In connection with acquired results and diagnosis evaluation we suggest the best treatment method for each individual couple.
During treatment we proceed from simple methods (timed sex, intrauterine insemination – IUI) to more advanced methods (IVF, ICSI, PICSI, etc.).
Exception is when we find more problematic pathology in the spermigramme result or blocked fallopian tubes, eventually when woman or man are of higher age. At this point, fertilization without modern IVF methods is very unlikely. Above that, by prolonging least effective methods of treatment, the patient is getting older. The chances to get pregnant by IVF treatment decrease rapidly after 35 years of age.
Ovulation induction is growth support and maturation in ovaries for following natural fertilization. Applied mainly for women with anovulative cycles, when there is irregular loosening of mature oocyte. For ovaries stimulation we use various medication – hormonal or non-hormonal based. Most used medication is clomiphenecitrate (Clostillbegyt, Clomhexal). Ultrasound examination during stimulation provides overview of follicle count in ovaries, where the oocytes develop. The character and height of endometrium is evaluated as well. Risks connected with this method are minimal – with exception of multiple pregnancy and eventual complications with multiple pregnancy connected.
Intrauterine insemination is the simplest method of assisted reproduction. By using stimulant medication, 2-3 oocytes are stimulated for maturation. For stimulation are usually administered Clomiphene citrate pills or gonadotrophine injections.
Treatment monitoring is done by ultrasound measuring of follicles sized from 18mm. The goal of IUI is to stimulate the growth and maturing as many follicles as possible (at least 1-3).
When follicles reach desired size, we apply the hCG injection which initiates ovulation.
In the morning of the same day of IUI, the partner provides sperm sample which is then prepared for insemination. Fresh sperm sample is after collection purified and concentrated. The doctor uses a thin catheter to inject prepared sperm to the uterine cavity. This is ambulatory, simple and painless operation (without anesthetics).
This treatment method is suitable in cases of immunological cervical factor or unknown sterility origin, when all examinations are within norms and spontaneous pregnancy is without success. Sometimes, this method is used with spermiogramme border values. Worlwide success rate of IUI is within the 8-10% range per cycle.
Advantage of IUI method is, that it doesn’t require oocytes collection nor anesthetics.
Before the IUI treatment, it’s necessary to undergo thorough examination of infertility cause.
Studies prove that this method is ineffective in cases when partner’s sperm is of low concentration or are of poor shape.
Women with ovulation disorders can undergo IUI treatment only if their reaction to stimulation is adequate. Hormonal treatment stimulates ovulation and IUI is timed for the ovulation term. Hormonal stimulation is usually applied to women without ovulation disorders.
In cases when it is not possible to use partner’s sperm, it is possible to undergo insemination by donor’s sperm (AID) when the sperm of thoroughly examined anonymous donor is used.
It’s necessary to follow the Czech Republic’s law and legislation. According to these regulations, using fresh sperm sample of anonymous donors for insemination is forbidden. All sperm samples must be tested, frozen and stored. After half’s year negative donor tests for infections, the samples can be used for insemination.
Partner couple can undergo several IUI cycles and if it is unsuccessful, the doctor usually suggests more effective treatment method – in vitro fertilization (IVF).
Minimal ovaries stimulation is intended for women, which don’t want to undergo classical IVF stimulation. For stimulation are used Clomiphen citrate pills in combination with low dosage of injected medicine, which are known from classical IVF cycles. Oocyte fertilization is achieved by ICSI, IMSI or PICSI methods. The probability of pregnancy is significantly lower than in the classical IVF cycle, although there is almost no risk of OHSS (hyperstimulation) and the costs of IVF stimulation are lower.
Most often is minimal IVF stimulation used in cases:
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