IVF

IVF, known internationally as IVF from the term in vitro fertilization, is one of the most important and effective methods of assisted reproduction. For many couples facing fertility problems, it can be the most appropriate option to achieve pregnancy.

IVF can be applied to different cases of infertility, such as tubal factor, endometriosis, ovulation disorders, mild or more severe sperm problems, unexplained infertility, as well as in cases where previous simpler treatments did not have the desired effect.

During the process of IVF, the fertilization of the egg by the sperm is carried out in the laboratory and not inside the fallopian tubes of the woman, as is the case with natural conception. Depending on the history and needs of the couple, fertilization can be done either with the classic IVF method or by microinsemination, i.e. as referred to by the English term, ICSI.

The decision to have IVF is important and often accompanied by stress, questions and practical difficulties. For this reason, proper information and step-by-step guidance are essential. The goal is for the couple to know what the process includes, what are the real possibilities, what factors affect the result and what are the next steps.

What is IVF?

IVF is a process in which the eggs are collected from the ovaries and fertilized in the laboratory with the partner's sperm or, where necessary, with donor sperm.

The fertilized eggs are monitored in the embryological laboratory and develop into embryos. Then one or more embryos are transferred to the uterus, with the goal of implantation and achieving pregnancy.

The method can be adapted to the needs of each couple. In some cases, classic IVF is applied, where the eggs and sperm are placed together in plates in the laboratory, and are expected to achieve fertilization on their own. In other cases, microinsemination is applied, where a sperm is injected directly into each mature egg.

In Which cases Is IVF indicated?

IVF can be suggested when there are factors that make it difficult or make natural conception impossible, as well as when previous efforts with simpler methods have not led to pregnancy.

Indicatively, it can be applied in cases such as:

blockage or severe damage to the fallopian tubes,
endometriosis,
unexplained infertility,
ovulation disorders,
mild or more severe male factor,
low ovarian reserve,
advanced reproductive age,
previous failed intrauterine insemination attempts,
need to use an egg donation or sperm,
need for pre-implantation genetic testing,
Cases where microinsemination is required due to severe sperm problems.

IVF must be selected individually. Not all incidents are the same and not all couples need the same approach. Proper planning is based on diagnosis, history, age, test results and real chances of success.

The couple must take into account the burden of time on achieving the goal, as well as on their psychology, seeing that the goal of raising their family is not achieved. Also how negatively could the uncertainty and the failure to achieve this goal affect their own relationship, as a couple. Especially When, despite the established or late process in a natural way, it does not lead to success, without having escalated the effort with extrinsic help.

The steps of IVF

The IVF process includes specific stages, which are designed and adapted according to the needs of each woman and each couple.

1. Investigation and Diagnosis of Infertility

The first step is to properly investigate infertility. Before starting any treatment, it is necessary to evaluate both the woman and the man, as infertility concerns the couple as a whole.

Investigation may include gynecological testing, hormonal examinations, ultrasound evaluation, uterine and fallopian tube control, sperm count and, where necessary, more specialized tests.

The goal is to identify, where possible, the cause of infertility and to design the most appropriate therapeutic strategy.

2. Preliminary Exams

Before the start of IVF, the necessary preliminary examinations are carried out. These help to safely prepare the woman and the couple for treatment.

Tests may include hormonal control, ovarian reserve control, ultrasound, blood and microbiological tests, as well as sperm evaluation.

In some cases, hysteroscopy, salpingography, genetic testing or other special tests may be needed, depending on the history and findings.

Proper preparation is decisive as it allows the doctor to choose the appropriate treatment protocol and reduce potential risks or unnecessary delays.

3. Preparation and stimulation of the ovaries

In classic IVF, the woman receives medication with the aim of stimulating the ovaries and developing more follicles.

The treatment is designed individually, depending on the age, ovarian reserve, history of previous efforts and the body's response.

During arousal, the woman is closely monitored by ultrasounds and, where necessary, by hormonal tests. In this way, the growth of the follicles is controlled and the treatment is adjusted to achieve the best possible result safely.

When the follicles reach the appropriate stage of maturation, the final maturation injection is programmed and then the ovulation.

4. Ovulation

the ovulation It is the process of collecting eggs from the ovaries. It is performed under ultrasound guidance and usually under slight anesthesia or intoxication, so that the woman does not feel pain.

The procedure is short and takes place in an organized medical environment. The collected eggs are delivered directly to the embryological laboratory, where they are evaluated for their maturity and quality.

After ovulation, the woman remains for a short follow-up and usually returns home the same day, receiving detailed instructions.

5. Sperm taking

On the day of the ovulation, a sperm sample is usually taken from the partner. The sample is processed in the laboratory to select the most suitable spermatozoa for fertilization.

In cases of severe male agent or azoospermia, sperm may have been surgically recovered from the epididymis or testicle. Depending on the case, frozen sperm or donor sperm may also be used.

Sperm quality plays an important role in choosing the fertilization method, i.e. whether classic IVF or microinsemination will be applied.

6. Fertilization and Embryo Cultivation

After collecting the eggs and processing the sperm, fertilization follows in the laboratory.

In classic IVF, the eggs are placed together with the spermatozoa in a special cultivation environment, so that the fertilization can be done in the laboratory in a way that simulates the natural process.

In cases where there is an indication, microinsemination is applied, i.e. ICSI. In this method, a selected sperm is injected directly into each mature egg.

The fertilized eggs are monitored in the following days in the embryological laboratory. Their development is continuously evaluated to select the most suitable embryos for embryo transfer or freezing.

The culture of the embryos can last until the 3rd day or until the stage of the blastocyst, i.e. on the 5th or 6th day, depending on the quality and development of the embryos.

7. Embryo Transfer

the embryo transfer It is the process in which the fetus or embryos are transferred to the woman's womb.

This is a short and usually painless procedure, which does not require anesthesia. It is performed with the help of a thin catheter, through the cervix.

The number of embryos to be transferred is decided individually, based on the age of the woman, the quality of the embryos, the history of previous efforts and the applicable medical and legal instructions.

In several cases, the transfer of a single fetus is preferred, in order to reduce the risk of multiple pregnancy, which is associated with an increased chance of complications.

8. Pregnancy Control

After the embryo transfer follows the waiting period until the pregnancy test. The test is done by a blood test to measure the β-chorionic gonadotropin, at the time the doctor will indicate.

If the result is positive, a recheck follows and then an ultrasound is planned to confirm the pregnancy and evaluate its progression.

If the result is not positive, the doctor discusses with the couple the findings of the cycle, evaluates what can be modified and plans the next steps calmly and realistically.

IVF or ICSI: Which method is appropriate?

The fertilization of the eggs can be done either by classic IVF or by microinsemination.

Classic IVF may be suitable when the sperm has satisfactory characteristics and there is no serious male factor.

ICSI is mainly chosen when there are problems with the number, motility or morphology of spermatozoa, when there has been a failure of fertilization or when the sperm is surgically taken.

The choice of the method is made after evaluation of the sperm, the eggs, the history of the couple and the previous attempts.

How long is an IVF cycle?

The duration of an IVF cycle depends on the protocol chosen. Usually, from the onset of drug stimulation to ovulation there is about 10 to 12 days.

Then follows fertilization, the cultivation of the embryos for a few days and the embryo transfer or the freezing of the embryos.

Overall, the process may take a few weeks, while in some cases a different timing or fetal transfer to a subsequent cycle may be required.

Realistic expectations in IVF

IVF offers significant potential, but is not a guarantee of success. The results depend on many factors, such as the age of the woman, the quality of the eggs, the quality of the sperm, the quality of the fetuses, the condition of the endometrium and the overall medical history of the couple.

The responsible approach requires honest information. The couple needs to know what are the odds, what are the limitations, what alternatives exist and what steps can follow if a cycle does not lead to pregnancy.

The goal is not to cultivate unrealistic expectations, but to properly guide with scientific precision, human care and respect for the path of each couple.

Specialized care by Ioannis Sklavounos

IVF is a process that requires experience, precision and personalized design. Each stage, from investigation to embryo transfer, is important and must be organized with care.

The Obstetrician-Gynecologist Ioannis Sklavounou It has 10 years of structured education in England and specialization in reproductive medicine, infertility and fetal uterine medicine, and another 20 years of experience and handling of extremely difficult cases in Greece, handling cases with multiple failures from Greece and abroad. His training in demanding medical environments abroad has provided him with substantial experience in the management of complex and difficult infertility incidents.

In each couple, the doctor personally deals with the investigation, evaluation and planning of the treatment. It devotes time and attention to each stage, without discounting the quality of care and without standardized solutions.

His experience in dealing with demanding incidents, his personal occupation and high success rates are important characteristics of his medical course. At the same time, his philosophy is based on honesty and realism: each couple is responsibly informed of their real chances, without cultivating false expectations.

The goal is for the woman and the couple to feel safe, guided and trusted at every step of the process. From the first visit to the result, the approach remains personal, humane and scientifically documented.

If you are considering IVF or want to be informed about the most appropriate method of assisted reproduction for your case, you can contact the doctor's office and schedule your appointment.

Ioannis A. Sklavounos MD MSC DFFP
Obstetrician Surgeon Gynecologist
Specialists & Retrained in Great Britain
T.Senior Clinical Fellow – Liverpool Woman’s Hospital UK

IVF

Fertility & IVF Center in Maroussi

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Bibliography

European Society of Human Reproduction and Embryology — Eshre. Guideline on Ovarian Stimulation for IVF/ICSI, 2019.
European Society of Human Reproduction and Embryology — Eshre. Good Practice Recommendations for IVF Laboratories, 2015.
National Institute for Health and Care Excellence — Nice. Fertility Problems: Assessment and Treatment, Clinical Guideline CG156.
American Society for Reproductive Medicine — ASRM. Optimizing Natural Fertility: A Committee Opinion, Practice Committee.
American Society for Reproductive Medicine — ASRM. Guidance on the Limits to the Number of Embryos to Transfer, Practice Committee.
Practice Committee of the American Society for Reproductive Medicine. Evidence-based treatments for couples with unexplained infertility: a guideline.
Alpha Scientists in Reproductive Medicine and Eshre Special Interest Group of Embryology. The Istanbul Consensus Workshop on Embryo Assessment.

IVF