Human Reproduction – IVF – Fertility

INTRAUTERINE INSEMINATION
In cases of moderate sperm defects and when future mother’s age is inferior of 40 years old intrauterine insemination is used as it remains one of the simplest techniques of assisted reproduction. Patient’s natural cycle may be followed at her country of origin and intrauterine insemination is scheduled in Greece when ovulation is identified by echography or hormonal tests. Success rates vary between 12% when one follicle is present and 17% for more than 2 follicles. In order to produce
more than one follicle patients are advised to use whether a simple pill called “clomiphen citrate” or low doses of gonadotropins. During this procedure sperm is collected and processed in order to select the most “competent” spermatozoa to inseminate.  Insemination takes place right afterwards with simple painless gynecologic gestures and patient is advised to lie down for 60 minutes. Patient is allowed to continue her normal life and return home right after. Complications are extremely rare and multiple
pregnancies are the most representative with a frequency of less than 20% in our clinic.
Cost = 600
Duration of stay=2-7 days

DONOR’S  SPERM INTRAUTERINE INSEMINATION

Unfortunately all men are not able to produce sperm because of non obstructive azoospermia. History of crypsorchea, severe and not treated varricocele, genetic problems may be responsible for complete absence of spermatogenesis. This is documented by a testicular biopsy and in that case couple is counseled to use donor’s sperm. Our centre owns a private sperm bank and cooperates with other Greek and European (especially Danish) sperm banks. This vast cooperation allows us to select a donor which resembles best to recipient’s physical characteristics, blood group and serology status. Donor remains by law anonymous and prior to the insemination an informed consent is signed by the couple in order to assure baby’s future.
Cost = 900
Duration of stay =2-7 days

IN VITRO FERTILIZATION

Unfortunately our modern way of life is mostly responsible for the increase of infertility cases. Women are obliged to pursuit their career and postpone the onset of their reproductive efforts. Environment is polluted and food chain is influenced by various toxins responsible for the deterioration of sperm’s quality. Lack of exercise, smoking and alcohol are contributing factors to increasing rates of infertility among young people nowadays. In vitro fertilization techniques are used in those cases where simple
measures are likely to fail like advanced maternal age, severe sperm defects and endometriosis. Although in most European countries IVF is prohibited in ages over 43 (sometimes in patients even over 42 years old), in our centre each case is individually approached and IVF is performed beyond that limit if good outcome is expected.  During all these years of hard efforts many patients of over 43 years old (our oldest patient who became pegnant with her own eggs is 45 years old) have achieved maternity by using their own oocytes in our centre and are ready to give their
testimonies. GENESIS ATHENS CLINIC treats about 3.500 cases of IVF/year and success
rates vary between 40-55 %. There are various medical protocols which can be used for IVF purposes.
Special care is taken to select the most appropriate one for couples in respect to case’s special characteristics (age, underlying reason of infertility, time to conception). IVF procedure is divided into 2 periods. First period takes place at patient’s country of origin and consists of two phases (suppression and stimulation phase) while second-one takes place in our centre (Athens) and consists of oocyte retrieval (pick-up), fertilization and embryon transfer. In the first phase, also called “suppression phase”, patients undergo a special treatment for approximately 10 days in order to isolate their own hormonal system. Once this is achieved, we enter the “stimulation phase” during which daily injections of gonadotropins are used to stimulate the ovaries and produce as much as possible follicles. Patient’s cycle is monitored with echography and blood measurements of estradiol. This procedure usually takes place in patient’s residence and lasts 12-14 days. Follicles grow with a rate of 1-2mm/day and oocyte retrieval is performed under sedation or local anesthesia when the majority of follicles achieve the maturity status (usually when size >18mm in the average diameter). Sperm is collected right afterwards and fertilization takes place using either simple IVF (if sperm parameters are fine) or ICSI (in cases of severe oligo asthenoteratozoospermia).  Embryo transfer is performed 2 to 6 days after oocyte retrieval and patients are advised to avoid any physical activity for 3 to 5 days and resume their normal life right afterwards. Pregnancy test is performed 12 to 14 days after embryo transfer.  Complications are rare and include hyper stimulation syndrome (4%), ectopic pregnancy (5%), hemorrhage (0, 5%), pelvic infection (0.2%) and multiple pregnancies (20%).
Duration of stay: 1 week
Cost: 5000
Embryon Transfer at the stage of Blastocyst
Great experience is acquired in treating patients with unexplained failure of IVF in other centers by simply using the technique of blastocysts e.g. delaying embryon transfer until 5 th and 6 th day post OPU. This procedure allows us to select the most viable embryons to transfer, perform embryo
transfer in a uterus which does not contract and increase success rates. Our experience is published in International Congresses and is unanimously accepted as an alternative tool in cases of repeated IVF failure. In addition, this technique reduces the rate of extra uterine pregnancy and is associated with lower multiple pregnancy rate.
Duration of stay: 10 days
Cost: 5000 euros

Egg Donation program

Unfortunately, time is an unbeatable enemy of human ovaries. Fertility declines progressively by the age of 35 year old and practically expires after the age of 44 year old due to inability of the ovaries to produce eggs of good quality. In some women this phenomenon appears even earlier because of genetic or environmental factors and in that case the dream of becoming parent becomes real only by “borrowing” the oocytes of another woman (volunteers). Special care is taken to select a donor compatible with recipient’s physical characteristics and assure safety regarding sexually transmitted diseases and genetic diseases. This is performed by regular checking of STDs, caryotype examination and testing for cystic fibrosis. Donor’s cycle is easily synchronized with recipient’s cycle and embryon
transfer is performed in the conventional way. Donor’s name remains anonymous as Greek law demands.
Duration of stay: 5-7 days
Cost: 6500
PREIMPLANTATION GENETIC DIAGNOSIS (PGD)
GENESIS ATHENS CLINIC is famous for being the first worldwide to provide preimplantation genetic diagnosis of embryons at the stage of blastocyst (The first live-birth after trophectoderm biopsy and preimplantation genetic testing of human blastocysts for b-Thalassaemia Kokkali et al 2005 Hum Reprod 20:1855-1859)-a technique which is routinely applied nowadays all over the world and which allows more accurate preimplantation genetic diagnosis. PGD is offered to couples suffering from a hereditary genetic or chromosomal disease which they do not want to inherit to their off-springs,
patients with numerous failed IVF attempts or patients with recurrent miscarriages. PGD can help us to identify HLA compatible brothers or sisters and “select” the embryo who at birth will give us its valuable stem cells and save his brothers or sisters who suffer from chronic and severe diseases (e.g. thalassemia, sickle cell anemia).In our centre there are already 15 HLA compatible babies born since 2006. IVF takes place in the usual conventional way and embryons produced are biopsied on day 3.  Embryon transfer is performed on the 6 th day under usual circumstances and success rates overcome 55 %. Recently, due to our valuable collaborations with Dr Fiorentino in Rome and Prof. Handyside in
Great Britain we are able to perform the advanced technique of caryomapping and Array CGH which allow us to choose the healthiest babies to transfer.
Duration of stay: 10 days