1. What do we mean when we say “In Vitro Fertilization”?

In vitro fertilization essentially refers to only one of the methods that can help a couple with infertilityproblems.. The correct term is Assisted Reproduction and covers a wide range of “treatments” such as insemination, induction of ovulation, and of course in vitro fertilization. By the latter we mean the fertilization of the egg by the sperm in an artificial environment and not inside the woman’s body and specifically in the fallopian tube, as is done by nature.

2. When should a couple seek the help of a Gynecologist who specializes in infertility?

Under normal circumstances a couple who consciously tries to have children should succeed within 12 to 18 months. The exact boundaries vary from country to country and there is even a slight divergence between the American and British schools. Of course, when we talk about conscious effort, we mean that both partners know how often and especially at the most point of the woman’s cycle, they have to make love without precautions.

3. What does a fertility test for both partners involve?

First, the doctor takes a detailed medical history from both partners, whom it would also be good to examine clinically. An ultrasound of the genitals, hormonal control and permeability control of the fallopian tubes are also necessary for the woman. Depending on the existing problem and his judgment, the gynecologist may recommend a laparoscopy and / or hysteroscopy. The quality of the man’s sperm must also be checked.

4. How does a treatment start?

After all the necessary information has been gathered and the specialist has come to the necessity of in vitro fertilization, the so-called treatment protocol is established. Thus, on the predetermined day of the cycle, a treatment is started with one or more hormones aimed at stimulating the ovaries so that they develop many follicles and not just one as is usually done in a normal cycle. With the same hormones we prepare the endometrium to accept future fetuses.

5. How is the patient monitored?

Usually after the first week, the patient – who of course is not sick – comes every two days for an ultrasound check of the number and size of the follicles as well as the thickness of the endometrium. Hormonal control of the ovarian response is usually performed. If necessary, the necessary fluctuations in the dose of hormones are made.

6. When are the ovaries ready?

We wait for the follicles, which contain the eggs, to reach a critical size and number. On top of that we consider that the eggs are mature and ready for egg collection. At the same time we make sure that the endometrium has the right thickness for embryo transfer. Then we administer a hormone which causes the final maturation of the eggs and their release into the follicular fluid.

7. When does ovulation take place?

Ovulation occurs approximately 36 hours after the final injection, chorionic gonadotropin. It is important for the patient to be extremely consistent with the schedule as an error of 2 or 3 hours can cause the follicles to rupture automatically, which in most cases means that the final stage of treatment fails.

8. How is ovulation performed?

It is done under aseptic conditions and with ultrasound control. With the administration of appropriate drugs the patient falls into a state of “intoxication” that causes analgesia. In some cases, ovulation is performed under general anesthesia. The fluid from the follicles is sucked out with a needle and delivered to the embryologist, who finds the eggs under a microscope.

9. How is fertilization done?

The husband delivers the sperm to the embryologist the same day. The eggs and sperm are placed in a special nutrient medium and sealed in special incubators where they are left for 24 hours. The next day the number of embryos is checked. Another 24 hours later the quality of the embryos is checked.

10. Are all eggs fertilized?

The eggs are fertilized at a rate of around 60-66%. Any number that approaches or even exceeds this number is satisfactory. Of course, the quality of the sperm and of course the eggs plays an important role.

11. When are embryos placed in the womb?

It does not require anesthesia and is generally a simple procedure for the patient. But it remains the most delicate moment for both the patient and the specialist However, it remains the most delicate moment for both the patient and the specialist as the fetuses, as well as the endometrium, are very sensitive. One method that is finding more and more supporters in the scientific community is that of the blastocyst where the embryos are transferred to the uterus on the 5th day after ovulation.

12. How many embryos are placed?

Usually 1-3 embryos are placed depending on the quality of the embryos. In exceptional cases and always with the consent of both the couple and the doctor more embryos can be transferred. In general, the number of embryos transferred tends to decrease because the risk of multiple pregnancies (twins) increases.

13. What about the excess embryos?

If the remaining embryos are of good quality then they can be frozen and used by the couple in a future endeavor which of course does not involve ovarian stimulation or ovulation.

14. When is the pregnancy test done?

About fifteen (15) days after the embryo transfer, a simple pregnancy test is performed. A blood serum test can also be done instead of urine. If the result is positive then an ultrasound test is performed in 2 weeks to confirm that everything is going well.

15. What is the success rate?

This is of course the most important question for couples. Success rates vary from Center to Center. Very important factors are also the age of the woman, the levels of her hormones and of course the sperm of the husband. Rates generally range from 30-40% for women up to 38 years old.