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 may be used in many different situations, including tubal-factor infertility, endometriosis, ovulation disorders, mild or severe sperm abnormalities, unexplained infertility, and when previous, less complex treatments have not produced the desired result.

During IVF, the egg is fertilised by sperm in the laboratory rather than in the woman’s fallopian tubes, as occurs in natural conception. Depending on the couple’s medical history and needs, fertilisation may be achieved either through conventional IVF or through intracytoplasmic sperm injection (ICSI).

Deciding to undergo IVF is an important step and is often accompanied by anxiety, questions and practical challenges. Clear information and step-by-step guidance are therefore essential. Couples should understand what the process involves, the realistic chances of success, the factors that can affect the outcome and what the next steps may be.

What is In Vitro Fertilisation?

In vitro fertilisation is a process in which eggs are collected from the ovaries and fertilised in the laboratory using the partner’s sperm or, where necessary, donor sperm.

The fertilised eggs are monitored in the embryology laboratory as they develop into embryos. One or more embryos are then transferred to the uterus with the aim of implantation and pregnancy.

Treatment can be tailored to each couple’s needs. In conventional IVF, eggs and sperm are placed together in a laboratory culture dish and fertilisation is allowed to occur. In other cases, ICSI is used, in which a single sperm cell is injected directly into each mature egg.

When Is ICSI Recommended?

IVF may be recommended when one or more factors make natural conception difficult or impossible, or when previous treatment with less complex methods has not resulted in pregnancy.

IVF may be considered in situations including:

blocked or severely damaged fallopian tubes;
endometriosis;
unexplained infertility,
ovulation disorders,
mild or severe male-factor infertility;
diminished ovarian reserve;
advanced reproductive age;
previous unsuccessful intrauterine insemination attempts;
the need for donor eggs or donor sperm;
the need for preimplantation genetic testing;
cases requiring ICSI because of severe sperm abnormalities.

The decision to proceed with IVF must be individualised. No two cases are the same, and not every couple needs the same approach. Appropriate planning is based on the diagnosis, medical history, age, test results and realistic chances of success.

Couples should also consider how time may affect their chances of achieving their goal and the emotional impact of repeated disappointment. Prolonged uncertainty and difficulty in building a family can also place strain on the couple’s relationship. This is particularly important when natural conception has not occurred despite a known delay or an extended period of trying, and treatment has not yet been escalated with medical assistance.

The Stages of IVF Treatment

IVF treatment involves a series of clearly defined stages, each planned and adapted to the needs of the individual woman and couple.

1. Fertility Assessment and Diagnosis

The first step is a thorough fertility assessment. Before any treatment begins, both partners should be evaluated, because infertility concerns the couple as a whole.

Assessment may include a gynaecological examination, hormone tests, ultrasound, evaluation of the uterus and fallopian tubes, semen analysis and, where appropriate, more specialised investigations.

The aim is to identify the cause of infertility wherever possible and to design the most appropriate treatment strategy.

2. Preliminary Investigations

Before IVF begins, the necessary preliminary investigations are performed to prepare the woman and the couple safely for treatment.

These may include hormone tests, assessment of ovarian reserve, ultrasound, blood and microbiological tests, and semen analysis.

Depending on the medical history and findings, hysteroscopy, hysterosalpingography, genetic testing or other specialised investigations may also be required.

Careful preparation is essential because it allows the doctor to choose the most appropriate treatment protocol and reduce potential risks or unnecessary delays.

3. Ovarian Stimulation

In a conventional IVF cycle, medication is used to stimulate the ovaries so that several follicles develop.

The treatment protocol is individualised according to age, ovarian reserve, previous treatment history and the woman’s response to medication.

During stimulation, follicular development is monitored closely with ultrasound and, where necessary, hormone tests. This allows treatment to be adjusted safely to achieve the best possible response.

When the follicles have reached the appropriate stage of maturity, the final maturation injection is scheduled, followed by egg retrieval.

4. Egg Retrieval

Intrauterine egg retrieval is the procedure used to collect eggs from the ovaries. It is performed under ultrasound guidance, usually with light anaesthesia or sedation so that the woman remains comfortable.

The procedure is brief and takes place in a fully equipped clinical setting. The collected eggs are transferred immediately to the embryology laboratory, where their maturity and quality are assessed.

After egg retrieval, the woman is monitored for a short period and can usually return home the same day with detailed aftercare instructions.

5. Semen Collection

A semen sample is usually provided by the partner on the day of egg retrieval. The sample is prepared in the laboratory so that the sperm cells most suitable for fertilisation can be selected.

In cases of severe male-factor infertility or azoospermia, sperm may be retrieved surgically from the epididymis or testis. Depending on the circumstances, frozen sperm or donor sperm may also be used.

Sperm quality is an important factor in deciding whether to use conventional IVF or ICSI.

6. Fertilisation and Embryo Culture

Once the eggs have been collected and the semen sample prepared, fertilisation takes place in the laboratory.

In conventional IVF, the eggs and sperm are placed together in a special culture medium, allowing fertilisation to occur in a way that resembles the natural process.

When clinically indicated, ICSI is used. In this technique, a single selected sperm cell is injected directly into each mature egg.

The fertilised eggs are monitored over the following days in the embryology laboratory. Their development is assessed continuously so that the most suitable embryos can be selected for transfer or cryopreservation.

Embryos may be cultured until day 3 or to the blastocyst stage on day 5 or 6, depending on their quality and development.

7. Embryo Transfer

Intrauterine embryo transfer is the procedure in which one or more embryos are placed in the woman’s uterus.

It is a brief and usually painless procedure that does not require anaesthesia. A thin catheter is passed through the cervix to place the embryo in the uterus.

The number of embryos transferred is decided individually, taking into account the woman’s age, embryo quality, previous treatment history and current medical and legal guidance.

Single-embryo transfer is often preferred in order to reduce the risk of a multiple pregnancy, which carries a higher risk of complications.

8. Pregnancy Test

After embryo transfer, there is a waiting period before the pregnancy test. A blood test is performed at the time advised by the doctor to measure beta-human chorionic gonadotrophin (β-hCG).

If the result is positive, the test is repeated and an ultrasound scan is then scheduled to confirm the pregnancy and assess its progress.

If the test is negative, the doctor reviews the findings from the cycle with the couple, considers what might be adjusted and discusses the next steps calmly and realistically.

IVF or ICSI: Which Method Is Right for You?

Eggs can be fertilised either through conventional IVF or through ICSI.

Conventional IVF may be appropriate when the semen parameters are satisfactory and there is no severe male-factor infertility.

ICSI is generally selected when there are problems with sperm count, motility or morphology, following previous fertilisation failure, or when sperm has been retrieved surgically.

The choice of method is made after evaluating the semen sample, the eggs, the couple’s medical history and any previous treatment attempts.

How Long Does an IVF Cycle Take?

The duration of an IVF cycle depends on the treatment protocol. From the start of ovarian stimulation to egg retrieval, treatment usually takes approximately 10 to 12 days.

Fertilisation is followed by embryo culture for several days and then either embryo transfer or embryo cryopreservation.

Overall, the process may take several weeks. In some cases, a different schedule or a frozen embryo transfer in a later cycle may be recommended.

Realistic Expectations of IVF

IVF offers significant possibilities, but it cannot guarantee success. Outcomes depend on many factors, including the woman’s age, egg quality, sperm quality, embryo quality, the condition of the endometrium and the couple’s overall medical history.

A responsible approach requires clear and honest information. Couples should understand their chances of success, the limitations of treatment, the available alternatives and the options that can be considered if a cycle does not result in pregnancy.

The aim is not to create unrealistic expectations, but to provide sound guidance with scientific rigour, compassionate care and respect for each couple’s journey.

Specialist Care from Ioannis Sklavounos

IVF requires experience, precision and individualised planning. Every stage—from assessment through to embryo transfer—matters and must be organised with care.

Preimplantation Obstetrician and Gynaecologist Ioannis Sklavounos has ten years of structured specialist training in the United Kingdom and expertise in Reproductive Medicine, Infertility, and Maternal–Fetal Medicine, followed by a further 20 years of experience managing highly complex cases in Greece, including patients from Greece and abroad with multiple previous treatment failures. His training in demanding clinical environments abroad has given him substantial experience in managing complex and challenging infertility cases.

Dr Sklavounos is personally involved in each couple’s assessment, evaluation and treatment planning. He devotes time and attention to every stage, without compromising the quality of care or relying on standardised solutions.

His experience in managing challenging cases, his personal involvement and his high success rates are important features of his clinical career. His philosophy is also grounded in honesty and realism: every couple receives responsible information about their genuine chances of success, without false expectations.

The aim is for each woman and couple to feel safe, supported and confident at every stage. From the first consultation through to the outcome, the approach remains personal, compassionate and evidence-based.

If you are considering IVF or would like advice on the most appropriate assisted-reproduction treatment for your circumstances, contact the clinic to arrange an appointment.

Ioannis A. Sklavounos MD MSc DFFP
Consultant Obstetrician and Gynaecologist
Specialist Training and Fellowship in the United Kingdom
T.Senior Clinical Fellow – Liverpool Woman’s Hospital UK

IVF

Fertility & IVF Centre in Marousi

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References

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