IVF (In Vitro Fertilization)

In vitro fertilization (IVF) is a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child.

During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs (embryos) are transferred to a uterus. One full cycle of IVF takes about three weeks. Sometimes these steps are split into different parts and the process can take longer.

IVF is the most effective form of assisted reproductive technology. The procedure can be done using your own eggs and your partner’s sperm. Or IVF may involve eggs, sperm or embryos from a known or anonymous donor. In some cases, a gestational carrier — a woman who has an embryo implanted in her uterus — might be used.

Your chances of having a healthy baby using IVF depend on many factors, such as your age and the cause of infertility. In addition, IVF can be time-consuming, expensive and invasive. If more than one embryo is transferred to your uterus, IVF can result in a pregnancy with more than one fetus (multiple pregnancy).

Your doctor can help you understand how IVF works, the potential risks and whether this method of treating infertility is right for you.

How it is done

Couples who decide on IVF enter a process that will take about 20 days.

In the first stage, the number of quality eggs is increased by inducing the mother’s ovaries with the necessary drugs.

The eggs are then collected with a fine needle through painless and short-term intervention. at the same time, the sperm cells are taken from the father candidate and passed through the necessary preparation steps and they are combined with each egg as a sperm.

Following the fertilization, the best quality of the embryos obtained is selected by transferring the embryos to the uterus through a painless and short-term procedure, usually on the 3rd day and, if necessary and appropriate, on the 2nd and 5th days.After that, the waiting period of the family starts and she gets the pregnancy test on the required day.

Firstly, the sperm sample is taken from the father candidate on the same day, is being washed.

The eggs are put together with the appropriate number of sperm in specially prepared solutions and after 18 hours, the fertilized eggs are being separated. In the following days the nascent embryo cell number, called the cell is no longer the case of fragmentation if relations with each other and if the cells are evaluated and classified. a few of them from embryos that are classified according to the appropriate quality are transferred to the mother. Other embryos are frozen and stored.

IVF method couple who decide to enter a process in about 20 days. The first stage of drug treatment is applied to obtain a sufficient number of eggs. Mothers of ovaries induced by drug treatment are necessary to increase the number of quality eggs after treatment lasts about 10-14 days, painless and short-term intervention with eggs are collected using a thin needle under anesthesia. The collected eggs are separated from other cells in the laboratory around extracting quality ones are processed. and at the same time that sperm cells are passed from father to taking the necessary preparation of each candidate are combined to become a sperm to the egg (fertilization).

Eggs and sperm are combined together in a special solution and the formation of the fertilization process is applied as the expected about 16-18 hours. Only this treatment must be a sufficient number of eggs and sperm for implementation. If the number or quality of sperm or eggs is less convenient if these methods fail. In this case, another treatment microinjection (ICSI) should be used.

The tube is baby and the only difference fertilization shape between microinjection injected with IVF sperm and egg together to put fertilization, a single sperm into each egg microinjection methods are expected to be self-microscopic catheters.

Usually, 3 days selecting the best quality from the resulting embryo following fertilization, necessary and, if appropriate, of the 2nd and 5th day from other days, the embryos are still painful and short-term transferred to the uterus with a transaction (transfer) is performed. After that, the family enters day waiting period is required and make the pregnancy testA

EGG DONATION

If the problem is originated from the woman and her eggs are not in good quality and quantity in the couples that can’t have baby, oocyte donation (egg donation) is used for getting pregnant.
The general success rate is more than 80% in IVF cycles with egg donation. So every woman can get her baby in every age.

To whom egg donation is performed?

-to women who has a uterus but undergoing pre-menopause

-to women who are undergoing menopause

-to women that their ovaries are taken out for any reason

-to women whose ovaries lost their activity because taking radiotherapy or chemotherapy

-to women whose eggs are low in quantity and quality

-to women who had recurrent miscarriages

-to women who has genetic disorders that can be inherited to their babies…

How to use egg donor for egg donation?

After deciding that egg donation is necessary for the patient couple, the donor is selected from the donor list of the center that consists of the women who applied for sharing their eggs. While selecting the suitable donor it is necessary to be careful about the physical properties of the couple.

After selecting the donor, menstrual periods of both donor and mother candidate is programmed to be gone together. And the eggs are induced in a donor, while the uterus is prepared in mother candidate and after collecting eggs from a donor and fertilized with father candidates sperms the embryos are transferred on day 3 or 5 of their growing. And the couple starts for waiting for a pregnancy test on 12th day after transfer.

The Requirements for Egg Donors:

1- the age of egg donor must be 20-35

2- donor must be physically healthy

3- the body mass index must be 19-29

4- donor must be psychologically healthy

5- donor shouldn’t have drug dependent

6-donor shouldn’t have any inherited genetic disorder

7-donors ovaries both should be healthy

8-should have karyotype analysis result 46, XX

9-required genetic and laboratory test is performed (Anti-Hiv 1, 2, HbsAg, Anti HBc, Anti-HCV, Syphilis, and sometimes if required HTLV-1 RHD, CMV, T.cruzi, cystic fibrosis, thalassemia, …)

How Egg Donation is performed?

Egg donation consists of three stages;

1-Deciding that we have to use egg donation and making PRE-PREPARATION:

making required tests and getting reports for mother candidate (FSH, LH, Estradiol, Prolactin on day 2 or 3 of menstrual bleeding, AMH on any day) and be sure that egg donation is needed. After this, starting to use some medicine to woman partner to refresh and strengthen the uterus and to man partner for inducing the quality of sperms. The donor is selected and bleeding time programing is performed for donor and mother candidate to start bleeding on the same day. If the mother candidate is in menopause,  bleeding is not required for her.
(This stage takes 1 week – 1 month and can be performed in patients’ country).

2-PREPARATION

On day 2 or 3 of bleeding (menstrual cycle, for both donor and mother candidate) in the month that couple decide to come for the treatment, making required extra tests to both women and start using some more medication like injections for inducing eggs in donor and some medicine for mother candidate for preparing the uterus for embryo. Generally, this medication stage takes 10 days. If the mother candidate is in menopause,  bleeding is not required for her (this stage takes nearly ten days and can be performed in patients’ country). After 12 days (on 14. day of bleeding) couple must be in Cyprus for oocyte pick up (OPU, egg collecting).

3- OPERATION

This starts with oocyte pick up (egg collection) from the donor and ends with embryo transfer on day 3 or 5 of embryo development to the uterus of mother candidate. The eggs that are collected from donor woman are fertilized with the father candidate sperms on OPU Day (Day 0). After 3 or 5 days, embryos are transferred to the uterus of mother candidate.  After transfer operation, couples can return to their countries whenever they want (this stage takes 3-5 days and patients must be in Cyprus). On 12th day after transfer beta-HCG test in the blood must be done for learning pregnancy is negative or positive.

SPERM DONATION

The couples who decide to perform sperm donation, a special medication protocol issued for increasing the number and the quality of the eggs of mother candidate.

After this, the eggs are collected and fertilized with donor sperm in laboratory conditions.

The embryos that are obtained are transferred to the uterus of mother

candidate and start waiting for pregnancy. And after 12 days pregnancy blood test has been made.

In the infertile couples, if the problem is raised from malefactors, if there is not any sperm in the ejaculate, sperms don’t have to fertilize property sperm donation can be used for having a baby.

The sperms that are being used for sperm donation are supplied from sperm banks. sperm donors are being checked about their health and physiological situation. And all rules that are necessary have to be performed during the selection of suitable sperms.

The rules are;

1- the age of sperm donor must be 20-45

2-the karyotype analysis result must be 46XY

3-physical and ethnical properties must be known

4-required genetic and laboratory test are performed (Blood Type, Thalassamia, Cystic fibrosis, SickleCell, Anti HIV1, and Anti HIV2, HBsAg, Anti HBc, Anti HCV, VDRL-RPR, HTLV-1/II Antibody, Chlamydia, Gonorrhea..)

To whom sperm donation is performed?

-to the men who have no sperm in their ejaculate

-to the men that have sperm cells but their cells have no fertilization capacity

-to the men that have genetic disorders that can be inherited to their babies

-to the men that there is no sperm in their TESA/TESE tissues

-to the women that want to be a mother without a partner

How to use sperm donor for sperm donation?

Firstly the sperm donors are checked for health situation for infectious and genetic disorders besides fertility capacity tests and then are stocked in the sperm banks. The sperms are selected from the bank lists according to patients’ choices with being careful about all physical properties to be suitable for especially dad candidate. After that, they are shipped in required conditions to centers and are used after thawing for sperm donation.

How sperm donation is performed?

Sperm donation consists of 3 stages;

1-Deciding that we have to use sperm donation and making PRE-PREPARATION:

making required tests and getting reports, (spermiogram, TESE /TESA Report, FSH, …) and be sure that sperm donation is needed. after this, starting to use some medicine to woman partner to refresh and strengthen the uterus and ovaries. (This stage takes 1 week – 1 month and can be performed in patients’ country)

2-PREPARATION

on day 2 or 3 of bleeding (menstrual cycle) in the month that couple decides to come for the treatment, making required tests to the woman and start using some more medication like injections for inducing eggs (this stage takes nearly ten days and can be performed in patients’ country). After 12 days (on 14. day of bleeding) couple must be in Cyprus for oocyte pick up (OPU, egg collecting).

3- OPERATION

this starts with oocyte pick up and ends with embryo transfer on day 3 or 5 of embryo development (this stage takes 3-5 days and patients must be in Cyprus). The eggs that are collected are fertilized with the bank sperm that was selected before by the couple or by the center on OPU Day (Day 0). After 3 or 5 days embryos are transferred to the uterus.  After transfer couples can return to their countries whenever they want. On 12th day after transfer, a beta-HCG blood test must be done for learning pregnancy is negative or positive.

EMBRYO DONATION

If the problem is originated from both woman and man in the couple, and both of them are infertile and can’t have baby, embryo donation is used for getting pregnant.

The general success rate is more than 80% in IVF cycles with embryo donation.

So every woman and man can get their baby in every age and every condition.

To which couples embryo donation is performed?

-to women who have a uterus but undergoing pre-menopause

-to women who undergoing menopause

-to women that their ovaries are taken out for any reason

-to women whose ovaries lost their activity because taking radiotherapy or chemotherapy

-to women whose eggs are low in quantity and quality

-to women who have recurrent miscarriages

-to women who have genetic disorders that can be inherited to their babies

and when the partner (father candidate)

-have no sperm in their ejaculate

-have sperm cells but their cells have no fertilization capacity

-have genetic disorders that can be inherited to their babies

-that there is no sperm in their TESA/TESE tissues

How to use sperm and egg donors for donation (embryo donation)?

After deciding that embryo donation is necessary for the patient couple, the egg donor is selected from the donor list of the center that consists of the women who applied for sharing their eggs. While selecting the suitable donor it is necessary to be careful about physical and ethnical properties of the couple. And sperm donor is selected from accredited sperm banks according to family candidates properties and their special demands is well.

After selecting the donors, menstrual periods of both egg donor and mother candidate is programmed to be gone together and sperms are shipped from the banks to fertility centers. The eggs are induced in egg donor, while the uterus is prepared in mother candidate and after collecting eggs from the donor on egg collecting day they fertilized with sperms of the selected sperm donor, then the embryos are transferred on day 3 or 5 of their growing into the uterus of mother candidate. And couple starts for waiting for a pregnancy test on the 12th day after transfer.

The Requirements for Egg Donors:

1- the age of egg donor must be 20-35

2- donor must be physically healthy

3- the body mass index must be 19-29

4- donor must be psychologically healthy

5- donor shouldn’t have drug dependent

6-donor shouldn’t have any inherited genetic disorder

7-donors ovaries both should be healthy

8-should have karyotype analysis result in 46, XX

9-required genetic and laboratory test are performed (Anti-Hiv 1, 2, HbsAg, Anti HBc, Anti-HCV, Syphilis, and sometimes if required HTLV-1 RHD, CMV, T.cruzi, cystic fibrosis, thalassemia, …)

The Requirements of Sperm Donors:

1- the age of sperm donor must be 20-45

2-the karyotype analysis result must be 46XY

3-physical and ethnical properties must be known

4-required genetic and laboratory test are performed (Blood Type, Thalassamia, Cystic fibrosis, SickleCell, Anti HIV1, and Anti HIV2, HBsAg, Anti HBc, Anti HCV, VDRL-RPR, HTLV-1/II Antibody, Chlamydia, Gonorrhea..)

How both egg and sperm (Embryo) Donation is performed?

Embryo donation consists of three stages;

 1-Deciding that we have to use embryo donation and making PRE-PREPARATION:

making required tests and getting reports for mother candidate (FSH, LH, Estradiol, Prolactin on day 2 or 3 of menstrual bleeding, AMH on any day) and be sure that egg donation is needed. Besides these, making required tests for father candidate and also decide that sperm donation is required (spermiogram, TESE/TESA Reports, FSH, LH, Testosterone). After this, starting to use some medicine to woman partner to refresh and strengthen the uterus. The donor is selected and bleeding time programing is performed for donor and mother candidate to start bleeding on the same day. If the mother candidate is in menopause,  bleeding is not required for her. And during this time, selected sperms are shipped from the banks  (This stage takes 1 week – 1 month and can be performed in patients’ country).

 2-PREPARATION

on day 2 or 3 of bleeding (menstrual cycle, for both donor and mother candidate) in the month that couple decide to come for the treatment, making required extra tests to both women and start using some more medication like injections for inducing eggs in donor and some medicine for mother candidate for preparing the uterus for embryo. Generally, this medication stage takes 10 days. If the mother candidate is in menopause,  bleeding is not required for her (this stage takes nearly ten days and can be performed in patients’ country). After 12 days (on 14. day of bleeding) couple must be in Cyprus for oocyte pick up (OPU, egg collecting). Then selected sperms are ready to use in the laboratory of the Center.

 3- OPERATION

this starts with oocyte pick up (egg collection) from the egg donor and ends with embryo transfer on day 3 or 5 of embryo development to the uterus of mother candidate. Couples must be here on the egg collection day or one day before. The eggs that are collected from donor woman are fertilized with the donor sperms on OPU Day (Day 0). After 3 or 5 days, embryos are transferred to the uterus of mother candidate.  After transfer operation, couples can return to their countries whenever they want (this stage takes 3-5 days and patients must be in Cyprus). On the 12th day after transfer, a beta-HCG blood test must be done for learning pregnancy is negative or positive.

PGD

Preimplantation genetic diagnosis (PGD) is a procedure used prior to implantation to help identify genetic defects within embryos. This serves to prevent certain genetic diseases or disorders from being passed on to the child. The embryos used in PGD are usually created during the process of in vitro fertilization (IVF).
PGD has also been used for the purpose of gender selection. However, discarding embryos based only on gender considerations is an ethical concern for many people.
PGD can test for more than 100 different genetic conditions.

The procedure is performed before implantation thus allowing the couple to decide if they wish to continue with the pregnancy.

The procedure enables couples to pursue biological children who might not have done so otherwise.

The following is a list of the type of individuals who are possible candidates for PGD:

• To the couples which carry genetic disorders
• To the couples which have genetic disorders in their family
• To the couples which are under risk because of their elder age
• To the couples which have recurrent misscarriage
• To the couples which have recurrent IVF failure
• To the couples which have severe male infertilityTo the couples that have risk of genetic disorder induced by gender chromosome

Tandem

Tandem IVF Cycle refers to IVF treatment where both the female patient and an egg donor receive treatment to stimulate their ovaries at the same time. North Cyprus IVF Center is one of the very first clinics in the world who adopted this revolutionary IVF treatment in order to give patients a chance of pregnancy with their own eggs while preparing an egg donor simultaneously as a back-up plan.

One of the main advantages of tandem cycle is that it allows you to receive a lower dose of medication compared to a standard IVF cycle. This is because you will already receive a number of donor eggs at the end of your IVF treatment so rather than trying to maximize the number of eggs obtained in your own cycle, we focus on obtaining just a few that can potentially give us a viable pregnancy. Higher dose of medication doesn’t necessarily correspond with a higher number of eggs. In fact, there is plenty of evidence that higher doses of stimulation can lower the quality of eggs, especially in poor-responding women. In standard IVF cycles, it can be seen as risky to aim for just a couple of eggs by keeping medication dosages at a minimum, but in a tandem cycle, this is a risk worth taking. Lower doses of drugs, while reducing the number of eggs to be obtained, can improve the quality and that, in itself, could possibly improve your chances of success with your own eggs. At the end of the IVF cycle, patients can choose any combination of donor/own eggs to use for the embryo transfer.  This also allows you to have a chance with your own eggs first and freeze donor’s eggs for a future cycle without facing the cost of two separate cycles should you end up having a sufficient number and quality of eggs with your own cycle.

Surrogacy

IVF surrogacy uses a third party “gestational surrogate” to carry the pregnancy when a patient is unable to carry a baby to term herself. The gestational surrogate may also be called the “gestational carrier” or “gestational mother.” The gestational surrogate signs a contract with the intended parent or parents to undergo an embryo transfer procedure using embryos created through IVF and to carry the resulting pregnancy.

For heterosexual couples, this generally means using embryos created using the eggs and sperm of the client couple. This means that, if the pregnancy is successful, the couple can bring home a baby who is 100% related to both partners, just as if they had been able to conceive and carry the pregnancy on their own. Single women opting for IVF surrogacy may use their own eggs and donor sperm. LGBT couples may also choose to use IVF surrogacy, using the eggs of one partner and donor sperm, if neither partner can carry the pregnancy themselves.

In all cases, the gestational surrogate has no genetic ties to the baby she carries. Gay couples often use a gestational surrogate, but as they will use donor eggs or the eggs of the surrogate herself (also known as “traditional surrogacy”) this process is not usually referred to as IVF surrogacy.

Egg Freezing

Egg freezing is a method of storing a woman’s unfertilised eggs to allow her to try to conceive at a later date, when natural conception would be unlikely. It may be seen as a way of preserving the possibility of fertility for women who are not in a position to become pregnant straight away, or whose fertility is at risk for medical reasons such as cancer treatment.

Frozen eggs may be stored for many years without significant deterioration. When the woman is ready to use her eggs, they are warmed, and then fertilised with sperm. The aim is for the fertilised egg to develop into an embryo, which can then be transferred to the woman’s uterus giving a chance of pregnancy.

Embryo Freezing

Embryo freezing is a procedure that allows people to store embryos for later use. A person can also freeze eggs, which are not fertilized. An embryo forms after fertilization and after the cells start to divide.

The first successful pregnancy resulting from freezing a healthy embryo took place in the 1980s. Since then, many people have frozen embryos and used them later.

A person may decide to store an embryo if they hope to become pregnant in the future, to donate to others, for medical research, or for training purposes.

The process begins by using hormones and other medications to stimulate the production of potentially fertile eggs. A doctor then extracts the eggs from the ovaries, either for fertilizing in a lab or for freezing.

Successful fertilization may lead to at least one healthy embryo. A doctor can then transfer the embryo to the womb, or uterus. If the treatment is successful, the embryo will develop.

Fertilization often results in more than one embryo, and the doctor can freeze and preserve the remaining embryos.

Laser Budding

Laser assisted hatching is a method, usually used in circumstances where the zona layer of the egg is thicker or harder than it should normally be and in cases where more than one IVF or micro-injection procedure has been carried out without any success; and the female partner’s age doesn’t play an important rule here.

There are lots of successful pregnancy cases on the third, fourth even on the ninth treatment via laser assisted hatching. In addition to assisted hatching, laser is also used to wash toxic metabolite  out of the embryo, and thus produce healthier embryos that are transferred to the future mother.

How many times can a couple try IVF treatment?

There is no limit for it. However, many IVF attempts can reduce the possibility of pregnancy. In some cases, several attempts are performed until we get a pregnancy. We have witnessed success after 8 or 10 attempts for some couples

Does age influence the chance of pregnancy?

Woman’s age is the most important factor influencing IVF cycle. Chance of pregnancy is higher for women younger than 35. Women between 35 and 38 are accepted fort the treatment, while women between 38 and 40 have lower chances. For those who are between 40 and 42, there is still a little hope and finally, women that are between 42 and 44 have nearly no chance of a successful IVF treatment.

Does the number of embryos influence the possibility of pregnancy?

The success expectancy with a single-embryo transfer is 28% while with a double-embryo there is a 48% chance of success. In single-embryo treatment, we can freeze more embryos which is a significant advantage for patients.

Is there a higher risk of miscarriage in IVF treatment?

The risk of miscarriage is a little higher after IVF treatment. This risk is not linked to the treatment itself but to the patient’s ability to become pregnant.

What about the chances of pregnancy with frozen embryos?

Sometimes, we may have some high-quality embryos left after IVF cycles. These embryos will be frozen to give the couple the option of using them in the future. Therefore embryo freezing may be a good advantage for patients. When thawed, 70% to 80% of these embryos are still viable and each transfer has a success expectancy of 50% to 80%.

Is there a possibility of multiple births with IVF?

Yes, when multiple embryos are transferred 25% of pregnancies with IVF are twins. (In the normal population, the rate is one set of twins per 80 births.) Triplets are seen in approximately 2-3% of pregnancies.

How long does in vitro fertilization (IVF) treatment take?

IVF treatment takes approximately 18–20 days. The patient can return to his/her country after the embryo treatment. The patient can get information about the required tests by contacting the doctor before coming to Cyprus. This way, everything will be ready for them upon their arrival to Cyprus

Do medicines used in IVF treatment increase the risk of ovarian cancer?

According to the research, medicines used in vitro fertilization treatment do not harm the ovaries.

How are the eggs collected? Is it a painful process?

Eggs are collected with the help of vaginal ultrasound. It is a process that is generally performed under short-term anesthesia.

How are embryos placed into the womb?

Embryo transfer is a simple process. An embryo is placed from the cervical field into the womb by using a thin plastic catheter with the help of ultrasound.

What is a ‘cycle’?

Your menstrual ‘cycle’ is the time between day one of one menstrual period until the day one of your next period, usually around 28 days. If you are undergoing any type of fertility treatment your treatment cycle will be based around your menstrual cycle.

Can I exercise as usual during my fertility treatment?

We suggest that you avoid strenuous exercise while undergoing fertility treatment, although gentle exercise may be fine. If you are considering exercising during your fertility treatment we recommend discussing this with your fertility specialist or nurse coordinator first.