IVF \ ICSI
What is IVF?
IVF is the original 'test-tube' baby technique. It was developed more than 30 years ago for the treatment of women with damaged Fallopian tubes, and this remains an important reason for treatment today.
What is ICSI?
Micromanipulation is a radical method of assisted reproduction. It is one of the most effective procedures, to help men overcome male infertility issues and has helped more and more couples suffering from infertility since 1992. ICSI (Intracytoplasmic Sperm Injection) is beneficial for all couples; however it is significant for those where fertilizatıon may be difficult, even when IVF procedures are used.
For example, couples dealing with male infertility factors such as — low sperm count, poor motility or movement of the sperm, poor sperm quality, trapped spermatozoa or if the sperm lacks the ability to penetrate the egg membrane. At Kyrenia IVF, the ICSI (Intracytoplasmic Sperm Injection) procedure is carried out as standard as part of all our IVF treatments, to ensure fertilization at no extra charge.
How does IVF work?
All IVF treatments begin with a course of hormone therapy to stimulate the development of several follicles in the ovary. These are collected as eggs, which are then fertilized in a test-tube ('in vitro') to create several embryos. After between two and five days in an incubator, one or two of these embryos are transferred through the vagina to the uterus, where implantation occurs and pregnancy begins. However, in IVF as in natural conception, not every embryo implants to become a pregnancy, which is why surplus embryos are frozen - so that a subsequent transfer might be tried if the first one fails. Freezing is now an essential part of every clinic's IVF program.
IVF Treatment Process
Step 1 – Getting Started
The first step is to discuss our program details with the Patient Coordinators — either by calling or sending an email via our Contact pages. You will be advised in details about the cost of the treatment, tests required and the details of our IVF process. Please use this opportunity to ask any questions, as it is very important for you to understand the treatment process entirely from the beginning to the end (and everything in between).
Step 2 – Tests
Before starting your IVF treatment, there are several tests that are needed to be carried out, in order for Dr. Verda to assess your fertility levels and prescribe the correct dose of medication that you will need to take before traveling to Cyprus.
Tests included:
• Hormone blood tests: FSH (Follicle Stimulating Hormone), AMH (Anti-Mullerian Hormone), TSH (Thyroid Stimulating Hormone), LH (Luteinizing Hormone), E2 and Prolactin
• Trans-vaginal ultrasound scan: Antral Follicle Count
Once you have the results, you will need to email them to your coordinator. Dr. Verda will go over the test results and confirm, if it is possible to move forward with an IVF treatment. We also ask you to complete and return a medical information form via email.
It is also important for your partner to have a semen analysis carried out before the IVF treatment, to ensure there are no issues with male infertility.
Step 3 – Medication
Medication is prescribed and taken before arriving at Kyrenia IVF. Pre-tests will determine the correct dose. Our IVF specialists will send you a prescription and a medication protocol clearly indicating the proper medication to take and when to take it. The stimulation medication is in the form of subcutaneous injections and is prescribed to stimulate the follicles that contain the eggs and to prevent premature ovulation.
Step 4 – In Cyprus
Initial scan
Day one of your menstrual cycle marks day one of the treatment process with medication. On day 10 you will fly to Cyprus. The initial scan consists of a trans-vaginal ultrasound to check the development of your follicles. (Dr. Verda may prescribe additional stimulation medication at this stage if necessary). If the eggs are ready, our dedicated nurses will administer an ovulation trigger injection that evening at your hotel. The injection stimulates the final maturation of eggs in the ovaries. The eggs will be then collected 34 to 36 hours after the injection is administered.
Egg & Sperm Collection
Our team will inform you regarding the time and the day of the egg collection. Upon arrival at the hospital, a nurse will show you your room and provide you with the garments necessary to wear for the procedure. You will be taken to the operating room where you will be sedated and asleep throughout the entire procedure. (Since you will be sedated you must NOT eat or drink after midnight the previous evening and we will remind you of this when you are in Cyprus).
Your eggs will be collected under transvaginal ultrasound guidance. A needle is inserted through the vaginal wall into the ovaries using ultrasound to locate each follicle. The follicular fluid is drawn up to obtain the eggs. Generally, the egg retrieval takes 20-30 minutes. You may experience some cramping and light bleeding after the procedure — however this is perfectly normal. You will be able to take a mild painkiller if necessary.
During the egg collection, our team at Kyrenia IVF will be preparing the sperm sample from your partner (or donor). Abstinence from ejaculation for two to three days prior to providing the semen specimen is recommended.
Fertilization
The most motile sperms are selected for fertilization. To ensure fertilization, our team uses the ICSI procedure. This technique involves the insemination of sperm into each egg by micro-injection. Once you have had the appropriate rest, our transfer team will take you back to your hotel. Our doctors will also discuss with you the amount of eggs that were collected and the sperm quality. Our team will also discuss with you any other information regarding the procedures carried out that day. After 24 hours, you will receive an update regarding the fertilization process and the amount of embryos.
Embryo Transfer
The embryos are transferred on either day three or day five of development. Our compassionate embryologist is highly skilled in identifying healthy embryos and in some cases will recommend extending embryo development to day five — also known as blastocyst stage. Blastocyst transfer is common in IVF cycles as it can increase the chances for success while decreasing the likelihood of multiples. Dr. Verda will work closely with our Embryologist to determine if a day three or day five transfer is ideal for you.
On transfer day, Dr. Verda will discuss with you the quality and quantity of your embryos. You can then decide how many embryos you wish to have transferred. Again you will be shown to a room and provided with the necessary garments. Embryos are transferred to the uterus through a soft embryo transfer catheter. This painless procedure is similar to a pap smear and does not require any anesthesia. The embryos are placed in a small amount of fluid inside the catheter, which is passed through the cervix at the time of a speculum examination and ultrasound guıdance. The embryos are placed in a position to reach the top part of the uterus. The catheter is removed and checked to ensure that all the embryos have been transferred. You are required to have a full bladder for the transfer procedure and we advise that you begin drinking water on the way to the hospital. After the embryo transfer is complete, your bed will be wheeled from the procedure room into your private room, all while you remain lying flat on your back. Since you must remain as flat as possible, a bed pan will be brought to you by the nurse approximately 15 minutes after the transfer procedure if needed.
If you desire to use cryopreservation, the good quality embryos that are not transferred can be frozen in liquid nitrogen, carefully labeled and stored in the embryo bank. These can be used in subsequent cycles if pregnancy is not achieved on the first attempt or if you decide to have more children at a later date.
Step 5 – The Result
The most accurate test for pregnancy is the beta HCG blood test — 12 days after the embryo transfer (day 1 being the day after transfer took place). HCG is also known as 'the pregnancy hormone'. The body begins to produce HCG when an embryo begins to implant in the uterus. While we understand many intended parents are anxious to find out the results at home, please wait until day 12. The ovulation trigger injection the nurse administered prior to egg collection contains HCG and if you test too soon you may pick up traces of this and NOT the HCG produced by pregnancy. The injection can remain in your system for 8-10 days so testing too soon may give a false positive. The beta HCG test will report the level of HCG hormone that is present.
In some cases, it can be difficult to have a blood test carried out. A home pregnancy test will indicate whether or not there is any detectable HCG in your urine and not the level present. Please wait to carry out a home pregnancy test 14 days after the embryo transfer. Please note HCG is present in urine in the highest concentration first thing in the morning.
If you have a positive result, it is very important that you continue the medication as advised by Dr. Verda. You can also advise your doctor / gynecologist as you will need support and subsequent tests and scans. You should repeat the beta test in 2 to 3 days. The goal is to have the level of HCG doubled every 3 days. If it is needed another beta test should be carried out in another 2-3 days’ time. If all three betas indicate a healthy pregnancy, then a vaginal ultrasound will be scheduled between 6 to 8 weeks of the pregnancy. At that time, your doctor will be looking for a heartbeat and a gestational sac to confirm the pregnancy. If the result is negative and you have had a blood test on day 12, ALL medications should be stopped straight away. If the result is negative and you have carried out a urine test on day 14, we recommend that you continue taking the medication as advised by Dr. Verda for another 2 days and test again. If the result is still negative, ALL medications should cease right away.
Any negative results on your pregnancy test is devastating — Dr. Verda and the Kyrenia IVF staff are available to answer any questions you have about the procedure and discuss further options for you.
