We apply the appropriate treatment according to patient’s age, hormonal profile, the history of previous IVF attempts. It is important to know what was the ovarian response to any short of previous treatments.
This allow us to determine the right and most suitable drug treatment.
We define 2 basic treatment schemes. The long protocol which lasts about 22-24 days divided in 2 phases. The so called "down regulation" phase which starts usually on day 21 of patient’s cycle.
During this phase we expect the period to come and the ovaries to start clear from any cystic follicles.
The second phase lasts around 12-14 days and during this phase we expect the ovaries to respond by producing a sufficient amount of follicles.
This scheme is suitable for women below 40 years of age with normal hormonal profile. The short protocol lasts around 10-12 days and starts from day 2 of patient’s cycle. It is suitable for patients who are "poor responders".
We should mention, that last few years the use of another ovarian stimulation protocol the so called ‘GnRH antagonists protocol‘ which lasts around 12-14 days, like the short protocol, but behaves like a long protocol regarding the number and the quality of the eggs collected.
This is suitable for patients with a history of ovarian hyper stimulation.
This term refers to the collection of oocytes 36 hours after the injection performed for maturation of follicles, as mentioned above. The patient must not have eaten or drunk anything. Through mild anesthesia (sedation), we collect the oocytes through a sonographically guided needle, while the husband gives sperm which the biologist receives for processing. Then, after the couple being informed for the number of oocytes retrieved and the sperm quality, the woman takes medication for preparation of her endometrium, so as to accept the embryos which will occur after fertilization.
This phase takes place in the laboratory, where the oocyte fertilization is conducted. Depending on the status of the sperm, either simple fertilization (IVF) or microfertilization (ICSI) is chosen (the latter if the sperm is considered weak). The next day, the couple is informed about the number of fertilized eggs and the embryos are then cultured for 2, 3 to 6 days, depending on each case separately.
This is a very important moment (not to mention sacred), where we place without any anesthesia and under aseptic conditions the best quality embryos we have chosen using a flexible catheter within the uterus (endometrium). After lying in a supine position for approximately 1 hour, the patient can go home. For a time period of 3-4 days, the patient remains at home while avoiding moving around, lifting weight, constipation and sexual intercourse. Diet is free, as well as her basic needs.
If the day of the embryo transfer there is an excess of good quality embryos we can freeze them . From 2008 we impose a new method of freezing called ‘vitrification‘ with excellent results. We can freeze embryos either on Day 2, Day 3 or Day 5-6 (blastocyst stage). 2 weeks later the patient does a pregnancy test which is a blood test called β-HCG. If we have transferred embryos in the blastocyst stage the pregnancy test can be done few days earlier.
The pregnancy rate in our Unit is overall 42% per cycle. The pregnancy rate varies according to age group and it has reached it’s pick which is 50% at the age group 29-34.
Panagiotis Karantzis born on 11/11/1963 in Athens.
He studied medicine at the University of Athens from which he graduated in 1990.
He specialized in Obstetrics and Gynecology from 1994 to 1998 entirely in M. Britain...