We are trying to have a child but the child doesn’t arrive; when should we seek medical help?

As conception chances do not exceed a 20% per month of efforts for a couple without infertility problems, the World Health Organization characterize a couple as ‘subfertile’ after one year of fruitless efforts; then a specialized search for infertility factors must be performed and a treatment must be scheduled. It is understood that if the couple’s medical history or routine medical follow up give rise to suspicions that a specific infertility factor is present, this should be searched for before the lapse of the one-year period of efforts in order to avoid waste of time.

If we visit an IVF Centre will we end up undergoing IVF in any case?

This is not true. In vitro fertilization is only one of the options available for assisted reproduction. All couples do not necessarily need IVF; there are also simpler ‘in vivo’ fertilization-based techniques which have their own indications. So according to your case you may only need some kind of hormonal regulation, ovulation induction, sexual intercourse programming, or intrauterine insemination. Only in the case that all the above fail you will be suggested to undergo in vitro fertilization.

What are the success rates of IVF today?

This is probably the most frequent question posed by couples in need of assisted reproduction. The answer given by various IVF Centers is often overdone or deceptive about success rates. Chances of success reaching up to 50% per IVF effort certainly exist, however those concern some specific categories of couples i.e. with moderate sperm disorders and young age of the woman. If we want to give an objective answer which is supported by data from the international medical literature, we should give an average rate of success at 35% per IVF effort which is of course modified according to each couple’s individual conditions. Another useful indicator is the cumulative success rate after a certain number of failed IVF efforts: it is estimated that a 70-75% of couples will achieve pregnancy after 3 or 4 efforts. As for the simpler assisted reproduction techniques, the success rate of intrauterine insemination does not exceed 18% per effort, while it seems to be useless for a couple to undergo more than 3 or 4 intrauterine inseminations with no positive results as the chances of success become even smaller.

For how many days during an IVF cycle am I going to have injections?

The number of days during which you should receive injections depends on the type of stimulation protocol applied: in long protocols you will need to perform injections for 20-22 days, while in short protocols you are going to perform injections for 12-14 days.

Which is the proper time to have my injections done during an IVF cycle?

The time of performing injections is not that important; the important thing is to perform them the same time every day (with a 1-hour deviation allowed). You should also be accurate with the time of the last injection prescribed by your physician for the final follicle maturation before egg collection.

Do I have to come for egg collection without having eaten?

Yes. You will be administered a mild sedation so you should not eat or drink anything for the last 8 hours before the scheduled time of egg collection.

Is my husband allowed to bring semen sample from home?

It is advisable that your husband gives his semen sample in the IVF Center to allow immediate elaboration of the sperm. If however the opposite is decided, the sample must arrive at the laboratory in no later than a half hour after ejaculation and must be kept warm until then.

Do I have to come for embryo transfer without having eaten?

No. Embryo transfer is performed without anesthesia as it is painless like a Pap smear test. You should note that at the day of embryo transfer you must have taken all morning doses of drugs prescribed by your physician (even the vaginal gels or tablets).

When will we be informed on the attempt’s success?

This most wanted answer that the attempt was successful and that you are now pregnant is given 14 days after the embryo transfer when you will be asked to have a blood test for the measurement of b-chorionic gonadotropin levels. You should definitely do this blood test, even in the case that you have a strong belief that you are not pregnant (because you have seen some vaginal bleeding for example) and not interrupt your drug support treatment before getting the test results. Moreover, you should not be based on urine pregnancy tests but always have the blood test done.

How long can my embryos remain frozen?

You should not be concerned about this. Experience so far has demonstrated that long-term freezing does not spoil the embryos; pregnancies have been achieved from embryos that remained frozen for up to 7-8 years. 

What is the coverage given by social security funds to IVF costs?

During the last years the Greek authorities have shown social sensibility to the problems encountered by thousands of infertile couples. Thus the majority of social security funds offer a satisfactory coverage of drug costs but for a restricted number of treatment cycles (3 to 4). Drug coverage reaches 75-100% that varies by type of fund or of drug administered. A block grant is also given for the costs of the effort. It is useful for you to get information from your fund on cost coverage before commencing an IVF effort.

Are there any short-term side effects of IVF drugs?

Concerning clomiphene citrate, this may in rare cases cause mild side effects such as headache, nausea, hot flashes, or vision disturbances which are fully reversible after interruption of administration.
As for gonadotropins, they do not cause primary side effects but only secondary ones due to the ovarian hyperstimulation. So, the stronger the ovarian response to gonadotropins is, the more frequent and expected the side effects are (such as bloating in the abdomen, abdominal pain, or breast pain). Certainly, the most serious side effect is the one known as ovarian hyperstimulation syndrome which cannot always be predicted and avoided as its occurrence is much contributed by the woman’s own characteristics. According to its severity, this syndrome is characterized by ovarian distention, fluid collection into the woman’s abdomen (or even into the thorax), abdominal distention, nausea, vomiting, breathing difficulty, tendency to thrombosis, kidney function disorders. Fortunately the ovarian hyperstimulation syndrome occurs in a small number of cases, the treatment of which must be meticulous.

Are there any long-term side effects of IVF drugs?

This question is almost always posed by couples that will join an IVF program, and becomes more anxious if the woman has to undergo many IVF efforts. The main concern is about the association of fertility drugs with the risk of developing various forms of gynecological cancer. So the answer to this question must be careful and scientifically grounded.

The relation between fertility drugs and breast cancer has been investigated in 12 large, reliable studies. In nine out of those studies there has been no proof of any statistically significant association between fertility drug intake and risk of breast cancer; in one of them an increase of risk was observed in the generally subfertile population regardless the intake of drugs; in one of them there was only a temporary increase in cancer occurrence (for the first year of drug intake) which was attributed to the development of pre-existing tumors; in only one of those studies (which was of a relatively low statistical validity) an increase in cancer occurrence was observed, and that was only in women using drugs for more than six ovarian stimulation cycles. It should be noted that the abovementioned conclusions regard ‘fresh’ ovarian stimulation cycles and not cryopreserved embryo-thawing transfer cycles. Subsequently, the results drawn until now are rather reassuring about the safety against future cancer development in women having undergone IVF efforts.

The relation between fertility drugs and endometrial cancer has been investigated in six large studies; none of these studies have revealed any significant correlation between administration of gonadotropin injections and increased risk of developing this type of cancer. Finally, the results drawn from a great number of reliable studies on the investigation of correlation between fertility drugs and risk of ovarian cancer appear to be equally reassuring.