IVF for Recurrent Miscarriage: What to Expect at Sakalli Cyprus IVF Fertility Center

• Chromosomal Abnormalities: This is the most common cause, especially for early miscarriages. Either the egg, the sperm, or the resulting embryo may have the wrong number of chromosomes (aneuploidy). Often, these abnormalities occur randomly, but the risk increases with maternal age. Sometimes, one parent carries a 'balanced translocation' – their chromosomes are rearranged but complete, causing no health issues for them, but increasing the risk of creating embryos with unbalanced chromosomes.

• Uterine Abnormalities: Issues with the shape or structure of the uterus (like a septum, fibroids, or scar tissue) can prevent an embryo from implanting properly or growing successfully.

• Hormonal Imbalances: Conditions like thyroid disorders, uncontrolled diabetes, or problems with progesterone levels (needed to support early pregnancy) can contribute to loss. Polycystic Ovary Syndrome (PCOS) is also sometimes linked.

• Immunological Factors: Sometimes, the mother's immune system may mistakenly attack the developing embryo. Autoimmune disorders (like Antiphospholipid Syndrome - APS) or blood clotting disorders (thrombophilias) can also play a role.

• Lifestyle Factors: Smoking, excessive alcohol or caffeine intake, obesity, and exposure to certain environmental toxins can increase miscarriage risk.

• Infections: Certain chronic infections in the uterus can sometimes be implicated.

• Male Factor: While less commonly the primary cause, issues with sperm DNA fragmentation might contribute in some cases.

• Unexplained: Frustratingly, in about 50% of cases, a specific cause for recurrent miscarriage is never identified despite thorough testing.

1. Thrombophilia:

Thrombophilia is a condition that makes the blood clot more easily than usual. This can impair placental function, leading to miscarriage. Women with thrombophilia are at an increased risk for pregnancy loss, and treatment with blood thinners can often improve pregnancy outcomes.

2. Autoimmune Factors:

Autoimmune disorders occur when the body mistakenly attacks its own cells. During pregnancy, this can involve the immune system attacking the embryo or placenta. In some cases, women with autoimmune diseases like lupus or antiphospholipid syndrome (APS) may face recurrent pregnancy loss.

3. Anatomical Reasons:

Structural abnormalities in the uterus can hinder the implantation or development of a fetus. These abnormalities, such as uterine septum or fibroids, can be identified through imaging tests and may require surgical correction.

4. Hormonal (Endocrine) Disorders:

Hormonal imbalances, such as thyroid dysfunction or polycystic ovary syndrome (PCOS), can interfere with the body’s ability to maintain a pregnancy. Proper management of these conditions is crucial for improving fertility outcomes.

5. Genetic Factors:

Chromosomal or genetic abnormalities in the embryo or either parent can lead to miscarriage. Genetic screening is often recommended for couples experiencing recurrent pregnancy loss to identify any underlying genetic causes.

• Parental Karyotyping: A blood test for both partners to check for balanced translocations or other chromosomal issues in the parents themselves.

• Uterine Evaluation: Assessing the uterine cavity shape and structure using:

• Hysterosalpingogram (HSG): An X-ray using dye to visualize the uterus and fallopian tubes.

• Sonohysterography: Ultrasound using saline infused into the uterus.

• Hysteroscopy: A thin camera inserted into the uterus for direct visualization.

• 3D Ultrasound: Provides detailed images of uterine anatomy.

• Hormonal Blood Tests: Checking thyroid function (TSH, T4), prolactin, ovarian reserve (AMH, FSH, Estradiol), and sometimes progesterone levels.

• Autoimmune and Thrombophilia Screening: Blood tests for conditions like Antiphospholipid Syndrome (APS) and inherited blood clotting disorders.

• Infectious Disease Screening: Testing for specific infections if suspected.

• Ovarian stimulation with medications to produce multiple eggs.

• Egg retrieval procedure (under sedation).

• Fertilization of eggs with sperm (usually via ICSI – injecting a single sperm into each egg) in the lab.

• Embryo culture for several days (typically to the blastocyst stage – Day 5 or 6).

• Addresses the #1 Cause: Since chromosomal abnormalities are the leading cause of miscarriage, PGT-A directly tackles this issue by ensuring only genetically balanced embryos are transferred.

• Reduces Miscarriage Risk: Studies (including observational data and meta-analyses) consistently show that transferring chromosomally normal embryos significantly reduces the risk of miscarriage, particularly in women with a history of recurrent loss or advanced maternal age. Some studies report miscarriage rates dropping significantly (e.g., potentially halving or more compared to untested transfers in certain groups).

• Increases Implantation Rates: Healthy embryos are more likely to implant successfully.

• Increases Live Birth Rate Per Transfer: By selecting viable embryos, the chance of achieving a healthy live birth from each transfer attempt is increased.

• Reduces Time to Pregnancy: Avoids the emotional and physical toll of transferring non-viable embryos that would inevitably lead to failed implantation or miscarriage.

• Reduces Risk of Chromosomal Syndromes: Prevents the birth of babies with conditions like Down Syndrome (Trisomy 21), Edwards Syndrome (Trisomy 18), or Patau Syndrome (Trisomy 13) caused by aneuploidy.

• Expertise & Experience: Clinics often boast highly experienced IVF specialists and embryologists, many with international training and long track records.

• Advanced Technology: Leading clinics invest heavily in state-of-the-art labs.

• High Success Rates: Clinics in Cyprus often report high success rates, sometimes exceeding European or US averages, particularly for treatments like egg donation or cycles involving PGT.

• Affordability: Costs for IVF and PGT in Cyprus are typically significantly lower than in the UK, Western Europe, or the USA, making advanced treatments more accessible.

• Favorable Legal Environment: North Cyprus law permits certain procedures that are restricted elsewhere, such as PGT for gender selection (often used for family balancing alongside health screening), treatment for single women and same-sex couples, and potentially higher age limits for treatment (up to 53-55 cited by some clinics).

• No Waiting Lists: Unlike some public healthcare systems, private clinics in Cyprus generally have no waiting lists, allowing treatment to commence quickly.

• Patient Support: Clinics often cater specifically to international patients, offering multilingual staff, assistance with travel and accommodation arrangements, and personalized coordination.

• Relaxing Environment: Many patients appreciate the less stressful, vacation-like atmosphere of Cyprus for undergoing treatment.

• Medical Team's Expertise: Research the qualifications and experience of the doctors and embryologists, especially their experience with PGT and managing complex cases like recurrent miscarriage.

• Laboratory Quality: Does the lab use advanced technology (NGS for PGT-A, good incubators, witness systems)? Ask about their embryology team's proficiency with biopsy and vitrification (freezing/thawing).

• Transparency: Are they open about their procedures, success rates (specific to your age group and PGT cycles), costs, and potential risks?

• Success Rates: Look for live birth rates per embryo transfer for PGT-A tested embryos in your age group. Be cautious of overly generalised or unusually high claims without clear data backing. Understand the difference between clinical pregnancy rates and live birth rates.

• PGT Expertise: Do they perform biopsies on Day 5 (blastocyst stage - generally preferred)? What genetic testing platform do they use (NGS is more comprehensive than older methods like FISH for aneuploidy screening)?

• Patient Reviews & Communication: Look for independent reviews focusing on communication, care quality, and outcomes. How responsive and supportive are the coordinators and medical staff?

• Personalized Approach: Do they tailor protocols based on your specific history and test results?

• Maternal Age: The number and quality of eggs retrieved decline with age, impacting the number of healthy embryos available for testing and transfer.

• Number of Euploid Embryos: Successfully obtaining chromosomally normal embryos is key. Sometimes, despite retrieving many eggs, few or no euploid embryos result, especially with advanced age or underlying egg/sperm quality issues.

• Uterine Factors: The health of the uterine lining is crucial for implantation, even with a healthy embryo.

• Clinic Expertise: The skill of the embryology lab in performing biopsy and cryopreservation significantly impacts outcomes.

• Initial Consultation: This often happens remotely (phone, video call). You'll discuss your medical history (including previous miscarriages and tests), review diagnostic results, and the clinic will outline a proposed treatment plan and costs.

• Pre-Treatment Testing: You'll likely need to complete required blood tests (hormones, infectious diseases) and potentially imaging (ultrasound) in your home country before traveling.

• Ovarian Stimulation: You'll start fertility medications (usually injections) at home, following the clinic's specific protocol, typically starting on Day 2 or 3 of your menstrual cycle. This phase lasts about 10-14 days, stimulating your ovaries to produce multiple follicles containing eggs. You'll likely need monitoring ultrasounds and blood tests locally during this time, coordinating with the Cyprus clinic.

• Travel to Cyprus: You'll travel to Nicosia towards the end of the stimulation phase, usually around Day 10-12 of your medication cycle.

• Final Monitoring & Trigger Shot: In Cyprus, you'll have final ultrasound scans to check follicle growth. When ready, you'll administer a "trigger shot" (hCG or GnRH agonist) to mature the eggs.

• Egg Retrieval: Approximately 36 hours after the trigger shot, the eggs are collected via a minor surgical procedure performed under light sedation at the clinic. It typically takes about 15-20 minutes.

• Sperm Collection & Fertilization: On the same day, your partner provides a sperm sample (or donor sperm is prepared). The eggs are fertilized with the sperm in the lab using ICSI.

• Embryo Culture: The resulting embryos are cultured in the lab incubator for 5-6 days to reach the blastocyst stage. Advanced incubators like the EmbryoScope may be used for optimal monitoring.

• Embryo Biopsy for PGT-A: On Day 5 or 6, skilled embryologists perform a biopsy, removing a few cells from the trophectoderm of each suitable blastocyst.

• Freezing & Genetic Testing: The biopsied embryos are typically frozen (vitrified) while the cells are sent for PGT-A analysis (often using NGS technology). Getting the results usually takes 1-3 weeks.

• Results & Embryo Selection: The clinic informs you of the PGT-A results, identifying which embryos are chromosomally normal (euploid).

• Frozen Embryo Transfer (FET) Cycle: In a subsequent cycle (often 1-2 months later, allowing your body to recover and prepare the uterine lining), you'll return to Cyprus (or coordinate preparation remotely). The uterine lining is prepared using medications (estrogen, progesterone).

• Embryo Thaw & Transfer: A selected euploid embryo is thawed and transferred into your uterus using a thin catheter – a simple, usually painless procedure done while you're awake.

• Post-Transfer & Pregnancy Test: You'll continue progesterone support and return home. A blood pregnancy test is usually done about 9-12 days after the transfer.

• Required Stay in Cyprus: Typically involves one trip for the initial IVF cycle/biopsy (around 15-21 days depending on protocol start) and a shorter second trip for the FET (around 3-5 days). Some clinics might offer protocols allowing for a fresh PGT-tested transfer in certain cases, requiring a single, longer stay.

Q1: Is IVF with PGT always recommended for recurrent miscarriage?

A: Not necessarily. It's most beneficial when the suspected cause is chromosomal abnormalities (common in unexplained recurrent loss or with advanced maternal age) or if parents carry a known translocation. If other specific causes are found (e.g., uterine septum, hormonal issue, clotting disorder), those should be treated first. A thorough diagnostic workup is essential before deciding on PGT.

Q2: How accurate is PGT-A?

A: Modern PGT-A using Next Generation Sequencing (NGS) is highly accurate (typically >98-99%) at detecting whole chromosome aneuploidies. However, it doesn't screen for single-gene disorders (that's PGT-M) or tiny deletions/duplications. There's also a small risk of mosaicism (embryos with mixed normal/abnormal cells) which testing might misinterpret, or rare errors in the biopsy/testing process.

Q3: Are there risks associated with the embryo biopsy for PGT?

A: When performed by experienced embryologists on blastocysts (Day 5/6), the risk of damaging the embryo is considered very low (less than 1%). Biopsying the trophectoderm (future placenta cells) is generally safer than older Day 3 biopsy methods.

Q4: Can PGT guarantee a healthy baby?

A: No. PGT-A significantly reduces the risk of miscarriage and major chromosomal syndromes like Down Syndrome. However, it doesn't screen for all possible genetic conditions, birth defects with other causes, or complications during pregnancy and delivery. It increases the chance of having a healthy baby.

Q5: Why is PGT for gender selection legal in North Cyprus?

A: The legal framework in North Cyprus allows for PGD/PGS to be used not only for medical reasons (screening for abnormalities) but also for family balancing (choosing the sex of the embryo to be transferred). This is prohibited in many other countries.

Q6: How do I choose between the different IVF clinics in Nicosia/North Cyprus?

A: Research thoroughly. Compare their experience specifically with recurrent miscarriage and PGT, check their lab technology, ask for detailed success rates relevant to your situation, read independent reviews, assess their communication and support, and compare detailed cost breakdowns. Consider virtual consultations with a few clinics before deciding.

Q7: What if PGT finds no normal embryos?

A: This is a difficult but possible outcome, especially with advanced maternal age or poor egg/sperm quality. The fertility specialist will discuss the results and potential next steps, which might include another IVF attempt, considering donor eggs/sperm, or exploring other options.