus IVF Centre regarding sex selection. Namely, these are Pre-Implantation Genetic Screening/Diagnosis (PGS/PGD) and MicroSort.
1- Pre-implantation Genetic Screening / Pre-Implantation Genetic Diagnosis
PGD (Pre-implantation Genetic Diagnosis) refers to embryo selection as a response to a known genetic disorder running in the family, therefore, it is applied purely for genetic disease prevention purposes. PGS (Pre-implantation Genetic Screening), on the other hand, refers to applying the exact same method of embryo selection in cases where there is no known genetic disorder in the male or the female partner. PGS is the correct term used when the technology is used to screen the embryos for identifying their sex (known as sex/gender selection)
The PGD/PGS technique is used as a part of an IVF treatment. The patient must undergo IVF treatment so that we can obtain her eggs (or donor eggs can also be used in cases where the female patient cannot use her own eggs). The eggs obtained are fertilized with the male partner’s semen sample and embryos are created. Once the embryos reach a certain stage of development, they are biopsied so that genetic screening can be performed and the sex of each embryo can be revealed accordingly.
North Cyprus IVF Centre is the only official clinic offering MicroSort in Europe, Middle East, Asia and Africa. MicroSort is a sperm sorting method which enables us to sort a sperm sample into X (female) and Y (male) bearing cells. That way, by having a sperm sample sorted into two batches, we know which sperm batch has the capability of producing a male child and which one can produce a female child.
However, the MicroSort technology is not as accurate as the PGS method described above. It is only 75% accurate for selecting Y-bearing cells and about 85% accurate for selecting X-bearing cells. In other words, if you opt for using the MicroSort technique only without the PGS technique, there is a likelihood that the sex of your child may not be accurately selected.
The MicroSort technology also has certain requirements. The semen sample of the male partner must contain a minimum of 70 million total motile sperm in the ejaculate so that the sort equipment can be used. For sperm samples that do not meet this criteria, the sort mechanism does not work properly and we cannot get desired results.
If the sperm sample is found sufficient for MicroSort, and if the patients are willing to accept a lower accuracy of sex selection, the MicroSort technique can be part of an artificial insemination (IUI) cycle, which allows for a non-invasive treatment.
More information on our alternative gender selection treatments can be found on the "Gender Selection" page of our website.
In this article, we talk about the procedures and processes involved in donor egg IVF treatment at North Cyprus IVF Centre.
Patients who are interested in undergoing IVF treatment using donor eggs are likely to belong in one of the following groups:
1- Women who have undergone IVF treatment with own eggs but failed to achieve or maintain a pregnancy (IVF failures or recurrent miscarriages).
2- Women who are menopausal or peri-menopausal who may or may not have undergone IVF treatment before.
3- Women whose ovaries have been removed or damaged during surgery.
4- Women with genetic problems
5- Women who have undergone chemotherapy or radiation therapy.
IVF treatment using donor eggs is significantly different from standard IVF treatments in terms of procedures and the medication use. As opposed to standard IVF treatments, during egg donor IVF treatment, an egg donor undergoes the medication stage instead of the patient (recipient). However, the recipient also uses certain medication in order to prepare her body for pregnancy. The steps involved in IVF with egg donation are as follows:
Step 1: Testing and Assessment
During this step, we ask that the couple seeking donor egg IVF treatment undergo a number of tests in order to make sure that the couple is fit for pregnancy. The testing stage will be different for each patient depending on their unique history of infertility. For instance, a patient who has undergone failed cycles or recurrent miscarriages with her own eggs will first need to be assessed with respect to ovarian function. If ovarian function indicates low reserves and low oocyte quality, then relatively simple tests such as an ultrasound scan and a few blood tests will suffice. However, if there is any reason to believe that factors other than the egg quality may have contributed to previous IVF failures or recurrent miscarriages, then additional testing will be required.
A patient who has never had treatment before, but requires donor eggs due to older biological age, then a general health screening as well as an ultrasound scan will be sufficient as the first round of testing. But again, if the patient suffered from infertility previously, then additional testing will be required.
If the patient has had failed cycles using donor eggs previously, then certain additional tests must be completed before proceeding with another treatment. Given that success with donor eggs at North Cyprus IVF clinic is very high, a failed cycle with donor eggs calls for a thorough investigation in order to make sure appropriate measures can be taken prior to another treatment in order to maximize your chances of success.
Step 2: Preliminary Work
Once your testing has been completed and our IVF experts have made an effective assessment of your unique treatment requirements, we will be at a position to recommend treatment and formulate your treatment program. With your treatment program, we are able to prescribe your medication along with a calendar of treatment which specifies what needs to be done on a daily basis.
This is also the point where you select your egg donor. For egg donor selection, we will be providing you with a donor/recipient form so that you can specify your donor requirements and we can narrow down our donor pool according to these specifications. At the end of this process, we will be able to send you a few donor profiles to choose from. However, due to donor anonymity, we are not able to show pictures of our donors. For more information on donor recruitment, please visit our "IVF with Egg Donation" page.
Since the majority of our patients come from abroad, we can design our treatments so that the preliminary work can be carried out locally with your local consultant so that you can use your medication locally, have your initial monitoring and come to Cyprus for a total of 6 days to finalize your treatment. If you do not have a local consultant, we may be able to recommend you one depending on your location. The medication protocol which will be used will be a mild one, aiming to prepare your endometrium for a successful embryo transfer.
Step 3: Arrival in Cyprus
Your treatment calendar will specify which days you will be required to be present at our clinic for finalization of your treatment. Once in Cyprus, we will be able to pick you up at the airport, deliver to your choice of accommodation and provide all ground transfers back and forth between our clinic and your hotel. For more information on accommodation options, please see our “Accommodation” page.
During your 6-day stay, you will be required to attend 3 appointments with us. One for your initial consultation, one for providing your partner’s semen sample (if partnered. If using a sperm donor, this appointment will not be necessary), and one for the embryo transfer. Frequent updates can be obtained from your patient coordinator in between procedures.
Step 4: Embryo Transfer
This is the final step of your treatment, and perhaps the most significant step. During your last appointment, you will be given information about the progress of your embryos and will be offered the choice of how many embryos you would like transferred into the uterus. Legally, we are able to transfer up to 3 embryos, but we can also transfer 1 or 2 embryos per your request.
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.