IVF With Own Eggs: A Beginner’s Guide

IVF with your own eggs involves collecting eggs from the ovaries, fertilising them in a laboratory, and transferring resulting embryos into the uterus. This process may be recommended in several situations, and outcomes can depend on factors such as age, embryo quality, and individual medical history.

This guide is based on the webinar “IVF with Own Eggs: A Beginner’s Guide,” presented by Dr Harry Karpouzis, Founder and Scientific Director of IVF Pelargos Fertility Group.

Watch the full webinar here

Summary

• IVF involves fertilising eggs outside the body and transferring embryos into the uterus
• ICSI is used in specific situations, particularly when fertilisation risk is higher
• IVF is recommended in defined clinical scenarios (e.g., blocked tubes, male factor infertility, age-related decline)
• Success depends on age, egg number, embryo quality, and lab conditions
• Many interventions and add-ons remain selective, conditional, or not fully proven
• All treatment decisions are individualized

What Is IVF?

IVF (in vitro fertilisation) means fertilisation occurs outside the body in a laboratory.

Process:

• Eggs are collected from the ovaries
• Sperm is collected from the male partner
• Fertilisation occurs under controlled laboratory conditions
• Resulting embryos are transferred into the uterus

Remaining embryos can be frozen using vitrification, a fast-freezing method that does not compromise embryo quality.

IVF vs ICSI: Fertilisation Methods and Decision Logic

Two Approaches

Conventional IVF

• Eggs and sperm are placed together
• Fertilisation occurs naturally

ICSI (Intracytoplasmic Sperm Injection)

• A single sperm is injected directly into each egg

Decision Logic

• ICSI was originally developed for severe male factor infertility
• It is now commonly used even when sperm parameters are normal

If egg numbers are low:

• Failed fertilisation has a greater impact on the cycle
• ICSI may be preferred

If sperm quality is excellent and no hidden issues (such as DNA fragmentation or oxidative damage) are suspected:

• Conventional IVF may have advantages due to natural selection

In some cases:

• Eggs may be split between IVF and ICSI

Why IVF Is Used

IVF is recommended in specific clinical situations:

• Blocked fallopian tubes: natural conception is not possible
• Severe male factor infertility: low count, motility, or morphology
• Age-related fertility decline: reduced egg number and quality
• Endometriosis: IVF may offer the best chance of pregnancy
• Unexplained infertility: particularly after failed treatments
• PCOS: when ovulation induction or IUI has not worked

Treatment Positioning

• IVF is often advised after less invasive treatments fail
• In unexplained infertility with low ovarian reserve:
  • Current clinical guidance does not strongly support IUI
  • IVF may be more effective

When a Couple Is Considered Subfertile

• Under age 35: after 1 year of regular, unprotected intercourse without pregnancy
• Over age 35: after 6 months

Time-Sensitive Situations

• In older patients or when time is limited (for example, before cancer treatment):
  • IVF may be recommended earlier

When IVF Is the Most Appropriate Option

IVF is often selected when:

• IUI or other treatments have failed
• Both fallopian tubes are blocked
• Ovarian reserve is low in unexplained infertility
• Rapid conception is medically necessary

The IVF Process

1. Ovarian Stimulation

Hormonal medications (similar to FSH and LH) stimulate follicle growth.

Approaches include:

• Conventional injectable stimulation
• Semi-natural cycles (tablets)
• Natural cycles (no medication)

2. Egg Retrieval

• Performed under sedation
• Minor procedure
• Eggs are collected from follicles

3. Fertilisation and Embryo Culture

• IVF or ICSI is used
• Embryos are cultured in the laboratory
• Often grown to blastocyst stage (day 5) for better selection

4. Embryo Transfer: Fresh vs Frozen

Fresh transfer

• Occurs in the same cycle

Frozen transfer

• Occurs in a later cycle

Decision Logic

Freeze-all may be used if:

• PCOS with high hormone levels
• Elevated progesterone on trigger day
• Endometriosis
• Inadequate endometrial thickness

In these contexts:

• Frozen transfers may result in equal or better success rates

Personalised Stimulation

Treatment is individualized based on:

• AMH levels
• Antral follicle count
• Hormone levels during stimulation
• Ultrasound monitoring

Adjustable factors:

• Medication dose
• Timing
• Trigger choice
• Time between trigger and egg retrieval

All of these can affect egg maturity and outcomes.

Using Your Own Eggs

Benefits

• Genetic link to the child
• Emotional value of biological parenthood

Limitations

• Success depends strongly on age and ovarian reserve
• After age 40:
  • Egg quantity and quality decline significantly
  • Success per cycle is reduced

Preparing for IVF

Baseline Tests

• AMH
• Antral follicle count
• Thyroid function (TSH ideally < 2.5)
• FSH, LH, oestradiol
• Semen analysis
• Ultrasound (fibroids, polyps)

Additional Tests (Selective)

May be considered depending on history:

• Sperm DNA fragmentation
• Thrombophilia screening
• Immunological testing
• Hysteroscopy
• Microbiome analysis

What Determines IVF Success?

1. Number of Eggs Retrieved

Age-dependent expectations:

• Under 35: around 12 eggs
• 35–37: 15–20 eggs
• 38–40: around 20 eggs
• Age 40: often more than 20 eggs needed for one chromosomally normal embryo

Interpretation:

• Pregnancy is still possible with fewer eggs
• Statistically, higher egg numbers improve chances, especially with age

2. Embryo Quality and Laboratory Factors

Important variables:

• Embryo grading
• Embryologist expertise
• Lab quality
• Time-lapse technology

Some clinics:

• Use AI systems to assist embryo selection and implantation prediction

Understanding PGT-A

PGT-A tests embryos for chromosomal abnormalities via biopsy.

Typically Considered In:

• Women over 40
• Recurrent miscarriages
• Recurrent implantation failure

Effects and Limitations

• May reduce miscarriage risk
• May improve success per transfer
• Does not increase cumulative pregnancy rates

Uncertainty and Tradeoffs

• Biopsy carries a small risk of embryo damage
• Results may include:
  • Euploid
  • Aneuploid
  • Mosaic
• Mosaic embryos may still be transferable after genetic counselling
• Testing is not 100% accurate
• Some embryos classified as abnormal may still have resulted in pregnancy

When IVF Does Not Succeed

Further cycles are often required.

Additional Investigations May Include:

• Genetic testing
• Hysteroscopy
• Endometrial assessment
• Immunology
• Advanced sperm testing

Supportive Approaches

• Lifestyle modification
• Stress management
• Acupuncture

If Prognosis Remains Poor

• Egg donation
• Surrogacy

Looking to the Future

Emerging areas include:

• AI-based embryo selection
• Advanced endometrial testing
• PRP
• Mitochondrial therapies
• Stem cell research

Positioning:

• These approaches are evolving
• Some remain experimental or not fully proven

How many eggs are too risky during stimulation?

Severe hyperstimulation is now rare due to:

• Vitrification
• Freeze-all strategies
• Use of specific triggers

If hyperstimulation is suspected:

• All embryos are frozen

Medication doses can be adjusted
Estrogen levels and follicle numbers are monitored

Cycle cancellation due to high egg numbers is generally unnecessary today

Do you accept patients aged 55?

In Greece:

• Legal limit is 54
• Patients aged 55 and older cannot be treated

Can ICSI be harmful or less beneficial?

If sperm quality is excellent and no hidden issues are present:

• Conventional IVF may have advantages

If egg number is low or male factor exists:

• ICSI improves fertilisation and embryo development

Can illness affect egg quality?

• Mild cold without fever: no expected impact
• Severe illness (flu, COVID-19): possible effect, unclear evidence

Decision:

• Mild illness: do not delay
• Severe illness: depends on severity

Does IVF increase multiple pregnancy risk?

Yes, if multiple embryos are transferred

Can patients choose multiple embryos?

Depends on:

• Age
• Legal regulations
• Previous attempts

Risks of twin pregnancy:

• Hypertension
• Preeclampsia
• Gestational diabetes
• Cesarean section

If IVF fails, should we switch to ICSI?

Depends on fertilisation rate

If fertilisation is poor:

• ICSI is the next step

Complex case: adenomyosis, endometriosis, poor embryos

Downregulation helps, but timing matters

Preferred sequence:

1. Stimulate ovaries
2. Collect eggs
3. Freeze embryos
4. Downregulate before transfer

Pre-stimulation downregulation:

• May reduce egg numbers

Additional considerations:

• Immunological factors
• Chronic infection
• Sperm selection
• Possible surgery (rare, individualized)

Should there be a break between stimulations?

Usually:

• Wait for one full cycle

Depends on:

• Age
• Ovarian reserve

Exception:

• Poor responders may undergo double stimulation

How can egg quality be improved?

Lifestyle and diet may help

Supplements with some evidence:

• CoQ10
• Melatonin
• Vitamin D
• Folic acid

Limitation:

• Age and genetics are primary determinants
• No guaranteed improvement

Should you stop the pill before stimulation?

Case-dependent

Logic:

• Low reserve: may avoid pill
• PCOS: pill may help regulate

Timing:

• Stop at least 6 days before stimulation

How does embryo freezing work?

• Vitrification prevents ice crystal formation
• Most embryos survive
• Non-survivors are usually poor quality

Mini IVF at age 42 with low AMH

• Protocol is valid in low reserve
• Response determines future adjustments
• One cycle is considered experimental

Is PGT-A dangerous?

• Small risk of embryo damage
• Benefits increase with age

Not always used because:

• Not fully accurate
• May exclude viable embryos
• Less evidence in younger women

Expected eggs and embryos at age 35.5

• 9–15 follicles
• Approximately 9 eggs realistically

Outcome depends on:

• Egg quality
• Sperm quality
• Genetics
• Protocol

Herpes during sperm collection

• Does not transmit to embryo
• May affect sperm quality
• Does not require cancelling fertilisation

After multiple failed transfers, consider donor eggs?

Depends on:

• Embryo quality
• Underlying cause

If embryos are good:

• Investigate:
  • Endometrium
  • Infection
  • Implantation window
  • Immunology

Is day-3 embryo freezing outdated?

• Day 5 is preferred in high-quality labs

Reason:

• Natural selection occurs by day 5
• Day 3 may include embryos that would not progress