In Vitro Fertilization (IVF)
IVF is one of the fastest growing fields of medicine globally. New techniques cross over quickly from research to clinical practice, in the pursuit for all the more effective treatments. With fertility rates in the western word dropping over the last few decades and couples postponing having children for financial or social reasons, the need for effectiveness has become more pressing than ever nowadays.
For us at MITERA Institute of Life, September 2017 signaled a new era. In partnership with the Institute of Life, we fully renovated our facilities, and invested in equipment and infrastructure. Our aim is to make the MITERA Institute of Life Assisted Reproduction Unit (IVF) a center of excellence for couples across Greece and Europe.
Qualified staff, ultra-modern facilities
The MITERA Institute of Life scientific team consists of leading fertility doctors and is fully dedicated to the needs of each couple, meticulously choosing the best treatment for them each time.
Our main mission at MITERA is to help infertile couples become parents, ensuring high effectiveness and security standards and limiting the stress that often accompanies an IVF attempt. To this end, we have created relaxing surroundings, very different from those encountered in other centers, focusing on comfort and discretion.
Patient safety is ensured by the fact that the Unit is housed within the largest gynecological and maternity center in Greece, staffed with qualified physicians of all medical specialties.
We took a step further, though, ensuring embryo safety within the lab. All critical lab parameters (temperature, pH, pressure and gas composition) are monitored continuously via the Log & Guard system by Octax. Any disruption is recorded and corrected immediately, before it even has the chance to affect the embryo culture conditions.
The lab’s clean air system was designed from scratch. Both the lab and the operating rooms are supplied with ultra-clean air, ensuring positive pressure compared to the other areas. The air quality was measured right after we commenced operations and was found to be class C, which is the best performance possible for an embryology lab.
A special volatile organic compound (VOC) sensor has also been installed, which checks for the presence of these substances in real time. It has been found that VOCs can affect the normal development of embryos.
In addition, we have installed an RI Witness system, which is an electronic witness that checks and records every process within the embryology lab. All Petri dishes and vials that contain biological material and are used in the lab carry a microchip, which is read wirelessly by the sensors mounted on each workstation. Each chip has its own electronic signature, which is unique for every couple. This ensures that the couples are matched to their embryos and rules out the chance of error. MITERA is one of the few centers in Greece with such a system in place, which has reported a zero rate of failure worldwide.
Apart from these safeguards, the culture system within the lab was upgraded with new incubators and a gas supply system. The culture system has been designed in a way that embryos need to remain outside an incubator for the shortest time possible. This allows us to culture embryos up to the blastocyst stage, a practice that has been proven to increase the success rates.
Latest generation techniques
Our embryology lab was one of the first to apply cryopreservation using the vitrification method.
This technique prevents the creation of ice crystals within the cells, which is the main reason why a large number of frozen embryos did not survive with the older techniques. Using the vitrification technique, the survival rates have reached 95%, whether applied on eggs or embryos.
Reliable cryopreservation of embryos at any stage of development opens up new possibilities in the field of human reproduction. Through vitrification, the ovarian stimulation and fertilization process may be detached from the implantation procedure. Put simply, we can stop time for the embryos whenever we want and thaw them when the implantation conditions are ideal.
In the case of preimplantation genetic diagnosis (PGD), vitrification allows cryopreservation of embryos during the blastocyst stage, after embryo biopsy, so there is ample time to perform the genetic analysis.
Furthermore, it is the first time that women who wish to preserve their fertility for medical or social reasons can freeze their eggs reliable at a young age and use them later in life.
The micromanipulation equipment also received a major upgrade. The microscopes were upgraded with a new optic system, which allows optimum sperm selection using ultra-high magnification (IMSI technique). This helps clinical embryologists choose sperm that is morphologically optimal, especially in cases of male infertility. In the area of preimplantation genetic screening and diagnosis (PGS and PGD), we are continuing our collaboration with the AlphaLab Molecular Biology & Cytogenetics Center, a member of HYGEIA Group. We have equipped the lab with a low-power laser system by Octax, which permits cell retrieval from embryos with the least possible disruption. With the help of the laser, we almost exclusively perform embryo biopsy during the blastocyst stage, which means that the validity of the result increases and embryo damaged is avoided.
The embryos are frozen right after the biopsy. This technique not only allows detection of single-gene disorders, such as thalassemia and cystic fibrosis, but also application of whole genome amplification methods, i.e. complete embryo genome analysis prior to implantation. Combined with the CGH and NGS array molecular biology techniques, this approach may provide solutions to even the most difficult cases, such as couples with a pathologic karyotype, or with repeated implantation failures or miscarriages, but also women at an advanced reproductive age. It is also the first time we can apply combined PGS and PGD on the same embryo, therefore, diagnosing both single-gene disorders and chromosomal anomalies at the same time.
The gift of giving
The IVF techniques are advancing in leaps and bounds and any improvement within the embryology lab, even a minor one, may be the reason for a much-wanted pregnancy. For us at MITERA, each case is difficult, meaning that we focus all our attention to it and apply the ideal method each time. These days, IVF units are very complex units and we believe that only within large hospitals such as MITERA can we invest in equipment and human resources so as to fulfill our promise to each infertile couple: treat each case individually, applying modern treatments with a smile and a sense of responsibility!
- Male infertility testing (semen analysis, activation test, DNA fragmentation assay)
- Female infertility testing (salpingography, ovulation test)
- ICSI and IMSI
- Preimplantation genetic screening / diagnosis (PGS/ PGD)
- Assisted hatching
- Blastocyst culture
- Egg & embryo cryopreservation via vitrification
- Cryopreservation of ovarian material
- Cryopreservation of sperm
- Testicular biopsy and cryopreservation of testicular tissue
- Egg donation
- Natural cycle and mild stimulation IVF
IVF has advanced in leaps and bounds over the last 30 years, both on a clinical and a lab level. As a result, couples these days have access to reliable and safe IVF treatment, with high chances of success.
During IVF, women undergo physical and mental stress. In countries where IVF treatment is funded by the state, studies have shown that the rate of women who give up before completing their treatment may reach up to 30%.
All these demand simpler IVF treatments and less emotional stress for women.
What is ovarian stimulation
In the ovarian stimulation protocol with GnRH antagonists, gonadotropins start being administered on the 2nd or 3rd day of the cycle and the antagonist is added later, to avoid ovulation. Through this protocol, the stimulation duration and, therefore, the number of days a woman needs to be injected ranges from 8 to 10 days, which is a significantly shorter period of time than the one required for the longer protocol with GnRH agonists. A comparative study of the two protocols showed that a lower rate of women interrupted their treatment in the antagonist group, demonstrating that treatment duration is significant in terms of a woman’s physical and mental condition. Apart from treatment duration, the number of injections is also significant for best compliance of the women and for avoiding errors in doses. Currently, there is a medication in the antagonist protocol that replaces the injections for the first 7 days with a single injection, greatly simplifying the ovarian stimulation process.
In Northern European countries and in Japan, but not in the USA, IVF units use mild/minimal stimulation protocols, which usually aim at retrieving up to 5 eggs.
The potential benefits of mild stimulation include lower medication doses, lower cost and avoidance of ovarian hyperstimulation syndrome. However, due to the reduced number of eggs, many times it is not possible to freeze extra embryos or to transfer one or two blastocysts.
Women with oncologic conditions
The survival of cancer patients has increased significantly due to modern treatment methods. So women aged between 14 and 40 who are about to undergo chemotherapy – which may lead to damage to or disrupted function of the ovaries – should consider techniques to preserve their fertility, such as ovarian stimulation, and cryopreservation of eggs or embryos, as well as cryopreservation of ovarian tissue. A problem that arises in these cases is the short time between diagnosis and treatment initiation. The modern stimulation protocols have solved this problem, as stimulation may be initiated at any stage of the cycle. The addition of antiestrogens, such as letrozole and tamoxifen, permits the use of these protocols in women with estrogen-dependent cancers.