Assisted Reproduction – IVF
In vitro fertilisation (IVF) is the most effective method of assisted reproduction — chosen after a complete evaluation, with success rates reaching 40–50% per cycle for women under 35.
When you need infertility investigation
Infertility is defined as the inability to conceive after 12 months of regular unprotected intercourse — or 6 months for women over 35. Earlier investigation is indicated when a known cause exists.
- Age over 35: Ovarian reserve declines — every month matters.
- Irregular or absent cycle: Possible ovulation disorder (PCOS, amenorrhea).
- Known condition: Endometriosis, fibroids, tubal damage or abnormal semen analysis.
- Recurrent miscarriages (≥2): Needs targeted couple evaluation.
- Previous treatments without success: Ovulation induction or intrauterine insemination (IUI).
Causes of infertility — female and male factors
Infertility involves the couple — in 40% of cases a male factor is found, in 40% a female factor, and in 20% a combination or unexplained.
- Ovulation disorders: PCOS, hyperprolactinemia, ovarian insufficiency.
- Tubal damage or blockage: From pelvic inflammatory disease, previous ectopic pregnancy or surgery.
- Endometriosis: Affects ovaries, tubes and egg quality.
- Endometrial pathology: Polyps, fibroids, intrauterine adhesions.
- Male factor: Oligospermia, asthenospermia, teratospermia or azoospermia.
- Unexplained infertility: All tests are normal but conception does not occur.
Tests before an IVF cycle
Before starting an IVF cycle, a complete pre-treatment evaluation is performed for a safe and individualized protocol.
- Hysteroscopy: Direct examination of the uterine cavity — exclusion of polyps, adhesions or septum.
- Genetic testing: Karyotype, carrier testing for hereditary conditions when indicated.
- Microbiological tests: STIs, immunological screening.
- Endometrial assessment: ERA test (implantation) in recurrent failures.
How infertility investigation is performed
The investigation is done for both partners simultaneously. It aims to identify the cause and determine the appropriate treatment.
- History and gynecological examination: Cycle, previous pregnancies, surgeries, sexual history.
- Hormonal testing (day 2–3): FSH, LH, estradiol, AMH — ovarian reserve assessment.
- Transvaginal ultrasound: Antral follicle count (AFC), uterine and ovarian assessment.
- Semen analysis (×2): Sperm count, motility and morphology.
- Tubal patency testing: Hysterosalpingography (HSG) or HyFoSy ultrasound.
IVF treatment — the steps of a cycle
An IVF cycle follows a standard protocol, individualized according to ovarian reserve and the woman's history.
- Step 1 — Ovarian stimulation: Gonadotropin injections for 10–12 days, with frequent ultrasound and hormonal monitoring.
- Step 2 — Egg retrieval: Transvaginal follicular aspiration under light sedation — 20 minutes, outpatient procedure.
- Step 3 — Fertilisation in the laboratory: Conventional IVF or ICSI — chosen based on sperm quality.
- Step 4 — Embryo culture: 3–5 days in the laboratory until blastocyst stage.
- Step 5 — Embryo transfer: Placement of 1–2 embryos into the uterus — simple, painless procedure without anaesthesia.
- Step 6 — Cryopreservation: Additional good-quality embryos are stored for future use.
Options and alternative protocols
There is no single IVF protocol for everyone. Individualisation increases the chances of success.
- Frozen-thawed embryo transfer (FET): Often higher success rates — especially after OHSS risk.
- Preimplantation genetic testing (PGT-A): Selection of chromosomally normal embryos — reduces miscarriages.
- Egg donation: For women with depleted ovarian reserve or genetic indications.
- Natural cycle IVF: Without or with minimal stimulation — for specific indications.
- Egg freezing: For social fertility preservation or before oncological treatment.
Success rates and prevention of complications
Success rates depend mainly on age and ovarian reserve. Transparency about expectations is fundamental.
- Under 35: ~40–50% live birth per embryo transfer.
- 35–37 years: ~35–40%.
- 38–40 years: ~20–30%.
- Over 40: ~10–15% with own eggs — significantly higher with egg donation.
- OHSS (Ovarian Hyperstimulation Syndrome): The most serious complication — avoided with individualized protocol and freeze-all strategy.
Symptoms
Infertility is defined as the inability to conceive after 12 months of regular unprotected intercourse — or 6 months for women over 35. Earlier investigation is indicated when a known cause exists.
- Age over 35: Ovarian reserve declines — every month matters.
- Irregular or absent cycle: Possible ovulation disorder (PCOS, amenorrhea).
- Known condition: Endometriosis, fibroids, tubal damage or abnormal semen analysis.
- Recurrent miscarriages (≥2): Needs targeted couple evaluation.
- Previous treatments without success: Ovulation induction or intrauterine insemination (IUI).
Infertility involves the couple — in 40% of cases a male factor is found, in 40% a female factor, and in 20% a combination or unexplained.
- Ovulation disorders: PCOS, hyperprolactinemia, ovarian insufficiency.
- Tubal damage or blockage: From pelvic inflammatory disease, previous ectopic pregnancy or surgery.
- Endometriosis: Affects ovaries, tubes and egg quality.
- Endometrial pathology: Polyps, fibroids, intrauterine adhesions.
- Male factor: Oligospermia, asthenospermia, teratospermia or azoospermia.
- Unexplained infertility: All tests are normal but conception does not occur.
This information is for educational purposes and does not replace medical advice. For diagnosis and personalized treatment, book an appointment.
Need an assessment?
Book an appointment at the Athens or Ioannina offices for a personalized evaluation with the doctor.