Centre of Assisted Reproduction: "Life begins with us..."
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.
Examination of the uterus (size, storage, mobility, painfulness) and ovarian palpation.
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.
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.
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).
These examinations include looking directly into the uterine cavity – and the insight into the abdominal cavity to see the uterus, ovaries, and fallopian tubes.
Blood tests for the presence of genetic abnormalities – a number of chromosomal aberrations (with repeated miscarriages, failed IVF cycles or embryo development arrests).
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.
Sperm analysis is one of the basic male infertility examinations.
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.
If the sperm analysis evaluation is to be representative, it should be evaluated after 2-3 days of sexual abstinence.
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.
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.
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.
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).
The potential risks include the incidence of multiple pregnancies in direct relation to the number of growing follicles.
After the procedure you can carry on with daily activities without restrictions.
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.
Over the course of the native IVF cycle, no hormonal stimulation of the ovaries is used. Our goal is to retrieve 1 spontaneous egg.
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.
There are two ways to prepare embryo transfer:
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.
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.
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.
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.
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.
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).
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.
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.
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.