Not all doctors, embryologist and nurses that work for an assisted conception unit are the same. There are differences. The knowledge and experience cannot be taken for granted and they can only be gained with continuous professional development and of course they reflect the pregnancy rates of each Unit. At Eugonia, we are proud of our international recognition as a result of our pregnancy rates which compete with the best pregnancy rates internationally and of our continuous presence in the scientific advances internationally with our pioneer research work.

The undertaking and publication of a scientific study needs an original idea, in-depth knowledge of the scientific literature and keeping up to date with the current developments, the maintenance of a detailed clinical database and the application of evidence-based medicine.

The publication in esteemed scientific journals means that the study and its scientific verification have successfully been put through in depth examination and have been accepted by internationally renowned scientists with great specialization in the subject in question.

The scientific team of Eugonia, coordinated by Dr T Lainas, already numbers a long series of scientific articles in esteemed scientific journals specialised in Human Reproduction and In Vitro Fertilisation. Apart from the international recognition of our Unit, this translates into an increase in pregnancy rates, a reduction in complications and thus an increased benefit for the couples that honour us with their trust.

Assisted Reproduction may significantly increase the chances of achieving a pregnancy in older women. At Eugonia, the pregnancy rates for women over 40 years of age is 28%, which is still lower in comparison to that of the group of younger women undergoing fertility treatments. However, the truth is that these women do not have the luxury of waiting or a time-schedule and should undergo assisted reproduction treatment as soon as possible.

It is well know, that the maximum fertility for a woman is established at the age of 24 (86% fertility), while for the group of women of age 25-30 this is about 78%. In the 30-34 age group the fertility starts to diminish (63%) and after the 35^th year of age this reduction is substantial (52%). Natural conception is quite rare after the age of 45 years (less than 0.1%) mainly due to the increase of chromosomal abnormalities in the oocytes.

This is not true in absolutely any case. It is estimated that in around half of the infertile couples, the cause of infertility is the male factor (either by itself or in combination with the female factor).

Children born through assisted reproduction treatment (ART) are as healthy and normal as children conceived naturally. As large epidemiological studies show, ART children do not have an increase in congenital and chromosomal abnormalities.

The proof is also the fact that 5,000,000 children have been born through ART internationally, some of which already have got kids naturally.

In thousands of children that have been carefully monitored, there has been no pathology or damage due to the ART methodology. The percentage of biochemical pregnancies and miscarriage is similar to these of natural conception. The few side effects of ART are mostly about the mother and not the fetus.

However, factors that increase the chances of children born with anatomical anomalies are the age of the woman, the time between the start of the ART and achieving the pregnancy and the presence of subfertility in the couple (Bonduelle et al 2002 Hum Reprod; Davies et al 2012 NEJM).

Assisted reproduction methods and in vitro fertilization programs have increased multiple pregnancy rates. Usually, twin pregnancies do not show any problems, as long as they are closely monitored and advanced care is offered. In high order multiple pregnancies (three or more fetuses etc.), problems are more common and more difficult to manage and they are affect the health of the mother and the chances of premature birth. Premature birth is the most serious cause of perinatal mortality and morbidity in fetuses and it correlates with the number of fetuses carried in the uterus.

For all the above reasons, the embryos transferred to the uterus should be as few as possible. If, despite these measures, an ART cycle results in a multiple pregnancy, there is the option of fetal reduction, however such a process raises great ethical dilemmas, while it may also jeopardize the survival of the remaining fetus(es).

This practice has been tried in the past in our Unit without returning the expected results and so we do not suggest it anymore. Usually this method is applied to women with poor ovarian response and/or advanced age, with the belief that it increases pregnancy rates, which in this group of women are already very low.

The transfer of all frozen embryos does not necessarily translate in higher pregnancy rates when compared to the transfer of one fresh embryo at a time. On the contrary, some embryos may not survive the freezing and thawing process which results in the loss of embryos and the futile physical and economic burden of a woman. At Eugonia, we advice on the fresh transfer of even one embryo, so as to avoid the stressful situation of freezing and thawing.

It is generally accepted that the number of oocytes produced from the ovaries of a woman during the ovarian stimulation with the use of drugs, correlates with the pregnancy rates. A large study of over 400,000 assisted reproduction treatment cycles from the UK shows that women with 15-20 oocytes had the higher pregnancy and birth rates.

No, that is not true. On the contrary, women with polycystic ovaries that undergo assisted reproduction treatment (ART) seem to have higher chances of achieving a pregnancy due to the increased production of oocytes and thus number of embryos.

At the same time though, women with polycystic ovaries are a high risk group for the development of ovarian hyperstimulation syndrome (OHSS). Current scientific literature data, amongst which is our study at Eugonia, the largest available with regard to the number of patients with polycystic ovaries, show that the protocol of choice is that of GnRH antagonists. It is well known that the use of antagonists in comparison with agonists (long protocol) correlates with a shorter stimulation duration, reduced use of gonadotrophins, same pregnancy rates and lower by 50% risk of severe OHSS development.

For all the above reasons, the use of the antagonist protocol for the stimulation of the ovaries in women with polycystic ovarian syndrome (PCOS) is imperative. In the case that the ovaries over-react, which increases the chances of developing OHSS, the triggering of the final maturation of the oocytes should be performed with the use of agonists (Arvekap or Buserelin) and not hCG (Pregnyl  or Ovitrelle), which totally eliminates the risk of developing OHSS. The transfer of the resulting embryos can be performed in following cycles with safety and excellent results.

This is a myth. At Eugonia, the majority of women will achieve a pregnancy at their first attempt. We can also provide a solution to previous failed IVF attempts from other Units.

Oocyte freezing can offer today a realistic solution to women that want to postpone getting pregnant in the near future, as well as in cases of premature ovarian failure. Recently, with the development of vitrification, oocyte freezing can result in high survival, fertilization, good embryo quality rates, which in turn result in higher pregnancy rates.

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The risk of developing ovarian or breast cancer is exactly the same as in the general population, as all large international epidemiological studies show. Breast screening should however be performed, especially in women that have completed their 35^th year of age.

See more here

Hysteroscopy is extremely useful, even if it is not obligatory prior to embarking on assisted reproduction treatment (ART). With hysteroscopy, the surgeon has the ability to closely examine the uterine cavity in real time, for an exact diagnosis and treatment of the possible pathologies, such as the presence of a polyp, adhesions, inflammation and congenital anomalies.

Hysteroscopy must be applied prior to ART when there is a finding in the hysterosalpingography or the ultrasound (adhesions, polyp, fibroid, prior uterine surgery). Routine hysteroscopy, both diagnostic and surgical, offers the best treatment option and it increases pregnancy rates.

See more about diagnostic hysteroscopy and hysteroscopic surgery.

In women with poor ovarian response that are close to menopause, the FSH is increased, suggesting poor ovarian function and poor ovarian reserves. Some suggest that the FSH should be measured at the start of every menstrual cycle, so as to identify the cycle with the lowest FSH levels in order to embark on an assisted reproduction treatment (ART) cycle. This practice, however, results in the inexplicable delay of the start of a treatment cycle, while it is possible for menopause to kick in, while waiting for a cycle with low FSH, which might never come.

At Eugonia, we advise that this group of women should immediately embark on an ART cycle, in order to gain as much time possible to repeat an attempt in the case of treatment failure. Either way, the pregnancy rates in this group of women are very low, but we have succeeded in achieving pregnancies that have resulted in the birth of healthy babies, even in women with very high FSH blood levels.

In general, there is some controversy whether or not to remove hydrosalpinges. Some argue that hydrosalpinges should be removed prior to embarking on assisted reproduction treatment as their contents can negatively affect the quality of the endometrium and lead to implantation failure of the transferred embryo(s). In contrast, some support that hydrosalpinges must be retained, as their removal may lead to a reduction in ovarian reserve and thus in a poor ovarian response during an assisted reproduction cycle. At Eugonia, based on our personal experience, we believe that the removal of  hydrosalpinges is not necessary when a woman undergoes her first assisted reproduction cycle. The removal of hydrosalpinges is suggested only in the case of a failed assisted reproduction cycle where good quality embryos have been transferred.

This is rather debatable. In general, endometriomas should be removed when their size and their anatomical positioning block the access to the ovary in order to aspirate the follicles during oocyte retrieval.