Infertility Diagnosis (female and male)

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Methods of diagnosis and reproductive medicine

Spermiogram, Date intercourse - timed intercourse, Intrauterine insemination, IVF - In vitro fertilization, ICSI - Intracytoplasmic sperm injection, PICSI - improved method ICSI fertilization, Assisted Hatching, Prolonged cultivation

In Vitro Fertilization (IVF)

IVF is the most commonly used method of assisted reproduction. Donation.

What you should know before you start on the first IVF (artificial insemination)

Personal and medical data, anamnesis, results of tests and other information.


Methods of diagnosis and reproductive medicine

Spermiogram - analysis of the ejaculate , which determine the quality of sperm and thus male fertility . This is a laboratory test ejaculate at which assesses two component properties - macroscopic and microscopic . Sampling takes place in the collection room by yourself after sexual abstinence 2-3 days.

Date intercourse - timed intercourse - if we know that a woman has a healthy and clear fallopian tubes and the man has normal sperm , approach to timer contact . After checks on ultrasound determines the optimal time of ovulation and plan the couple the best time for intercourse.

Intrauterine insemination - use for free tubal patency and the physiological values ??of sperm . Directly into the uterine cavity , less often in the cervix , introducing the best quality sperm ( after processing in the andrology laboratory) . The procedure is performed outpatient basis without anesthesia , using a thin plastic catheter.

IVF - In vitro fertilization - in vitro fertilization is used when a good quality of sperm in the case of missing or impassable ligation failure simpler methods , in cases of endometriosis , ovarian malfunction . To prepare the woman's body to prescribe stimulant medications facilitate the growth of multiple follicles ( tubes containing eggs ) in the ovaries. Collection of ova only takes a few minutes and if a woman has no trouble leaving after 2 hours in the company of home. On the same day partner gives women a sperm sample . With good quality sperm with eggs oplozují by adding and fertilization happens in a natural way in incubators.

ICSI - Intracytoplasmic sperm injection - with poor quality sperm as in the previous IVF prevent fertilization or in cases of immunological factor ( woman produces antibodies against sperm ) , the eggs oplozují ICSI . Selected individual sperm are injected into each egg individually into a special micromanipulator . Embryologist this micromanipulation technique inserted into the prepared sperm directly into a mature egg. This method significantly increases the success achieved pregnancy in couples with infertility causes to male as to fertilize each egg using only one healthy sperm.

PICSI - improved method ICSI fertilization vyjíčka used -selected mature sperm with a reduced incidence of chromosomal anomalies. The gain of mature sperm is used bowl with hyaluronan gel , the enzyme surrounding egg to which they bind only mature sperm bind to the oocyte complex . Embryologist to fertilize using only the sperm , which are attached to hyaluronan gel.

Assisted Hatching - use in cases where there is suspicion of a stronger container embryos that would be feasible in the uterine wall , or in the event of failure of fertilization in IVF cycles předchozívh or ICSI . In assisted hatching needle micromanipulation embryologist disrupt packaging embryos and thus significantly increases the chance of its implantation in the uterine wall and pregnancy.

Prolonged cultivation - if we want to achieve the best results , it is advisable to extended cultivation.


In Vitro Fertilization (IVF)

IVF is the most commonly used method of assisted reproduction, which solves the problem of blocked fallopian tubes, but it is done in other cases: the lack of ability of ovaries to produce eggs, endometriosis, immunological and male factor infertility.

Diagnosis of causes of infertility couple is on the basis of:

  • gynecological and ultrasound;
  • determine hormone levels affecting the regulation of the reproductive cycle;
  • dynamic endocrine tests;
  • microbiological examination;
  • UZ hysterosalpingography;
  • laparoscopic and hysteroskopického finding;
  • Thyroid function tests;
  • immunological tests;
  • comprehensive genetic testing;
  • Andrological and
  • sexology examination.

Diagnostic algorithm:

  • basic conditions of treatment;
  • evaluation of ovulation;
  • ovarian reserve;v
  • semen analysis;
  • status of the fallopian tubes and pelvis;
  • uterus;
  • immunology of reproduction.

Treatment options

  • correction endokrinopathií;
  • complex surgical treatment;
  • rehabilitation therapy by Moses;
  • treatment with assisted reproductive techniques (ART):
    • insemination;
    • micromanipulation methods;
    • ensure donor program in its entirety (sperm, eggs);
    • microsurgical men for sperm retrieval (TESE, MESA);
    • cryopreservation of gametes, embryos and tissues of the reproductive system;
    • treatment with the use of preimplantation genetic diagnosis (PGD).
  • opportunity to consult with a wide range of testing ensures comprehensiveness of care.

Basic concepts

First, the partners using hormonal stimulation of the ovaries causes the formation and maturation of eggs (in the follicles). At the appropriate time, which is determined by one or more hormonal and ultrasound examination of ovarian follicles aspirated contents, which then look for eggs in the laboratory. Follicular fluid is in short-term anesthesia using a vaginal ultrasound probe path.

Fertilized egg (fertilization)

Progress in embryology laboratory. The resulting eggs are placed into tubes with the culture medium and then adding the treated sperm fertilization partner or donor. With good sperm is called "classical IVF method," in which the eggs are cultured together with sperm in a special medium and checked whether there is a " spontaneous " fertilization " in vitro ". If the sperm count is insufficient, or is a so-called " immunological factor infertility ", it could fertilize the eggs as described above occur. In this case, you must use the micromanipulation technique called " intracytoplasmic sperm injection " (ICSI).

Transferring embryos (embryo - ET)

Embryo transfer normally takes place at our clinic after the second - 3rd consumption of eggs in stage 2-8 cells. Transmit a maximum of three embryos, but it is often recommended to transfer only two embryos, additional excess embryos can be frozen. Custom embryo transfer is performed with a thin cannula through the cervix of the uterus as painless outpatient performance.

Micromanipulation - intracytoplasmic sperm injection (ICSI)

Technique that is using a special device (micromanipulator) injectable single sperm directly into the cytoplasm of the egg. It is used in case of lack of partner's sperm parameters (low concentration and sperm motility), the collection of surgical sperm retrieval from the testis, the repeated failure of fertilization in previous cycles, immunological factors and certain other indications.

Prolonged culturing embryos

In a special media can reclaim some of the embryo to the highest stage of development, which can be achieved in the laboratory (the so-called blastocyst). Cultivation in this phase lasts approximately 5-6 days. Prolonged cultivation allows longer monitor the development of embryos and select the best quality embryos for transfer. This reduces the likelihood of introduction of embryos with reduced cell division. The embryos are transferred into the uterine lining better prepared and have a higher chance of fixing.

AH - Assisted Hatching

The principle of this method lies in the gentle opening the package embryo (zona pellucida) laser. The aim is to increase the success of attachment (implantation) embryo in the uterus. Indications for AH is the age of the patient over 35 years, repeated failure to achieve pregnancy after embryo transfer quality and also increased levels of FSH patient. AH can recommend a patient embryologist in the event of an optically thicker container embryo.

Cryopreservation of embryos

If we have a larger number of good quality embryos, they can be frozen for later use. If a woman does not become pregnant in stimulated IVF cycle, introducing in one of the next menstrual cycle after hormonal preparation easier thawed embryos into the uterus.

Surgical sperm

File surgical techniques, which can be obtained by direct sperm from testicular tissue donation or epididymis is possible to use if the sperm are not present.

  • MESA - aspiration of sperm from the epididymis
  • TESA - Testicular Sperm Aspiration
  • TESE - extraction of sperm from testicular tissue


Donation of reproductive cells is double-blind. The obtained cells can be used only for the treatment pairs, which for health reasons, there is no other chance for pregnancy. When selecting a donor or donors to the couple chooses to basic characteristics (blood type, eye color, hair color, height, weight, ethnicity, education, character and interests). Never under applicable laws know the identity of the donor.

Donation of reproductive cells is free, the donor will receive compensation efficiently, cost-effectively and demonstrably incurred expenses related to the donation. The amount of the refund is determined by internal regulations of the University Hospital of:

Terms donation

  • age 18-35 years for egg donors, 18 to 40 years for donor sperm
  • at least completed secondary education
  • good overall health
  • negative results of HIV infection, hepatitis B and C, syphilis
  • with donor sperm satisfactory sperm count and negative urine test for the presence of Chlamydia trachomatis
  • absence of genetic risk
  • valid health insurance in the Czech Republic

The course of sperm donation

  • Those interested in donating sperm must undergo primarily a sperm test, which you can order by phone at 00420 734 421 860. When ordering, please communicate that you are a potential donor sperm.
  • Before sampling is necessary to keep 2-5 days of sexual abstinence (time since last ejaculation). Avoid alcohol and excessive physical and mental exertion. Semen quality also affect certain factors like stress, drugs, smoking, common diseases, use of medications.
  • Result sperm will be communicated by telephone within a week of the test.
  • If the sperm parameters satisfy the requirements for donors undergo clinical - genetic consultation. During this consultation will be discussed with you personal and family history and genealogy compiled. The following blood and urine tests, including examination of chromosomes and molecular genetic examination and urological examination.v
  • Complete results will be known in about two months. If they are right, you can begin to have regular semen collection.
  • Collection and freezing of semen is only possible at the time of entrance examination for infections that are transmitted by blood and sexual intercourse (three months from taking). Semen collection shall be continuous for a total of 6 weeks. If the samples do not take place at the time of initial examination, it must be carried out again. Each time the semen is carried out urine.
  • In total there are 10 vials need to freeze the sperm. Number of samples depends on the quality and volume of ejaculate, usually just 2-3 visits.
  • After 180 days from the last dose of sperm freezing the entire process is completed confirmatory testing of blood. After this examination is possible to use a sperm donor to pay compensation efficiently, cost-effectively and demonstrably incurred expenses related to the donation.

The course of egg donation

  • Initial examination of donors is a clinical- genetic testing, which can be ordered by phone 00420 734 421 860. When there is a zájemkyní discussed personal history, family history, blood tests and urine (urine bring with you in a sterile container) and genetic laboratory tests.
  • The results of all tests are available in about two months, the information given to the prospective donor phone.
  • In the event that all of the above tests are OK, followed by specialized gynecological examination by a gynecologist our center, which then drives the next steps.
  • There will test the hormonal profile (blood), plans to hormonal stimulation. Donors after a certain period injected drugs that lead to growth and maturation of multiple eggs in the ovaries. During that time the 2-3 ultrasonic inspection for gynecology.
  • During hormonal stimulation may occur so-called ovarian hyperstimulation syndrome, which manifests itself mainly edema, in rare cases, severe swelling of total heavy with the presence of fluid in the abdominal and thoracic cavity and a bleeding disorder. In the most serious cases of ovarian hyperstimulation syndrome may be the reason for hospitalization. All of our physicians at our center is the occurrence of hyperstimulation syndrome be prevented in time. The risk is lower in donors than in women, which results in assisted reproduction treatment in pregnancy.
  • The last injection is administered 1 and 1 day prior to collection of eggs.
  • On the day of egg collection is necessary check-ups and blood-borne infections through sexual contact.
  • Oocyte retrieval is performed under general anesthesia.

What you should know before you start on the first IVF (artificial insemination)

  • 1

    Age Partners

  • 2

    If the partner is pregnant, how many times she was pregnant and how the pregnancy was terminated

  • 3

    How long trying to get pregnant

  • 4

    Have already been a treatment for infertility ? If yes , what was the type of treatment

  • 5

    For a more detailed conversation with the doctor and also to plan your arrival, send us your extract and extract your partner from medical records of previous examinations. all documents must be written in capital letters.

If you register, take the results of these tests (if not, you can pass control to place at the first consultation):

  • Gynecological hormones 2-4 days of menstrual cycle - FSH, LH, PRL, estradiol, progesterone
  • Thyroid - FT4, anti- TPO, TSH
  • Anti - Müllerian hormone (AMH / ICM , AMH / MIS)
  • Thrombophilic mutations
  • The study of immunity - antibodies against sperm , testes, placenta
  • Analysis of the swab from the throat and vagina, including fungi, mycoplasma, Ureaplasma, Chlamydia
  • Results kolposkopického examination cervical cytology
  • Spermiogram
  • If available - the results of laparoscopy

The best time of check-ups - a week before menstruation, ultrasound control - then you can take drugs to stimulate , including stimulus program and timetable for further action.