Ovulation is the process in which one or more follicles are released from one of the ovaries. As it is perceived this corresponds to the fertile phase of the menstrual cycle. In women with a stable menstrual cycle, this usually occurs about 14 days before the expected period (menstrual period). Every month several eggs begin the process of maturation in the ovaries. Usually, however, only one of them completes the entire procedure successfully and is released into the pelvic cavity to reach the fallopian tube.
When the ovaries face difficulties producing mature eggs, the brain releases a hormone called FSH, which stimulates the ovaries to be more effective in producing eggs. In a woman who has a good fertility status, FSH is normally under 10, with rates above 25 being generally problematic. Although the probability of pregnancy decreases with age and high FSH levels, it goes without saying that this is feasible as long as the ovaries are functional and produce ova.
The fertile days of a woman depend on her cycle. If a woman has a fixed cycle, she can find her ovulation day 14 days before her next period (1st day is considered the Day 1 of menstruation) and the fertile days are 2 days before the expected ovulation and two days later.
Insemination is a relatively easy method of assisted reproduction, during which we process the sperm, improve its characteristics and inject it into the uterine cavity with a thin catheter. The main advantage of the method is that it is less intrusive than IVF and requires mild to no medication, making it more economical as a process. In some cases, it is possible to repeat the effort, even on a monthly basis, after a medical evaluation until the desired result is achieved. Good conditions for intrauterine insemination are the woman’s age (the younger the woman is the younger the age of her ovaries are, with more qualitative eggs), the translucency of the fallopian tubes so that the sperm reaches the ovum and fertilize it, as well as the existence of a sufficient number of moving sperms in the male sample. In vitro fertilization, as we have mentioned earlier and as opposed to insemination, besides therapeutic, has a diagnostic character, since it allows us to see, for the first time and in a more obvious way, the fertility capacity of both the egg and the sperm, bypassing any difficulty – something not controlled by insemination – while we are able to create an embryo, which according to its architecture can characterize its quality, but also to choose it among others, but without knowing its genetic direction.
The more unstable your cycle is, the more difficult it is to predict ovulation. However, if you have ovulation, then sexual intercourse two or three times a week is enough to help you conceive.
IVF, in vitro fertilization (IVF) is the most common method of medically assisted reproduction. It was first applied successfully to humans in 1978. In vitro fertilization, as the word says, is fertilization outside the body: instead of fertilizing the ovum from the sperm to its natural environment, which is the woman’s tube, this process is performed in the lab. It is of high importance the bypass of a certain function of the body when, for various pathological factors, it cannot be done in the body.
- The procedure starts with ovarian stimulation. During treatment, the development of more follicles is possible only after the use of administered hormonal preparations that cause controlled ovarian hyperstimulation and thus the development of many follicles. It is important to mention that IVF can also be performed in a natural cycle where a follicle develops in the ovary every month.
- The next stages are the collection of the eggs and their fertilization by sperm cells. The sperm is placed together with the eggs in a specially designed area where some hours later their fertilization (either IVF or ICSI method) and embryo production are controlled.
- The final stage is embryo transfer, which takes place two, three or five days later, and whose technique plays a big role in the result.
- The number of transplanted embryos depends, in particular, on the age of the woman, according to the legislation, the history of previous pregnancies or attempts but also depend on the cause of infertility. Finally, if surplus embryos are of excellent quality, they may be eligible for cryopreservation for future use of the couple.
The method can be implemented in two ways:
- either following the woman’s natural cycle, where a single follicle develops in the ovary.
- Or with mild drug stimulation to create more follicles, thus increasing the likelihood of fertilization.
However, it is important to mention that if insemination does not have a positive result, no one, unfortunately, is in a position to know the reason of failure, as well as the factors that prevented the conception.
This method solves infertility problems from both the woman (e.g. occluded tubes, fibroids, endometriosis, etc.) and the man (e.g. low mobility, small sperm count, abnormal semen morphology). Usually the cumulative success rate can reach 60-65%, at younger ages. However, the success rate per cycle or effort depends on many factors, with the most important being the age of the woman and the cause of infertility.
Endometriosis occurs when the endometrium, that is, the tissue that normally lifts the inner wall of the uterus and detaches each month along with the blood of menstruation, grows out of it. It usually attaches to organs of the pelvic region, such as in the fallopian tubes, in the ovaries or behind the uterus, and sometimes extends to the intestine and the bladder. The most common symptom is severe pains and cramps in the abdomen just before and during the period (dysmenorrhea). In addition, other symptoms of endometriosis include irregular cycles, infertility, pain during sexual intercourse (dyspareunia), gastrointestinal discomfort, and even intense / frequent tiredness.
The annual gynecological examination consists of a series of tests that are very important for the health and fertility of the woman. Annual gynecological testing is a “process” that should not be neglected and many women ignore its significance. The annual gynecological check is made to ensure a woman’s healthy sexual lifestyle and to discover any conditions that have not manifested – or are going to manifest – symptoms. The right test includes a series of examinations, different for each age, that should be done systematically so that you can recognize any changes that occur in your body over time as well as being informed about proper prevention in order to avoid illness from a disease, information on sexually transmitted diseases as well as knowledge about the proper hygiene and protection of your gynecological area.
Published studies show that there is no relationship between fertility drugs and specific cancers. Fertility drugs used for ovarian stimulation, based on existing scientific data, cannot be considered as a cause or pre-condition for the development of uterine, ovarian or breast cancer.
In contrast, infertility itself and lack of pregnancy appear to slightly increase the likelihood of ovarian cancer. Exceptionally, the use of clomiphene citrate for over 12 months (in some studies only) showed a small increase in the likelihood of occurrence of marginal tumors in the ovary, and therefore the convergence of scientific opinions is that clomiphene citrate is only given for six months. The results from the studies (until December 2016) allow us to convey a rather reassuring message to patients exposed to fertility drugs. Continuous monitoring of new-incoming data and periodic meta-analysis of all studies are the most important factors for proper information for doctors and patients.
Cystic Fibrosis or Infections (Cystic Fibrous Disease) caused by mutations in the CFTR gene is the most common hereditary condition of the white tribe that causes death at an early age. Cystic Fibrosis is not a communicable disease, but a hereditary one. To get sick, one must have two pathological genes that he inherits from both his parents who are carriers of the disease without knowing it. People who have damage to one of the two chromosomes of the gene are carriers and do not suffer. The frequency of birth of children in Greece is 1/2500 newborn.
- 1/700 couples are both carriers of the disease with 25% chance of giving birth to suffering children.
- If only the mother is examined and does not carry any of the mutations, then the chances of a child being born are 1/17000
- If the mother finds a mutation in the CFTR gene then the chances of a child being born without the father being examined is 1/100. If the father is examined with 85% detection and no mutation found, the risk of having a child carrying the disease is reduced to 1/700.
- With 99% detection and no mutation found, then the risk decreases even more, with the probability of the child suffering from the disease being 1/4000.
Although social conditions have changed, the physiology of the woman’s body remains stable with fertility beginning to weaken after 35 years. Women are born with a certain number of follicles (in each round about 900 ova lost) in their ovaries. One egg matures every month and can be fertilized. As the years go by, the available eggs slowly become less numerous because the ovaries are unable to produce new eggs (after 35 remaining 10% of the reserve). Also, their quality is reduced, as the genetic material changes over time. The chances of chromosomal abnormality (Down syndrome) in women aged 35 years are 1: 11,999, while in age 42 is 1: 1766 and at the age of 45 is 1: 352 respectively. The egg freeze is suggested to be performed till the age of 38 years, depending on the specificity of each woman (pathological hormone control, low anti-mullerian hormone (AMH), low follicular reserve after ultrasound examination, etc.). Surely the sooner you do it the better it is, but it’s never too late to protect your fertility and give yourself the chance of maternity in the future.
Spinal Muscular Atrophy is considered one of the most common causes of infant mortality whose causes are purely genetic. It is distinguished in 4 subtypes in terms of the clinical picture, i.e. the age of onset of symptoms and their severity. The most serious suspects type I and II are characterized by the inability in the infant to stand and walk without help and reduced to minimal autonomous respiratory capacity that can lead to death even immediately after birth. It is inherited in an autosomal way. In 95% of cases the disease is due to a homozygous lack of exons 7 and / or 8 of the SMN1 gene. Parents who are carriers of this deficiency, without knowing it, are 25% likely to have a child with this disease.
The incidence of the disease in the white race is approximately 1: 18,000 (1 in 40 people may be a carrier). Spinal Muscular atrophy (SMA) is considered to be the third most common genetic disease after Mediterranean anemia and Cystic Fibrosis. That is why the American Academy of Genetics recommends the prenatal control, i.e. the detection of the agents of this disease.
Ovarian hyperstimulation is a condition (iatrogenic complication) that can occur in women with an increased number of follicles (polycystic ovaries) and especially in younger women undergoing fertility treatment by IVF. It is due to the excessive ovarian response to exogenous gonadotropin administration even at times and in small dosages. Depending on the severity of the symptoms and the clinical picture of the woman, it can be characterized as a mild – moderate – severe condition and occurs before or after embryo transfer.
The prevention of this complication is mainly focused on:
- Determination of high risk women
- Correct selection of ovarian stimulation protocol
- Proper and low-dose medications (gonadotropins)
- Achieve stable E2 levels
- Dose of HCG on the last day of stimulation.
The existence of overstimulation does not reduce the likelihood or progression of a pregnancy.
In these cases the following symptoms are usually observed:
- Sudden weight gain
- Strong swelling of the abdomen before or 2-3 days after oocyte
- Breathing difficulty
- Motion sickness
- Stomach ache
If your doctor thinks that you are likely to develop ovarian hyperstimulation, then you should modify your activity and diet as follows:
- Minimize salt in your foods.
- Increase fluid consumption and drink 10-12 glasses a day of fruit or beverage juices with electrolytes. You can drink water only if you cannot tolerate the previous ones. Do not drink refreshments containing sugar or refresh light.
- Avoid white bread, pasta, and white rice. You can consume small quantities of whole grain products – pasta, bread, rice paddy.
- Reduce food intake with high sugar content:
Biscuits, sweets, ice cream, ketchup and various other prepared sauces.
Increase protein intake:
- Egg whites and lean meat (fish, poultry).
- Rest and relax physical activities (exercise or sexual contacts).
- Weigh yourself daily and score your weight. If your weight rises sharply (eg 1 ½ kg within 1 day), then you must let us know.
- Increase abdominal perimeter. Every morning you measure the perimeter of your abdomen at the height of the umbilicus. If you notice a difference from one day to another greater than 2-3 cm please let us know.
The role of blood coagulation throughout pregnancy is crucial. From the conception, blood clotting performs a crucial function, since proper blood flow (and therefore oxygen and nutrients) helps in the implantation, growth and maturation of the fertilized egg. Later, in the course of pregnancy, the uninterrupted supply of the placenta depends on its good perfusion.
During pregnancy, the pressure caused by the swollen uterus in the abdominal vessels combined with the possible existence of thrombophilia can lead to the pregnancy-hypercoagulability of the pregnant woman. This means that the risk of thrombosis and occlusion of placental blood vessels that may lead to premature aging, fetal growth inhibition syndrome, pre-eclampsia (increase in mother’s pressure), premature labor and / or endometrial death increases. The expectant mother therefore performs a simple blood test, which includes the basic (coagulation factors and proteins) and gene control of thrombophilia.
In cases where a woman is diagnosed with Thrombophilia does not mean that she will have a problematic pregnancy but she will simply need to take special anticoagulation treatment that will be given to her by her gynecologist, depending on the results of her blood test investigations.