IVF Treatment with Egg Support (Tandem Cycle)

Egg supplementation treatment is a particular form of treatment and is a method preferred by patients with reduced ovarian reserve. In this treatment, while the female patient is provided with egg development through normal in vitro fertilisation treatment since a small number of eggs will develop, the egg donor is also given treatment at the same time, and eggs are collected from the donor to increase the number of eggs to be used in the patient’s treatment. In this way, the number of embryos formed after fertilisation with sperm taken from the patient’s partner and, therefore, the chance of pregnancy is increased. Since we use the ICSI method in all fertilisation procedures in our centre, our male patient’s sperm can fertilise both the small number of eggs of our female patient and the eggs of a young and healthy egg donor at a much higher rate. The embryos created with the patient’s and the donor’s eggs are monitored separately. At the appropriate developmental stage, our patients are consulted, and the most suitable embryos are transferred to the uterus of our female patient. It is also known that sometimes patients with less psychological burden due to an egg donation can produce eggs in better numbers and quality. What the tandem cycle means should be discussed in detail with patients before treatment because some of the eggs will be taken from a healthy and young donor, and some of the embryos that will be formed will also carry the donor’s genetics. Of course, egg supplementation is a treatment recommended for patient groups who need it and is used only to increase significantly the low pregnancy chances of patients in this group. Egg donation is still a sensitive issue in society and should be carried out by well-established centres that guarantee complete security and confidentiality in their treatments. In our centre, we work with great devotion to bring a smile to the faces of our patients to whom we add egg supplements and to crown their families with a baby. Our team, fully aware of the issue’s sensitivity, carries out all transactions in complete confidentiality and information is not shared with third parties under any circumstances.

The most accurate answer to the question of “Where is tandem cycle treatment performed?” is that, as with all in vitro fertilisation treatments, the entire treatment should be carried out by a centre that provides professional service and operates on the principle of complete confidentiality. In an IVF centre, in addition to the polyclinic section where patients are examined, there are multi-specialty units where IVF procedures are performed. In these units, not standard gynaecologists but in vitro fertilisation specialists who have completed their postgraduate training in gynaecology and assisted reproductive treatments and have received a certificate or diploma can work. When all these requirements are evaluated, the choice of the country, the centre, and, most importantly, the doctor are the main factors determining success. Asst. Prof. Burcu Özbakır works at our centre. She completed her higher education in England on egg donation and supplementation and in vitro fertilisation treatment and holds the title of being the only doctor with a diploma in her field on the island of Cyprus.

Tandem cycle IVF is not a treatment that can be performed in every country, and since it involves egg donation, it can only be performed in countries where egg donation is legal. Cyprus is a good option in this respect and is one of the few countries in Europe where egg supplementation is done with eggs taken from donors. Moreover, Cyprus has become a rising trend in Europe in the last decade, as it offers much more affordable and different options than its European counterparts and has been subject to an intense influx of health tourism from European countries. In addition to Turkish being spoken throughout the country, the fact that almost everyone also speaks English minimises the language problem throughout the island, and patients are quickly provided with a comfortable process. It is also preferred because there is no need for a visa or passport for patients from Turkey, and it is easy to obtain a visa for patients from Europe and the Middle East. All treatments in our centre are carried out with the control and approval of the TRNC Ministry of Health. Egg supplementation, that is, tandem cycle treatment, is provided with complete security on a completely legal basis. For this reason, the application rate for tandem IVF treatment is relatively high in our centre.

The tandem cycle is a supplementary method to increase treatment success in patients whose ovarian reserve has decreased but is not yet exhausted and who can obtain eggs in small quantities. In the group of patients to whom this treatment will be recommended, clear information should be obtained regarding the patient’s ovarian reserve and some medical conditions. The conditions sought before the tandem cycle IVF treatment are listed below:

• It should be determined by some special hormone analyses that the female patient’s ovarian reserve has decreased. The results of these analyses should be in the range supporting that some eggs are still in the ovarian reserve.
• In the ultrasound evaluation of the female patient, small egg cysts called antral follicles should be observed in the ovaries; this finding can be an essential indicator that eggs can be developed.
• It is desired that the female patient does not have a chromosomal disease such as Turner Syndrome, which can be passed on genetically to her children and affects ovarian reserve. If the cause of decreased ovarian reserve is genetic, then the chance of a healthy pregnancy will be meagre, as the few eggs obtained will also have a defective genetic structure.
• The female patient must have at least one ovary.

The patient group that meets these conditions and is thought to have low reserve is determined as the ideal patient candidate for egg supplementation (tandem IVF). Since it is not possible to obtain healthy eggs from a female patient whose reserve is determined to be completely depleted, or who has entered menopause, or who has a genetic disease that has depleted ovarian reserve, or who is congenitally or subsequently missing both ovaries for a reason, direct egg donation treatment will be the treatment method that will bring success in those patient groups.

There is an age limit and range for becoming an egg donor, but there is no set age limit for receiving egg supplements. Nevertheless, acting quickly in the range where the ovarian reserve decreases is necessary, and treatment should be performed before the reserve is exhausted. For patients who apply at the age of 45 and above, treatments can be performed by evaluating whether the general health status of the female patient is suitable for the pregnancy process and obtaining approval from the Ministry of Health Coordination Board. This is also important in terms of protecting the health of the female patient because our only goal is not to achieve pregnancy but to have a healthy baby that we will give to a healthy mother. Such approval is not required for the patient group under the age of 45, and we still act to correct the disorders in the general health status of our patients before treatment. Thanks to our academic doctor, an expert in the field in our centre, all these online consultations and consultancy services are provided free of charge. The fact that our patients receive this consultancy service not only from a patient coordinator but also from a patient coordinator under the supervision of a doctor is a factor that increases success and is an element that patients should pay attention to.

It is crucial that the question of “How does egg supplementation work?” is answered before starting the treatment and that the patients fully understand the treatment method because patients’ full knowledge of the treatment processes will increase their compliance with the treatment and increase the chance of pregnancy. After the treatment decision, the patient’s medical examinations should be completed first. Then, the planned time interval for the treatment should be clarified because there will also be an egg donor who needs to be synchronised with the patient. The menstrual cycle of the selected donor should be synchronised with the patient’s cycle so that eggs can be produced from both patients simultaneously. The examinations that need to be completed before the treatment are not a bureaucratic requirement but rather a series of screenings in the preparation process of the female and male patients for pregnancy. The problems detected in these screenings should be corrected as much as possible before the treatment, and the possibility of an additional setback should be minimised by taking the necessary precautions. For this reason, the treatments of both our patients and our donors are not started before their examinations and research are completed, and in this way, the success rate in our centre can be increased to a very high level.

The treatment stages of our patients whose examinations and research have been completed and whose suitability for treatment has been determined are explained in detail below:

The patient’s egg/oocyte development period: The period during which patients start treatment depends on the menstrual cycle of the female patient and the selected donor. Long- or short-protocol treatments can be arranged according to the patient’s medical conditions. In the short protocol treatment, the injections that stimulate the ovaries are started within the first five days of the menstrual period, and the maturation of the eggs is monitored. In the later days of the treatment, additional injections are added to keep egg development under control. In the extended protocol, the suppressive injection is started on the 21st day of the female patient’s previous menstrual period, and the injections that will stimulate egg development are started with the menstrual period. In egg development treatment, not only injections are used, but vitamins, antibiotics, hormone supplements, blood clotting, and various drugs for the immune system are also added to the treatment as needed.

Some injections that develop eggs or control ovulation are administered intramuscularly, and some are administered directly under the skin (subcutaneous). Since the needles administered subcutaneously are very small, can be easily applied to the belly or arm area, and the possibility of incorrect application is low, they can be administered by patients after a short training. Intramuscular injections are usually administered from the hip and should be administered by medical personnel.

During the treatment process, the patient’s egg development should be monitored at certain intervals, and medication adjustments should be made at the necessary times because each patient is different from the other. It is a known fact that personalised treatments increase success. Our female patient is asked to have a vaginal ultrasound at specific intervals in the determined treatment program. The reason for the ultrasounds to be performed vaginally is that the follicles, or small egg cysts, can be measured much more clearly, and much more precise decisions can be made. The risk of incorrect measurement is high since the image will be quite blurry and small in ultrasounds viewed abdominally. As a result of the vaginal ultrasounds performed, the growth rate of the follicles is monitored, and the necessary adjustments are made. In addition to monitoring egg development, the endometrium’s maturation, the uterus’s inner wall, is also measured and monitored. Since the egg-enhancing drugs used are hormonal in structure, they will also stimulate the maturation of the endometrium, and the endometrium will be ready for pregnancy.

Since most of our patients live outside of Cyprus, they prefer to have their examinations during the follicle and endometrium monitoring process with their local doctors. As long as the measurements are correctly done, the treatment will not be disrupted since our doctor manages the entire process, and medication adjustments are made accordingly. Nevertheless, when the end of the egg development treatment is approached, at least the final examination is done by our doctor before egg collection. If any additional precautions need to be taken, they can be taken. In this way, the time our patients need to stay in Cyprus is shortened. Nevertheless, our doctor provides all our patients who want the entire treatment monitoring process done in our centre with follicle monitorisation without any additional charge.

In the follow-ups of egg development treatments, patients whose follicles, or egg cysts, have matured are planned to have a trigger injection as a result of the final examination by our doctor, and the eggs are collected within 34-36 hours following this shot. The timing of the egg collection process is another factor that determines success. In early collections, eggs may not be collected; in late collections, eggs will not be found because the follicles have ruptured. For this reason, having our doctor perform the final check-up of our patients before the trigger injection and planning the timing increases our success.

Egg development and egg collection in egg donors: Since the patient needs to have supplemental eggs developed, the egg donor starts the egg development treatment at the same time as the patient by synchronising their menstrual cycle. In recent years, in cases where it is difficult to find a suitable donor or in patients whose menstrual cycles are not very regular, to provide an egg guarantee, eggs are collected from the selected donor in advance and stored either as eggs or as embryos by fertilising them with the sperm of the male patient until the patient’s treatment. This situation can be preferred because it ensures that the donor’s menstrual cycle is not disrupted due to the need for synchronous movement and increases success in selected patient groups. Donors with mature egg follicles created with egg development treatment are given a trigger injection at the planned time interval, just like our patients, and the eggs are collected under light anaesthesia at the specified time. Egg donation does not harm the donor’s ovarian reserve. For this reason, donors can continue their everyday lives by continuing the necessary follow-ups following donation.

All treatment processes of our egg donors are carried out in our centre; in this way, the best efficiency is obtained from the donor in a controlled manner, and safety is maximised. Our aim here is to maximise success by keeping the health of our patients and donors. Our doctor makes donor selections; donor candidates between the ages of 21 and 29 are preferred, donors who donate frequently are not selected, recombinant drugs used by the same patients are used on donors and in this way, success is maximised.

Collection of our patient’s eggs: Egg collection is performed under light anaesthesia, i.e. sedoanalgesia. In this way, the patient is both asleep and does not feel pain, and since they have not received deep anaesthesia, they wake up immediately after the procedure. The quality and duration of the egg collection procedure takes between 10 and 20 minutes depending on the number of eggs to be collected, the experience of the doctor and the condition of the ovaries. Especially in our patients with low ovarian reserve, the doctor’s expertise and equipment are crucial in collecting the maximum yield and eggs from the follicles (egg cysts). After our female patient is asleep under light anaesthesia, our doctor cleans the patient’s genital area, reaches the ovaries in the abdomen through the vagina with an egg collection needle specially selected for the patient and collects the eggs one by one under ultrasound assistance. The collected eggs are simultaneously transferred to the embryology laboratory one by one. The procedure is terminated after all matured eggs are collected. Just before the patient is awakened, our doctor performs a trial catheter test to decide which catheter will be suitable for the patient during the transfer to reach the inner wall of the uterus. In this way, it is determined which catheter will give the patient the best result on the embryo transfer day.

Fertilisation of eggs: One of the most frequently asked questions is how the fertilisation of the patient’s and donor’s collected eggs is performed and monitored. After the donor’s and patient’s eggs are rested in separate places, the cells around them are cleaned, and fertilisable eggs are detected. Only eggs at the M2 development level can be fertilised at this stage. M1 eggs are not yet ready to be fertilised but are very close to maturing and reaching M2 quality. These eggs are monitored, and if they reach M2 maturity, they are fertilised. GV-type eggs have not matured and cannot be used in fertilisation. In the anomaly or postmature type, either the egg has an abnormal appearance or is old and, therefore, unhealthy, and these eggs are not used in the fertilisation process. When using donor eggs for the patient, the best quality and structured eggs are always used, and thus, the patient’s good quality embryo count is kept at the highest level.

In this treatment method, the sperm of the male patient is used. Before all sperm collection procedures, the male patient is asked to abstain from sexual intercourse for 2 to 4 days because this abstinence period provides the best results. When eggs are collected from the female patient and the donor, the male patient provides a sperm sample at the same time and the unused portion is destroyed unless there is a special freezing request. The timing of the sperm-providing procedure is adjusted in such a way that the patients and the donor cannot meet for the safety of both our patients and the donor.

The sperm sample taken is first washed and then concentrated and examined. In our tandem cycle treatments, the ICSI procedure is routinely used to increase the success of the treatment. In this way, the best sperm selected, those with the best structure and motility, are injected into the eggs individually. In this way, the sperm does not make an effort to enter the egg, and better sperm can be selected for fertilisation. As a result, the fertilisation success of the eggs is higher than that of self-fertilised eggs.

Embryo development (embryo culture): Fertilisation control is performed at a specific time interval the day after fertilisation, and the number and quality of fertilisation are recorded. While 2 PN is a sign of healthy fertilisation, 1 PN or 3 PN are signs that fertilisation may be unhealthy. Fertilisation may not be observed at all in some eggs. The rate of healthy fertilisation depends on the preparation process and egg quality of the female patient, the preparation process and egg quality of the donor, the sperm quality of the male patient and laboratory conditions. During this process, our accepted oocyte or egg donors are followed up directly by a doctor at our centre and, like all our patients, are treated with the best quality medications. In this way, our donors, who already have the best features, are ensured to receive correct and highest quality treatment, increasing the eggs’ fertilisation success.

The formed embryos, whose fertilisation is monitored, are regularly looked after and monitored in our specific laboratory with a particular living and nutritional environment. Of the embryos whose development is monitored, the ones with good quality develop well, while the development of the embryos with poor quality usually remains underdeveloped. The monitoring of the process in the IVF laboratory should be done very meticulously. For this reason, the embryologist monitors this process closely and shares the information obtained with the doctor and patients daily. The donor is not informed about the embryos or patients in any way after the donation following the donation procedure.

While the embryo development process continues, our female patient is started on additional hormone supplements in the form of pills, gels, injections or suppositories to help the endometrium, the inner wall of the uterus, mature. The choice and dosage of drugs are determined according to the patient’s clinical information.

Embryo transfer: When the embryos are ready for transfer, the embryo transfer procedure is performed. This procedure is easy and painless if no cervical shape problem or narrowness exists. Therefore, it does not require anaesthesia. Since embryo transfer is an emotional and memorable moment, if there is no medical reason, the patient being awake during the embryo transfer is motivating for the patient and can positively affect the success of the pregnancy. Therefore, anaesthesia is applied only when necessary in embryo transfer procedures at our centre.

An infertility specialist performs the embryo transfer procedure. In this procedure, the embryo or embryos selected through the most suitable catheter passed through the cervix are transferred to the most appropriate place in the endometrium or the intrauterine cavity. Embryo transfer can be performed between embryo development’s first and sixth days. However, the embryo development days that provide the best pregnancy success are the third and fifth days. As long as the embryos remain in the external environment during the development process, the development of the weak ones usually lags, and the strong ones generally continue their development. Although this is a situation that positively affects pregnancy, sometimes embryos with a chance of pregnancy can be lost, and this situation can negatively affect the chance since it reduces the number of embryos. In tandem cycle treatment, embryo follow-up is performed separately for those obtained from the patient’s eggs and those obtained from the donor. Important decisions such as which embryos will be transferred in the transfer and on which day of development this transfer will be made are made by considering both the condition of the embryos, the patient’s clinical condition and expectations. During the decision-making process, the doctor, embryologist and patient are interviewed, and decisions are made together to achieve the healthiest results for the patients.

Another issue in embryo transfer is how many embryos will be transferred. In many countries, this limit is 1 or 2. According to the TRNC laws, a maximum of three embryos can be transferred because multiple transfers increase the risk of multiple pregnancies. In addition, the chance of pregnancy increases as the number of embryos transferred increases. For this reason, when deciding how many embryos will be transferred to patients, both the chance of pregnancy and the risks should be calculated. For this, the decision is made together with the doctor and the patient after the discussions between the patients regarding the number and quality of embryos, their clinical conditions, and the patient’s expectations. Patients prefer Cyprus to make decisions more efficiently and have more options during this process.

On the day of embryo transfer, the embryos planned to be transferred are placed in embryo glue without any additional charge. Thanks to this liquid, the chances of embryos adhering are increased, and the possibility of pregnancy is further increased. In addition, assisted hatching is applied to suitable embryos free of charge before embryo transfer. Assisted hatching is thinning the embryo membrane from a certain point with a special laser and increasing the chance of the embryo adhering after transfer.

Since we guarantee our patients excellent quality and number of eggs as supplementation in our centre, if there is no problem with the sperm of our male patient, our patients usually have many first-quality embryos, and it is possible to store these remaining good embryos after the transfer. Storing these embryos on behalf of our patients after the approval of our patients provides a much more accessible treatment for a second baby if pregnancy is achieved. If pregnancy is not achieved, it offers our patients a much easier second chance.

The duration of the treatment is decided according to the treatment protocols of the patient and the donor. The menstrual cycles of our patient and the donor can be synchronised for the treatment, or the treatment can be done with mature and ready eggs. Patients who receive short protocol treatment lasts 17 to 21 days. In patients who receive long protocol treatment, the treatment starts before menstruation; therefore, it lasts an average of 24 to 28 days, including the medication usage period. Since most of our patients live outside Cyprus, the first part of the treatment can be done where the patients are to shorten their time in Cyprus. Our doctor, who evaluates the results of this first part, which includes medication use and ultrasound follow-up, can arrange our patients’ medications remotely.

In addition to treating our female patient, the donor receives egg development treatment and is monitored by our doctor. When the donor’s eggs mature, they are collected by our doctor, and the eggs obtained are added to the treatment of our patients.

After our female patient’s eggs and uterine lining have matured, she comes to Cyprus and all the procedural parts of the treatment are completed here. In this way, the time patients need to be in Cyprus will be between 7 and 9 days, depending on the day of embryo transfer.

The first conditions sought for acceptance of donors are the criteria determined by the TRNC Ministry of Health. We also have additional conditions in our centre that will increase the chance of pregnancy. To become a donor, the legal criterion is to be between the ages of 20-35 and to keep the egg quality at the highest level; priority is given to donor candidates between the ages of 20-29 in the evaluations made by our doctor.

Another analysis performed on donors is genetic research. First, after a detailed family history is taken, the donor’s chromosome number analysis (karyotyping) and screening for some genetic diseases, such as Thalassemia and Sickle Cell Anemia, which may be more common in the region, are performed. Suppose there is a suspicion of an additional problem in the history. In that case, further screening is performed for these conditions, and only people found to be completely healthy are accepted as donors.

Another issue that needs to be done for donor candidates is infectious disease screening. Although the majority of our donors are university students, all candidates are routinely screened for infections such as Hepatitis B, C, HIV and Syphilis, and only donors with negative infection tests are treated.

Before donation, all candidates are also interviewed by our infertility specialist. In this interview, a detailed medical history is taken, a thorough psychological analysis is done, a gynaecological examination is performed, and some primary analyses such as blood type are completed. Only candidates with expected results can be accepted as donors.

The purpose of all these evaluations is to protect both the donor’s health and the safety of our patients. For this reason, all these analyses and assessments made by our doctor are kept in the patient file, and this archive information is carried out in coordination with the Ministry of Health.

In all our donation treatments, we show care and attention to the donor candidates in a way that benefits the sensitivity of this particular donation they want. We use the same quality medicines and treatment methods as our patients. This way, we achieve the highest success in oocyte or egg donations and guarantee our donors’ health.

Donor selection is a situation that must be carried out with care. Due to the sensitivity of the situation, collecting all information about the donor, matching the donor with the patient, and having the same infertility specialist treat both the patient and the donor will maximise the reliability and success of the treatment.

Another critical issue in egg donation is choosing the donor and synchronising it with the patient receiving the treatment. Although the donor has passed all the tests and analyses, other factors are also crucial in choosing a suitable donor. One of these is that the female patient’s physical characteristics are compatible with the donor’s. While half of the embryos to be created with the donation are genetically transmitted from the male patient, the other half will be transmitted from the donor. For this reason, the compatibility of the donor’s physical characteristics with our female patient will help the child to be very similar to our female patient. The primary characteristics that are looked at for compatibility are skin colour and tone, eye colour, hair colour and type, race, face shape, body structure and height. In the TRNC, the relevant law requires the donor to be completely anonymous. For this reason, donor photos cannot be shared with patients to ensure the safety of both the patient and the donor. The most suitable donors among those who will be most ideal for the patient’s physical characteristics are determined by the doctor, and the decision is made by communicating the essential physical characteristics with the patients verbally or in writing.

Another feature that is taken into consideration for donors to be compatible with patients is their blood type. The compatibility of the child’s blood type with the mother or father prevents future problems in terms of blood donation if necessary. Also, it prevents parents who will not share their donation information with their children from getting into a difficult situation. Despite all this, the compatibility of the donor’s blood type with our patients is not a feature that increases the success of the treatment, and even if the blood type is not compatible, if the patient wishes, treatment can be applied with a donor of a different blood type with the patient’s consent.

Other characteristics of donors that are also evaluated are social characteristics such as personality, education level, and profession, and the compatibility of these characteristics should be considered as much as possible when making the selection.

Another feature that should be considered for menstruating patients is the menstrual dates of the donor and the patient. In treatments where fresh eggs are used, the donor and the patient must have their menstrual period simultaneously and receive treatment. In patients who do not menstruate, the treatment is planned according to the menstruation of the selected donor. In the treatments performed in our centre, to increase the success of the treatment, the menstrual patterns of the donors are not changed too much because the chance of obtaining maximum quality eggs from a donor whose ovulation cycle is not altered increases. Therefore, the synchronisation of patients with incompatible menstrual patterns with the donor should either be completed in a long time, or another donor should be offered to the patient.

With the egg development treatment given to donors, several eggs are organised to be collected. To obtain the desired quality and number of eggs, paying attention to some factors is necessary. These are the age of the donor, the donor’s ovarian reserve, the resting time of the donor’s ovaries, the quality of the donor’s follow-up and treatment, the quality and correct use of the egg development drugs used for the donor, and the donor’s compliance with the treatment. The proper selection of these variables will increase the success rates to the highest level. All these parameters are carefully evaluated in our centre, and our infertility specialist doctor personally organises all the donors’ treatments and the most appropriate treatments for both our donors and our patients. Especially in tandem cycles, it is aimed at increasing the patient’s chance of pregnancy with the donated eggs they will receive in addition to their eggs. In this way, our patients are guaranteed to obtain eggs in a quantity and quality that will exceed their needs. In our centre, with donor eggs that guarantee the need and even provide more than the need, if no problem is observed with the sperm, more embryos than the need can be obtained, and good quality embryos can be stored after the treatment and that will allow a second treatment are provided. In this way, our patients have two treatment opportunities: they either have a second chance with a very suitable treatment opportunity or have the option of having a sibling for their children.

Since both the patient’s and donor’s eggs are used in tandem cycle treatment, some of the embryos created carry the genetics of both the female and male patient. In contrast, others have only the genetics of the male patient and donor. Therefore, when choosing a donor, paying close attention to the physical similarity between our female patient and the donor will help all babies resemble our female patient. During the embryo transfer period, our patients, our doctor and our embryologist decide which embryos will be transferred together.

As with all IVF processes, the aftermath of tandem cycle IVF treatment is as important as the treatment itself. Certain precautions will increase success. For this reason, continuing to support our patients after treatment and during the treatment process will be very important.

The main factors affecting the success of the treatment in egg-augmented in vitro fertilisation treatment are the ovarian reserve of the female patient, the sperm count and quality of the male patient, the ovarian reserve and quality of the donor, the age of the donor, the quality of the treatment applied to the donor, the thickness of the inner wall of the female patient’s uterus and the structure of the uterus, the stress level of our couple and their compliance with the treatment, the technical competence of the doctor and embryologist, the working conditions of the laboratory and the number and quality of the embryos transferred. Since many of these variables will be clear before the transfer, it is essential for the patients to use their medications as recommended and to stay calm by staying away from stress after the transfer. It is known that staying away from stress increases the success of pregnancy in patients.

One of the questions people wonder about after treatment is how long it is necessary to lie down. It has been proven that lying down for more than one or two hours after embryo transfer is ineffective in increasing success. Lying down constantly can decrease pregnancy success because it increases stress in the patient. What patients need to do is to take into account the recommendations of their doctor, be as active as a potential pregnant woman, and not lie down constantly unless there is a particular situation.

Foods that should not be consumed after treatment are another critical issue. Consumption of substances such as sage, green tea, coffee and cola is not recommended during pregnancy, nor is it recommended after our IVF treatment. In addition, not consuming foods that cause bloating will increase the patient’s comfort.

On the 12th day following the embryo transfer, a pregnancy test, namely B-HCG, is checked in the blood to see if the pregnancy has occurred. If pregnancy has occurred, the pregnancy test can be positive before the recommended date, but it is still not recommended to do the test earlier. The reason for this is that the trigger injection applied before the egg collection procedure in our patient’s treatment also caused the test to be falsely positive and caused the test result to be misinterpreted. In addition, even if pregnancy has occurred in tests performed before the specified date, since the test may not have become positive yet, it may cause unnecessary sadness. It may cause a miscarriage as a result of stopping the treatment. Our patient must share the test result performed on the recommended day with her consultant or doctor. Every positive test result performed on this date means pregnancy. The positive test value is recorded, and the test is requested to be repeated two days later. This is to determine the rate of increase in the test and whether it is compatible with a healthy pregnancy. In the test two days later, a doubling is usually observed compared to the first value, but an increase of at least 66% will be sufficient to show a healthy increase.

All patients with a positive pregnancy test result should continue taking their current medications. Our doctor will evaluate the test results, make the necessary adjustments to medication use, and make medically essential recommendations.

As with all IVF treatments, there is a risk that pregnancy will not occur in tandem cycle IVF treatment. If the patient has a negative result in the first test, a repeat test may be requested if necessary. Patients whose test results are confirmed to be negative are asked to stop taking their medications. In patients with treatment failures, the patient files are examined in detail, a detailed analysis is made as to why pregnancy was not achieved, and measures that can be taken before the next attempt are determined to increase pregnancy success.

In Cyprus, both regular IVF treatment and egg donation are entirely legal. The legal regulations regarding these treatments have been prepared to protect the patient under the relevant laws and regulations so our patients can easily have these treatments. In addition, our centre has no marriage requirement, and we register our patients who apply as a couple. Since there is no marriage requirement for IVF treatments in the TRNC, our patients from all over the world come to Cyprus for treatment.

In our treatment, we use the sperm of our male patient to fertilise both our patient’s eggs and the donor’s eggs, and we legally record the resulting embryos under the name of our couple.

Patient confidentiality is another vital element in egg supplement treatment. As in all our treatments, we maintain complete patient confidentiality in this treatment and do not share any patient or donor identification information or treatment details. The strict control in our centre in this regard is to ensure that neither the family can identify the donor nor the donor can identify the family. This way, we can treat our patients and donors with complete confidence. In addition, this information is not shared with third parties because most of our patients want the treatment they receive to remain confidential. Our patients’ natural sensitivities are fully considered, and treatments are carried out under the principle of confidentiality.

Another legal issue regarding egg supplementation is the screening of the donor. It is mandatory that all screenings determined by the Ministry of Health are completed before accepting the donor and that the donor is found to be healthy. All infection screenings, genetic screenings, psychological evaluations and primary analyses such as blood type determined by the Ministry of Health are performed in all donor applications in our centre, and egg donations are received only from suitable donors.

Due to the law, we cannot share information on the tandem cycle price on our website. You can contact us for detailed information.