Pre-implantation Genetic Diagnosis

Cyprus IVF Clinic



All IVF treatments begin with a course of hormone therapy to stimulate the development of several follicles in the ovary. These are collected as eggs, which are then fertilized in a test-tube ('in vitro') to create several embryos.

After between two and five days in an incubator, these embryos are transferred through the vagina to the uterus, where implantation occurs and pregnancy begins. However, in IVF as in natural conception, not every embryo implants to become a pregnancy, which is why surplus embryos are frozen - so that a subsequent transfer might be tried if the first one fails. Freezing is now an essential part of every clinic's IVF programme.

Micromanipulation is a radical method of assisted reproduction. It is one of the most effective procedures to help men overcome male infertility issues and has helped more and more couples suffering from infertility since 1992.

ICSI (Intracytoplasmic Sperm Injection) is beneficial for all couples, however it is significant for those where fertilizatıon maybe difficult, even when IVF procedures are used.

At Kyrenia IVF, the ICSI (Intracytoplasmic Sperm Injection) procedure is carried out as standard as part of all our IVF treatmentsto ensure fertilization at no extra charge.

Preimplantation Genetic Diagnosis (PGD) is a procedure carried out prior to implantation to help identify genetic defects within embryos created through IVF. The procedure is used to prevent certain diseases or disorders from being passed on to the child.



Couples at risk of passing on a genetic disease or condition may qualify for PGD under the following criteria:
  • Women aged 35 and over
  • Carriers of sex-linked genetic disorders
  • Carriers of single gene defects
  • Those with chromosomal disorders
  • Women experiencing recurring pregnancy loss associated with chromosomal concerns
  • Couples wanting to balance their family


PGD can identify the presence of the following disorders:
Recessive sex-linked disorders such as haemophilia, fragile X syndrome, and most Neuromuscular dystrophies, Dominant sexlinked disorders such as Rett syndrome, incontinentia pigmenti, pseudohypererparathydroidism, and vitamin D resistant rickets, Single gene disorders such as cystic fibrosis, Tay-sachs, Huntington disease, and sickle cell anaemia, and Chromosomal rearrangements such as translocation, inversion, deletions and Aneuploidy.

The needed Medical Tests:
Women Hormone Blood Tests:
  • FSH (follicle stimulating hormone)
  • TSH (thyroid stimulating hormone)
  • E2 (estradiol)
  • Prolactin
  • AMH (anti-mullerian hormone)


Trans-vaginal scan (Ultrasound Scan) for ovarian & uterine assessment Ultrasound Scan:
The purpose of these scans is to measure your response to medication. More precisely, the purpose of the scan is the following:
  • Assessment of endometrial appearance and thickness
  • Assessment of uterine conditions (to make sure there are no uterine pathologies that may interfere with our treatment).
  • Assessment of the ovaries. Semen Analysis:
  • A semen analysis helps assess the quality of a sperm sample with respect to key parameters including sperm volume, concentration (count) per mL, motility, morphology, pH and round cell count.


Infectious Diseases Screening:
  • Anti-HIV – test for HIV/AIDS infection
  • Anti-HCV – test for Hepatitis C virus infection
  • Rubella IgG- IgM – test for German measles infection
  • CMV IgG – test for Cytomegalovirus infection
  • HbsAg – test for Hepatitis B virus infection
  • VDRL – test for Syphilis infection
  • Anti- Hbs



How to start the treatment:


Step 1
To Read everything carefully and send all of your questions to your coordinator. Please don’t hesitate to ask as many questions as you want. Please Know that you have the right to schedule a call or video call at anytime to ask and get to know your coordinator and doctor. We believe the relationship between the doctor & patient is very important, as she will be performing your treatment, this is why you should be relaxed and happy with your doctor.

Step 2
Fill the application form that is sent to you by your coordinator or you can schedule a call with your coordinator and she will ask you some questions.

Step 3
Schedule a pelvic scan date with your Gynecologist. Also, to make the required Medical Tests.

Step 4
Send the application form, Medical tests results, and Scan to your coordinator.

Step 5
Once you have sent your results. Within 24 hours, your coordinator will send you an assessment letter from the doctor. This assessment letter, will have everything included, about your situation, success rates, best treatment for you, and advices

Step 6
At this time after everything has been organized, you will be receiving your medical Treatment protocol and a prescription to start your treatment.



In Cyprus



Initial scan
Day one of your menstrual cycle marks day one of the treatment process with medication following. On day 10 you are will fly to Cyprus. Your coodinator will be in touch that evening to advise your pick-up time for the appointments in Cyprus.
The initial scan consists of a trans-vaginal ultrasound to check the development of your follicles. (Dr Verda may prescribe additional stimulation medication at this stage if necessary). If the eggs are ready, our dedicated nurses will administer a ovulation trigger injection that evening at your hotel. The injection stimulates the final maturation of eggs in the ovaries. The eggs will be then collected 34 to 36 hours after the injection is administered.

Egg & Sperm Collection
Our team will advise you of your pick-up time for the day of egg collection. Upon arrival at the hospital, a nurse will show you to your room and provide you with the garments necessary to wear for the procedure. You will be taken to the operating room where you will be sedated and asleep throughout the entire procedure. (Since you will be sedated you must NOT eat or drink after midnight the previous evening and we will remind you of this when you are in Cyprus).
Your eggs will be collected under transvaginal ultrasound guidance. A needle is inserted through the vaginal wall into the ovaries using ultrasound to locate each follicle. The follicular fluid is drawn up to obtain the eggs. Generally, the egg retrieval takes 20-30 minutes. You may experience some cramping and light bleeding after the procedure — however this is perfectly normal. You will be able to take a mild painkiller if necessary.
During the eggs collection, our team at Kyrenia IVF will be preparing the sperm sample from your partner (or donor). Abstinence from ejaculation for two to three days prior to providing the semen specimen is recommended.

Fertilization
The most motile sperms are selected for fertilization. To ensure fertilization, our team uses the ICSI procedure. This technique involves the insemination of sperm into each egg by micro-injection. Once you have had the appropriate rest, our transfer team will take you back to your hotel. Our doctors will also discuss with you the amount of eggs that were collected and the sperm quality. Our team will also discuss with you any other information regarding the procedures carried out that day. After 24 hours, you will receive an update regarding the fertilization process and the amount of embryos.

Embryo Transfer
The embryos are transferred on either day three or day five of development. Our compassionate embryologist is highly skilled in identifying healthy embryos and in some cases will recommend extending embryo development to day five — also known as blastocyst stage.

Blastocyst transfer is common in IVF cycles as it can increase the chances for success while decreasing the likelihood of multiples. Dr. Verda will work closely with our Embryologist to determine if a day three or day five transfer is ideal for you.

On transfer day, Dr. Verda will discuss with you the quality and quantity of your embryos. You can then decide how many you wish to have transferred. Again you will be shown to a room and provided with the necessary garments. Embryos are transferred to the uterus through a soft embryo transfer catheter. This painless procedure is similar to a pap smear and does not require any anaesthesia. The embryos are placed in a small amount of fluid inside the catheter, which is passed through the cervix at the time of a speculum examination and ultrasound guıdance. The embryos are placed in a position to reach the top part of the uterus. The catheter is removed and checked to ensure that all the embryos have been transferred. You are required to have a full bladder for the transfer procedure and we advise that you begin drinking water on the way to the hospital. After the embryo transfer is complete, your bed will be wheeled from the procedure room into your private room, all while you remain lying flat on your back. Since you must remain as flat as possible, a bed pan will be brought to you by the nurse approximately 15 minutes after the transfer procedure if needed.

If you desire to use cryopreservation, the good quality embryos that are not transferred can be frozen in liquid nitrogen, carefully labeled and stored in the embryo bank. These can be used in subsequent cycles if pregnancy is not achieved on the first attempt or if you decide to have more children at a later date.



The Result

The most accurate test for pregnancy is the beta hCG blood test — 12 days after the embryo transfer (day 1 being the day after transfer took place). hCG is human chorionic gonadotropin, also known as 'the pregnancy hormone'. The body begins to produce hCG when an embryo begins to implant in the uterus. While we understand many intended parents are anxious to find out the results at home, please wait until day 12. The ovulation trigger injection the nurse administered prior to egg collection contains hCG and if you test too soon you may pick up traces of this and NOT the hCG produced by pregnancy. The injection can remain in your system for 8-10 days so testing too soon may give a false positive. The beta hCG test will report the level of hCG hormone that is present.
In some cases, it can be difficult to have a blood test carried out. A home pregnancy test will indicate whether or not there is any detectable hCG in your urine and not the level present. Please wait to carry out a home pregnancy test 14 days after the embryo transfer. Please note hCG is present in urine in the highest concentration first thing in the morning.
If you have a positive result, it is very important that you continue the medication as advised by Dr. Verda. You can also advise your doctor / gynaecologist as you will need support and subsequent tests and scans. You should repeat the beta test in 2 to 3 days. The goal is to have the level of hCG double every 3 days. If it does another beta test should be carried out in another 2-3 days time. If all three betas indicate a healthy pregnancy, then a vaginal ultrasound will be scheduled between 6 to 8 weeks of the pregnancy. At that time, your doctor will be looking for a heartbeat and a gestational sac to confirm the pregnancy. If the result is negative and you have had a blood test on day 12, ALL medication should cease straight away. If the result is negative and you have carried out a urine test on day 14, werecommend that you continue taking the medication as advised by Dr. Verda for another 2 days and test again. If the result is still negative, ALL medication should cease right away.
Any negative result on your pregnancy test is devastating — Dr. Verda and the Kyrenia IVF staff are available to answer any questions you have about the procedure and discuss further options for you.