Commonly asked questions and their answers
The duration varies between 15-30 days, depending on the treatment protocol.
The beginning of the treatment is based on the period and consist of the following stages.
Controlled Ovarian Stimulation (COS) plays a crucial role in the increased success rates of IVF pregnancies over the last three decades.
The protocol is selected according to the specificity of each woman's cycle, the response of the ovaries to previous efforts, the age and other factors that the doctor assesses. Mild protocols are more patient-friendly, faster, at lower cost and fewer complications. Recent studies have shown that mild ovarian stimulation protocols are associated with better quality ovaries, embryos and endometrium, while birth rates appear to be similar to traditional protocols.
However, in their application, these protocols are not rigid, because each body reacts in its own way to drugs. An important part of our work is to determine the optimal therapeutic protocol and the ideal dosage for each individual case.
Children from IVF are as healthy and normal as children from natural conception. As large epidemiological studies show, there is no increase in the percentage of congenital and chromosomal abnormalities.
More than 8,000,000 children from IVF have been born and quite a number of them have already have their children with natural conception.
In hundreds of children studied carefully, no tampering or damage due to the methodology has been observed. The rate of miscarriages and retinal pregnancies is similar to the rate of those in natural conception.
The age limit for women who undergo assisted reproduction treatment is 50, according to Greek legislation.
According to the Greek legislation (Ν. 4737/2020 (ΦΕΚ Α’ 204/22-10-2020) cryopreserved embryos can remain in storage for up to 5 years. The duration of cryopreservation can be extended for a maximum period of twenty (20) years with a written request of the couple every five (5) years.
On average, a proportion of 5-10% of frozen embryos do not survive this process, regardless of storage time. Many studies have shown that the survival of embryos is not related to their storage time. The embryos are just as good as the day they were frozen, and there have been worldwide births of healthy children coming from cryopreservation over 20 years old!
Most inherited diseases (such as β-Mediterranean anemia, cystic fibrosis, Down's syndrome, etc.) can now be checked by pre-implantation genetic diagnosis (PGD). Through this method, while the embryo grows in culture conditions in the embryological laboratory, a small fraction (1-2 cells) is analyzed for hereditary diseases. In this way, it is possible to select for embryo transfer only healthy embryos without genetic abnormalities.
Read more about Pre-Implantation Genetic Diagnosis (PGD), PGS and the new NGS method, that are successfully applied to Eugonia.
Gender selection is forbidden by the Greek legislation, unless it becomes necessary to prevent the transmission of gender related hereditary diseases.
The risk of developing cancer in the ovary, uterus or breast is exactly the same as that of the general population, as all major international epidemiological studies all show. Of course, the breast should be carefully checked, especially in women who have reached the age of 35 years. See more
It is known that some women do not have the ability to produce their own eggs. These women have no other option of having a child than the egg donation. This means that they have to undergo IVF in which their husband's sperm will be used, with some other woman's eggs. The donation concerns the disposal of all oocytes received from an anonymous donor for use by one or more anonymous recipients.
This category includes:
- Women have lost their ovaries, who for some reason
- Women who have received radiotherapy or chemotherapy,
- Young women in early menopause,
- Women whose ovaries do not respond to even high dosage of stimulation drugs.
Eugonia has a successful and specialized egg donation program based on strict ethical standards. Our program focuses on the patient, avoiding the profile of mass-scale donation programs. This is also reflected in the top success rates of the Unit.
Greek legislation allows single women to undergo assisted reproduction treatments using donor sperm. The sample will come from a Sperm Bank, while the woman should have previously conduct a notarial act of consent and recognition of the child.
Frozen eggs keep the chronological age of the woman on the day of freezing. Therefore, it is important that the procedure is done at the youngest age. The ideal age for a female to freeze eggs is between 25-36 years without this meaning that even older women can not go into this process. However, according to surveys the younger the woman, the better the quality and the number of eggs and the greater the chances of a future pregnancy.
It is not necessary to have a caesarean section after an IVF treatment.
The choice of method depends on the history and the course of the pregnancy
of each woman.
The pregnancy resulting from IVF is valuable and requires special care.
The goal remains a healthy baby and two happy parents.
The appearance of embryos cannot give us any information on chromosomal abnormalities. The evaluation of embryos is performed by observing their morphological appearance (number of cells, presence of fragmentation etc.) under the microscope and it correlates with the prognosis of achieving a pregnancy. It is very possible for an embryo of excellent quality to carry chromosomal abnormalities. For the detection of such anomalies, a special genetic testing called preimplantation genetic testing should be applied. In this way, healthy embryos can be selected for transfer to the uterus, while embryos with anomalies can be excluded.
See more about the methods of preimplantation genetic diagnosis and preimplantation genetic screening.
It is possible for a woman to undergo assisted reproduction treatment in a natural cycle without the use of drugs to stimulate the ovaries.
In a natural cycle, there is no stimulation of the ovaries with drugs, but monitoring with a series of utlrasounds and blood hormone measurements of the progress of the one and only (lead) follicle and the endometrium. Due to the high risk of premature and untimed ovulation and thus failed oocyte retrieval, this protocol has been replaced with the modified natural cycle (MNC).
In the MNC, during the last few days there is administration of antagonists and a minimal dose of gonadotrophins. In this way we can avoid the loss of the oocyte due to premature ovulation.
Amongst others, the advantages of natural cycles include the absence of drug administration for ovarian stimulation, the absence of side-effects and complications, the small time duration, the reduced cost and probably the best receptivity of the endometrium.
Disadvantages include that we place our hopes in one follicle from which we can only retrieve one oocyte, which must be mature in order to fertilize, needs to divide and develop into a good quality chromosomally normal embryo with a good potential and able to implant in the uterus and result in a pregnancy. Thus, another disadvantage is the reduction in the pregnancy rates.
Indications may include a poor ovarian response, multiple failed assisted reproduction attempts, the desire to avoid taking any drugs and some exceptionally rare contra-indications for the use of ovarian stimulation drugs.
Indications may include a poor ovarian response, multiple failed assisted reproduction attempts, the desire to avoid taking any drugs and some exceptionally rare contra-indications for the use of ovarian stimulation drugs.AMH (antimullerian hormone) is produced by small follicles (<6 mm) in the ovaries of a woman.
A large number of studies suggest that AMH greatly reflects the total number of follicles that remain in the ovaries, i.e. it is a powerful indicator of ovarian reserve and a prognostic factor of ovarian response in an assisted reproduction treatment (ART) cycle to follow.
AMH levels are reduced as the age of the woman increases and as the ovarian reserve decreases, while at the same time there is a simultaneous reduction in the number of developing follicles visible on ultrasound. On the contrary, in cases of a large number of follicles, as with women with polycystic ovaries, AMH levels are excessively increased. It has also been suggested that AMH blood levels are a prognostic factor for the pregnancy chances of an ART cycle to follow, although this is debatable.
In Eugonia, in line with new scientific developments, we use the AMH measurement in combination with ultrasound assessment of the ovaries (number of small antral follicles and ovarian volume) and FSH and estradiol (E2) levels, in order to determine ovarian reserve and select the optimal stimulation protocol.
When we examine the psychology of an infertile couple we refer to various emotional and social factors which act synergistically in a complicated manner and can affect the assisted reproduction procedure through biological mechanisms. The effect of these psychological factors is not always expected. Psychology is not a factor that can be measured and it may exert its effects in different ways in different people. This is why its effect on the outcome of the assisted reproduction treatment cannot be measured.
The psychology of an infertile couple may include amongst others: anxiety and depression symptoms which may be attributed or attribute themselves to the infertility, insufficient communication within the couple, a vicious circle of anger – guilt, when one blames the other for the infertility, low self-esteem and a feeling of personal insufficiency which is connected to the incapability of childbearing, the stress that woman or the man experiences, many times without them realizing it, either in relation to the infertility itself, or due to random events, low sexual desire, etc.
Couples that are presented with infertility issues often have to face important and difficult dilemmas, for example whether and when are they going to embark on assisted reproduction treatment, which is going to be the cost, how many time will they try, or how are they going decide on a variety of alternative treatments (e.g. adoption, oocyte or sperm donation, etc.).
For all the above reasons, the psychological support of the couples that face infertility issues has been established as a routine abroad and nowadays in Greece as well.
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.
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 35th 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.
Biological age relates directly to ovarian reserve, i.e. the follicular reserve that exist in the ovaries of a woman. The most commonly performed tests in order to determine ovarian reserves is hormone blood tests for FSH, estradiol and anti-mullerian hormone (AMH) and a transvaginal ultrasound scan for the measurement of the ovarian volume and the number of basal antral follicles on the 2nd or 3rd day of the menstrual cycle.
Yes, it is now feasible to safely and effectively treat severe OHSS.
Since 2010, the new and promising strategies, that are applied in Eugonia, in order to vanish the risk of severe OHSS, tend to make the syndrome a complication of the past.
In particular, we apply the antagonist protocol in women of high risk of OHSS,by replacing the HCG with agonist hormone(GnRHa) and freeze all the embryos or oocytes. The novel treatment that has been designed by Dr Lainas and the scientific team of Eugonia has been described as pioneering by the international scientific community and has also been internationally accepted as a tertiary prevention method of the syndrome. Note that until recently there was no treatment for sever OHSS and its management was symptomatic and just relieved any symptoms, with the need for hospitalization that included paracentesis, the intravenous administration of albumins and possible admittance into an intensive care unit for numerous days. With this novel and revolutionary treatment (administration of GnRH antagonist in the luteal phase), the woman can be immediately relieved of her symptoms and for observation purposes only very few visits in our unit are needed.
At Eugonia, the majority of women will get pregnant on their first try, while it is generally accepted that most women with normal pregnancy chances will succeed within the first 3 treatment cycles.
Despite all progress on diagnosing the cause of infertility, unexplained infertility remains the most common type of infertility. The factors studied in the investigation of infertility (eg hormonal profile, sperm quality, tubal passage, etc.) are very limited and impossible to detect every possible cause of infertility. Around 25-30% of infertile couples have been shown to have unexplained infertility.
Embryos that have resulted from assisted reproduction treatments (IVF or ICSI) can be checked for genetic abnormalities with the use of preimplantation genetic diagnosis techniques. In this way, specific genetic mutations or chromosomal abnormalities which are responsible for certain known congenital and hereditary diseases in the embryo can be detected. Any affected embryos can be isolated and excluded from the embryo transfer.
See more on preimplantation genetic diagnosis and preimplantation genetic screening.
An important decision that must be taken after discussion with the couple involves the number of embryos transferred to the uterus. The choice of number of embryos transferred must meet a fine balance between the increasing pregnancy chances, which are usually enhanced by increasing the number of embryos, and at the same time reducing the chances of a multiple pregnancy, which is achieved by reducing the number of embryos. This decision can be taken after a discussion with you, by taking into consideration the age of the woman, the quality of your embryos, your medical history and any previous assisted reproduction treatment cycles. According to national legislation the number of embryos transferred must not exceed three for women below the age of 40, and four for women over 40 years of age.
A limited but increasing number of studies suggest treatment with the DHEA hormone (dehydroepiandrosterone) in women with poor ovarian response.
DHEA seems to act favourably on the ovarian response, the embryo quality and the pregnancy rates.
However, the data so far do not show significant statistical improvement after DHEA treatment, and more clinical studies are necessary to confirm a possible positive effect of this hormone on women with low ovarian reserve. In addition, PRP treatment is a new proposal that is still at a very early experimental stage and is far from safe for women with low AMH levels.
The quality of the services provided and the expertise of an Assisted Reproduction Unit (ART Unit) should only be judged by the result, i.e. the pregnancy rates.
The official recording of the pregnancy rates of ART Units by a national body and their publication could provide a reliable criterion for the selection of an ART Unit. This already happens in many advanced countries (e.g. USA, UK, France, Germany, Austria). In Greece, the operation of the independent National Body has been for now suspended. One of its missions was to record and publish the pregnancy results of all ART Units that operate in the country. It is expected that soon enough, this national gathering and recording of data will be the official source of the pregnancy rates of the ART Units of our country and in this way, anyone interested will be able to compare the various Greek ART Units, as well as many ART Units abroad.
