IVF/FERTILITY

Various medical conditions and other factors can contribute to infertility. An individual case may have a single cause, several causes or sometimes non-identifiable causes. Overall, 1/3 of infertility cases is caused by female reproductive issues, 1/3 by male reproductive issues and 1/3 by both male and female factors or by unknown factors.

Out of all the female factors, ovulation problems are most often caused by the Polycystic ovary syndrome (PCOs). Blocked tubes can be a result of adhesions due to a previous surgery or caused by pelvic floor infections like chlamydia or gonorrhoea. 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, hypogonadotropic hypogonadism often caused by anorexia nervosa and hyperprolactinaemia can negatively affect fertility. Congenital uterine abnormalities, like uterine diaphragms, bicornuate and 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, immunological or unknown reasons can also cause infertility. Obesity usually causes ovulation problems. Advancing age is one of the common causes 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.

In as many as 20% of infertility cases, no cause can be identified. This is known as unexplained infertility. Conditions like presence of NK cells in the blood, anti-sperm antibodies and DNA fragmentation in the sperm analysis etc. have also been associated with infertility.

Every woman trying for a pregnancy should start taking folic acid. A folic acid dose of 400mg daily is 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 reduction of alcohol consumption can improve natural conception or IVF-related pregnancy rates. Research shows that binge drinking can be detrimental as excessive alcohol lowers testosterone levels and sperm quality, as well as quantity. Alcohol can also reduce female fertility, although it is not entirely clear as to how this works.

A woman who is over the age of 37 should have a mammography done before she goes on to try conceiving. 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 environment. Furthermore, it can damage the DNA in both eggs and sperm. 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 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 a CEMACH report in the UK.

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.

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 anti-mullerian hormone (AMH) is a measure of the quantity of eggs. Egg quality though depends mainly on age. Laparoscopy and tubal check or HSG, depending on the suspicion of endometriosis, 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 should be done, including HIV, Hep B, Hep C and Syphilis check according to the HFEA protocols. An HbAic test should be done 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, immunological tests (NK cells), karyotype, cystic fibrosis screen and sperm DNA fragmentation tests might be recommended.

Hysteroscopy is advised when there is a non-suspicious and clear ultrasound. Also, Pelargos IVF team recommends this after 2 failed IVF cycles or 1 IVF failed cycle with top quality blastocysts transferred. Hysteroscopy is needed to surgically remove a sub-mucous fibroid or a uterine diaphragm found in the ultrasound.

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 haemoptysis.

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

The plan of action for those suffering from endometriosis depends on the position and stage of endometriosis, as well as other co-existing infertility factors, as well as the symptoms caused.
Is the severe pain affecting the patient’s quality of life or is infertility the only issue? Management of each case is different.

At Pelargos we can offer surgical treatment of endometriosis when needed. A multidisciplinary team is available to carry out laparoscopic surgery in cases of severe endometriosis. The surgeries are done at the best operating theatres equipped with the latest tech, at One Day Surgery Unit in Athens on the premises of the biggest maternity hospital, IASO.

Pelargos IVF team can offer detailed consultation on each case and tailor-made treatments.
We can treat you surgically when required or through special IVF protocols, taking into consideration all the independent factors. We follow RCOG and NICE protocols.
Each endometriosis case differs. Do not hesitate to contact us and book a Skype or a face-to-face consultation. Our success rates in endometriosis related infertility are extremely high.

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. Therefore, doctors should be cautious when diagnosing PCOs.

Polycystic ovarian syndrome 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 be 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.

Research shows that PCOs could increase chances of miscarriage. Women with PCOs do not ovulate every month. This may have a benefit. In advanced age, PCOs usually gets better. Women with PCOs have usually more eggs in older age, than women without it.

Treatments of PCOs infertility can vary from cycle monitoring and controlled intercourse to oral drug use that causes ovulation with/without IUI, 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 hyper-stimulating PCOs ovaries.

At Pelargos we believe that each case is different and needs to be dealt with in a specific way. We think there are easily managed PCOs and PCOs that requires a more complex approach (can have a different and characteristic appearance in ultrasound monitoring). Each case needs to be dealt with in a different IVF protocol.

What we want to achieve at Pelargos is zero degree of hyperstimulation and good success rates. Where others reduce the dose of the medication needed we may have to increase it, but still avoid hyper-stimulation. 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 hyper-stimulated before – do not hesitate to contact us for an online consultation, assessment and tailor-made innovative protocols.

Since 1978 when Luise Brown, the first IVF baby was born, thorough research, invention of new medication and modern technologies like vitrification have advanced the treatment greatly.
Contemporary equipment, like the embryoscope, can closely monitor the growth of cultured embryos. Introduction of pregenetic selection and diagnosis in IVF has greatly increased success rates/cycle and reduced 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. At Pelargos we believe that every single IVF cycle protocol should be individualized. Each case is different and should be dealt with as such.
Dr Karpouzis personally assesses the patients’ medical history and previous IVF attempts during the initial Skype or in-clinic consultation and takes you through your IVF cycle in Athens step by step. Honesty in predicting success rates, integrity and support by a specialised team throughout the procedure are of paramount importance to us.

We follow international guidelines but do not hesitate to apply innovative protocols in difficult cases. We trust the embryological laboratories we work with, and we treat each case as unique. For us every couple are humans with their own personal story and not just numbers in our statistics.
If you want to know more about our tailored, individualized protocols, book a consultation with Dr Karpouzis.

We call a cycle natural when there are no drugs used apart from a trigger injection. We usually retrieve up to one egg per one natural cycle. We can go ahead with one natural cycle and a fresh transfer or two, three or more consecutive natural cycles, freeze technique and transfer on a frozen cycle.

A semi-natural cycle happens when the ovulation is caused by administration of pills.
In semi-natural cycles and depending on the pill used, we can possibly retrieve 2 or more eggs per cycle.
We can transfer on a fresh cycle or go ahead with 2 consecutive semi natural cycles and transfer on a frozen cycle.
An IVF cycle where a minimal injectable gonadotrophin dose is given with or without ovulation pills, is called a mini IVF.

We believe that in certain cases, a natural, semi-natural or a mini cycle can have the same or better results than a normal IVF cycle. These cycles cost less, have minimum risk of hyperstimulation, are less intrusive and avoid drug side effects. If carefully selected for appropriate cases, these cycles can sometimes give almost equal results to those using high doses of medication.

If you are considering a natural, semi-natural or a mini IVF cycle, but you’d like to clarify any details, do not hesitate and book an appointment with us.

At Pelargos IVF we strongly believe that the secret of IVF success lies in thorough analysis of each presented case. This is why the initial consultation at Pelargos IVF is a lengthy and detailed one. Lead consultant Dr Karpouzis guarantees supervising each case personally from start to finish. We use individualised, innovative protocols for every single case.
If you are a poor responder, with low AMH and a minimum number of eggs, retrieved in previous IVF attempts, find out more about:

– Our maximum drug dose, short protocol or
– Our double stimulation high 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 had 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 have severe endometriosis, please book an appointment with us to find out about:
-Our endometriosis freeze-all and contraceptive pill pre-treatment, protocol

If you are a straightforward IVF case contact us for a thorough consultation.
-Even in straightforward IVF cases we believe that the choice of medication, dosage, a step down or step up technique, freeze all or not freeze all – varies in each case.