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  • WE WANT TO GET TO KNOW YOU

    In a first conversation with you, we first talk about your “history”.
    Is your menstruation cycle regularly? Did you already have fertility treatments? Completing the questionnaires, which you can receive after the appointment or even print out, help us.

Consultation

It does not matter whether it is the first time you are seeking medical advice on fertility or whether urological and/or gynaecological examinations have revealed that you require a fertility treatment. Feel free to make an appointment for a consultation for you and your partner. It would be helpful if you bring previously existing examination results along but you are not required to undertake examinations solely for this purpose. Generally a pregnancy will occur in 85% of couples having intercourse without contraception within one year. Why it has not worked in your case may have different reasons. Some of the most common causes are problems concerning menstrual cycle, dysfunctional tubes or inadequate sperm quality.
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During the first consultation we will talk to you about your ‘history’. Is your menstrual cycle regular? Or have you previously had infertility treatment? The questionnaires that we ask you to fill in prior to consultation will be of assistance to us. Once you have made an appointment we will send the questionnaires to you or alternatively you can print them directly out from the webpage. According to the length of your unfulfilled wish for children we can induce the necessary steps for treatment. However, in some cases it is not possible to find the reason why a couple is not becoming pregnant. This is referred to as idiopathic sterility. Often, at the end of the consultation we already can tell which therapy would be recommended to you. Sometimes it is necessary to have a second consultation. It is important to us that you ask all questions and address all topics that you would like to talk about. In the end it is you who has to decide whether you want to go through with therapy and if so at what time.

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Laboratory tests

The hormonal balance in the body is dependend on many parameters. It could be a hormonal imbalance that is the cause for a woman not to become pregnant or not staying pregnant. A blood test will reveal malfunctions of the thyroid gland, the pituitary gland, the kidneys or the ovaries (eg increased level of ‘male’ hormones). As levels of hormones (such as oestradiol and progesterone) involved in the ovarian function have varying levels during the menstrual cycle they need to be evaluated recurrently.
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Several common hormonal dysfunctions occur frequently such as thyroid dysfunction, increased prolactin, or even diabetes mellitus and its successor. These problems should be properly regulated before starting fertility treatment. The fertility treatment might apply stricter regulations about this then your general practitioner or your physician might have. If regulation is not sufficient enough to solve the problem we might commence a hormonal stimulation directly aiming at the oocyte maturation, ovulation and also the support of the luteal phase.
Before starting fertility treatment we require serological examinations of both partners checking for HIV I and II, Hepatitis B and C. In couples having had several abortions and before commencing an ICSI therapy we recommend a chromosomal analysis performed from a blood sample. The blood samples can be directly taken at our clinic.

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Sperm analysis

When you are trying to conceive- especially when a pregnancy has never been established, sperm quality should be one of the first things to analyse. This examination is performed by urologists, dermatologists qualified in andrology, as well as in our own laboratory.
In our clinic we provide a separate room for sperm donation. When you have an appointment one of our laboratory staff will show you to this room. There, you will be provided with a sterile cup on which your name will be written and you are able to ask any further questions. Once you have locked yourself in you have all the time you require. The cup with the deposit is left on the table in the room. Afterwards you are ready to leave the clinic since the analysis of the sperm will take a while. The results will be available to you by phone between 11am and noon the following day. We are aware that for a lot of men depositing sperm in the clinic is distressing.
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Hence, we try to ease the situation by being as discrete as possible. In the donation room several magazines are available and off course your partner may join you. It is important for the analysis of the sperm not to have an ejaculation or intercourse 3 to 5 days prior to donation. If it is not an option for you to ejaculate in the clinic, it is possible to do so at home and bring the sperm to the clinic. In this case the sperm would need to be kept at body temperature and be transported best within 30 to 60 minutes to our clinic. 

The sperm is analysed afterwards in our aboratory. This is where the concentration, the motility and the morphology of sperm are determined. If an infection is suspected bacteriological examinations are ordered. The result of the sperm evaluation determines which therapy we would recommend to you. As the sperm quality may naturally vary we often require a second analysis as confirmation.

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Important information to our Spermiogramm

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Normal values of sperm 
Concentration (Sperm count)minimum of 20 million per milliliter
Oligozoospermreduced concentration of sperm
Asthenozoospermreduced mobility of sperm
Teratozoospermreduced morphology of sperm
Oligoasthenoteratozoosperm (OAT)reduced concentration, mobility and morphology
Azoospermno sperm in the ejaculate
WHO 2010 normal values of sperm 
Concentration (number of sperms)at least 15 millions/ml
Progressive mobile sperm (categories A+B)>=32 %
Local and immobile sperm (categories C+D)>=40
Morphology (Sperm form, different guidelines
here)
minimum of 15%
  

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Menstrual cycle monitoring

A menstrual cycle is monitored in order to determine whether a follicle matures, ovulation takes place and whether progesterone is produced. Normally, each month the follicle that matures contains one oocyte which -after ovulation-reaches the fallopien tube where fertilisation by sperm may occur. Only after further four days the fertilised oocyte will get to the uterus where it might implant. Duing the first few weeks of pregnancy the hormone progesterone is produced by the corpus luteum which evolves at the ovaries from the ovulated follicle. Progesterone supports the pregnancy. Women with a regular menstrual cycle of 28 days are expected to reveal normal results. Women that have a prolonged menstrual cycle, irregular menstrual cycle or first signs of menopause should have their follicle growth checked.
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To investigate the follicle growth a vaginal ultrasound examination is performed on the 10th day of menstrual cycle. This examination meassures look the follicles seen at either ovary as well as the thickness of the endometrium. Most of the time only one larger follicle can be seen. The ultrasound is repeated after 2 days if the follicle is still not large enough. A follicle ready to ovulate has a size of about 20mm. Often a number of smaller follicles (=10mm) can be seen at the same time. Once one large follicle can be identified, a blood test will reveal the estradiol and lutenising hormone levels. The estradiol correlates with oocyte maturity and an increased LH level triggers ovulation.  It is favourable to see a follicle half way through the menstrual cycle sized 18-22mm with correlating estradiol and LH levels. There are natural variations between cycles. However, if repeatedly no follicle can be found, a hormonal stimulation would be recommended to you.

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Fallopian tubes

During ovulation the follicle will burst and the mature oocyte is released travelling down the fallopian tubes. The fastest sperm will swim through the vagina and uterus to the fallopian tubes where fertilisation may occur. Additionally to the growth of follicle (see menstrual cycle monitoring) and the sperm quality see Sperm analysis) the tubes need to be intact for pregnancy to occur.

There are various methods to determine whether the fallopian tubes are continuous.
The first method used was an x-ray contrast examination. Nowadays an endoscopy is performed. With the help of a catheter a dyed liquid is injected into the uterus. This liquid will eventually move through the fallopian tubes to the abdomen.

This can be seen and followed on the monitor. The procedure is performed under general anaesthetics but most of the time you may leave the hospital the same day. Endoscopy (chromopertubation) is the most reliable way to find out about the passage of the fallopian tubes. This procedure is recommended for patients that previously have had abdominal surgery and for patients after lower abdominal infections.

Uterus examination – Hysteroscopy

The uterus is lined with a cell layer called endometrium. A few days after conception the embryo will implant in the endometrium. Uterus malformations preventing the embryo from implanting are rare reasons for pregnancy not to occur or for miscarriages.

A hysteroscopy can assess the condition of the uterus. A 3mm thin hysteroscope is inserted into the uterus and as salt solution is added the uterus unfolds. The monitor then shows the inner uterus with the openings of the fallopian tubes and any abnormalities can be detected. This procedure will only take a few minutes. It is performed during the first half of the menstrual cycle. The hysteroscopy takes place in our clinic with or without anaesthetics- as you wish.

Malformations of the uterus that exist since birth (for example a septum in the uterus) can be removed surgically. Also fibroids and cluttering of the endometrium can interfere with pregnancy and would need to be removed before starting therapy.

Recurrent Miscarriages

Miscarriages occur in 11-15% of all pregnancies. The percentage will increase continuously with women´s age reaching 50% once the women´s are past age 45. The reason for this are randomly occurring chromosomal defects. This can not be treated. However, if there are 3 or more consecutive miscarriages it is referred to as abitual abortions. This concerns 1% of all pregnancies. In some of the patients defects can be defected that can be treated, so further examinations may be useful.
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  1. Hysteroscopy – to exclude malformations of the uterus
  2. Blood sample for chromosomal analysis – to exclude congenital genetic defects
  3. Blood sample for hormone analysis -to exclude hormonal causes (eg thyroid gland malfunction)
  4. Blood sample to exlude imbalance of clotting factors and antibodies as a cause


Unfortunately, finding the cause will not mean that further miscarriages can be prevented entirely. A reason for habitual abortions can not always be found. Nonetheless, our experience shows that even many of there patients will be able to carry out pregnancies.

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