Services

Female infertility diagnosis

Frozen embryo transfer

• Frozen embryo transfer is considerably less complicated than the classic IVF program. It consists of three stages: getting the endometrium ready, transferring the embryos and maintaining the luteal phase. 

  Frozen embryo transfer is one of ART techniques.

  Basically, it is an in-vitro fertilization program minus the stimulation stage. This technique is advisable when the IVF protocol for some reason was unsuccessful. By preserving the embryos, the parents receive a kind of moral support boost, because even if the first try fails, there is always a second chance. Besides, it will be easier and a lot cheaper.

  Many couples choose to tray frozen embryo transfer program after a successful IVF attempt to have a second baby. 

  The end result of this technique depends on various factors which include:

  • The quality of the frozen embryo
  • The endometrial thickness and if it is ready for the embryo transfer
  • The hormonal therapy strategy.

  Some scientists claim that the high dosage of hormones that women are injected with during the stimulation can alter the qualities of their endometrium and may have negative effect on its ability to accept and nourish the embryo. 

  If the patients use the frozen embryo transfer program, there is no need to do take hormones in such high doses, which makes this program closer to the natural way of things. Consequently, the pregnancy is likely to go more smoothly from the physiological point of view. 

  Is it necessary for the father to do a medical check-up with this protocol? Yes, it is. Even though he is not actually involved in the process of the transfer and has done the required tests during the first cycle, the frozen embryo transfer recommendations list does contain several obligatory examinations. As for the mother, out of all the usual hormone level exams she only has to do the progesterone blood test, because this hormone is prescribed to ensure a healthy pregnancy. 

  Sometimes, though fairly rarely, the usual superovulation stimulation protocol is still required to prepare the endometrium for the transfer. This happens when there is no natural ovulation and if the standard preparatory procedures yielded no results. 
  Regardless of their education level, many people still consider embryo cryopreservation a dangerous procedure that has the potential to harm their future baby. Sometimes, it may be hard for the parents to understand this process. These couples would rather dispose of their spare embryos, which is completely unnecessary and unfounded, just because they are afraid to freeze it. 

  However, it is essential to realize the difference between a common freezing and cryopreservation. When you freeze something the usual way, the water in the issues crystalizes under the influence of low temperatures and destroys the cell membranes. Cryopreservation in liquid nitrogen happens at the ultra-low temperature of -196 С°. Under these conditions, the ice simply does not have enough time to form. After they are defrosted, more than a half of all embryos can be successfully implanted into the womb tissue and start developing there. Out of 100 frozen embryos, only 5 or 6 of them are lost. Studies have proved that in those cases the cause of death is not related to cryopreservation, but is normally of genetic origin. Large-scale case studies have also demonstrated, that children born from frozen embryos are not any different from other children in terms of general health and course of development, and the pregnancy is usually less problematic. It might be connected to lower amount emotional stress for the parents. 

  Frozen embryos can be preserved for a very long time. An additional prove to that is the birth of a girl named Emma in 2017. Her embryo has been cryopreserved for 25 years, since 1992. The only condition is to strictly abide by the rules of cryopreservation and defrosting procedures. 

  In Altravita we use various ART techniques. Thanks to high-level equipment and the skills of our doctors, we keep our statistic results up to the highest standards. You can get more information about cryopreservation from our gynecologists. Call the clinic using the phone number on our website and make an appointment.

  Call the clinic using the phone number on our website and make an appointment.

TESE/TESA

• TESA can be used as a diagnostic procedure to detect causes of male infertility, or as a procedure to recover sperm from the testicles from men with obstructions or ejaculatory problems that cannot be treated by any other methods.

  In the TESA procedure, a very fine needle is passed into the testicles under anaesthetic, and a tiny amount of tubules is removed from the seminiferous tubules (network of tiny tubes inside the testicles, where sperm are produced). These tubules are then processed in the laboratory and checked for the presence of sperm, which can be used to fertilize eggs.

  Sperm retrieved from the seminiferous tubules in a TESA procedure are less mature and less motile than sperm found in ejaculated seminal fluid. As such, ICSI or IMSI are required to achieve fertilization with TESA sperm.

Preimplantation Genetic Testing (PGT)

• PGD

  Pre-implantation genetic diagnosis (PGD) refers to genetic profiling of embryos created through IVF prior to the transfer into the patient’s uterus. During PGD the embryos are screened for a number of specific genetic disorders, so as to exclude the possibility of selected embryos having these particular abnormalities.

  PGD enables patients with a chronic disease in their family history to avoid passing it on to their children. A specialist may recommend PGD if patients have a family history of severe genetic diseases or previous miscarriages due to genetic disorders.

  PGS

  The term preimplantation genetic screening (PGS) is used to denote procedures that do not look for a specific disease but use PGD techniques to identify embryos at risk. PGS involves checking the embryos chromosomes for common abnormalities. Chromosomal abnormalities are a major cause of miscarriages and the failure of embryos to implant. They can also cause such serious medical conditions as Down’s syndrome.

  PGS is normally recommended for:

  • older patients ( women over 35 years old);
  • patients with a history of recurrent miscarriages;
  • patients with a history of unsuccessful IVF cycles after the embryo transfer stage;
  • patients with a family history of chromosomal diseases.

Natural Cycle IVF

• What is IVF in natural cycle? IVF in natural cycle uses ultrasound monitoring of growth of the dominant follicle in the ovary of the patients with preserved ovulation.

  With a follicle size of 18 mm, either under the control of an ovulation test, or after the intramuscular injection of an ovulation trigger, a follicle is punctured to obtain an egg. The rest of the IVF program process remains the same.

  To increase the effectiveness of IVF, the program includes the study of egg’s spindle apparatus.

  IVF in the natural cycle: pros and cons

  The reason for the low demand for IVF in the natural menstrual cycle is that it is characterized by a fairly low efficiency. The pregnancy rate is lower than with insemination in the natural cycle, it is about 7% in terms of each started cycle.
  This is due to the fact that not every mature follicle is an egg carrier. In addition, because of the puncture, only one egg is extracted, which may not be able to fertilize. Also, when using this method, there is a risk of canceling the oocyte collection procedure due to premature ovulation.

  The advantage of this method is to minimize the risk of complications such as ovarian hyperstimulation syndrome.

  The undoubted advantages of the IVF method in the natural cycle include the possibility of carrying out the procedure for several menstrual cycles in a row. However, note that a single puncture of stimulated ovaries will do less harm than multiple.

  Another advantage of IVF in natural cycle is that comapered to other programs its cost is usually lower than in programs where superovulation stimulation is performed.

  Also, unlike in other programs, no special preparation for IVF in the natural cycle is not required.

  The package includes (depending on the Doctor’s prescription)

  • Prescribing natural cycle treatment plan;
  • Consultation with Infertility doctor (up to 3 times);
  • Follicle ultrasound (up to 3 times);
  • Hormone level tests for monitoring ovarian stimulation (LH, estradiol, progesterone express-tests – up to 3 times)
  • One of the following medications:
  • Diphereline (0.1)
  • Chorionic gonadotropin (up to 10.000)
  • Ovarian puncture in natural cycle
  • Staying in a hospital ward for 3 hours for monitoring purposes
  • Embryological stage:
  • Oocyte identification and assessment; 
  • 2 sperm specimen preparation for fertilization;
  • In vitro fertilization: ICSI;
  • Embryo culture;
  • Oocyte spindle apparatus assessment.

  The package does not include

  • Medications that are not listed in the program description;
  • Medical assistance in case of emergency conditions;
  • IMSI;
  • Assisted hatching;
  • Embryo biopsy;
  • All kinds of preimplantation genetic diagnosis;
  • Embryo storage;
  • All consultations with related specialists;
  • The use of donor material and its defrosting.

  IVM procedure

  IVM means in vitro egg maturation (in vitro) followed by IVF. The specialists of AltraVita clinic have sufficient capabilities and knowledge to conduct this process with high efficiency, as evidenced by reviews of IVF in natural cycle.

  The combination of IVM and IVF methods makes it possible to simultaneously obtain a mature egg from a dominant follicle and a number of immature eggs from small (antral) follicles. Egg maturation takes place “in vitro”, and a mature egg undergoes fertilization in the standard way. High-quality embryos obtained by both methods are transferred into the uterus.

  Indications for IVF in the natural cycle in conjunction with IVM

  • Polycystic Ovary Syndrome
  • Significant risk of ovarian hyperstimulation syndrome
  • A history of benign hormone-dependent tumors
  • Contraindications to the induction of superovulation
  • Factors Affecting IVM Choice
  • The ability to avoid the risk of developing ovarian hyperstimulation syndrome
  • Lack of hormonal stimulation
  • Affordable cost of the procedure, which is caused by a small amount of hormonal drugs used

Intrauterine Insemination

Other services

IVF

• Whom is IVF treatment suitable?

  • Women who have been diagnosed with unexplained infertility
  • Women with fallopian tubes obstruction
  • When other techniques such as fertility medication or intrauterine insemination (IUI) have not been successful
  • When a limited number of oocytes are available
  • Male partner has serious fertility problems
  • Couples are using donated eggs or their own frozen eggs in their treatment
  • Couples are using preimplantation genetic screening to avoid passing on a genetic condition to the child

  IVF Treatment steps

  • Consultation with reproductive endocrinologist; selection of the individual stimulation protocol.
  • Ovulation induction according to the protocol chosen in order to ensure a higher number of eggs.
  • Monitoring of the hormonal stimulation under ultrasound. The number of matured eggs and quality of uterine lining will be checked.
  • Egg retrieval is performed by gynecologist under general anesthesia. The whole procedure takes 10-20 minutes.
  • Sperm collection, analysis and preparation. Semen is prepared for fertilisation by removing inactive cells and seminal fluid in a process called sperm washing.
  • Fertilisation using ICSI or IMSI methods.
  • Cultivation of embryos. The produced embryos are being cultivated in special incubators for 5-6 days. Their development is closely monitored by experienced embryologists. If necessary, PGS or PGD can be performed to select embryos free from genetic diseases. 
  • Embryo transfer is a painless transfer of the best embryo into the woman’s uterus. Spare embryos will be cryopreserved by vitrification.

  Frozen embryo transfer is one of ART techniques. Many couples choose to try frozen embryo transfer program after a successful IVF attempt to have a second baby.

IVF after 40 years

• IVF after 40 years

  Pregnancy after 40 is a fairly rare occurrence even if you try to conceive naturally. IVF can be a possible solution to this problem for women over 40.

  The ability to get pregnant, gestate and give birth to a child is determined by the age of woman planning to become a mother.

  How to get pregnant over 40?

  For a woman after 40 years a possibility of the natural conception and normal pregnancy decreases year after year. 

  Modern ART and IVF come to help patients over 40. Such methods are actively used in AltraVita center. Such methods are actively used in AltraVita center. To determine the possibility of getting pregnant with her own eggs for a woman over 40, ovarian reserve assessment is required.

  For this reason the following options are used:

  • Determination of AMH (anti mullerian hormone) - allows you to predict the chances of conception, although it does not affect fertility itself and decreases with age;;
  • FSH (follicle-stimulating hormone) - the ovarian reserve means sufficient if there is a value of 10 mIU / ml and below;;
  • Antral follicles count — the follicles are counted during ultrasound examination.

  At this age IVF is often performed in natural cycle, because a large number of eggs cannot be obtained during a stimulation.

IVF tests

• For woman

  • Blood type and Rh factor
  • Complete blood count — valid for 1 month
  • Biochemical blood analysis (Protein total, ALT, AST, Bilirubin total, Urea, Creatinine, Glucose) — valid for 1 year
  • Clinical urine analysis — valid for 1 month
  • Coagulogram (prothrombin, thrombin time, aPTT, fibrinogen concentration) — valid for 1 month
  • Smear for flora from urethra, cervix, vagina — valid for 1 month
  • Blood test for detection of HIV, Syphilis, Hepatitis B and C  (must be done only at AltraVita clinic) — valid for 3 months
  • Hormonal screening (AMH, LH, FSH, Prolactin on day 2-3 of menstrual cycle, T4 free, TSH) — valid for 6 months
  • Smear for cytology from endo and exocervix — valid for 1 year
  • Mammary ultrasound (under 35 y.o) — valid for 1 year
  • Mammography (35 y.o. and over) — valid for 1 year
  • Pelvic ultrasound — valid for 1 year
  • Thyroid ultrasound — valid for 1 year
  • Chest X-Ray — valid for 1 year
  • Physician conclusion — valid for 1 year
  • ECG — valid for 1 year

  Medically indicated tests (upon doctor’s request)

  • СА125 before second IVF program
  • Hysteroscopy, endometrial pipelle biopsy are performed for more detailed examination of endometrial tissue
  • Karyotype blood test is done once in life

  For man

  • Blood type and Rh factor
  • Blood test for detection of HIV, Syphilis, Hepatitis B and C  (must be done only at AltraVita clinic) — valid for 6 months
  • Semen analysis (must be done only at AltraVita clinic) — valid for 3 months

  Medically indicated tests (upon doctor’s request)

  • Karyotype blood test is done once in life
  • Depending on the results of medical tests, patients may be asked to visit the following specialists
  • geneticist
  • breast oncologist
  • endocrinologist
  • psychiatrist
  • infectious disease specialist