IVF in Cyprus (In vitro fertilisation) was initially only used as a last resort for patients who could not conceive due to infection or damaged tubes. However, IVF procedures in North Cyprus have been carried out for over 20 years and the medical world continues to innovate and develop this extremely important area of medicine. Today, in North Cyprus IVF is used as an effective treatment for infertility caused by various factors including endometriosis, blocked fallopian tubes, male factor infertility, low sperm count or motility, advanced female age, reduced ovarian reserve and unexplained infertility.
There are various factors which affect IVF success rates. The techniques used, the egg and sperm quality and the structure of the uterine wall are all important factors affecting the results you will receive from your North Cyprus fertility treatment.
IVF with ICSI – Getting Started
Stage 1 – Initial Contact and Registration
The first step is to complete our contact form or send an email to firstname.lastname@example.org. Julie, the patients coordinator, will respond to your enquiry and give you all the information you need. At this stage, it’s important to get answers to all of your questions so make sure you ask anything that comes to mind, no matter how silly or insignificant it may seem.
Stage 2 – Tests
Since you are using your own eggs, there are a few tests that you will need to have before starting treatment. All tests should be done on day 2, 3 or 4 of your period between 1 and 6 months before your intended treatment month.
The required tests are as follows:
* Hormone blood tests: FSH (Follicle Stimulating Hormone), AMH (Anti-Mullerian Hormone), TSH (Thyroid Stimulating Hormone), E2 (Estradiol) and Prolactin
* Trans-vaginal ultrasound scan: Antral Follicle Count
These can be done by your family doctor but if you don’t want to involve him/her then you can contact any private gynaecologist and they will be happy to assist. We have partner clinics in various locations around the UK so please have a look at our list of affiliated clinics to see if there is one located near you.
(We can also do the tests at Dogus during your treatment if you come to us for your full IVF cycle. You will need to travel to Cyprus on the first day of your period and stay for approximately 20 days.)
When you receive the results of your tests, you email them to Julie and she will discuss everything with Dr. Firdevs who will confirm that you can proceed with IVF treatment using your own eggs.
Stage 3 – Medical Information Form and Deposit
Once you are comfortable and decide that you want to proceed, you will be sent a Medical Information Form to complete. You should fill out your full medical history and any special requirements and return it by email to your patient coordinator. At this stage, you are required to pay a deposit of £200/200 Euros to secure your treatment. Deposits are non-refundable and are valid for 6 months.
Stage 4 – Getting Your Medication for IVF in Cyprus
By now, you will have completed all your tests and returned the medical information form and deposit. You will know the month you are coming for treatment and you will have an approximate idea of dates. We recommend that all patients take an oral contraceptive pill to regulate the menstrual cycle. This is not compulsory but it does make it easier to plan in advance.
We will send you a prescription for the medication required prior to your stay in Cyprus. You can use this prescription to get the medication from your local pharmacy. If you do not want to use a local pharmacy or the cost of medication is expensive then you can order the medication from our distributor in UK who supplies the medication at Cyprus prices and can deliver worldwide.
Along with the prescription, we will send you a full treatment protocol providing specific instructions regarding what medication to take and when to take it.
Don’t forget, you can phone or email your coordinator at anytime if you have questions or simply need some reassurance.
What medication do I need to take prior to coming to Cyprus ?
Gonadotropins – Gonadotropins are taken as subcutaneous injections and provide stimulation to the follicles that contain the eggs during the stimulation phase. Gonal F, Puregon, Menopur and Menogon are the most commonly used injections in Dr. Firdevs’ protocols. The dose will depend on your fertility status but regardless of whether you are on a high or low dose, you will do one injection daily from day 2 until day 11 of your menstrual cycle.
Cetrotide – This is a gonadotropin-releasing hormone antagonist. It suppresses pituitary and ovarian hormone production and prevents premature ovulation. Cetrotide will be administered by subcutaneous injection from day 6 until day 11 of your treatment cycle when the follicles are approximately 12 – 14 millimeters in size.
What medication do I need to take for IVF in Cyprus ?
When you arrive in Cyprus, Dr. Firdevs will assess whether you need additional medication to increase your chance of pregnancy. Some of the possible medications you may be prescribed include Monodox (doxycyline) antibiotics, Prednol (prednisolone) tablets, Progestan (progesterone)pessaries, Clexane (enoxaparin) injections and Proluton Depot (hydroxyprogesterone caproate USP) injections.
Stage 5 – Coming to Cyprus
You should arrive in Cyprus on day 10 of your treatment cycle (unless you are coming to us for the entire treatment in which case you will arrive on day 1 of your period).
The day after you arrive for your IVF in Cyprus program, you will visit Dogus IVF Centre where you will meet Dr. Firdevs and one of our International Patients Coordinators for the first time.
You will have a trans-vaginal ultrasound scan to check that your follicles have developed well. Dr. Firdevs will decide whether you need any additional stimulation or whether you are ready for the Pregnyl (HCG hormone) injection which is administered to finalise the maturing process. This takes 36 hours.
If you are ready for the HCG injection, the nurse will visit your hotel that evening at approximately 11pm to administer it.
Stage 6 – Egg Collection
On the day of egg collection, you will be collected from your hotel at approximately 9am and taken to Dogus IVF Centre. You are not allowed to eat or drink from midnight the previous evening since you will be having a sedative.
When you arrive at Dogus you will be shown to a bedroom by one of our nurses. All bedrooms are equipped with a full electric hospital bed, LCD television, fridge, sofa or armchair and an en-suite toilet.
You will be provided with a disposable gown, hair net and plastic shoe covers which should be worn over bare feet or socks.
The nurse will take you from your bedroom into the operating theatre when it is time for your egg collection. Our anesthetist will administer a sedative and you will sleep throughout the procedure.
Dr. Firdevs will then collect your eggs via ultrasound guided follicle puncture.
Whilst the egg collection is occuring, the male partner is asked to provide a semen sample. (If you are using donor sperm, this will be thawed and prepared.) Two to three days of sexual abstinence is recommended prior to providing the semen sample. The sample is analysed and washed with a special solution of nutrients to isolate the more motile sperm. Traditionally, the sperm was placed into a sterile dish containing the egg and fertilisation was allowed to occur naturally. At Dogus IVF Centre, we use the ICSI procedure in every treatment as it guarantees fertilisation. Please see ICSI for more information.
Stage 7 – Embryo Development
After the ICSI procedure is completed, the eggs are incubated for a period of twenty four hours, after which time the embryologist will establish if fertilisation has occurred. You will be contacted by one of the patient coordinators to advise you on the number of embryos.
Over the next few days, the embryos will be left to develop. Our embryologists prefer to have as little contact with the embryos as possible while they are developing because when the embryos are removed from the incubator, the humidity and temperature will change and this change can affect their development.
You can use this time to enjoy your holiday, relax and soak up the fabulous Cyprus sunshine knowing that your future babies are in safe hands.
Stage 8 – Your Embryo Transfer
On average, approximately 80% of the fertilised eggs will continue to divide and after 3 days in the Dogus clinic laboratory they will be composed of 8 cells. At this point, Dr. Firdevs will decide whether she is doing a 3 day transfer or 5 day transfer weighing up the pros and cons for each option.
When you arrive at Dogus on the day of your embryo transfer, you will get an update regarding how many embryos you have and what quality they are. You will then decide what you would like to transfer. Normally we recommend that you transfer the healthiest three embryos because this gives a good balance between maximising the chance of pregnancy at the first attempt and minimising the risk of multiples. We can transfer a maximum of 4 embryos and we can also transfer 1 or 2 embryos if that is your preference.
Using a vaginal speculum, Dr. Firdevs exposes the cervix which is then cleaned with sterile solution. The culture medium containing the embryos is loaded into a thin plastic tube (catheter) with a syringe on one end. Dr. Firdevs carefully guides the catheter through the vagina and cervix, and releases the embryos into the uterus under careful ultrasound guidance to the optimum position, exactly 2cm below the top of the womb.
High quality embryos remaining after the transfer can be frozen for use at a later date.
Stage 9 – The Pregnancy Test
On the evening of your embryo transfer you should relax and have as much rest as possible. You can return home later that night or the following day. Once you get home you can continue your normal routine, although prolonged strenuous exercise or activity is not recommended. You should not sunbathe or take hot baths for the first few weeks after embryo transfer because it can alter your core body temperature and the temperature within your uterus. Please see “Dos and Don’ts” for more information.
Twelve days after your embryo transfer, you can have a HCG blood test. At this stage, the blood test is the only way to definitely find out if the IVF cycle has worked because it is still too early to get an accurate result with a urine test. The blood test can be arranged with your family doctor or a local private fertility clinic.
In some countries it is difficult to arrange a HCG blood test and so it may be necessary for you to perform a urine pregnancy test. In this situation you should wait until 14 days after embryo transfer and make sure you use first morning urine.
If the HCG blood test or urine test are positive:
It is important to continue the medication exactly as prescribed for the first trimester. Your hormones are already artifically raised and so you must maintain that level until the placenta is strong enough to look after the baby on its own.
You can tell your normal doctor that you are pregnant and you will be registered and follow the program for pregnant women in your country.
At 7 weeks gestation (7 weeks from day 1 of your last period) you can have an ultrasound scan to confirm the number of embryos which have implanted and to check the foetal heart beat.
If the HCG blood test is negative:
All medication should be stopped. You will experience a bleed approximately one to two weeks after stopping medication once the hormones leave your system.
If the urine test is negative:
You must continue taking the medication for two further days and then repeat the pregnancy test with first morning urine. If the result is again negative all medication must be stopped.
Please note that whatever the result, our International Patient Coordinators will continue to provide help, advice and support.