Of course you can, we stress out to all women who are about to commence with the programme that they are not incapacitated and they do not have to discontinue their everyday activities and habits.

Oocyte retrieval is conducted transvaginally under ultrasound guidance and with mild anesthesia (sedation). Therefore, the patient awakens rapidly and may go home with the appropriate instructions.

As already mentioned, during ovarian stimulation monitoring nothing changes significantly in the woman’s everyday activities. Moreover, the woman can return to work the very next day following oocyte retrieval. However, after embryo transfer and for at least 3-4 days, she must remain at home. The patient must avoid lifting weight, sexual intercourse, exercise, using stairs and must be careful with constipation.

The woman who underwent embryo transfer is not ill. She can use the toilet, take her bath and eat with her spouse.

You do not discontinue the medication you are taking and you have to check serum estradiol levels and progesterone the next day. From there on, according to test results, the dosage of drugs is increased or decreased so as to maintain them within therapeutic levels.

When the serum levels of b-HCG exceed 1200 IU/l, which occurs 2-2 1/2 weeks later.

Levels of b-HCG should be overdoubled every 2 to 3 days.

Injections are now administered subcutaneously. In other words, we use a small-gauge needle used for diabetic patients and after a demonstration and training by the IVF Unit’s personnel, women can self-inject, without the need for a third person with experience in intramuscular injections.

Till the age of 39, we can transfer up to 3 embryos. After this age limit, we can transfer up to 4 embryos. This is what greek legislation imposes concerning in vitro fertilization.

Legalisation in our country is considered to be one of the most liberal. It allows the use of gametes (eggs-sperm) from an anonymous donor, after both parties fill in respective consent forms. These oocytes may come from women who are already participating in an IVF programme and have an excess of oocytes and declare in written that they wish to donate a small number of these (sharing). Donated oocytes may also come from women who wish to enroll to an IVF programme (volunteers) and donate their oocytes to other women.

The Unit’s laboratory has to inform the couple on the day of embryo transfer about the quality of embryos. Embryo quality is graded from GRADE I (excellent quality) to GRADE IV (poor quality).

The woman discontinues medication and awaits for her menstruation. It is wise to schedule an appointment immediately afterwards and discuss, in an overall perspective, the entire attempt performed (what did not go well so as to change the next time, medication, ovarian stimulation protocols, drug dosage). Through an IVF attempt, we all become wiser.

Usually two things should be done:

a) Diagnostic hysteroscopy in order to check the endometrial cavity and exclude the presence of polyps, inflammation, septum and adhesions.

b) Thrombophilia testing. This test concerns a series of blood tests that help us improve medication treatment usually with additional anticoagulant treatment, thus improving the conditions of implantation and therefore the receptivity of endometrium.

There was an initial enthusiasm in the decade of 1990. It is now well established and it has been proven in several studies that anti-paternal antibodies do not help as much as initially believed.

We know that it is a difficult decision but the best solution is to use donated oocytes. By using different genetic material, the success rates change significantly and may even reach 50%.

Your husband’s sperm may in one occasion be reduced in number and motility, but may be more than sufficient for a cycle of assisted reproduction. Things become difficult if the sperm is at the limits of azoospermia (absence of sperm). Then, the only choice is the performance of a testis biopsy and a spermatozoons search. If no spermatozoons are recovered, the only choice is to use donor sperm.

If varicocele is of great extent and severity, then restoration and treatment by an Urologist may help improve the sperm. In case of small or moderate varicocele in combination with a moderate quality sperm, the best choice would be in vitro fertilization, as the results of such an operation are modest and valuable time is lost.

The answer is not that simple. It all depends on the size of the cyst. Usually, small sized cysts less than 4cm are not immediately surgically operated upon. It is better to choose ovarian stimulation or IVF. The question is what happens if the cyst is greater than 5cm, in which case the cyst occupies vital space within the ovary and therefore makes the production of a satisfactory number of follicles difficult. My personal opinion is that in this case, if the woman has not undergone any other IVF attempt or has not been operated before in the past, is entitled to at least one IVF attempt since she has at least a 30-40% success rate. If she fails, she must undergo surgery before trying again for IVF.

The answer is once again not that simple. It depends on the location of the myoma and whether it affects the endometrial cavity. We should also take into account the number of myomas, the patient’s age and if she has been operated before in the past for the same reason. Therefore, the answer for this question is not simple and usually is individualized for each patient.

There is no limit, but the answer to that question could not be just a simple figure. It depends on the woman’s age, the quality and the number of oocytes and therefore the number of embryos after an IVF cycle. If this number is extremely poor, it is best not to submit the woman to injectable medication with high doses of drugs. It is wiser to continue with natural cycles or donated eggs. If all this is considered too much for the couple or beyond their psychological endurance, it would be best for the couple to discontinue. Above all is the psychological and physical health of the woman and the couple.

It is considered as an alternative option for women alleged as poor responders, in other words , women that produce small amount of eggs despite taking high doses of medications in order to stimulate the ovaries. It can be offered to women with medical history of cancer, not allowed to take ART medications. Women should be aware that using natural cycle in ART has a 35% drop out due to premature ovulation. Having said that the success rate drops significantly especially in women over 40. This occurs due to the low implantation rates for women of this particular age group. Another factor which affects in an negative way the outcome of natural cycle when applied in IVF is the ‘behavior’ of the dominant follicle especially in women well over 40 which can practically disappoint both patient and doctor. Close observation of hormone levels implicated in the ovulation process can predict with significant accuracy the ovulation ‘window’. An alternative to the ‘pure’ natural cycle is the use of modified natural cycle, where with the use of very small dosage of gonadotropins 50-75 IU and with the concurrent use of GnRH antagonist the retrieval of the ‘precious’ egg can be achieved easier.

This particular age group should divided in 2 subgroups. In the first group concerning women between age 40-44 the pregnancy rate it’s not higher than 20% dropping to the level of 10% at the age of 44 . In the second group concerning women well over 45 the pregnancy rate is even lower to rather disappointing levels. In this subgroup the option of using donor eggs is strongly recommended.

The answer is simple. The eggs retrieved from women of that age are mostly chromosomally abnormal and this effects the quality of the produced embryos which as you may assume is rather poor. This leads to an increased number of IVF failures or miscarriages.

In my professional opinion after so many failures and in view of the advanced age I would strongly recommend the use of donor eggs. The pregnancy rate is in this case hovers over 50-60% as the use of eggs of a women younger than 35 reduces the chances of developing chromosomal abnormal embryos. The other option is so much stressful and with so unsatisfactory results.

When the HCG levels never exceed 1000-1200 IU in order to see a intrauterine gestational sac implanted.

The stage of pregnancy when a single or multiple gestational sacs are identified in the endometrial cavity by ultrasound.

The stage of pregnancy when inside the gestational sac a embryo with fetal heart beating is detected.