Infertility treatment methods

Intrauterine insemination is a method of artificial insemination recommended when ovulation is regular and spermogram results are within the norm.

Washed sperm, or spermatozoa removed from other components of the seminal fluid, is injected directly into the woman’s uterus.

If the male partner’s sperm cannot be used, it is possible to use donor sperm in AIUI – Artificial Intrauterine Insemination.

In Vitro Fertilisation is a major method of assisted reproductive technology in which eggs cells are fertilised by sperm outside the body.

In Vitro Fertilization or IVF is a technology in which eggs cells are fertilized by sperm outside the body. Eggs removed from the woman’s ovaries after hormonal stimulation are fertilized by washed sperm – spermatozoa removed from the other components of seminal fluid. The egg and sperm are combined in a fluid medium inside a special cultivation dish in an incubator.

In Vitro Fertilization is recommended when sperm quality is within the norm. The most important factor is the shape of the sperm. If the spermogram results show abnormalities, ICSI is recommended to choose the best sperm to fertilise the egg, thereby minimising the risk of an unhealthy embryo.

IVF process at ReproGenesis

• The first step is filling in a questionnaire in order to provide relevant information about your medical history.
• Based on information provided and consultation with a specialist, the most suitable treatment method will be determined.
• Secondly, a series of tests will be conducted: hormonal profile, STD tests and sperms analysis.

IVF cycle includes:

• Consultation
• Treatment protocol
• Sperm analysis on the day of eggs fertilization
• Eggs retrieval
• General anaesthesia
• Fertilization of mature oocytes via ICSI
• Extended embryo cultivation
• Assisted hatching
• Embryo transfer

IVF cycle with donated eggs includes:

• Consultation – the most suitable donor is chosen from our extensive donor database. We are able to locate a near-perfect match of your physical features, character traits, hobbies and interests etc. (as well as height, hair and eye colour, blood type and Rh factor). All of our sperm donors are tested for mental diseases, genetic and hormonal disorders as well as infectious diseases including HIV.
• Treatment protocol
• Partner’s sperm analysis on the day of eggs fertilization
• Stimulating medications for the donor, monitoring of the donor’s IVF cycle, donor’s oocyte retrieval
• Fertilization of all mature eggs via ICSI
• Extended embryo cultivation, assisted hatching and embryo transfer
• Ultrasound exam of the recipient
• Donor’s compensation

The embryos are cultivated for five days. The embryo transfer is always on day 5 of the cultivation in comparison to other clinics when embryo transfer is on day 2 or 3. On day 5, the embryos are at the blastocyst stage which is the best stage for implantation in the uterus. This increases the chances of a successful pregnancy. The day 5 embryo transfers will go ahead regardless of the weekend or holidays.

Embryo Monitoring

• You receive daily information about your embryos development and get a DVD record – from the egg fertilisation stage until the five-day embryo.
• Embryo monitoring can increase chance of pregnancy by more than 10% and reduce the risk of miscarriage to less than 6%.

IVF Price Cost

The cost of IVF is significantly lower in the Czech Republic than in other countries. At ReproGenesis, we offer premium quality service at prices twice lower than in the United Kingdom or the United States. However, IVF price is individual and dependent on personal requirements and medication needed. For more information on prices, please go to our price calculator or contacts us at info@reprogenesis.cz.

IVF Success Rate

Thanks to our professional care, advanced methods and state-of-the-art equipment, our clinic achieves up to 68% IVF success rate. More than 2 600 healthy children have already been born at ReproGenesis. For more information see our results.

IVF for women over 40

Women of advanced age are welcome at our clinic. We are specialised in treatment of women over 40. The legal age of artificial insemination is 49 in the Czech Republic.

MACS (Magnetic-Activated Cell Sorting ) - new generation of best-quality sperm selection

(MACS) system is an efficient method to select functional sperm and improve pregnancy rates.Genetic integrity of the spermatozoon is essential for normal embryo development. A high level of DNA fragmentation in sperm cells can negatively affect embryo cleavage and subsequent development leading to blastocyst arrest or early miscarriage. DNA damage represented by fragmentation and subsequent sperm apoptosis may be a cause of male infertility that standard methods – sperm concentration, morphology assessment and motility analysis cannot detect.

A major causative factor for sperm DNA damage is oxidative stress generally increasing with the age and/or inflammatory infections, cigarette smoking, drug use, exposure to environmental pollutants and elevated testicular temperature.

Therefore, MACS Annexin V System was designed to selectively remove these defective although morphologically indistinguishable cells from sperm preparations. The procedure begins with magnetic labeling of unwanted cells and then, they are passed through a separation column where they are selectively retained. Intact living spermatozoa without DNA fragmentation pass through the column and are collected for later use (ICSI or cryopreservation).

Gain of the sperm ready for fertilization represents the key advantage over traditional DNA fragmentation tests in which patient obtain only impractical information on percentage of damaged cells. Similarly, methods for morphological assessing, like IMSI, cannot provide sufficient picture about the state of the DNA in the sperm nucleus.

Intracytoplasmic Sperm Injection or ICSI is a micromanipulation procedure that involves the careful selection of high-quality well-formed sperm with good motility. Using a microscope, a micro-pipette first immobilises a single sperm by cutting its tail with its point. The spermatozoa is then injected into the egg cytoplasm.

When sperm concentration and motility are low and sperm are not well-formed, ICSI might be the only available procedure to fertilize an egg.

ICSI process at ReproGenesis

• The first step is filling in a questionnaire in order to provide relevant information about your medical history.
• Based on information provided and consultation with a specialist, the most suitable treatment method is determined.
• Secondly, a series of tests will be conducted: hormonal profile, STD tests and sperms analysis, blood type and Rh factor.

If ICSI is required with either donated eggs or sperm the most suitable donor is chosen from our extensive database. We are able to locate a near-perfect match of your physical features, character traits, hobbies, and interests etc. (as well as height, hair and eye colour, blood type and Rh factor). All of our sperm donors are tested for mental diseases, genetic and hormonal disorders as well as infectious diseases including HIV.

ICSI cycle includes:

• Consultation
• Treatment protocol
• Sperm analysis at the day of eggs fertilization
• Eggs retrieval
• General anaesthesia
• Fertilization of mature oocytes via ICSI
• Prolonged embryo cultivation
• Assisted hatching
• Embryo transfer
• Ultrasound exam

ICSI cycle with donated eggs includes:

• Consultation
• Treatment protocol
• Partner’s sperm analysis at the day of donated eggs fertilization
• Stimulating medications for the donor, monitoring of the donor’s IVF cycle, donor’s oocyte retrieval
• Fertilization of all mature oocytes via ICSI
• Extended embryo cultivation, assisted hatching and embryo transfer
• Ultrasound exam of the recipient
• Donor’s compensation

The embryos are cultivated for five days. The embryo transfer is always on day 5 of the cultivation in comparison to other clinics when embryo transfer is on day 2 or 3. On day 5, the embryos are at the blastocyst stage which is the best stage for implantation in the uterus. This increases the chances of a successful pregnancy. The day 5 embryo transfers will go ahead regardless of the weekend or holidays.

PICSI is a micromanipulation technique that improves the process of selecting sperm for ICSI. A protein which is found in the membrane surrounding the egg (HA protein) is used to select the best sperm according to how well the sperm bind to it. The more mature a sperm is the more likely it is to bind to HA protein. Research shows that sperm that bind have a lower probability of chromosomal abnormalities and higher DNA integrity. Sperm unsuitable for fertilisation lack specific protein receptors, and do not bind to the protein.

Advantages of PICSI over ICSI

PICSI selects the best sperm not just on appearance but on the sperms ability to fertilise an egg. It is a more refined way of choosing the best sperm for injection.

PICSI process at ReproGenesis

• The first step is filling in a questionnaire in order to provide relevant information about your medical history.
• Based on information provided and consultation with a specialist, the most suitable treatment method will be determined.
• Secondly, a series of tests will be conducted: hormonal profile, STD tests and sperms analysis, blood type and Rh factor.

Reasons for PICSI

• Low fertility rate after ICSI
• Spermogram results repeatedly at the low end of the norm
• Compromised embryo development in previous cycles
• History of miscarriage
• Woman 35 years or older

Semi-continuous monitoring of embryos is a method whose aim is to monitor the embryo development in the incubator. In fact, this revolutionary system gives us an opportunity of significant "insight" into the whole embryo development. It helps us to select the most suitable embryo(s) to be transferred into the uterus to cause a pregnancy.

The introduction of this optical system in incubators gives us a chance to let embryos develop undisturbed during the entire culture period and they do not need to be tested outside the incubator.

In the time lapse incubator called Embryoscope, the embryos are placed in individual wells of a special culture dish and a photo of the embryos is taken regulary. The images are automatically stored and made into a continuous data record. Throughout their development embryos remain safe and undisturbed inside the incubator. The fewer disturbances your embryos receive, the more likely they are to develop somewhat as close to they should in their natural environment of the womb. Embryoscope continually monitors the embryos and indicates if they are dividing correctly and within set time frames.

The key events in embryonic development should happen at specific time points. Some embryos can develop too fast or too slow, sometimes abnormal division of the cells occurs and abnormalities can form. Time lapse imaging helps in choosing the embryo with the highest implantation potential.

Embryologists will grade embryos on the number of cells, their shape, level of fragmentation, thickness of the outer shell etc.

Without embryo monitoring equipment embryologists may assess an aneuploid embryo to be normal and decide that it is suitable for transfer. But, of course, it may not be normal. If it is abnormal, it may not implant or may lead to a miscarriage. With embryo monitoring, an embryologist has lots of information on how the embryo divides, what it looks like whilst dividing etc. This information can be used to assess whether a normal looking embryo is indeed ‘normal’.

Time-lapse embryo monitoring can also sometimes determine early on which embryos are most likely to make it to the blastocyst stage. This may mean that we can transfer embryos earlier in the knowledge that the best ones have been chosen.

What are the risks of monitoring?

There are no known risks associated with monitoring. The facility operates in the same manner as the standard incubator that is always used for the cultivation of embryos.

MESA/TESE procedures are recommended when the ejaculate contains no sperm, a low concentration of sperm, abnormally shaped sperm or sperm that is not fully developed.

MESA (Microsurgical Epididymal Sperm Aspiration)

Performed under general anesthesia, the MESA procedure involves direct retrieval of spermatozoa from the epididymal tubules with a syringe. The sperm concentration is then determined. If no sperm is present, the TESE procedure is performed.

TESE (Testicular Sperm Extraction)

The TESE procedure involves removing a small portion of tissue from the testicle. The extracted tissue is checked for sperm concentration.

Sperm obtained in these procedures is then prepared for ICSI (Intracytoplasmic Sperm Injection). If the sperm concentration is sufficient it is possible to freeze the surplus sperm for future use to avoid the surgical procedures.

Reasons for MESA/TESE

• The ejaculate contains no sperm
• A low concentration of sperm
• Abnormally shaped sperm
• Sperm that is not fully developed.
• Vasectomy

Embryo cultivation usually takes place in laboratory conditions for 2 to 5 days after the eggs have been removed from the ovaries.

We recommend a five-day cultivation of embryos when there are a sufficient number of embryos produced as this enables us to select the healthiest embryos for transfer.  When only a few embryos are produced, (2-3) and they show differences in development, it may be possible to transfer the embryos into the uterus on the second or third day of cultivation.

PGD refers to a number of screening procedures performed before embryos are transferred into the uterus. PGD allows for the exclusion of embryos with genetic disorders, including chromosomal abnormalities such as chromosomal translocation, aneuploidy or other structural defects, or monogenic disorders. A cell (blastomere) of the embryo is extracted and subjected to comprehensive genetic analysis.

Pre-implantation Genetic Diagnosis – PGD

• PGD screens embryos created through IVF for inheritable serious genetic disorders in order to avoid passing on the condition to offspring.

Pre-implantation Genetic Screening – PGS

• PGS is a screening process that helps identify chromosomal abnormalities e.g. Downs Syndrome before the embryo is implanted in the uterus.

Reasons for PGD / PGS

• Compromised embryo development in previous cycles
• Spermogram results repeatedly at the low end of the norm
• History of miscarriage
• History of genetic disorders
• Advanced age of man or woman

Assisted Hatching or AH is a valuable technique in IVF treatments.

After the embryo attaches to the wall of the uterus, it is essential that it shed the zona pellucida, a tough membrane which protects it during the cultivation period. In some cases the embryo fails to implant because the zona pellucida is too thick.

Assisted hatching involves creating a minor defect in the membrane, allowing for a better chance of the embryo implanting in the endometrium. The embryo is at no risk during this procedure.

Embryo transfer is a procedure whereby embryos are placed into the patient’s uterus. It is a simple, painless procedure very much like a routine gynaecological exam.

Embryos are deposited in the uterus through a thin catheter.

Cryopreservation of Embryos (embryo freezing) is undertaken if there are surplus healthy embryos following transfer.  A special freezing technique called vitrification is used for embryo freezing. This technique involves quick yet gentle freezing. Embryos are then placed in a cryobank and kept at -196 °C (-321 °F). Frozen embryos may be stored for a few decades.

Frozen embryos are gently thawed when required for transfer. They are used when the fresh embryo transfer was unsuccessful or when a sibling is desired after a previous success.  The main advantage of cryopreservation of embryos is that it completely removes the necessity of hormonal hyper-stimulation of the ovaries.

After hormonal stimulation, eggs may be removed from the ovaries and frozen. This procedure is recommended to young women who are about to undergo an oncological treatment but it is available to any woman wishing to preserve her eggs for later use.

Sperm may be frozen for a number of reasons:

• As part of a sperm donor scheme
• To preserve healthy sperm before oncological treatment
• For couples waiting for donor eggs
• As a backup in case a fresh sample is unable to be produced on the day of egg retrieval

EmbryoGlue® is an implantation promoting transfer medium. It is not glue in the literal sense but it is enriched with everything that an embryo needs to help implantation in the womb and so helps this process.

EmbryoGlue® contains a high concentration of implantation promoting protein, which is present in the follicular, oviductal and uterine fluids. Studies have shown that the concentration of this protein increases dramatically on the day of implantation and decreases to near normal levels by the next day, indicating that it is important for implantation.

Embryos are transferred to this medium before embryo transfer to allow the protein to bind to the embryo. Both the embryo and the wall of the womb have receptors for this protein. In this way it is thought that the EmbryoGlue® acts like an adhesive for the embryo as it implants in the wall of the womb.

Does EmbryoGlue® Work?

Independent studies show that it does have a positive impact on the implantation rate compared to embryo transfers without EmbryoGlue.

Test ERA (Endometrial Receptivity Array) is a molecular diagnostic test to investigate the receptivity of endometrium. Receptivity of the endometrium is a condition in which the endometrium (uterine lining) is ready for implantation (nesting) of the embryo.

Normally, the endometrium is evaluated by using ultrasound that can assess only height and texture of the endometrium. ERA offers an option that increases the likelihood of pregnancy for couples with repeated failure of implantation.

ERA test at the molecular level will determine the expression levels of 238 genes that participate in endometrial receptivity. It will therefore make it possible to evaluate whether the endometrium is properly receptive for embryo transfer in given days or whether the so called “window of implantation” is shifted.

ERA test is carried out optimally during the cycle preceding the one in which the embryo transfer is planned. The tissue for the test is obtained by biopsy of the endometrium. The result will therefore enable us to set the appropriate date of embryo transfer individually for each client.

ERA test is highly sensitive and enables detection of the receptivity of endometrium and is a good choice for women with repeated unsuccessful embryo transfers.