Centre of Assisted Reproduction: "Life begins with us..."

Methods of infertility treatment

YOUR HAPPINESS IS CRUCIAL FOR US. WE PROVIDE THE MOST MODERN INFERTILITY TREATMENT

BEFORE THE INFERTILITY TREATMENT WE PROVIDE A DETAILED EXAMINATION

In order for the treatment of infertility to be optimal, it is necessary to find out its cause. Several methods are currently available that focus on examining the individual infertility factors in both men and women. In some cases, simple methods are sufficient; in other cases we need to explore more detailed and complex methods.

Female examination methods

vyšetření na ivf klinice

Gynaecological palpation examination

Examination of the uterus (size, storage, mobility, painfulness) and ovarian palpation.

Transvaginal ultrasound of the uterus and ovaries

Describes the shape and size of the uterus, the height and quality of the endometrium, tracks the growth of follicles in the ovaries at different stages of the cycle, the presence of cysts, and pathological formations in the lower pelvic area.

Examination of hormonal profile – blood tests

This test provides information about the condition of the ovaries and their ability to generate mature eggs. Blood sampling is performed on the 2nd or 3rd day of the menstrual cycle.

Examination of the uterus and fallopian tubes – Hysterosalpingography

This test detects the patency of the fallopian tubes, if they are opened, and displays the shape of the uterine cavity. It is possible to carry out a modern ultrasound-guided technique (Sono HSG) or under the control of an X-ray (X-ray HSG).

Surgical examination methods – laparoscopy, hysteroscopy

These examinations include looking directly into the uterine cavity – and the insight into the abdominal cavity to see the uterus, ovaries, and fallopian tubes.

Genetic testing for female infertility

Blood tests for the presence of genetic abnormalities – a number of chromosomal aberrations (with repeated miscarriages, failed IVF cycles or embryo development arrests).

Immunological tests for infertility

We examine antisperm antibodies, antibodies against the trophoblast (placenta), and against the embryonic shell (zona pellucida). Modern laboratories can determine problems in cellular immunity and suggest a follow-up treatment. This is not included among the basic examinations.

Male examination methods

vyšetření na ivf klinice

Sperm analysis is one of the basic male infertility examinations.

What is sperm analysis?

Sperm analysis is a laboratory examination of sperm quality. We evaluate ejaculate volume, sperm count, their mobility, and morphology (shape of head, neck, and flagella). A semen sample is usually obtained via masturbation.

What are the average sperm analysis values?

If the sperm analysis evaluation is to be representative, it should be evaluated after 2-3 days of sexual abstinence.

What is the course of action when we get a poor sperm analysis result?

If the sperm analysis shows an abnormality, it is advisable to repeat the test again in two to three months. Only after getting repeated abnormal values will we advise visiting a urologist or andrologist (a male infertility specialist). This recommendation is based on the length of spermatogenesis – sperm development – which lasts approx. 75 days. It is important to remember that the sperm analysis outcome cannot be concluded from one single result. Spermatogenesis is a dynamic and variable process that is influenced by a number of factors (acute illness, changes in lifestyle, environmental changes, etc.). If you want to have a real picture of your spermatogenesis, we recommend that you carry out this examination three times in a row, always with a delay of two to three months.

What are the techniques for sperm collection at the Clinic?

  • Please empty your urinary bladder before the collection.
  • Wash hands and genitals including the foreskin with soap and rinse well with clean water.
  • Use a clean disposable paper towel for drying.
  • Open the sterile container just before collection.
  • Before collecting the sample, check your name and surname on the sterile sample container!
  • Complete collection by masturbating into the sample container.
  • After sample completion, close the container tightly and place on the transfer window in the room and press the signal button.
  • For IVF treatment or sperm cryopreservation, please take a seat at the reception, and blood will be drawn from you for STD infections (HIV, hepatitis B, C, syphilis).
  • At our clinic, it is possible for your partner to be present during the sperm collection, but the sample should not be contaminated with saliva.

What are the techniques for sperm collection outside the Clinic?

Sperm collection can also be done outside of the clinic, but in this case, it is necessary to deliver the sample to us within 60 minutes, personally. During transport, it is important to maintain the body temperature of the sample.

  • Please empty your bladder before the collection.
  • Wash hands and genitals including the foreskin with soap and rinse well with clean water.
  • Use a clean towel for drying.
  • Open the sterile container just before collection.
  • Complete the collection by masturbating into a sample container and, after completion, close container tightly.
  • Please keep the sample at body temperature until your arrival at the clinic. You achieve this by placing the cup underneath your clothing in direct contact with your body surface.
  • Transfer the sample to the clinic in person; at the latest, 60 minutes after collection.
  • The sample must be given to the andrology laboratory worker in person. A signature is required to confirm it is your biological material.
  • For IVF treatment or sperm cryopreservation, please take a seat at the reception, and blood will be drawn from you for STD infections (HIV, hepatitis B, C, syphilis).

INREFTILITY TREATMENT METHODS

IUI – INTRAUTERINE INSEMINATION

For whom is this method intended?

IUI is intended for couples when several attempts to get pregnant have failed despite the proof of ovulation in females and well planned sexual intercourse. The cause of the failure is often a mild sperm quality disorder, which may be overcome just by performing IUI. Another cause could be an immunological infertility factor.

Benefits of this method

The success rate of IUI is from 5% to 15% per cycle (depending on the woman´s age). Most often, if there is no pregnancy after 3 IUI cycles, we recommend in vitro fertilization (IVF).

Risks

The potential risks include the incidence of multiple pregnancies in direct relation to the number of growing follicles.

SHOW ME THE PROCESS OF IUI TREATMENT

Course of action IUI:

  1. Performing IUI precedes the ovarian stimulation with Clomiphene Citrate at a dose of 1-2 tablets daily from day 3 to day 7 of the cycle. IUI can also be performed in the natural cycle, without stimulation.
  2. Treatment monitoring is done by measuring the endometrial height and size of the follicles by ultrasound.. The aim of the stimulation before IUI is usually 1-2 maturing follicles.. When the follicles reach the desired size, we inject a trigger shot, which causes the eggs to mature and we plan to perform IUI.
  3. On the appointed day, in the morning, the partner provides a sperm sample (if possible after 2-3 days of sexual abstinence), which will be prepared for insemination. The preparation of sperm in the laboratory takes about 2-3 hours. Subsequently, the doctor inserts a fine catheter through the cervix into the uterus, and injects the sperm sample there.
  4. We recommend taking pregnancy test 14 days after the procedure.

After the procedure you can carry on with daily activities without restrictions.

IVF – IN VITRO FERTILIZATION – FERTILIZATION OF AN EGG OUTSIDE THE WOMAN´S BODY

For whom is the IVF treatment method intended?

  • Women diagnosed with blocked fallopian tubes
  • Women diagnosed with endometriosis
  • Women who have problems with the release of eggs (ovulation) and who were not successful with the use of Clomiphene Citrate
  • Couples with severe male factor infertility
  • Couples with immunological factor infertility
  • Couples who have been trying to conceive for several years and have found no cause for their infertility (unexplained infertility)

How is IVF treatment performed?

The whole process of in vitro fertilization (IVF) begins with the hormonal stimulation of women which causes the maturing of a higher number of eggs. Stimulation is performed by applying an injection containing FSH (follicle stimulating hormone) and LH (Luteinizing hormone). Often, women administer the injection themselves.

The course of stimulation is monitored by a doctor via ultrasound at several day intervals. Mature eggs are then retrieved under general anaesthetic by ovarian punctures with ultrasound guidance. On the same day of the egg retrieval, the husband or partner of the patient submits a sperm sample.

The retrieved eggs are fertilized with the sperm and the resulting embryos are then stored (cultivated) outside the woman’s body. After several days of cultivation, the best embryos are transferred into the uterus – embryo transfer. The remaining top quality embryos can be frozen and preserved for later use.

ALTERNATIVES TO IVF METHOD

NATIVE – NATURAL IVF CYCLE WITHOUT HORMONAL STIMULATION

Over the course of the native IVF cycle, no hormonal stimulation of the ovaries is used. Our goal is to retrieve 1 spontaneous egg.

MINIMAL STIMULATION

We perform minimal ovarian stimulation using very low doses of the stimulation medication in order to obtain a lower number of eggs. The course of stimulation is very gentle for the woman and is well tolerated. For the stimulation we use Clomiphene Citrate tablets or very low doses of injectable preparations, which are known from conventional IVF cycles.

In practice, minimal stimulation is mostly used in the following cases:

  1. previous stimulation was complicated by ovarian hyperstimulation syndrome (OHSS)
  2. a woman is afraid of higher doses of hormone stimulation
  3. women with polycystic ovarian syndrome (PCO syndrome)
  4. repeated failure of infertility treatment using conventional IVF
  5. the necessity of minimizing the cost of treatment

FROZEN EMBRYO TRANSFER

There are two ways to prepare embryo transfer:

  1. Transfer of thawed embryos during a woman's natural cycle
    In this protocol, it is necessary to follow the woman's natural cycle and plan to do the frozen embryo transfer. It is used in women with a regular menstrual cycle and ovulation, and the advantage is the almost zero use of hormonal preparations.
  2. Transfer of thawed embryos after hormonal preparation of the uterus
    During preparation, it is necessary to use synthetic hormones (oestrogens) according to a precise physician´s dose schedule. The goal is to prepare the optimal endometrial height of the uterus so as to be able to accept the implanted embryo. The quality of the endometrium is checked by ultrasound around the 12th – 14th day of drug use and, after adding the progesterone, we plan to schedule the transfer for the exact day. This protocol is used in women with an irregular cycle or in women with low endometrium.

Both protocols have comparable success rates and it is up to a physician to decide on which is better for the patient. As soon as the endometrium has been well prepared, and the frozen embryo transfer has been planned, embryologists thaw the embryo in the laboratory about 2-3 hours before the scheduled transfer time. The subsequent frozen embryo transfer takes place just like with the transfer of fresh embryos.

THE GOAL OF ASSISTED REPRODUCTION IS THE BIRTH OF A HEALTHY CHILD.
We can choose the most suitable method to fertilize the egg based on the number of sperms, motility, and morphology of the sperm.

CLASSICAL METHOD OF INSEMINATION

Even though the sperm analysis is normal, but the couple does not conceive spontaneously, usually a doctor will recommend fertilization by the classical method, when we add modified sperm to the egg directly, and let the sperms fertilize.

ICSI (INTRACYTOPLASMIC SPERM INJECTION)

If the sperm analysis values are reduced (sperm count, motility or morphology), it is suitable to use a delicate procedure called ICSI for fertilization, when the embryologist injects a single sperm into the cytoplasm of the woman´s egg, bringing about fertilization.

PICSI (PHYSIOLOGICAL INTRACYTOPLASMIC SPERM INJECTION)

Using this method when selecting the sperms, we take under consideration not only the sperm morphology or the lifespan, but also their adequate functional quality such as sperm immaturity or chromosomal anomalies. This method is recommended in the case of recurring failure of previous IVF / ICSI (and failure of both the fertilization and subsequent embryo development), or if the patient has a history of recurrent miscarriages.

TESE/MESA

If there is no evidence of sperms in ejaculate (azoospermia), it is possible to try to get the sperm cells by surgical collection. Sperm can be obtained using the MESA (micro epididymal sperm aspiration) technique, where we perform microsurgical epididymal sperm aspiration, or by using the TESE (testicular sperm extraction) technique, in which a small piece of tissue is surgically removed from the testicle. The material is subsequently processed and, if sperms are obtained, these can be used for ICSI.

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oplození vajíčka

WE ALSO USE OTHER METHODS WHICH CAN INCREASE THE SUCCESS RATE OF THE ENTIRE TREATMENT

Assisted
Hatching

This is a micromanipulation method in which a small hole is created in the outer layer of an egg shell (zona pellucida) to help the embryo to break out or ”hatch”, which simplifies its implantation in the uterus. AH is done on the 3rd day of cultivation in those patients whose embryos have a thick zona pellucida (egg shell).

Prolonged
cultivation

Thanks to the media culture we can cultivate embryos outside the patient’s body 3-6 days after the egg collection. With this extended cultivation we can select embryos with the highest quality for the embryo transfer itself or cryopreservation.

PGD/PGS

Preimplantation genetic testing of embryos (PGD/PGS screening). For this examination we need to remove several cells from a five-day old embryo. For PGD testing we use FISH, ACGH and PCR methods, NGS and karyomapping.

Embryo Vitrification

In cases when in one treatment cycle we get a larger number of the highest quality embryos, we can perform long-term freezing of the embryos by using vitrification. This method has a high percentage of success when, after thawing, the embryos have the same quality and, therefore, the pregnancy success rate is the same as in the original cycle.