Fertility Services

Our Fertility Services offer comprehensive diagnosis and treatment for couples and individuals struggling to conceive. With advanced reproductive technologies and personalised care, we help you achieve your dream of starting or growing your family.

Our Fertility Services

  • Initial fertility assessment
  • Ovulation induction
  • Intrauterine insemination (IUI)
  • In vitro fertilisation (IVF)
  • Intracytoplasmic sperm injection (ICSI)
  • Frozen embryo transfer (FET)
  • Blastocyst culture and transfer
  • Assisted hatching
  • Male fertility treatments
  • Fertility preservation

When to Seek Fertility Help

Consider a fertility consultation if:

  • You’ve been trying to conceive for 12 months without success (if under 35)
  • You’ve been trying for 6 months without success (if 35 or over)
  • You have irregular or absent periods
  • You have a known fertility condition (endometriosis, PCOS)
  • You have a history of recurrent miscarriage
  • You or your partner have a known medical condition affecting fertility
  • You’re planning pregnancy after cancer treatment
  • You want to preserve your fertility for the future

Initial Fertility Assessment

For Women

Medical history:

  • Menstrual cycle regularity
  • Previous pregnancies
  • Medical conditions
  • Surgical history
  • Medications

Investigations:

  • Hormone blood tests (FSH, LH, AMH, oestradiol, prolactin, thyroid)
  • Pelvic ultrasound (antral follicle count, uterine assessment)
  • Tubal patency test (HyCoSy or HSG)
  • Hysteroscopy if indicated

For Men

Medical history:

  • Previous pregnancies fathered
  • Medical conditions
  • Medications
  • Lifestyle factors

Investigations:

  • Semen analysis (sperm count, motility, morphology)
  • Hormone tests if indicated
  • Ultrasound if indicated
  • Genetic testing if indicated

Ovulation Induction

What Is It?

Ovulation induction uses medication to stimulate the ovaries to produce eggs in women who don’t ovulate regularly or at all.

Who Is It For?

  • Women with irregular or absent periods
  • Women with polycystic ovary syndrome (PCOS)
  • Women with unexplained infertility (with timed intercourse)

Medications Used

Clomiphene citrate (Clomid):

  • Oral medication taken for 5 days early in the cycle
  • Stimulates the pituitary gland to release FSH
  • First-line treatment for anovulation

Letrozole:

  • Oral medication, alternative to clomiphene
  • Often used for PCOS
  • May have better outcomes for some women

Gonadotropins (FSH injections):

  • Injectable hormones
  • Used when oral medications don’t work
  • More powerful stimulation
  • Requires careful monitoring

Monitoring

  • Ultrasound scans to track follicle development
  • Blood tests to monitor hormone levels
  • Timing of intercourse or insemination

Risks

  • Multiple pregnancy (twins or more)
  • Ovarian hyperstimulation syndrome (OHSS)

IUI (Intrauterine Insemination)

What Is IUI?

IUI is a fertility treatment where prepared sperm is placed directly into the uterus around the time of ovulation, giving sperm a better chance of reaching the egg.

Who Is IUI Suitable For?

  • Unexplained infertility
  • Mild male factor infertility
  • Cervical factor infertility
  • Ovulation disorders (combined with ovulation induction)
  • Ejaculation difficulties

The IUI Process

1. Ovarian stimulation (if needed)

  • Medications to stimulate egg development
  • Monitoring with ultrasound and blood tests

2. Trigger injection

  • hCG injection to trigger ovulation
  • Timing is carefully planned

3. Sperm preparation

  • Semen sample collected
  • Sperm washed and concentrated
  • Best quality sperm selected

4. Insemination

  • Prepared sperm inserted through the cervix into the uterus
  • Quick procedure (5-10 minutes)
  • Similar to a smear test
  • Usually painless

5. Pregnancy test

  • Approximately 2 weeks after insemination

Success Rates

  • 10-20% per cycle (varies by age and diagnosis)
  • Usually recommended for 3-6 cycles before considering IVF
  • Cumulative success rates improve with multiple cycles

Advantages

  • Less invasive than IVF
  • Lower cost than IVF
  • Minimal medication (can be done in natural cycle)
  • No egg collection procedure required

IVF (In Vitro Fertilisation)

What Is IVF?

IVF is an assisted reproductive technology where eggs are collected from the ovaries and fertilised with sperm in a laboratory. The resulting embryos are then transferred to the uterus.

Who Is IVF Suitable For?

  • Blocked or damaged fallopian tubes
  • Severe male factor infertility
  • Endometriosis
  • Unexplained infertility (after failed IUI)
  • Advanced maternal age
  • Genetic testing requirements (PGT)
  • Previous failed fertility treatments
  • Using frozen eggs or embryos

The IVF Process

1. Ovarian stimulation (8-14 days)

  • Daily hormone injections to stimulate multiple eggs
  • Regular monitoring with ultrasound and blood tests
  • Dose adjustments as needed

2. Trigger injection

  • hCG or GnRH agonist injection
  • Given when follicles are mature
  • Egg collection scheduled 34-36 hours later

3. Egg collection (egg retrieval)

  • Minor procedure under sedation
  • Ultrasound-guided needle aspiration
  • Takes 15-30 minutes
  • Recovery for 1-2 hours

4. Fertilisation

  • Eggs and sperm combined in the laboratory
  • Conventional IVF or ICSI
  • Fertilisation checked the next day

5. Embryo culture

  • Embryos monitored for 3-6 days
  • Development assessed daily
  • Best embryos selected for transfer

6. Embryo transfer

  • Simple procedure (no anaesthesia needed)
  • Embryo(s) placed in the uterus using a thin catheter
  • Takes 5-10 minutes
  • Rest briefly, then go home

7. Luteal phase support

  • Progesterone supplementation
  • Supports the uterine lining
  • Continues until pregnancy test (and beyond if positive)

8. Pregnancy test

  • Blood test approximately 11-14 days after transfer

IVF Protocols

We offer various stimulation protocols tailored to your individual needs:

Long Agonist Protocol

How it works:

  • GnRH agonist (e.g., Buserelin, Lupron) started in the luteal phase (day 21) of the previous cycle
  • Agonist “downregulates” the pituitary gland, preventing premature ovulation
  • Stimulation with gonadotropins begins once downregulation is confirmed
  • Continues until trigger injection

Best suited for:

  • Normal ovarian responders
  • Women with regular cycles
  • When precise control of ovulation timing is needed

Advantages:

  • Well-established protocol with predictable response
  • Good synchronisation of follicle development
  • Flexible scheduling

Duration: Approximately 4-5 weeks

Short Agonist Protocol (Flare Protocol)

How it works:

  • GnRH agonist started on day 1-2 of the cycle
  • Initial “flare” effect stimulates natural FSH release
  • Gonadotropins added shortly after
  • Uses the body’s natural hormone surge

Best suited for:

  • Poor ovarian responders
  • Women with low ovarian reserve
  • Older women

Advantages:

  • Shorter treatment duration
  • May improve response in poor responders
  • Uses natural FSH boost

Antagonist Protocol

How it works:

  • Stimulation with gonadotropins starts on day 2-3 of the cycle
  • GnRH antagonist (e.g., Cetrotide, Ganirelix) added when follicles reach 12-14mm
  • Antagonist prevents premature LH surge and ovulation
  • Continues until trigger injection

Best suited for:

  • High responders (PCOS)
  • Women at risk of OHSS
  • Poor responders
  • Most patients in modern IVF

Advantages:

  • Shorter treatment time (10-14 days)
  • Lower risk of ovarian hyperstimulation syndrome (OHSS)
  • More patient-friendly (fewer injections initially)
  • Can use GnRH agonist trigger (further reduces OHSS risk)

Duration: Approximately 2-3 weeks

Natural Cycle IVF

How it works:

  • No stimulation medications
  • Single egg develops naturally
  • Careful monitoring to catch ovulation

Best suited for:

  • Women who cannot use hormonal stimulation
  • Those who prefer a natural approach
  • Repeated poor response to stimulation

Considerations:

  • Lower success rates per cycle
  • Risk of cycle cancellation if egg is lost
  • May need multiple cycles

Mild Stimulation IVF

How it works:

  • Lower doses of gonadotropins
  • May combine with oral medications (Clomid/Letrozole)
  • Aims for 3-6 eggs

Best suited for:

  • Women concerned about OHSS
  • Those preferring a gentler approach
  • Cost-conscious patients

Advantages:

  • Fewer eggs but potentially better quality
  • Reduced side effects
  • Lower medication costs

Time-Lapse Embryo Monitoring

What Is Time-Lapse?

Time-lapse technology uses a specialised incubator with a built-in camera that takes images of embryos every 10-20 minutes throughout their development. This creates a continuous video of embryo development without disturbing the culture environment.

How Does It Work?

  • Embryos remain in a stable, undisturbed environment
  • Camera captures thousands of images over 5-6 days
  • Software analyses development patterns
  • Embryologists review detailed developmental history

Benefits of Time-Lapse

Improved embryo selection:

  • Identifies embryos with the best developmental potential
  • Detects abnormal development patterns not visible in standard assessment
  • Provides additional selection criteria beyond appearance

Undisturbed culture:

  • Embryos stay in optimal conditions continuously
  • No need to remove embryos from incubator for daily checks
  • Stable temperature, humidity, and gas levels

Detailed information:

  • Complete developmental timeline
  • Timing of cell divisions
  • Detection of abnormalities (multinucleation, reverse cleavage)
  • Better prediction of blastocyst development

Documentation:

  • Video record of your embryos’ development
  • Can be shared with you to show your embryos growing

Who Benefits Most?

  • Patients with multiple good-quality embryos (helps select the best)
  • Previous failed cycles (may identify embryo quality issues)
  • Patients undergoing single embryo transfer
  • Those wanting additional reassurance about embryo selection

ICSI (Intracytoplasmic Sperm Injection)

What Is ICSI?

ICSI is a specialised form of IVF where a single sperm is injected directly into each egg to achieve fertilisation. It’s used when standard IVF fertilisation may not be successful.

Male factor infertility:

  • Very low sperm count
  • Poor sperm motility
  • Abnormal sperm morphology
  • Sperm retrieved surgically (PESA, TESA, micro-TESE)
  • High sperm DNA fragmentation

Other indications:

  • Previous failed fertilisation with standard IVF
  • Low number of eggs collected
  • Using frozen sperm
  • Using frozen eggs
  • Preimplantation genetic testing (PGT)

The ICSI Process

  1. Eggs collected as in standard IVF
  2. Mature eggs identified
  3. Single sperm selected for each egg
  4. Sperm injected directly into the egg
  5. Fertilisation checked the next day
  6. Embryo culture and transfer as standard IVF

Success Rates

  • ICSI fertilisation rates: 70-80%
  • Pregnancy rates similar to conventional IVF
  • Particularly beneficial for severe male factor

Blastocyst Culture and Transfer

What Is Blastocyst Transfer?

Blastocyst transfer involves growing embryos in the laboratory until day 5-6 (blastocyst stage) before transfer, rather than transferring on day 2-3.

Advantages

  • Better embryo selection (strongest embryos reach blastocyst)
  • Higher implantation rate per embryo
  • Allows single embryo transfer (reduces multiple pregnancy risk)
  • Better synchronisation with the uterus
  • Allows time for genetic testing (PGT)

Considerations

  • Not all embryos reach blastocyst stage
  • Risk of no embryos for transfer (if all arrest)
  • May not be recommended if few embryos available

Frozen Embryo Transfer (FET)

What Is FET?

FET uses embryos that were frozen from a previous IVF cycle and thawed for transfer in a subsequent cycle.

When Is FET Used?

  • Excess embryos from fresh IVF cycle
  • All embryos frozen (freeze-all strategy)
  • After preimplantation genetic testing
  • After failed fresh transfer
  • For fertility preservation

FET Protocols

Natural cycle FET:

  • Transfer timed with natural ovulation
  • No or minimal medications
  • Suitable for women with regular cycles

Hormone replacement (HRT) cycle:

  • Oestrogen and progesterone given to prepare the lining
  • More control over timing
  • Suitable for irregular cycles

Stimulated cycle:

  • Mild ovarian stimulation
  • Transfer timed with ovulation

Success Rates

  • FET success rates are now comparable to or better than fresh transfers
  • Vitrification technology has significantly improved embryo survival (>95%)

Surgical Sperm Retrieval

For men with no sperm in the ejaculate (azoospermia), sperm can be retrieved surgically:

PESA (Percutaneous Epididymal Sperm Aspiration)

  • Needle aspiration from the epididymis
  • Used for obstructive azoospermia
  • Local anaesthesia
  • Quick procedure

TESA (Testicular Sperm Aspiration)

  • Needle aspiration from the testicle
  • Used when PESA unsuccessful
  • Local anaesthesia

Micro-TESE (Microscopic Testicular Sperm Extraction)

  • Surgical retrieval under microscope
  • Used for non-obstructive azoospermia
  • Best chance of finding sperm in difficult cases
  • General anaesthesia required

Assisted Hatching

What Is It?

Assisted hatching is a laboratory technique where a small opening is made in the outer shell (zona pellucida) of the embryo to help it “hatch” and implant.

When Is It Used?

  • Older women (over 38)
  • Thickened zona pellucida
  • Previous failed implantation
  • Frozen embryos

Success Rates

Success rates depend on many factors:

Factors Affecting Success

Female age:

  • Under 35: Highest success rates
  • 35-37: Good success rates
  • 38-40: Declining success rates
  • Over 40: Significantly reduced success rates
  • Over 43: Very low success rates with own eggs

Other factors:

  • Cause of infertility
  • Ovarian reserve (AMH, AFC)
  • Sperm quality
  • Number and quality of embryos
  • Uterine factors
  • Lifestyle factors
  • Previous treatment history

Our Approach to Success

  • Individualised treatment protocols
  • Advanced laboratory techniques
  • Experienced embryology team
  • Comprehensive support throughout treatment
  • Continuous improvement and monitoring of outcomes

Emotional Support

We understand that fertility treatment can be emotionally challenging:

  • Counselling services available
  • Support at every stage of treatment
  • Clear communication about progress
  • Realistic expectations discussed
  • Resources and support groups

Your Fertility Journey With Us

Step 1: Initial Consultation

  • Review of medical history
  • Discussion of concerns and goals
  • Initial investigations arranged

Step 2: Diagnosis

  • Results reviewed
  • Diagnosis explained
  • Treatment options discussed

Step 3: Treatment Planning

  • Personalised treatment plan created
  • Timeline and process explained
  • Consent and preparation

Step 4: Treatment

  • Close monitoring throughout
  • Accessible support team
  • Adjustments as needed

Step 5: Outcome

  • Pregnancy test and follow-up
  • Early pregnancy monitoring if successful
  • Review and next steps if unsuccessful

Frequently Asked Questions

How long does IVF take? One IVF cycle takes approximately 4-6 weeks from the start of medication to pregnancy test.

Is IVF painful? Injections may cause mild discomfort. Egg collection is done under sedation and is not painful. Embryo transfer is usually painless.

How many embryos should be transferred? We recommend single embryo transfer in most cases to reduce the risk of multiple pregnancy. This is discussed individually based on age, embryo quality, and history.

What are the risks of IVF? Main risks include ovarian hyperstimulation syndrome (OHSS), multiple pregnancy, and emotional stress. These are carefully managed with monitoring and protocols.

Can I work during IVF? Most women can continue working during IVF. You may need time off for monitoring appointments and 1-2 days rest after egg collection.

What if IVF doesn’t work? We review each cycle to understand what happened and discuss options for next steps, which may include another cycle with protocol adjustments, different approaches, or alternative family building options.

Book a Consultation

If you’re ready to explore your fertility options or have been trying to conceive without success, our team is here to help. Contact us at info@salamivf.com or call +973 1725 5095 to schedule your fertility consultation.