Course of assisted reproduction

Preparations for therapy in Sanatorium Helios SK s.r.o.
Before starting your own IVF cycle it is necessary for you to be interviewed by our gynecologist or embryologist. The gynecologist or embryologist suggests to you tests and examinations which will help in diagnosing the reason for your infertility. According to the tests and examinations results we will then offer you a special therapy programm, if you both accept the proposed programm, you and your partner will be given instructions on the methods of assisted reproduction and be put on the IVF programm.

We will always respect your own decisions during the interview and we promise to go through all the procedures of assisted reproduction only with your written consent. During the consultations the doctors in Sanatorium Helios will explain to you in detail the meaning and processes of IVF cycle the expectations and what you have to do. It is also the best time for you to ask all the questions you might have concerning the infertility treatment. If your partner hasn't already undergone a sperm quality test it is essential to do so before the start of the therapy in order to be sure that there will be enough helathy sperms for the whole IVF cycle. You can start your own treatment cycle after determining the medical schedule (stimulation protocol). You will be under complete supervision of your personal doctor and it is possible to contact him in case of any problems or doubts anytime during the whole therapy process.

IVF usually begins with hormonal injections to stimulate of multiple ovulation in the ovaries. However, it is possible to start with an IVF cycle without any hormonal intervention. This procedure is called a "natural cycle" and only one egg is retrieved. To increase the success rate in the first cycle it is better to retrieve more than one egg during IVF.

Stimulation
You will be given hormonal injections (FSH) for the first 2 weeks until the eggs have been confirmed to be sufficiently matured which will be determined by an ultrasound examination of the ovaries and the level of hormones in the ovaries. Another injection (HCG) is then applied to trigger off ovulation 34-36 hours before the planned egg transfer.

Oocyte retrieval
A puncture needele is used for retrieval of oocytes under an ultrasound control. The whole procedure takes approximately 15 -20 minutes in general anaesthesia. The thin needle pricks the wall of the vagina in the region of vaginal arch through which it passes into the ovaries. After reaching the ovaries the follicular fluid is drained off and handed over to an embryologist who scans it and searches for oocytes. The oocytes are assessed acording to their stage of maturity and quality. The embryologists use for storage of oocytes in optimal conditions a special chamber with artificialy controlled environment again to maximize the success rate.

Sperm retrieval
To secure a suficient number of sperms for the IVF it is necessary to abstain from sexual intercourse 2 days before the sperms are retrieved from the male by ejaculation. However, an abstinence of 4 days is not advised to avoid having sperms with low quality. The sperm retrieval procedure can be completed in one of our retrieval rooms. Also you can do it at home and bring a specimen to our centre. However, the period between ejaculation and processing the semen can not last more than 60 minutes otherwise it will result in the impairment of ejaculate.

Fertilization
Oocytes and sperms are transfered into our laboratory.The oocytes are then cleaned and deprived of liquid and other cells and prepared for IVF. Prepared sperm and oocytes are merged together in glass dishes and left in an incubator overnight. In case of extreme infertility in men it is possible to use the ICSI method.
Fertilization results are checked the following day. The difference between a fertilized and an unfertilized egg can be detected by the presence of two round shapes – pronuclei which will be visible in a fertilized egg.
Pronuclei contain egg as well as sperm DNA. An embryo is formed by fusion of the egg and sperm therefore its nucleus is a combination of both DNA. Successfully fertilized egg must be left over in laboratory for several days. Embryos are developed in special miniincubators providing stable environmental conditions which are very important for further development of embryos. Embryologists carefully take notes of the number of successfully developping eggs. The one or two best embryos are chosen and transfered into the uterus (it is up to you wether we transfer 1 or 2 embryos ). The rest of healthy embryos could be at your request frozen for future use.

Microinjection of a sperm into the egg (ICSI)
There are several forms of IVF and one of them is a very special technique of spermatic microinjection – ICSI. ICSI is an abbreviation from anglo-latin intra-cytoplasmic sperm injection. During this process a single sperm is injected carefully and directly into the cytoplasm of an ovum. The ICSI method is used in cases of extreme male sterility when there are only few mobile sperms with normal morfology in the ejaculate used for IVF. If there are no sperms in the semen (azoospermia) the ICSI method can be combined with surgical sperm retrieval from epididymis – MESA (microsurgical epididymal sperm aspiration) or directly from the testes — TESE (testicular sperm extraction).
MESA or TESE may be applied in cooperation with ICSI to achieve successful insemination even in men who could not become biological fathers a few years before. For the application of the ICSI technology even the immature or low motile sperms are useful since they don't need any active movement to reach the ovum and inseminate it.

Embryo transfer
Embryos are stored in the laboratory in optimal conditions until they are ready to be transfered into the uterus. The embryo transfer is a simple surgical procedure, it takes only a few minutes and it doesn`t involve any anesthesia or sedatives. An embryo is attached to a special bipartite catheter. The catheter is carefully inserted throug the cervix with the use of a thin tube into the uterus where the egg is released. The egg is held in place with the help of the front and back part of the uterus which normally touch each other and therefore it is possible to get up and walk away without any risk.

After the transfer
To prepare the endometrium for embryo implantation it would be necessary to apply hormonal support in the form of tablets. This helps the endometrium to swell and thus increases a chance for its successful attachment inside the uterine cavity. From that day of transfer it is just a matter of time whether the embryo has been implanted successfully and has started its development. The pregnancy test (ß-HCG blood test) and ultrasound examination should be done about 12 – 14 days after transfer.