Our fertility specialists will provide you with the highest quality fertility care for your IVF cycle. Medicana IVF Center IVF treatments encompass the following steps:
Your Initial Consultation
You will meet with one of our physicians, at which time we will review your medical history and establish your unique IVF treatment plan.
Pretreatment testing will include blood work to determine hormone levels, blood tests , a semen analysis (if applicable), and a uterine assessment. In order to have the optimal outcome with your IVF treatment, we review your medical history and the results of your pretreatment testing before we finalize a protocol that is tailored for you.
IVF Coordinator Consultation
you will meet with one of our IVF coordinators to review your protocol and plan your calendar.
Controlled Ovarian Hyperstimulation
An IVF cycle begins with ovarian stimulation and ultrasound monitoring. A baseline pelvic ultrasound will ensure a healthy starting point before initiating medication for the stimulation and assessment of egg production. You will take hormone injections to recruit multiple eggs from your ovaries. During this time, follicular development and hormone levels will be monitored for appropriate growth for several days. Once your follicles have reached the ideal size, you will be ready for egg retrieval.
Ultrasound-guided, transvaginal egg retrieval is a procedure in which a long, thin needle is passed through the vaginal wall into the ovary. The physician aspirates the follicles from each ovary and the follicular fluid is collected in test tubes, where the embryologist carefully searches for the eggs. The eggs are cleaned, counted, and placed in an incubator. Later that day, the eggs are fertilized with sperm either by standard insemination or Intracytoplasmic sperm injection(ICSI). Injuries during this procedure are extremely rare. Structures near the ovaries, such as the bladder, bowel, or blood vessels, could possibly be injured and require further surgery. Limited bleeding from the ovaries may occur, but the need for transfusion is extremely rare. Infections following transvaginal egg retrieval are also possible, but are rare.
Embryo Culture and Assessment
During IVF, your embryos are cultured for up to six days in a temperature-controlled incubator. Each day the embryos are evaluated for quality and development. This information is shared with the doctors to help determine the appropriate day for embryo transfer, which is typically performed on day three or day five of embryo culture or day six in the case of PGS/PGD. Our embryologists will call you each day to update you on the embryo quality and to answer any questions you may have.
Embryo Transfer or Blastocyst Transfer
Embryos are typically transferred back to the uterus on day three, when the embryo is at a multicell stage, or day five or six, when the embryo is at a blastocyst stage. This simple procedure usually requires no anesthesia. Your doctor and embryologist will discuss the number of embryos to transfer that will provide you the highest probability of success and the lowest probability of high-order multiple births. You will be given ample time to discuss your embryos and decide on the number of embryos to transfer. You also will receive pictures of your embryos being transferred. You will relax in the room for a short period of time once the embryo transfer is complete. The transfer itself may cause mild irritation to the cervix or uterus.
We will schedule your pregnancy test 10-12 days after your transfer. When your first pregnancy test is positive, a repeat value will be obtained approximately 48 to 96 hours later. To confirm the positive pregnancy test, we will schedule an obstetrical ultrasound two weeks following the second pregnancy test. At this visit we will be confirming the implantation of embryo(s) and fetal heart motion.
Your specialist may recommend PGT if:
- you are over 35 and have a higher risk of having a baby with a chromosome problem (such as Down’s syndrome)
- you have a history of recurrent miscarriages
- you have had several unsuccessful cycles of IVF where embryos have been transferred, or
- your sperm are known to be at high risk of having chromosome problems.
How does PGT work?
The procedure for PGS is usually as follows:
1. You undergo normal IVF or ICSI treatment to collect and fertilise your eggs
2. The embryo is grown in the laboratory for two to three days until the cells have divided and the embryo consists of about eight cells.
3. A trained embryologist removes one or two of the cells (blastomeres) from the embryo.
4. The chromosomes are examined to see how many there are and whether they are normal.
5. One, two or three of the embryos without abnormal numbers of chromosomes are transferred to the womb so that they can develop. Any remaining unaffected embryos can be frozen for later use
6. Those embryos that had abnormal chromosomes are allowed to perish or may be used for research
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 Medicana IVF, the ICSI (Intracytoplasmic Sperm Injection) procedure is carried out as standard as part of all our IVF treatmentsto ensure fertilization.
ICSI Treatment Process
Step 1 Sperm Retrieval
The male partner is asked to provide a sperm sample by masturbation in a quiet, private room. In cases of azoospermia, the sperm is retrieved either from the epididymis from the testes (TESE).
Step 2 Sperm Preparation
Following careful sperm preparation, the best quality spermatozoon is chosen for injection into the oocyte (egg).An electronic micromanipulator connected with an inverted microscope is used for this method.
Step 3 Fertilization
The oocyte is immobilized and with the use of an ICSI micropipette the spermatozoon is injected within the cytoplasm of the oocyte through the zona pellucida (membrane surrounding the egg). Once the ICSI micropipette is removed and the spermatozoon successfully placed within the egg, the zona pellucida seals back and the egg closes resuming its original shape.
The fertilized oocytes are observed to determine normal division and growth until the day of embryo transfer.
For more information regarding any of the programs at Medicana IVF Center, please feel free to contact us.
What is PGD ?
PGD is a technique used throughout IVF-ET, wherever embryos square measure tested for malady genes and solely healthy embryos square measure transferred into a female internal reproductive organ.
PGD – however may be a diagnosing created ?
Embryos square measure obtained by combining eggs and sperm cell within the laboratory. From every embryo, one or 2 blastomeres are removed and tested. If the embryo is judged to be freed from the disorder, are transferred to the cavum.
What square measure the indications for PGD ?
Indications for PGD square measure –
Advanced maternal age ( > thirty nine years)
Repeated IVF/ICSI –ET failure cycles
Unexplained physiological condition
Known genetic causes.
What does PGD/PGS involve?
All couples requesting PGD must first undergo an IVF cycle to stimulate the ovaries to produce a number of eggs. These eggs are collected and fertilised using the male partner’s sperm. The resulting embryos are cultured in the laboratory. Embryo biopsy can be performed either on Day 3 or Day 5 after egg collection. Embryos that have developed to at least 5-6 cells are suitable for biopsy. A hole is drilled in the outer shell of the embryo using laser and 1 or 2 cells are removed for genetic analysis. This procedure which is done at the 3rd day gives us the chance of having fresh transfer on the 4th or 5th day. The embryos are kept in culture while the testing of the biopsied cells proceeds. Genetic test results are usually obtained within 24 hours of embryo biopsy. Our embryologists will discuss the PGD results with the couple at the completion of testing. When available, one or two unaffected embryos can be transferred on Day 4 or Day 5. When a number of embryos are identified as being genetically suitable for transfer, morphological criteria are used to determine the best embryo/s for transfer. Surplus unaffected embryos will be grown in culture to Day 5 or Day 6. If they reach an appropriate stage of development (ie: form a good quality blastocyst) they will be frozen. These embryos may be used in a subsequent IVF cycle if the couple do not achieve a pregnancy with the fresh embryo/s. Embryos that are affected or have a chromosome abnormality are discarded.
However, For the last two years, we prefer performing PGS (Preimplantation Genetic Screening ) procedures ( not targeting a specific disease ) at the 5th day instead of the 3rd day. We wait until the 5th day after the egg collection to choose the best ones and make the embryo biopsy from the trophectoderm cells instead of the embryo itself. So, the risk of damaging the embryo becomes virtually zero ( which was estimated to be around 5 % with the Day 3 biopsy) and also the number of the embryos to be screened decreases causing a lower cost. We use NG-CGH (Next Generation Comparative Genomic Hybridization ) technology to check all ( 24 pair ) the chromosomes of the embryos for screening purposes such as advanced maternal age or repeated implantation failures.
A debatable disadvantage about this procedure ( Day 5 biopsy ) is that we should freeze the embryos since the results will be available in 24 to 36 hours which can be too late for the fresh transfer. The only problem is that couples come to our centre again in two or three months for only a few days for the transfer of the healthy embryos found. Besides, our statistics shows that the pregnancy rates are exactly the same as the fresh ones. Furthermore, some recent studies reveals that transferring the frozen embryos may give even higher implantation rates since ovarian stimulation with high dosage of hormones may impair the endometrial receptivity. It is very easy to have frozen embryo transfer. Otherwise, transfer is cancelled. But we think that this is much better than realising the baby is not healthy during the pregnancy with a probable miscarriage..
ICSI (Intra-Cytoplasmic Sperm Injection) is defined as a single sperm injection into the cytoplasm of an egg. The technique requires a single sperm with the best morphology and motility to be injected into the cytoplasm of an egg. Until now, visual evaluation of a single sperm has been the only available method for choosing the best sperm cell for egg insemination. Embryologists often have to deal with immature sperm cells. Such effects from these cells are evaluated at the same time during embryo development. Sperm cells with good morphology and motility may have other defects and may not be suitable for visual evaluation, etc. – DNA fragmentation, late development. Those defects affect the quality and development of the embryo as well as the possibility of miscarriage.
Using the latest PICSI technique (injection of the physiologically best sperm cell into the cytoplasm of an egg) it is possible to select sperm cells without visible defects. This method improves the selection of sperm cells by up to 98%. In this technique, sperm cells are placed into hyaluronic acid which will attach to mature sperm cells. Only completely mature sperm cells which have reached the last stage of spermatogenesis have developed attachment receptors for hyaluronic acid. Immature sperm cells have high DNA fragmentation, aneuploidy (abnormal number of chromosomes) and immature cytoplasms. Using the latest PICSI technique will increase the possibility of getting a successful pregnancy.
World Health Organisation defines Infertility as not being able to become pregnant after a year of trying. If a woman keeps having miscarriages, it is also called secondary infertility. Today, lots of couples have infertility problems in every part of the world. Infertility may be due to a single cause in either you or your partner, or a combination of factors that may prevent a pregnancy from occurring or continuing. About a third of the time, infertility can be traced to the women. In another third of cases, it is because of the man. The rest of the time, it is because of both partners or no cause is found. Drugs, surgery and IVF are common treatments. Happily, two-thirds of couples treated for infertility go on to have babies.
When to see a doctor for infertility:
In general, don’t be too concerned about infertility unless you and your partner have been trying regularly to conceive for at least one year. You should see your doctor earlier, however, if you’re a woman and:
- You’re age 34 or older and have been trying to conceive for six months or longer
- Your periods are irregular or not at all.
- Your periods are very painful
- You have been diagnosed with endometriosis or pelvic inflammatory disease (PID) before.
- You’ve had more than one miscarriageIf you’re a man, talk with your doctor if you have:
- Low sperm count
- A history of testicular, prostate or sexual problems
Infertility is one of the main specialities of Medicana International Hospital. Infertility treatments such as IUI, IVF/ICSI, laparoscopies and hysteroscopies are performed everyday. Medicana International Hospital does over a thousand IVF cycles each year with high success rates.The clinic has also its own andrology lab for male infertility and perform procedures such as TESA or microscopic TESE (testicular biopsy).
What is IVF ?
In vitro fertilization (IVF) today is a well-known common word to most of us. But not so long ago, it was a mysterious procedure for infertility that produced what were then known as “test-tube babies.” Louise Joy Brown, born in England in 1978, best known as the world’s first “test-tube baby” had conceived outside her mother’s womb.
Unlike the simpler process of intrauterine (IUI) or artificial insemination — in which sperms are placed in the uterus and conception precedes otherwise normally — IVF involves combining eggs and sperms outside the body. Once an embryo or embryos form and observed as healthy, they are then placed into the uterus. IVF is a complex and expensive procedure; only about 5-10 % of couples with infertility seek it out. However, since its introduction in the GB in 1978, IVF and other similar techniques have resulted in more than 1 million babies in all over the world.
What Causes of Infertility, Can IVF help ?
When it comes to infertility, IVF may be an option if you or your partner have been diagnosed with:
- Low sperm counts
- Problems with your womb or fallopian tubes
- Problems with ovulation ( egg production)
- Antibody problems that harm sperm or eggs
- The inability of sperm to penetrate or survive in the cervical mucus
- An unexplained fertility problem
Certainly, IVF is not the first step in the treatment of infertility. Instead, it’s reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination haven’t worked. Also with advanced maternal age ( over 40 ) ivf may be considered as a first line treatment option not to lose much time.
If you think that IVF might make sense for you, carefully assess any treatment center before undergoing the procedure.
Here are some questions to ask your doctor at the fertility clinic:
- How many cycles per year do you do?
- What is your pregnancy ratio per embryo transfer?
- What is your pregnancy rate for couples in our age group and with our fertility problem?
- Are the doctors and staff always available and accessible ?
- How many of those deliveries are twins or other multiple births?
- How much will the procedure cost, including the cost of the drugs?
- How much does it cost to store embryos and how long can we store them?
- What Can I Expect From IVF?
The first step in IVF involves injecting hormones to yourself so you produce multiple eggs instead of only one each month. You will then be tested in every other day to determine whether you’re ready for egg retrieval.
Prior to the retrieval procedure, you will be finally given an injection that makes the developing eggs mature. Timing is important; the eggs must be retrieved just before they emerge from the follicles in the ovaries. It is about 36 hours after the final injection. If the eggs are taken out too early or too late, they won’t develop normally. Your doctor may do blood tests or an ultrasound to be sure the eggs are at the right stage of development before retrieving them.. All women are given pain medication and full anesthesia during the retrieval in our Centre.
Day 5 ( blastocyst ) transfer
In our centre embryos are usually transferred back into the womb five days after eggs have been collected. This has been our routine practice for the last five years. With the development of new embryo culture media, it has been demonstrated that it may be possible to increase the success of IVF and ICSI treatment by transferring the embryo at day five or six after egg collection. These late stage, pre-implantation embryos are called blastocyst.
Which patients will benefit from a blastocyst transfer?
We often make the decision to transfer blastocyst depending on the number and quality of embryos available three days after egg collection. If we may not select the best two embryos for embryo transfer because there are a large number of rapidly developing, good quality embryos on day 3, we prefer delaying the embryo transfer to day 5 or day 6.
The embryo transfer procedure itself is the same.
How many blastocyst transfer is ideal for me ?
Patients having blastocyst transfers in our centre will only be able to have a maximum of two blastocysts transferred. This is because published data indicates that the chances of pregnancy following the transfer of blastocysts are high and therefore there is an increased risk of a multiple pregnancy.
Currently, we perform the following assisted reproductive techniques in Medicana IVF Center:
- Classical IVF
- ICSI ( microinjection)
- Blastocyst Culture
- Laser-Assisted Hatching
- Embryo Freezing
- Sperm and testicular tissue freezing
- Ovarian Cortex Freezing
- Blastocyst Transfer
- PGD ( Embryo Biopsy)
- Microscopic TESE ( testicular biopsy)
- TESA ( Testicular sperm aspiration for obstructive reasons)