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Infertility Treatments

N/C (Natural Cycle) is a treatment option for women who are unable or do not want to take fertility drugs. Women may not wish to go through a new stimulation cycle, after a failed treatment and choose a simpler and less demanding option, such as the Natural Cycle.

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Intrauterine Insemination (IUI) is a fertility treatment that involves placing processed sperm, with optimized concentration and motility, directly into the uterus.

IUI can be performed with or without administrating fertility medications. Compared to timed sexual intercourse, IUI has 2 times higher pregnancy rate.

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The term IVF covers a wide range of assisted conception techniques used to treat infertile couples. Since the announcement of the birth of Louise Brown in 1978 – the first IVF baby born at Bourn Hall Clinic, England – until nowadays, thousand of couples have achieved pregnancy.

IVF is suitable for treating female factor infertility (e.g. blocked fallopian tubes) as well as male factor infertility (e.g. low sperm concentration). Success rates per treatment cycle depend on various factors such as female age and infertility factor. At present, the overall success rate may reach 60-65%, after completing 3-4 treatment cycles.

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Spermatozoa sometimes fail to fertilize even when they are artificially placed in close proximity of eggs during conventional IVF. In most cases gamete micromanipulation (ICSI, intra-cytoplasmic sperm injection) is the only way to overcome this problem.

The embryologist using micromanipulation techniques and microscopic laboratory facilities, deposits a single spermatozoon directly into the cytoplasm of the oocyte.

 

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Blastocyst is the embryonic development stage 5-6 days after fertilization and it is a sign of normal development and high degree potency. Only a few and not all embryos are capable of reaching the blastocyst stage under in vitro culture. Blastocyst culture requires the use of specialized culture media and a state-of-the-art laboratory with experienced embryologists and optimum culture conditions.

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During an IVF cycle, the woman takes hormones that induce controlled ovarian stimulation in order to collect more than one oocytes.

The more oocytes are produced in the ovaries and collected by the IVF doctor, the more will be suitable to be fertilized with husband’s sperm. Consequently, the more fertilized oocytes available, the higher the chances of having very good quality embryos to be transferred back to the uterus, achieving high implantation and pregnancy rates.

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The aim of ovarian stimulation in IVF is to produce many oocytes and therefore embryos, so as to have top quality embryos available for embryo transfer. Good quality embryos that will not be transferred to the uterus, may be frozen under controlled conditions and stored under liquid nitrogen at -196oC, a temperature at which all chemical reactions within cells should be suspended. The choice to cryopreserve embryos or not, belongs to the couple since there are ethical, religious and philosophical issues that should be considered.

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Testicular sperm extraction (T.E.S.E) is a technique that can be used to obtain a small amount of testicular tissue and is actually a surgical biopsy of the testis under local anesthesia. It is a revolutionary procedure, given that sperm doesn’t have to mature and travel through the epididymis in order to fertilize an oocyte. However, due to sperm immaturity, testicular sperm is used with ICSI.

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Τhe last few years,  assisted reproductive technology, molecular biology and cytogenetics have progressed considerably, opening up new options in the diagnosis of hereditary and genetic disorders.

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Assisted hatching is a technique where a gap is made in the zona, surrounding the embryo. Early stage embryos are surrounded by an outer shell, zona pellucida, which protects embryonic cells. When the developing embryo reaches the uterus, it has to break out or “hatch” out of its zona pellucida in order to successfully implant and continue its development. In some IVF cases it is necessary to improve the ability of the embryo to hatch out of its shell by reducing the thickness of the zona pellucida (assisted hatching).

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Every woman is born with a finite number of oocytes, which is more than 2 million. Oocytes remain quiescent at this immature stage for many years. At puberty, when commencing with the first menstruation, a clutch of oocytes begins a maturation pattern every month which finally leads to ovulation.

 

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Egg freezing is a fast developing process in which oocytes are collected, frozen and stored. Later, when the woman wants to get pregnant, oocytes can be thawed, fertilized and finally transferred back into the uterus as embryos.

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Choosing the best embryo for transfer has always been a matter of controversy. Among embryos that look similar, there are only a few offering a high chance of achieving a pregnancy. However, the difficulty in selecting the best embryos together with the couples’ (and doctors’) anxiety to achieve their goal would result in transferring more than one embryo back into the uterus. If a pregnancy was established, it was usually a multiple pregnancy that carries great risks for the mother and the babies.

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IMSI is a method of selecting spermatozoa according to their morphology, using high resolution microscopy (allows enlargement almost x 6000 times), compared to microscopy currently used.

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It is possible to transfer in the oocyte, apart from a nucleus, other organelles of a donor cell, such as mitochondria. This technique is known as cytoplasmic transfer – the cytoplasm is a gell-like substance that contains the nucleus and cellular organelles.

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There are several cases of women which can’t produce their own oocytes. Some women have lost their ovaries after radiotherapy or chemotherapy, young women with premature ovarian failure or women whose ovaries do not respond not even to the highest doses of IVF hormones. These women must resort to egg donation for a successful pregnancy. This means that they should undergo IVF treatment, where the sperm of their husband or donor sperm may be used with the oocytes of another woman (donor eggs).

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Sperm donors are usually university or college students or they work in the public or private sector or they may run their own business. Sperm donors are characterized by social awareness and social contribution. Sperm donors are usually young-adults, between 19 to 35, with full legal capacity. They are healthy men, whose personal and family records are free of infectious, genetic or hereditary diseases.

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Surrogate mother is the woman that carries and gives birth to a baby for the couple who want to have a child but it is impossible or dangerous for the woman to get pregnant.  Surrogate mother transfers the rights and obligations of parentage to the intended parents after giving birth to the child. The word surrogate, derives from the subrŏgare (to substitute), meaning appointed to act in the place of. Prospective parent is the individual or couple who are willing to raise the child after his/her birth.

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