IVF Step by Step
Our individualised approach means that every couple will vary in how their treatment is planned and managed.
Stimulation of the ovaries with hormones known as gonadotrophins is usually required for a period between 10 to14 days. The hormones are in the form of self-administered subcutaneous injections and need to be taken daily. The aim is to stimulate the ovaries produce multiple follicles simultaneously. Your response to the hormones is monitored very closely with daily hormonal blood tests and ultrasound scans on alternate days, to pick up the slightest changes, which will impact on the choice of medications and timings of treatment. Medications may be altered and dosages may be changed if required. This level of monitoring may be inconvenient in the short term, but we believe it is vital and can make the difference in the quality of the eggs you produce. This approach in treatment is strictly individualized and it is this attention to detail and dedication that contributes to excellence in results.
When the follicles in the ovaries reach the appropriate size we plan your egg collection. A trigger injection is given approximately 36 hours before the egg collection. The exact timing of the trigger injection and the egg collection is essential for the optimal outcome with regards to the egg quality and quantity.
On the day of the egg collection you need to present at the clinic in the morning, having had nothing to eat or drink from midnight the night before your procedure. Nail polish, make-up, jewellery and contact lenses should be removed prior to coming in. Prior to moving to the operating theatre you will be reviewed by the cardiology and the anaesthetic team and you will be asked to sign the relevant consent forms.
Egg collection is a day case procedure, which usually lasts for approximately 20 minutes and is performed under light sedation. With the use of a fine needle under ultrasound guidance, the fluid in the follicles in each ovary is aspirated and the eggs are obtained.
Following the procedure you will be given antibiotics and painkillers and you will be taken to a recovery room to rest, for approximately 2-3 hours. Once you are fully awake and able to eat, drink and pass urine, you will be able to leave the clinic. You are strongly advised to arrange for someone to drive you home and avoid driving for 24 hours.
Shortly after the eggs are retrieved, the male partner produces a semen sample. Frozen or donor sperm may also be used.
The eggs and the sperm are put together in a culture dish and incubated overnight to undergo fertilisation and create the embryos. As with a natural conception, once the eggs are exposed to the sperm, many sperm will attach to the egg but usually only one sperm will enter each egg. This process is known as fertilisation.
If there are concerns with regard to sperm quality, a variant of IVF known as ICSI (intracytoplasmic sperm injection) is likely to be advised to achieve fertilisation. This involves the injection of a single sperm selected by the embryologist directly into the egg.
Following fertilisation, the embryos are cultured in the laboratory under optimum conditions, resembling the natural environment and are monitored regularly by our embryologists to make sure they are developing normally.
Two to three days after the egg collection, the embryos have usually divided into four to eight cells. They subsequently continue to develop and by day 5 they reach the “blastocyst stage”. The embryos are then scored against a specific grading system, which allows us to select the best possible embryo(s) for transfer.
Whenever appropriate, we aim to culture the embryos for five or six days, to allow them reach the “blastocyst’ stage”, which is likely to improve the chances of success. However, If only a small number of embryos are available, then the embryo transfer will be scheduled on the 2nd or 3rd day following the egg collection.
Embryos that are not transferred will be assessed for suitability to be frozen for future use. In most cases, we would only advise freezing top quality blastocysts to secure a high chance of surviving the freeze/thaw process (>90%).
Embryos will usually be transferred on Day 3 or 5 but may, on occasion, be transferred on Day 2 or 6 after egg collection.
What will determine the number of embryos we transfer are your age, your previous reproductive history and the quality of your embryos.
We always adhere to rules laid out by the Greek National Authority of Assisted Reproduction, which dictate the number of embryos allowed to transfer.
We give you pictures of your embryos and we show you them on a screen, via a camera we have placed in the laboratory. We then transfer your embryos to your uterus using a soft catheter, which is gently passed through your cervix.
The procedure is painless (similar to a smear test) and you do not need any sedation. We always encourage your partner to attend the procedure.
The days following the embryo transfer are crucial for the implantation of the embryo(s). Therefore we continue the close monitoring to pick up even slight changes in your hormone levels, which could negatively affect the outcome if left undiagnosed. You will be taking progesterone supplements, which could be in the form of pessaries, vaginal gel, subcutaneous, or intramuscular injections, during that time to support the lining of the uterus. Medications are often adjusted as a result and tailored to your body’s needs to promote the embryo implantation.
The pregnancy test will be 15 days after the egg collection. In the event of a positive pregnancy test, the frequent monitoring of your pregnancy hormonal levels to ensure optimal levels and the progesterone supplementation are both continued. An ultrasound scan is usually performed 2-3 weeks later to confirm the viability of the pregnancy.
We continue communication with our pregnant patients throughout the pregnancy, often adjusting their medication and providing advice and support whenever necessary.
Should your pregnancy test, unfortunately, be negative then you will be offered a Skype or face-to-face, free of charge follow-up consultation with Dr Diamantopoulos, to discuss the details of your treatment, get answers to your questions and be advised on the best way of moving forward.