Fertility Treatments

In Vitro Fertilisation (IVF)

IVF is the process by which eggs are fertilised by sperm outside the uterus (in vitro) in the embryology lab. IVF is the main treatment used in infertility when other methods of assisted reproductive technology have failed.

The main steps in the IVF process are:
- Ovarian stimulation with the administration of hormones and monitoring of ovarian response
- Egg collection
- Semen sample collection
- Fertilisation in the lab (Classical IVF or Intra Cytoplasmic Sperm Injection (ICSI))
- Embryo culture and development
- Embryo transfer

Classical IVF is where freshly washed sperm are placed in the same dish as the eggs and left to fertilise overnight. ICSI is a more specialised technique where one spermatozoon is injected into the egg.

Donor Sperm

Donor sperm is used in cases where every chance of finding mature physiological spermatozoa either in the ejaculate or following testicular biopsy has been excluded. Additionally, donor sperm is needed in cases of single women.

Our Center collaborates with two international sperm banks, namely Cryos International and European Sperm Bank. The donor semen samples obtained from these two banks comply both with European and Greek Laws. Each sperm sample has a certificate to verify the good health of the donors. Donors are selected on a case by case basis, determined by blood groups and characteristics.

Intracytoplasmic Sperm Injection (ICSI)

Intracytoplasmic Sperm Injection (ICSI) involves the injection of a single spermatozoon directly inside the cytoplasm of the egg. It is a process that is performed by experienced embryologists under a specially modified microscope at high magnification using a micro-needle. It is a technique used when the sperm sample is very poor, or in cases where there has been little or no fertilisation after classical IVF.

Testicular Sperm Biopsy

In cases that no spermatozoa are found in the ejaculate (Azoospermia), a surgical procedure can be performed to obtain spermatozoa directly from the testicles.

There are several techniques such as PESA (Percutaneus Sperm Aspiration) and MESA (Micro-epididymal Sperm Aspiration) but TESE (Testicular Sperm Extraction) is the one most commonly used.

TESE involves the extraction of testicular tissue, through a small incision made in the scrotum. Alternatively a fine needle may be used to aspirate fluid and tissue directly from the testis (Testicular Sperm Aspiration-TESA). Both can be performed on the day of egg collection or at a prior date. If it is performed on a date prior to egg retrieval, the spermatozoa found are cryopreserved until the day of egg collection. It is performed at Newlife by specialised Urologists to minimise damage to the testis and to obtain adequate samples. All these procedures are performed as day case procedures without the need for admission.

Intra-Uterine Insemination (IUI)

Intra-uterine insemination (IUI) is the one of the first choices of infertility treatment. It is a relatively simple procedure, where a prepared semen sample is placed directly inside the womb, using a soft catheter. It is a widely used procedure, for women with open fallopian tubes.

It is used in cases of:
- Unexplained infertility
- Ovulation problems
- In cases of mild sperm problems (oligospermia and/or asthenospermia)
- In cases of male sexual dysfunction (erection problems)

IUI can be performed in a woman’s natural cycle or after the administration of medications.

Preimplantation Genetic Testing

There are two types of Preimplantation Genetic Testing:
- Preimplantation Genetic Diagnosis (PGTM) is used to diagnose specific genetic disorders. It is used when one or both partners have a known specific genetic disorder. Or when both partners carry the same genetic trait and want to choose embryos that are free from that disease.
- Preimplantation Genetic Testing (PGTA) is a technique to screen embryos for aneuploidy - a condition where an abnormal number of chromosomes are present in each cell.

This process involves removing a single cell (blastomere) on day 3 of embryo development or removing a few cells from a day 5 or day 6 blastocyst embryo. The embryos are unharmed by this process. The blastomeres that are obtained are analysed for abnormalities. Only healthy embryos are transferred into the uterus based on this analysis.

The main indications for preimplantation genetic testing are:
- High risk of chromosomal abnormalities or severe monogenic hereditary disease in children
- Genetic defects linked to the child's gender
- Repeated miscarriages
- Premature birth or miscarriage with chromosomal disorder in the past medical history
- Numerous unsuccessful IVF cycles with implantation failure

Preimplantation genetic testing can only be undertaken for medical reason according to Greek law. Therefore it cannot be used for family balancing reasons.

Employing these tests does not necessarily mean that there is an increased chance of pregnancy and in certain cases they may even be detrimental to a treatment cycle.

Blastocyst Transfer

The blastocyst is the staged reached by the embryo on day 5-6 post egg collection. This is the final developmental stage prior to implantation in the uterus which signals the start of a pregnancy. It is the last day that embryos can survive in the lab. Embryos can be transferred at this point, or at any point before the blastocyst stage.

Advantages of blastocyst transfer compared to earlier stage transfer include:
- better selection of embryos to choose from
- higher success rates as a result of only choosing embryos which have successfully completed preimplantation development
- lower chances of multiple pregnancies as a smaller number of embryos can be transferred

At Newlife we run a successful blastocyst culture and transfer programme for cases which meet specific criteria. The final decision about whether we opt for blastocyst transfer is made on day 3 of embryo development. This decision is based on the number and quality of embryos, the maturity of the endometrium and the individual woman’s history.

Sperm Freezing

Freezing and storage of semen samples or testicular tissue are performed in the following cases:
- For men unable to attend the IVF unit on the day of the partner’s egg collection or the day of treatment. A sample can be frozen at any time prior to the scheduled date of treatment. This is particularly helpful in certain cases for couples coming from abroad
- For men having difficulties producing a sperm sample on the day of egg collection for psychological reasons
- For men that have sperm parameters that vary from sample to sample
- For men that are single and wish to ‘preserve’ their fertility
- In cases of testicular removal, and/or programmed chemo or radio therapy
- In cases of surgical sperm collection (biopsy), so that there is no need for repetitive invasive surgical procedures

The quality of the sperm samples that are frozen is not affected over time if the proper techniques of cryopreservation are employed.

Assisted Hatching (laser)

Assisted hatching (AH) is the procedure by which a small hole is made in the zona pellucida of the embryo so that hatching can occur easier. Hatching usually occurs naturally and it is required so that the embryo can implant in the uterus. In certain cases, the embryologist may consider it necessary to help the embryo with this process (e.g. embryos with a thick zona pellucida, women older than 37 years etc.)

There are various ways to perform assisted hatching. At Newlife this procedure is carried out using the latest laser technology, which is the safest, fastest and most effective method available.

Embryo Freezing

In many couples, but particularly those who are young, an IVF treatment cycle may lead to the production of many embryos. After embryo transfer there may still be a number of good quality embryos remaining. These surplus embryos can be frozen, stored and used in a subsequent cycle.

In some cases due to the poor quality of the endometrium or severe ovarian hyperstimulation syndrome, a fresh embryo transfer is not carried out and all embryos must be frozen for future use.

The freezing technique used is called vitrification and the embryos can be stored for a long period of time without affecting their quality.

Frozen embryo transfer cycles have many advantages:
- High success rates, without having to go through stimulation with the use of hormones and egg collection
- Reduced cost
- Optimal endometrial preparation
- Fertility preservation

Freezing and storing of surplus embryos is also particularly helpful in egg donation cycles. A successful egg donation cycle which results in frozen embryos means that a couple can try to have a biological sibling in a subsequent cycle. This is not always possible if the couple does not have any frozen embryos as the donor used in the first attempt may no longer be available.

Ovulation Induction

Ovulation Induction is the process by which we use specific drugs (hormones), either pills or injections, to stimulate the ovaries to produce eggs. In some cases this therapy may result in a pregnancy without any further need for treatment. In the majority of the cases, however, this therapy is used in conjunction with other types of therapy like intrauterine insemination or in vitro fertilization (IVF).

The drugs most frequently used for ovulation induction are clomiphene citrate, aromatase inhibitors and gonadotropins.

Ovarian Cyst Aspiration

In many cases, ovarian cysts may develop; these are mainly benign and result from the ovarian function. Their presence may negatively affect the response of the ovaries to drug regimes. In these cases it may be essential to aspirate the cyst (empty the contents with the use of a fine needle) in order for the treatment to continue without problems. This procedure is carried out at Newlife with or without anesthesia, depending on each case. Ovarian cyst aspiration is performed under ultrasonographic guidance.