Infertility clinics - ivf treatment

» What infertility is and how do we diagnose it?
» What is the diagnosis of infertility based on?
» Can only special tests determine lock of ovulation?
» How are the fallopian tubes evaluated?
» How is the sperm studied?
» How do we treat infertility?
» What is insemination?
» What are the assisted methods of reproduction based on?
» What are the stages of in-vitro fertilization?
» Is infertility effected by lifestyle?


What infertility is and how can we diagnose it? We are talking about infertility, when after one year of regular unprotected sexual-intercourses, the woman can not get pregnant. It refers to what is called "statistical couples", who are trying. In practice, from 100 couples trying to have a baby about 90% might end with success in 2 years (80% in the first year). That group of 10% of couples is diagnosed as infertile. Women over the age of 35, and particularly over age 40, should seek professional advise regarding infertility, usually sooner than after a year of trying to get pregnant.. The age of the woman is one of the main conditional factors effecting female fertility. What are the causes of infertility? The causes of infertility divides into : male, female , and joint male and female infertility. The male factor this usually the drop in the ability of the sperm to fertilize the egg. The female factors includes: mechanical causes (not patent or improperly functioning fallopian tubes), hormonal (irregular or complete loss of ovulation), immunological. What is immunological infertility? IThis condition is relatively seldom observed. Certain antibodies develop in the woman's and man's organism, and they might cause weakening of the sperm activity and a loss of its' ability to fertilize. Furthermore, in such cases the process of implantation of the developing embryo into the uterus or fetal development in the early stage pregnancy, can be disturbed. The diagnosis includes the investigation of heterogeneous groups of antibodies, in the blood serum. During the treatment-pharmacotherapy- we use vaccines prepared from partner's serum. In many such cases in - vitro fertilization is considered.

What is the diagnosis of infertility based on? It is composed of many tests involving both partners. The period of diagnosis should be limited to a relatively short time ( 2 months ). In this period of time the following tests are carried out:
- semen analysis,
- hormonal, immunological test after intercourse (Post Coital Test-PCT),
- ovulation monitoring,
- fallopian tubes evaluation,
- endoscopic diagnosis.

Can Only special investigation determine lack of ovulation? For women the onset of ovulation is the presence of characteristic mucus before half of the menstrual period. The popular self- measurement of temperature only indicates the presence of ovulation, however it does not allow the evaluation of the quality of this ovulation.

How are the fallopian tubes studied? Such test is performed during the first phase of the menstrual period, between the end of menstruation and the next ovulation. It is done by injecting contrast-material through an instrument placed at the neck of uterus. The contrast-fluid fills the neck, cavity of uterus as well as the fallopian tubes. Simultaneously, a series of radiological pictures is made, which clearly shows the internal condition of the tubes. The patency of the tubes can also be evaluated optically, during diagnostic laparoscopy.

How is he sperm analyzed? The basic investigation which tests male's fertility is sperm analysis. This investigation is executed aftera 4-days sexual abstinence. The Man has to deliver sperm received during masturbation in his house or in the clinic. The sperm should be kept in temperature approximating body temperature and be delivered as soon as possible to the laboratory. A considerable percentage of sperms can die or reduce its' survivability, if the sperm is not examined within 30 minutes, nor it is not kept at 37 degree temperature . The investigation of semen should uncover disorders related to its' number, motility and different morphological irregularities of sperms and seminiferous fluid (semen). A reduced number of sperms should not be treated as a final diagnosis of infertility,but rather as a factor suggesting a problem with fertility. At present, we consider concentration of less than 20 million sperms per mililitre as inadequate., However, pregnancy is sometime possible even small quantities of sperms. Test after intercourse (PCT).
Test after intercourse (Post Coital Test) is used to evaluate the activity of sperms in the female cervical mucus during an appropriate period of time after intercourse. The basic sperm test should precede the PCT. In order to perform this investigation, the woman is invited to clinic about 10-14 hours after intercourse on the day preceding her expected ovulation. The mucus sampled from the neck of uterus is studied under microscope. The number as well as motility of sperms are observed and analyzed. The test is considered positive (fail), if there are no live sperms in the mucus or they do not move. The result is considered negative (good), when there are at least 6 active sperms in a microscopic field of vision x 400. The presence of correct number but motionless sperms suggests an immunological cause of infertility. An inflammatory factor should also be excluded (by testing saples from the channel of uterine neck). Testicular biopsy.
A biopsy of the testicles is sometimes performed in cases of total lack of sperms in semen but the presence of normal level of FSH in blood. Under general anaesthesia a segment of testicular-tissue is harvested and a further histopathologic investigation is used to estimate the presence or lack of sperm-producing cells in the testicles.

How do we treat infertility? The treatment of infertility involves a few methods used for fertility restoration of both partners. In cases where the cause of infertility is known or alleged, the apropriate treatment is applied. Among the most practical methods are:
- improvement of general gynecological health of the woman,
- improvement of the general state of health of the man and improvement of the quality of his semen,
- achive ovulation cycles,
- use of methods of Assisted reproduction.

What is insemination? This is a relatively simple painless procedure, based on intra-uterine injection of specially prepared sperms, in the laboratory, best on the day of expected ovulation. The sperms are injected into the uterus directly through a thin catheter. After short rest the patient may home.

What is the Assisted Reproductive Technology (ART ) based on? These methods which are usually called in - vitro fertilization (IVF) are based on placing the oocytes (eggs-Ovum) and partner's sperms, together in a laboratory tube, outside of the woman's body. Within 24 hours the fertilization of the eggs should occur. It is possible to transfer the embryos thus created into the uterus after several days ( most commonly after 48 hours) if the embryos develop properly.

What are the in-vitro fertilization stages? This method consists of following stages:
- preparation
- hormonal stimulation
- harvestin (pick-up) of oocytes (eggs)
- embryological part (fertilization in the laboratory)
- transfer of embryos into the uterus
- expectation for pregnancy test. How is the preparation done? In this phase both partners are do laboratory tests evaluating their state of health and fertility as well as the choice of the best type of the In-vitro treatment is chosen. In this phase the partners must sometimes take medications which will be , helpful in of the apropriate time. What hormonal stimulation depends on? It causes the growth of suitable number of follicies in ovaries. It is obtained by taking injection everyday from the first days of period to about 8-10 days. In this time patients have supervisory visits. How ovocytes are receiving? This is comparatively short procedure executed in general anesthesia. The ovaries are punctured by needle through vault of vagina under control of USG. Ovocytes are searched in follicular liquid. After short rest patients is going home. What the embryological part depends on? It is a few laboratory actions leading to fertilization and further embryogenesis. In some cases it is necessary to make micromanipulation depending on injection to every ovocyte of individual sperm. What the application of embryos depends on? This reminds practically artificial insemination. With the help of he special thin catheter the embryos are injected to cavity of uterus. Operation should be executed gently. Why several embryos are giving? Therefore, after introduction of embryos to uterus, the majority of them does not nest and can not develop. No more than 2-3 embryoes are giving, to avoid the risk of polycyesis. At present we limit the number of passed embryos. What is goes on in phase of expectation? In this time patient receives medicines helping the implantation and development of early pregnancy. The maternity test was executed after 10-12 days from application of embryos.

What is the influence of lifestyle on infertility? It usually concerns men. The sitting lifestyle, lack of movement, nicotinizm, harmful working conditions (high temperatures, the electromagnetic radiation, heavy metals e.g.), unbalanced diet can be often the cause of unexplained infertility. It can also influence on anatomy and motility of sperms. At women the lifestyle has not such meaning. Genital tracts infections and immunological diseases have the influence on infertility rather. Man, who wants to be fertile should avoid alcohol, cigarettes as well as any medicines, which could have unfavourably influence on quality of semen whether reduce sexual efficiency. Proper rest, average intensified physical exercises, healthy low-fat diet, and rich in wholemeal products, fruit, or vegetable - this main recommendations. Men with overweight should drop superfluous kilogrammes. These who exercise exceptionally intensely should exempt a pace ( but do not stop exercise completely). The vitamin C improves absorption in alimentary canal such ingradiens : zinc, copper, potassium, calcium, and vitality and survivability of sperms. It also prevents getting stuck sperms together. Vitamin E, anti - oxidant, improves fertility at men with normal quantity of sperms, but with simultaneous large amount of free radicals in blood and in seminiferous liquid. Vitamin C is also anti- oxidant. The men with low zinc level in organism can take in tablets additionally. The advantage from usage of herb preparations, such like ginseng, are not proven. They should avoid testicles overheating, therefore men should rather give up with hot baths whether sauna. Though at present the results of observations show the lack of fertility disorders cause by wearing tight underwear or trousers, however wearing of looser clothes will not harm. To prevent the decrease the quantity of sperms in ejaculum, man should limit the quantity of sexual intercourses to one every two , three days, except of period when the woman ovulates. The latiest investigations show, that every-day intercourses, or even several times daily, in two days before and in day of ovulation improves the percentage of pregnancy. Though the number of sperms is then reduced in ejaculum, still renewed store of sperms has greater chance for penetration to mucus and the fertilization of ovocyte. In such formulation fertilization is not a single process and continuous.
Women, who smoke one or more packages of cigarettes daily as well as these who began smoking before 18 year of age are in group of risk of infertility. They have about 20% smaller chances to go pregnant in comparison with non-smoking women and these who threw smoking burning 20 cigarettes. The relationship among caffeine consumption and infertility was also confirmed. Caffeine is not only in coffee, but also in tea, many cold draughts, chocolate as well as in considerable number universally practical medicines. Even small consumption of alcohol (np. five drinks a week) can disturb fertility as well as adverse harm effect on developing embryo. The frequent irrigation of sheath can disturb the fertility by changes of biocenosis, that means of bacterial complection of sheath and enlarging the risk of inflammatory processes of genital organs. The sexual behaviours, such the intercourses with many partners, without usage the condoms, intercourses during menstruation leads to the increasing risk of the microorganisms transferred with tract sexual, which can cause the development of contagion of smaller pelvis leading in effect to infertility or paracyesis.