What is infertility and how common is it throughout the world?

Infertility is the term used when a couple fails to conceive after 1 year of regular intercourse. Infertility is seen among 10-15% of the couples throughout the world.

What causes infertility?

In addition to poor quality eggs or blocked tubes, endometriosis is also attributed to causing infertility in females. Poor sperm quality or count is usually the cause of male fertility.

When should one get treatment and get evaluated for infertility?

Women are evaluated for infertility on the second or third day of menstruation and semen analysis is done after 3-5 days of sexual abstinence. During this period, various tests like hormone levels, pelvic exam, ultrasonography, semen analysis and for infectious diseases can be done. If required, inside of the uterus is best examined after menstruation. Doctors can decide the best form of treatment after the consulting the results of these tests.

What is artificial insemination?

Intrauterine Insemination (IUI) or more commonly known as Artificial Insemination is the term used when semen is washed to increase the concentration of progressive motile sperm and injected into the uterus on ovulation day. This is done to increase the coupleís chances of getting pregnant.

How many times can one have artificial insemination?

There are no limits to the number of attempts of Artificial Insemination. It is recommended however, that patients consider more advanced methods of ART after 2-3 failed attempts.

When should one start treatment for In Vitro Fertilization (IVF)?

Your doctor will explain the best time to start treatment after the initial consultation, exam and blood tests. Your clinician may start your treatment on the 2nd or 3rd day of your period, concurrent with your initial work-up if he/she

We live in a distant area. Can we have our tests and exams done at a local clinic?

Providing that we are in close contact with the clinician having your tests at a clinic close to you is feasible. We also have colleagues located in many cities.

I have a Histerosalpingography report from before. Do I need to have another HSG taken?

If you have not had any other procedures done after your last HSG, and if the results are not older than three years, you do not need to redo the procedure. Normally hysteroscopy is the more preferred procedure to evaluate the endometrium.

How soon can I begin treatment, after a failed IVF attempt?

We usually recommend a three month break after an IVF attempt. In the donor egg program if there are suitable donors available, a recipient can try every month. A natural IVF cycle can also be done every month.

How many times can one try IVF?

A couple can try as many times as they wish provided they can handle the costs.

Why is IVF an expensive procedure?

This method requires a highly trained staff and latest technology in equipment. The equipment and materials used in an IVF lab are all imported and costly. Also most of the materials used are disposable and in single use format. In the United States the cost of one cycle is $6,500 excluding the cost of the drugs used to stimulate the ovaries.

How long does the egg collection procedure take?

The duration of the procedure depends on the number of follicles that need to be aspirated. Normally it takes about 5-10 minutes. You should assume that the preparations, procedure and recovery time will take roughly 2 hours total.

Is the egg collection procedure painful?

The procedure is not painful but can cause mild discomfort. At our clinic, we use mild anesthesia administered through an IV line which relieves the discomfort. A patient rarely will need a heavy dose of anesthetic drugs.

How will I feel after the egg collection procedure?

Drowsiness is the most commonly seen side effect of the anesthesia. Patients report aches in the groin area near the bladder. Because the ovaries are enlarged, patients usually feel this ache before the egg collection procedure.

When will my husband be asked to collect a semen sample?

Your husband will be asked to provide a semen sample on the day of egg collection. You will have to come to the clinic together on the day of the procedure. Please tell your doctor if your husband will have trouble providing the sample in a clinic atmosphere. He can collect the sample at home and bring it to the clinic. There are special condoms that are non toxic for sperm or if necessary sperm can be frozen in advance for use on the egg collection day.

Can someone who has no sperm have children?

There are procedures available to men who do not have sperm in their semen. These procedures involve taking tissue samples directly from the testes in various ways depending on the situation. If sperm is found in those tissue samples, then microinjection (ICSI) can be used to inseminate the eggs.

What are my treatment options if no sperm cells are found after TESA or TESE?

After trying the various procedures available for azoospermic men, sperm is still not found, then sperm donation should be considered as the next available option.

What is the procedure involving sperm donation?

The procedure is the same as in regular IVF and the success rates are the same as regular IVF procedures. Donor sperm samples are taken from donors that have been tested and matched prior to the procedure.

Do all eggs get fertilized?

The average fertilization rate is 65% while some couples have a higher fertilization rate, there are instances of total fertilization failure.

Can a woman who enters menopause prematurely have children?

Yes, it is possible, donor eggs can be inseminated with her partnerís sperm as is done in a regular IVF procedure. It can be done if requested but some countries have made it illegal.

Can a menopausal woman become a mother? What is the age of motherhood?

A menopausal woman can get pregnant regardless of her age. A donorís eggs can be fertilized with her husbandís sperm. Even if the woman is healthy, IVF on women of advanced age is ethically controversial. Although there are no legal age limits, we do not perform the procedure on women over the age of 50. If we determine upon evaluation that the couple is incapable of educating and caring for the child, then we can refuse treatment.

How can one have children if all efforts to find sperm or eggs have failed?

Some couples who have had IVF done, wish to donate their embryos to other childless couples. Embryo donation is legal in North Cyprus and is performed in our clinic.

When are embryos frozen?

Embryos can be frozen on any day starting from the day after it is fertilized until the 6th day of culture. We at our clinic, prefer to fertilize on day 1, 3 and 5 (blastocyst stage).

Is there a difference between an embryo that has been frozen and thawed and a fresh embryo?

Use of frozen embryos is easier psychologically and less costly. But the pregnancy rates for fresh embryos are better than frozen.

Why donít some embryos implant even if they are good quality?

A good quality embryo has a higher potential to be genetically normal, but perceived quality is not the absolute criteria. There are other unknown factors influencing the pregnancy rate such as endometrial receptivity

How long should I rest after the embryo transfer procedure?

Resting fifteen or twenty minutes after the transfer is usually sufficient. We do not recommend heavy exercise and walking for long distances. Women who work at a desk can work the next day resume daily activities. Sexual intercourse is allowed two days after the transfer. Although there is no scientific proof in this area, we recommend that women refrain from hard exercise or beginning a new sport.

I am located far away from the clinic, how soon can I go home?

You can go away right after the procedure as long as you do not walk.

When can I bathe after the procedure?

You can bathe a few hours after the procedure. We do not recommend extreme heat as is found in Turkish baths, saunas or solariums. Also we recommend that you refrain from physical therapy using ultrasound for a few days after the procedure. There is no scientific proof backing this restriction.

How soon after the procedure can we have sexual intercourse?

You can have sexual intercourse two days after the embryo transfer. Some people recommend longer periods of sexual abstinence, but studies show that intercourse on the day of the transfer does not affect the pregnancy rate.

What is Preimplantation Genetic Diagnosis Ė (PGD)?

One or two cells (blastomeres) are taken out and special genetic tests are performed on them. Embryos that are shown to be genetically normal are selected and transferred back to the uterus.

How long do I have to use the drugs?

Doctors normally recommend that you continue using your drugs until after positive pregnancy test result. The duration varies depending on the patient and the drug protocol. In the standard protocol using agonists, our patients continue using progesterone for 15 days following the embryo transfer. Some clinics may ask patients to continue using the drugs for three months, however there are studies showing that this is not necessary.