Before we are able to plan your treatment cycle, there are a number of tests you need to undergo (see below). These tests determine your fertility and your ovarian reserve. These tests are important as we plan your medication protocol based on the results. You may well have had these tests previously, but we need the results to be dated between 1 and 6 months before you plan to start the procedure. All blood tests need to be completed on day 2 or 3 of your menstrual period.

The hormonal tests that are needed:
• FSH (follicle stimulating hormone)
• LH (luteinising hormone)
• AMH (anti-mullerian hormone)
• TSH (thyroid stimulating hormone)
• E2
• Prolactin
• Ft4

Additional tests FOR WOMAN:
• Anti-HIV – test for AIDS infection/ HIV
• Anti-HCV – test for Hepatitis C Virus
• Rubella IgG-IgM – German measles infection
• CMV IgM- test for Cytomegalovirus infection
• HbsAg – test for Hepatitis B virus infection
• VDRL – test for Syphilis infection
• AntiHbs
• Toxoplazma IgG-IgM
• Blood Group
• CBC

Tests for Man:
• HbsAg
• AntiHbs
• Hiv
• Hcv
• Vdrl
• Blood Group
• Spermiograma

You will also need to have a trans-vaginal ultrasound scan so an antral follicle count can be performed. The blood tests you can do them before you come or you can do them in the hospital, but the hormonal tests must be performed before traveling for treatment. The whole procedure takes around 3 weeks and you must travel from day 1 of the treatment. If you start the procedure in your home country, you can only travel for 10 days.

At this stage, you will be sure of which treatment you will be doing and we will be planning for your arrival. As soon as the required tests (above) are completed and you have an idea of which month you are starting your IVF treatment, we will advise you to start on a monthly contraceptive pill. This will regulate your monthly menstrual period.

An individual protocol will be prepared. This will provide you with instructions on how to take the medications, and when. The protocol is in an easy to read calendar format. Please do not forget to get in touch with your coordinator if you need help or assistance regarding the prescription.

Medications to Use if you start the procedure in your home country:

You will start daily injections from day 2 until day 11 (depending from person to person) of your menstrual period. The medication is made up of hormones, LH (luteinising hormone) and FSH (follicle-stimulating hormone). This will stimulate your ovaries to produce follicles. The second medication is an injection, from day 6 to day 11 (this also depends from person to person on when to start the medication) of your treatment cycle, at which point your follicles will be around 12-14 mm in size. This will be started after follicle stimulation to prevent untimely ovulation by blocking the hormone (Medication-releasing hormone-GnRH) that causes eggs to be released from the ovaries.

If you decide to come to Cyprus for the whole treatment period, you will arrive on day one of your menstrual period. Otherwise, you should arrive on day 10 of your cycle, which means 9 days after your menstrual period has started. Your coordinator will contact you to set up an appointment for the following days.

Doctor will measure your follicles and inform you if there is a need for further stimulation or whether you are ready for the hCG trigger injection that completes the maturing process. Ideally, your follicles should be around 18 mm-20 mm. If there is a need to stimulate the follicles further, we will wait one more day before administering the hCG injection; if the follicles are big enough you will take the trigger injection around midnight that night.

The egg retrieval will be scheduled when the follicles have reached an appropriate size, approximately 36 hours after the hCG-injection.

Egg Collection is done under light sedation so that you will be comfortable. The procedure will take 15 minutes. Please note that you’re not allowed to eat or drink 6 to 8 hours before egg collection day because of the sedation you will be given. The egg collection will take place using an ultrasound guided follicle puncture and your eggs will be immediately transferred to the laboratory. As the doctor starts the egg collection process, your partner will be asked to provide a sperm sample. To obtain the highest quality of sperm, we recommend you do not have sexual intercourse for at least 2 days prior to egg collection.

The embryologist will verify if fertilisation has occurred. This means that we will monitor (after 24 hours) the pronuclear stage; a pronuclear is the nucleus of an egg cell/a sperm cell that must combine during the process of fertilisation. Each one contains half the number of chromosomes of the male and female.  During the next few days, the embryos remain incubated to develop. As recommended by the Embryologist it is necessary to leave the embryos undisturbed and not remove them from the incubators to keep the environment consistent.

According to the laboratory rates, 90% of the pronuclear embryos will develop and will be comprised of 8 cells on the third day. Embryo biopsies are done on day 3 and examined in the lab for genetic diagnosis. The analysis takes 2 days. The results are shared with you on the day of embryo transfer before the procedure takes place.

When you arrive in the hospital on the day of the embryo transfer, your patient coordinator will let you know how many embryos have developed correctly and what stage the embryos are at. You will make the final decision on how many of the embryos you would like to be transferred. Our recommendation is to transfer three embryos as this will give the best chance of a pregnancy from one IVF cycle.

There is no need for sedation during this procedure and you are allowed to eat and drink. It is necessary to have a comfortably full bladder, so you will need to drink water beforehand. Using a vaginal speculum, the doctor will expose your cervix and sterilise the vagina and the cervix. With the help of specialist equipment, your embryos will be transferred into the uterus under ultrasound guidance. After the transfer, you will need to lie down flat for at least 2 hours. It is recommended to rest as much as you.

You will need to arrange a hCG-blood test, 12 days after transfer, to find out if your IVF hasbeen successful.

There are some countries who do not provide a blood test. If this applies to you, you will need to wait 2 more days and on day 14 perform a urine pregnancy test. To get an accurate result please use your first morning urine. If it is negative, please continue using the post transfer medications and repeat the test after 2 days.

If the outcome of the urine test is positive, you need to continue the prescribed medications.

If the hCG blood test outcome is negative, you need to stop taking medications immediately and once the hormones leave your body, you will experience a bleed about 2 weeks later.

Please update us, either way, by contacting your coordinator who will provide you with support and give you the right advice.