IVF/FERTILITY

IVF/FERTILITY

Mr Karpouzis has seven years of experience in the fertility/assisted conception field. Has been trained in the UK and is accredited by the BFS, for Embryo transfers and infertility/assisted conception. He believes that every single infertility case is different and needs to be treated like this. We guarantee personalized, one to one care and holistic approach to your problem.

A hematologist, an endocrinologist, a psychologist,and a dietician will stand by you, in order to help you with your problems, either through virtual consultations or clinic appointments, during your stay in the city of Athens. Mr Karpouzis will create innovative and tailored made IVF protocols for you and will deal personally with your case, from the initial consultation, till the time that you will have a positive pregnancy test. Our collaborating embryologic labaratories, guarantee excellent success rates.

FERTILITY - PREGNACY

FAQ

How many years should I try for a pregnancy, before I address a fertility specialist?

Statistics show that 65% of women will finally conceive after 6 months of regular sexual intercourse and 85%, after 1 year. Half of those that have not managed to get pregnant in the first year, will finally achieve a pregnancy, if they carry on their tries for a second consecutive year. The diagnosis of infertility is usually given to couples that have been attempting to conceive for at least 1 year, without success. In the U.K a couple seeks help after one year of unsuccessful regular, unprotected ,sexual intercourse. We, at Pelargos IVF, believe that a woman over 35 years old, should preferably start investigating after 6 months, whereas women younger than 35 years old, can delay it to the year. Of course if subfertility problem is highly suspected or known, investigations need to start much earlier.

Which are the most common reasons of subfertility?

Many different medical conditions and other factors can contribute to infertility. An individual case may have a single cause, several causes or sometimes non-identifiable cause. Overall, one third of infertility cases are caused by female reproductive issues, one third by male reproductive issues and one third by both male and female factors or by unknown factors.

Out of all the female factors, ovulation problems, are most often caused by PCOs syndrome. Blocked tubes can be a result of adhesions due to a previous surgery or caused by pelvic floor infections like chlamydia or gonorrhea. Endometriosis is a disease that causes painful periods and can affect fertility in many different ways, one of them being tubal function problems.

Hormonal disorders, like thyroid malfunction, hypogandotrophic hypogonadism often caused by anorexia neurosa and hyperprolactinaemia, can all of them negatively affect  fertility. Congenital uterine abnormalities, like uterine diaphragms, bicornuate, didelphys uterus, cause infertility and recurrent miscarriages. Fibroids can be, depending on size and position, surgically treated factors of infertility.

Premature menopause caused by genetic, anosologic or unknown reasons, can also cause infertility. Obesity usually causes ovulation problems. Increasing age itself is the most important and most difficult to diverse cause of infertility, affecting both the quantity, but mainly the quality of the eggs. Male factors, can vary from small degree problems in sperm amount, mobility or morphology to complete azoospermia (no sperm) due to obstruction, hormonal, chromosomic or genetic reasons.

Almost in 20% of the infertility cases, no reason at all can be found and this is defined to be  unexplained infertility. Conditions like presence of NK cells in the blood, anti sperm antibodies and DNA fragmentation in sperm analysis etc. have also been associated, with infertility.

What can I do to increase my chances of getting pregnant?

Every woman trying for a pregnancy should start taking folic acid. 400 μg of folic acid are enough, unless a woman suffers from epilepsy or diabetes and is on medication. Women should ensure that they are immune to Rubella, before getting pregnant. If not, they should get vaccinated and start trying for a pregnancy 6 weeks after.

Cutting down on alcohol is very important for both women and men. Recent research has shown that alcohol reduction, can improve natural conception or IVF related pregnancy rates. Especially for men there is research showing that binge drinking can be detrimental to a sperm analysis and that excessive alcohol lowers testosterone levels and sperm quality, as well as quantity. Alcohol can also reduce female fertility, although mechanisms are not understood clearly.

A woman who is over the age of 37, should have a mammography before she decides going forward with a pregnancy. Smoking can also affect fertility, both for men and women and should preferably be stopped or significantly reduced. Recent research results have shown, that smoking can affect each stage of the reproductive process, including egg and sperm maturation, hormone production, embryo transport and uterine envιronment. Furthermore, it can damage DNA in both eggs and sperms. Finally, this could increase the miscarriage rates. Quitting smoking can improve natural fertility and some of the effects of smoking, can indeed be reversed within a year.

Weight control is one of the most important factors. Reduced BMI under the age of 18 and increased BMI over 30 can affect fertility in different ways. Obese women should start a diet in order to reduce their weight before getting pregnant. Not only to improve their ovulation and pregnancy rates, but also to reduce risks during pregnancy. Deaths by cardiac causes, linked to obesity are now the most common type of death among women during pregnancy and childbirth, according to the CEMACH report in the U.K.

Obesity also adversely affects IVF success rates and increases the complication rates of egg collection. Controlling weight between the normal BMI limits is of utmost importance.

Which are the basic investigations for subfertility?

A couple that has been trying for more than a year, when the woman’s age is under 35 or more than 6 months if the woman is over 35 years old, should start investigating.

Basic tests are a complete sperm analysis and culture for the man. A hormonal check on Day 2-4 of the cycle. LH, FSH, estradiol, testosterone, prolactin and thyroid function tests are very important. An ultrasound scan is also important to rule out cysts, polycystic ovaries, polyps or fibroids and to assess the antricle follicular count of each woman. An AMH (anti mullerhian hormone) is a measure of the quantity of eggs. Quality though, depends mainly on age. Laparoscopy and tubal check or HSG, depending on the suspicion of endometriosis or not, should be performed in order to assess tubal patency.

Before any sort of fertility treatment, IUI or IVF a full infection screen for the couple, including HIV, Hep B, Hep C and Syphilis check according to the HFEA protocols should be done. An HbAic test when a woman suffers from diabetes, Chlamydia and Ureoplasma cultures, as well as CMV, toxoplasma and Rubella immunity are recommended tests by the Pelargos team.

In case there is a recurrent miscarriages history, previous unexplained failed IVF cycles, severe oligospermia or family history of chromosomic or gene diseases, tests like a thrombophilia screen, anosologic tests (NK cells), karyotype ,cystic fibrosis screen and sperm DNA fragmentation tests are recommended.

Regarding hysteroscopy, when there is a non-suspicious and clear ultrasound, Pellargos team recommends this after 2 failed IVF cycles or 1 IVF failed cycle with top quality blastocysts transferred. Of course hysteroscopy is needed to surgically remove a sub mucous fibroid or uterine diaphragm found in ultrasound.

Endometriosis and Infertility

Endometriosis is a disease that causes severe pain in periods and/or deep pain during sexual intercourse. In endometriosis, the endometrial lining of the womb is found outside the womb, inside the tummy, most commonly in the ovaries, where it can cause the so called ‘chocolate cysts ‘, the uterine ligaments and the peritoneum. At every single menstruation the displaced lining of the womb bleeds, causing pain. Rarely endometriosis can be found in places such as the bladder, bowels or even lungs. Depending on its position, it can also cause rare symptoms like blood in the urine, blood and pain in defecation or hemoptysis.

Endometriosis can cause infertility in many different ways. It can distort and damage tubes anatomically, through adhesions formation. According to another theory inflammatory and anosological factors can affect the follicular maturation, ovulation and embryo implantation.

What is the best thing to do when suffering from endometriosis, depends on the position and stage of endometriosis as well as other coexisting infertility factors, as well as the symptoms caused. Is the severe pain affecting quality of life or infertility the only issue? Management of each case is different and depends on the above.

At Pelargos we can offer surgical treatment of endometriosis when needed. There is a multidisciplinary team If needed to go ahead with severe endometriosis laparoscopic surgery at state of the art operating theaters with last word of technology equipment at the best One Day Surgery Unit in Athens, in the premises of the biggest Maternity Hospital, IASO.

Pelargos IVF team can offer detailed consultation on each case and tailor made treatments. Either surgical If needed or through special IVF protocols, taking into consideration all the independent factors, keeping always in mind what is the main issue, we try to treat and always based on RCOG and NICE protocols. Each endometriosis case differs. Do not hesitate to contact us and book a Skype or face-to-face consultation. Our success rates in endometriosis related infertility are extremely good.

Polycystic Ovarian Syndrome and Infertility

Polycystic ovarian syndrome is a metabolic syndrome with specifically defined criteria. Not all women who have polycystic appearance in the ovaries on ultrasound, have the metabolic syndrome. This is why we need to be really careful, before we label a woman as PCOs. Polycystic ovarian syndrome though, is the leading cause of female infertility.

The hormonal imbalance in PCOs can cause irregular ovulation or even lack of ovulation. The mechanism of this anovulation is uncertain, but there is evidence of arrested antral follicle development, which may have been caused by abnormal interaction of insulin, LH and granulosa cells. The endocrine disruption itself may also directly decrease fertility. Weight control is very important in PCOs and ovulation.

Also research has resulted to the fact that PCOs syndrome could increase the chances of a miscarriage. Women with PCOs do not ovulate every month. This may have a benefit. As age is increased usually PCOs get better. Women with PCOs have usually more eggs in older age, than women without PCOs.

Treatments of PCOs infertility can vary from: cycle monitoring and controlled intercourse to oral drug use that causes ovulation combined with IUI or not and finally IVF. IVF in women with PCOs is quite tricky. Patients with PCOs are at high risk of hyperstimulation. On the other hand, resistant PCOs cases make it very difficult to stimulate the ovaries. There is a delicate balance between stimulating and not hyperstimulating PCOs ovaries.

At Pelargos we believe that each case is different and needs to be dealt with a specific way. We think there are:  easy to deal with PCOs and difficult to deal with PCOs, which have a different and characteristic appearance in ultrasound monitoring. Each case needs to be dealt with a different IVF protocol.

What we want to achieve at Pelargos is 0 degree of hyperstimulation and good success rates. Where others reduce the dose of the medication needed we may have to increase it, but still not hyperstimulate. Freezing of embryos and top quality vitrification methods at our cooperating IVF Units are  highly significant methods used in our protocols.

If you do have resistant PCOs or If you have been hyperstimulated before do not hesitate to contact us , for an online consultation, assessment and tailor made innovative protocols.

IVF. When, where and why?

Since 1978 when Luise Brown, the first baby from IVF was born, thorough research, invention of new medication, modern technologies like vitrification, contemporary equipment like the embryoscope which can closely monitor the growth of cultured embryos, as well as the introduction of pregenetic selection and diagnosis in IVF, have all together managed to increase success rates /cycle to the maximum degree ever and reduce complications to the minimum.

In spite of that, IVF is still an intrusive procedure, which needs to be done carefully in order to safeguard each patient’s health and has not reached a guarantee of success worldwide. At Pelargos we believe that every single IVF cycle protocol should be individualized. Each case is different and should be dealt with as such. Mr Karpouzis personally assesses medical history and previous IVF attempts at the initial Skype or clinic consultation and takes you through your IVF cycle in Athens step by step. Honesty regarding the predicting success rates, integrity and support by a specialised team throughout the procedure,  is of paramount significance to us.

We follow International Guidelines, but do not hesitate to apply innovative protocols on difficult cases. We trust our collaborating embryological laboratories to the maximum degree and we treat each case as unique. For us every couple are humans with their own personal story and not just numbers for our statistics.

If you want to know more about our tailor made, individualized protocols, book a consultation with Mr. Karpouzis

Natural Cycle/ Semi Natural Cycles /Mini IVF

We call natural a cycle, where no drugs are used apart from a trigger injection. At every natural cycle, we usually retrieve up to 1 egg. We can go ahead with one natural cycle and a fresh transfer or 3 consecutive natural cycles, freeze technique and transfer on a frozen cycle.

We call semi natural, the cycle where only pills causing ovulation are used. In semi natural cycles and depending on the pill used, we can retrieve up to 2 eggs/cycle. We can transfer on a fresh cycle or go ahead with 2 consecutive semi natural cycles and transfer on a frozen cycle. Mini IVF is called the IVF cycle where a minimum injectable gonadotrophin dose is given together or without ovulation pills.

We believe that in special cases a natural, semi natural or MINI cycle can have equal or even better results, than a normal IVF cycle. These cycles cost less, have minimum risk of hyperstimulation, are less intrusive, avoid drug side effects and If carefully selected for particular cases, can sometimes give almost equal results to high dose medicated cycles.

If you are considering going ahead with a natural, semi natural or mini IVF cycle, but you have lots of things to clarify, do not hesitate. Book an appointment with us.

IVF Tailor Made protocols

At Pelargos IVF,we strongly believe that the secret in IVF , is hidden behind thorough analysis of each case. This is why our initial consultation is long and also extra detailed. Lead consultant Mr. Karpouzis, guarantees dealing on each case personally from the start till the end. We use individualised, innovative protocols for every single case.

If you are a poor respondent, with low AMH and minimum amount of eggs retrieved in previous IVF attempts find out more about:

-Our maximum drug dose short protocol or
-Our double stimulation high Clomid dose + low gonadotrophin dose mix protocol with freeze all technique.

If you are a resistant PCOs case, with poor quality eggs retrieved before or If you have hyperstimulation with low doses before, contact us to have a consultation regarding:

-Our short , antagonist,  high dose, freeze all protocol with agonist trigger.

If you are a severe endometriosis patient book an appointment with us to find out about:

-Our endometriosis freeze all and contraceptive pill pretreatment, protocol.

If you are a straightforward IVF case contact us for a thorough consultation.

-Even in straightforward IVF cases we believe that, drug choice, dose choice, step down or step up technique, freeze all or not freeze all, depends on each case, have their significance and each adds to the final positive pregnancy result.

Always there to care.

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