IVF Myths & Facts

Myths & Facts

  1. All assisted reproduction units are the same

    Not all doctors, embryologist and nurses that work for an assisted conception unit are the same. There are differences. The knowledge and experience cannot be taken for granted and they can only be gained with continuous professional development and of course they reflect the pregnancy rates of each Unit. At Eugonia, we are proud of our international recognition as a result of our pregnancy rates which compete with the best pregnancy rates internationally and of our continuous presence in the scientific advances internationally with our pioneer research work.

  2. The application of the most recent developments in assisted reproduction is certain

    The in depth knowledge and application of the most recent developments play a major role in the success of a treatment cycle. Not all doctors, embryologists and nurses are the same, as knowledge and experience cannot be taken for granted. This cannot always result in a miracle, but it can maximize the pregnancy rates.

  3. Assisted reproduction treatment is the same for all women

    Every woman that undergoes assisted reproduction treatment is physically unit, with a specific medical history and cause for infertility. This is why personalized treatment is not just feasible, but also necessary to increase pregnancy rates. During the last few years, there has been great progress in the development and improvement of ovarian stimulation protocols that are effective, but at the same time patient-friendly with minimal side-effects. This is also what can be achieved with the use of the new , mild stimulation protocols, and the one injection protocols, for which Eugonia is a pioneer.

  4. An assisted reproduction unit with published research work has higher pregnancy rates

    The undertaking and publication of a scientific study needs an original idea, in-depth knowledge of the scientific literature and keeping up to date with the current developments, the maintenance of a detailed clinical database and the application of evidence-based medicine.

    The publication in esteemed scientific journals means that the study and its scientific verification have successfully been put through in depth examination and have been accepted by internationally renowned scientists with great specialization in the subject in question.

    The scientific team of Eugonia, coordinated by Dr T Lainas, already numbers a long series of scientific articles in esteemed scientific journals specialised in Human Reproduction and In Vitro Fertilisation. Apart from the international recognition of our Unit, this translates into an increase in pregnancy rates, a reduction in complications and thus an increased benefit for the couples that honour us with their trust.

  5. Assisted reproduction offers the chance of having a child to women of all ages

    Assisted Reproduction may significantly increase the chances of achieving a pregnancy in older women. At Eugonia, the pregnancy rates for women over 40 years of age is 28%, which is still lower in comparison to that of the group of younger women undergoing fertility treatments. However, the truth is that these women do not have the luxury of waiting or a time-schedule and should undergo assisted reproduction treatment as soon as possible.

    It is well know, that the maximum fertility for a woman is established at the age of 24 (86% fertility), while for the group of women of age 25-30 this is about 78%. In the 30-34 age group the fertility starts to diminish (63%) and after the 35th year of age this reduction is substantial (52%). Natural conception is quite rare after the age of 45 years (less than 0.1%) mainly due to the increase of chromosomal abnormalities in the oocytes.

  6. Women are the ones mainly responsible for infertility issues

    This is not true in absolutely any case. It is estimated that in around half of the infertile couples, the cause of infertility is the male factor (either by itself or in combination with the female factor).

  7. Children born through assisted reproduction treatments are equally normal to the ones born through natural conception

    Children born through assisted reproduction treatment (ART) are as healthy and normal as children conceived naturally. As large epidemiological studies show, ART children do not have an increase in congenital and chromosomal abnormalities.

    The proof is also the fact that 5,000,000 children have been born through ART internationally, some of which already have got kids naturally.

    In thousands of children that have been carefully monitored, there has been no pathology or damage due to the ART methodology. The percentage of biochemical pregnancies and miscarriage is similar to these of natural conception. The few side effects of ART are mostly about the mother and not the fetus.

    However, factors that increase the chances of children born with anatomical anomalies are the age of the woman, the time between the start of the ART and achieving the pregnancy and the presence of subfertility in the couple (Bonduelle et al 2002 Hum Reprod; Davies et al 2012 NEJM).

  8. Pregnancies after assisted reproduction are high risk

    Assisted reproduction methods and in vitro fertilization programs have increased multiple pregnancy rates. Usually, twin pregnancies do not show any problems, as long as they are closely monitored and advanced care is offered. In high order multiple pregnancies (three or more fetuses etc.), problems are more common and more difficult to manage and they are affect the health of the mother and the chances of premature birth. Premature birth is the most serious cause of perinatal mortality and morbidity in fetuses and it correlates with the number of fetuses carried in the uterus.

    For all the above reasons, the embryos transferred to the uterus should be as few as possible. If, despite these measures, an ART cycle results in a multiple pregnancy, there is the option of fetal reduction, however such a process raises great ethical dilemmas, while it may also jeopardize the survival of the remaining fetus(es).

    See more here.

  9. Frozen embryos from natural cycles give higher pregnancy rates

    This practice has been tried in the past in our Unit without returning the expected results and so we do not suggest it anymore. Usually this method is applied to women with poor ovarian response and/or advanced age, with the belief that it increases pregnancy rates, which in this group of women are already very low.

    The transfer of all frozen embryos does not necessarily translate in higher pregnancy rates when compared to the transfer of one fresh embryo at a time. On the contrary, some embryos may not survive the freezing and thawing process which results in the loss of embryos and the futile physical and economic burden of a woman. At Eugonia, we advice on the fresh transfer of even one embryo, so as to avoid the stressful situation of freezing and thawing.

  10. The more oocytes I have, the higher is my chance of getting pregnant

    It is generally accepted that the number of oocytes produced from the ovaries of a woman during the ovarian stimulation with the use of drugs, correlates with the pregnancy rates. A large study of over 400,000 assisted reproduction treatment cycles from the UK shows that women with 15-20 oocytes had the higher pregnancy and birth rates.

  11. Women with polycystic ovaries do not have many chances of getting pregnant

    No, that is not true. On the contrary, women with polycystic ovaries that undergo assisted reproduction treatment (ART) seem to have higher chances of achieving a pregnancy due to the increased production of oocytes and thus number of embryos.

    At the same time though, women with polycystic ovaries are a high risk group for the development of ovarian hyperstimulation syndrome (OHSS). Current scientific literature data, amongst which is >our study at Eugonia, the largest available with regard to the number of patients with polycystic ovaries, show that the protocol of choice is that of GnRH antagonists. It is well known that the use of antagonists in comparison with agonists (long protocol) correlates with a shorter stimulation duration, reduced use of gonadotrophins, same pregnancy rates and lower by 50% risk of severe OHSS development.

    For all the above reasons, the use of the antagonist protocol for the stimulation of the ovaries in women with polycystic ovarian syndrome (PCOS) is imperative. In the case that the ovaries over-react, which increases the chances of developing OHSS, the triggering of the final maturation of the oocytes should be performed with the use of agonists (Arvekap or Buserelin) and not hCG (Pregnyl or Ovitrelle), which totally eliminates the risk of developing OHSS. The transfer of the resulting embryos can be performed in following cycles with safety and excellent results.

  12. In order to get pregnant you need more than one assisted reproduction treatment cycles

    This is a myth. At Eugonia, the majority of women will achieve a pregnancy at their first attempt. We can also provide a solution to previous failed IVF attempts from other Units.

  13. I can preserve my fertility by freezing oocytes

    Oocyte freezing can offer today a realistic solution to women that want to postpone getting pregnant in the near future, as well as in cases of premature ovarian failure. Recently, with the development of vitrification, oocyte freezing can result in high survival, fertilization, good embryo quality rates, which in turn result in higher pregnancy rates. Read more.

  14. Is there a connection between fertility drugs and cancer?

    The risk of developing ovarian or breast cancer is exactly the same as in the general population, as all large international epidemiological studies show. Breast screening should however be performed, especially in women that have completed their 35th year of age. Read more here

  15. Is it necessary to undergo a hysteroscopy prior to assisted reproduction treatment?;

    Hysteroscopy is extremely useful, even if it is not obligatory prior to embarking on assisted reproduction treatment (ART). With hysteroscopy, the surgeon has the ability to closely examine the uterine cavity in real time, for an exact diagnosis and treatment of the possible pathologies, such as the presence of a polyp, adhesions, inflammation and congenital anomalies.

    Hysteroscopy must be applied prior to ART when there is a finding in the hysterosalpingography or the ultrasound (adhesions, polyp, fibroid, prior uterine surgery). Routine hysteroscopy, both diagnostic and surgical, offers the best treatment option and it increases pregnancy rates.

  16. Should the start or not of an assisted reproduction treatment cycle be based on the FSH levels?

    In women with poor ovarian response that are close to menopause, the FSH is increased, suggesting poor ovarian function and poor ovarian reserves. Some suggest that the FSH should be measured at the start of every menstrual cycle, so as to identify the cycle with the lowest FSH levels in order to embark on an assisted reproduction treatment (ART) cycle. This practice, however, results in the inexplicable delay of the start of a treatment cycle, while it is possible for menopause to kick in, while waiting for a cycle with low FSH, which might never come.

    At Eugonia, we advise that this group of women should immediately embark on an ART cycle, in order to gain as much time possible to repeat an attempt in the case of treatment failure. Either way, the pregnancy rates in this group of women are very low, but we have succeeded in achieving pregnancies that have resulted in the birth of healthy babies, even in women with very high FSH blood levels.

  17. Do hydrosalpinges need to be removed prior to assisted reproduction treatment?

    In general, there is some controversy whether or not to remove hydrosalpinges. Some argue that hydrosalpinges should be removed prior to embarking on assisted reproduction treatment as their contents can negatively affect the quality of the endometrium and lead to implantation failure of the transferred embryo(s). In contrast, some support that hydrosalpinges must be retained, as their removal may lead to a reduction in ovarian reserve and thus in a poor ovarian response during an assisted reproduction cycle. At Eugonia, based on our personal experience, we believe that the removal of hydrosalpinges is not necessary when a woman undergoes her first assisted reproduction cycle. The removal of hydrosalpinges is suggested only in the case of a failed assisted reproduction cycle where good quality embryos have been transferred.

  18. Do endometriomas need to be removed prior to assisted reproduction treatment?

    This is rather debatable. In general, endometriomas should be removed when their size and their anatomical positioning block the access to the ovary in order to aspirate the follicles during oocyte retrieval.

Commonly asked questions and their answers

  1. Is it possible to identify chromosomal abnormalities in embryos based on their morphological appearance?

    The appearance of embryos cannot give us any information on chromosomal abnormalities. The evaluation of embryos is performed by observing their morphological appearance (number of cells, presence of fragmentation etc.) under the microscope and it correlates with the prognosis of achieving a pregnancy. It is very possible for an embryo of excellent quality to carry chromosomal abnormalities. For the detection of such anomalies, a special genetic testing called preimplantation genetic testing should be applied. In this way, healthy embryos can be selected for transfer to the uterus, while embryos with anomalies can be excluded.

    See more about the methods of preimplantation genetic diagnosis and preimplantation genetic screening.

  2. Can I have an assisted reproduction treatment cycle without any drugs?

    It is possible for a woman to undergo assisted reproduction treatment in a natural cycle without the use of drugs to stimulate the ovaries.

    In a natural cycle, there is no stimulation of the ovaries with drugs, but monitoring with a series of utlrasounds and blood hormone measurements of the progress of the one and only (lead) follicle and the endometrium. Due to the high risk of premature and untimed ovulation and thus failed oocyte retrieval, this protocol has been replaced with the modified natural cycle (MNC).

    In the MNC, during the last few days there is administration of antagonists and a minimal dose of gonadotrophins. In this way we can avoid the loss of the oocyte due to premature ovulation.

    Amongst others, the advantages of natural cycles include the absence of drug administration for ovarian stimulation, the absence of side-effects and complications, the small time duration, the reduced cost and probably the best receptivity of the endometrium.

    Disadvantages include that we place our hopes in one follicle from which we can only retrieve one oocyte, which must be mature in order to fertilize, needs to divide and develop into a good quality chromosomally normal embryo with a good potential and able to implant in the uterus and result in a pregnancy. Thus, another disadvantage is the reduction in the pregnancy rates.
    Indications may include a poor ovarian response, multiple failed assisted reproduction attempts, the desire to avoid taking any drugs and some exceptionally rare contra-indications for the use of ovarian stimulation drugs.

  3. Is there a specific hormone that shows how fertile I am?

    AMH (antimullerian hormone) is produced by small follicles (<6 mm) in the ovaries of a woman.

    A large number of studies suggest that AMH greatly reflects the total number of follicles that remain in the ovaries, i.e. it is a powerful indicator of ovarian reserve and a prognostic factor of ovarian response in an assisted reproduction treatment (ART) cycle to follow. AMH levels are reduced as the age of the woman increases and as the ovarian reserve decreases, while at the same time there is a simultaneous reduction in the number of developing follicles visible on ultrasound. On the contrary, in cases of a large number of follicles, as with women with polycystic ovaries, AMH levels are excessively increased. It has also been suggested that AMH blood levels are a prognostic factor for the pregnancy chances of an ART cycle to follow, although this is debatable.

    In Eugonia, in line with new scientific developments, we use the AMH measurement in combination with ultrasound assessment of the ovaries (number of small antral follicles and ovarian volume) and FSH and estradiol (E2) levels, in order to determine ovarian reserve and select the optimal stimulation protocol.

    Read more here.

  4. How much can stress affect the outcome of a treatment cycle?

    When we examine the psychology of an infertile couple we refer to various emotional and social factors which act synergistically in a complicated manner and can affect the assisted reproduction procedure through biological mechanisms. The effect of these psychological factors is not always expected. Psychology is not a factor that can be measured and it may exert its effects in different ways in different people. This is why its effect on the outcome of the assisted reproduction treatment cannot be measured.

    The psychology of an infertile couple may include amongst others: anxiety and depression symptoms which may be attributed or attribute themselves to the infertility, insufficient communication within the couple, a vicious circle of anger – guilt, when one blames the other for the infertility, low self-esteem and a feeling of personal insufficiency which is connected to the incapability of childbearing, the stress that woman or the man experiences, many times without them realizing it, either in relation to the infertility itself, or due to random events, low sexual desire, etc.

    Couples that are presented with infertility issues often have to face important and difficult dilemmas, for example whether and when are they going to embark on assisted reproduction treatment, which is going to be the cost, how many time will they try, or how are they going decide on a variety of alternative treatments (e.g. adoption, oocyte or sperm donation, etc.

    For all the above reasons, the psychological support of the couples that face infertility issues has been established as a routine abroad and nowadays in Greece as well.

  5. Can I get pregnant after the age of 40?

    Assisted Reproduction may significantly increase the chances of achieving a pregnancy in older women. At Eugonia, the pregnancy rates for women over 40 years of age is 28%, which is still lower in comparison to that of the group of younger women undergoing fertility treatments.

    It is well know, that the maximum fertility for a woman is established at the age of 24 (86% fertility), while for the group of women of age 25-30 this is about 78%. In the 30-34 age group the fertility starts to diminish (63%) and after the 35th year of age this reduction is substantial (52%). Natural conception is quite rare after the age of 45 years (less than 0.1%) mainly due to the increase of chromosomal abnormalities in the oocytes.

  6. How can I determine my biological age?

    Biological age relates directly to ovarian reserves, i.e. the follicular reserves that exist in the ovaries of a woman. The most commonly performed tests in order to determine ovarian reserves is hormone blood tests for FSH, estradiol and anti-mullerian hormone (AMH) and a transvaginal ultrasound scan for the measurement of the ovarian volume and the number of basal antral follicles on the 2nd or 3rd day of the menstrual cycle.

  7. Is it possible to treat Severe Ovarian Hyperstimulation Syndrome?

    Yes, it is now feasible to safely and effectively treat severe OHSS. The novel treatment that has been designed by Dr Lainas and the scientific team of Eugonia has been described as pioneering by the international scientific community and has also been internationally accepted as a tertiary prevention method of the syndrome. Note that until recently there was no treatment for sever OHSS and its management was symptomatic and just relieved any symptoms, with the need for hospitalization that included paracentesis, the intravenous administration of albumins and possible admittance into an intensive care unit for numerous days. With this novel and revolutionary treatment (administration of GnRH antagonist in the luteal phase), the woman can be immediately relieved of her symptoms and for observation purposes only very few visits in our unit are needed.

  8. How many assisted reproduction treatment cycles should I have?

    At Eugonia, the majority of women will get pregnant on their first try, while it is generally accepted that most women with normal pregnancy chances will succeed within the first 3 treatment cycles.

  9. Could I have unexplained infertility?

    Despite all progress on diagnosing the cause of infertility, unexplained infertility remains the most common type of infertility. Around 25-30% of infertile couples have been shown to have unexplained infertility.

  10. Μπορεί να γίνει προεμφυτευτική διάγνωση;

    Embryos that have resulted from assisted reproduction treatments (IVF or ICSI) can be checked for genetic abnormalities with the use of preimplantation genetic diagnosis techniques. In this way, specific genetic mutations or chromosomal abnormalities which are responsible for certain known congenital and hereditary diseases in the embryo can be detected. Any affected embryos can be isolated and excluded from the embryo transfer.

    See more about the methods of preimplantation genetic diagnosis and preimplantation genetic screening.

  11. How many embryos should be transferred in order to have high pregnancy rate?

    An important decision that must be taken after discussion with the couple involves the number of embryos transferred to the uterus. The choice of number of embryos transferred must meet a fine balance between the increasing pregnancy chances, which are usually enhanced by increasing the number of embryos, and at the same time reducing the chances of a multiple pregnancy, which is achieved by reducing the number of embryos. This decision can be taken after a discussion with you, by taking into consideration the age of the woman, the quality of your embryos, your medical history and any previous assisted reproduction treatment cycles. According to national legislation the number of embryos transferred must not exceed three for women below the age of 40, and four for women over 40 years of age.

    More information

  12. Is there a treatment for women with abnormal hormone levels (high FHS – low AMH)?

    A limited but increasing number of studies suggest treatment with the DHEA hormone (dehydroepiandrosterone) in women with poor ovarian response./p>

    DHEA seems to act favourably on the ovarian response, the embryo quality and the pregnancy rates, while at the same time it seems to decrease the treatment cancellation rates due to poor ovarian response.

  13. Which pregnancy rates should I trust?

    The quality of the services provided and the expertise of an Assisted Reproduction Unit (ART Unit) should only be judged by the end-result, i.e. its pregnancy rates.

    The official recording of the pregnancy rates of ART Units by a national body and their publication could provide the ones interested with a reliable criterion for the selection of an ART Unit. This already happens in many advanced countries (e.g. USA, UK, France, Germany, Austria). In Greece, the operation of the independent National Body has been for now suspended. One of its missions was to record and publish the pregnancy results of all ART Units that operate in the country. It is expected that soon enough, this national gathering and recording of data will be the official source of the pregnancy rates of the ART Units of our country and in this way, anyone interested will be able to compare the various Greek ART Units, as well as many ART Units abroad.

    More information on selecting an IVF Unit.

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Dr Lainas talks on SKAI (in greek)

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