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Diagnostic methods – care provided by the physician
The first visit of a couple who have decided to undergo an examination to find the causes of possible infertility begins with a detailed medical history and suggestion for necessary diagnostic tests for both the woman and the man. The most appropriate treatment procedure is recommended based on the examinations.
Diagnosis most often includes
- a detailed history to detect any adverse factors affecting the conceiving
- necessary hormonal examinations
- gynaecological and ultrasonographic examination
- spermiogram or urological examination
- other examinations necessary to chose the method of treatment, which may be related to the anatomy of the genitals (hysteroscopy, laparoscopy, HyCoSy), or other general immunological, genetic, haematological examinations.
Based on the findings, the gynaecologist will suggest the treatment method most suitable for the treated couple. We generally go from less demanding to more demanding methods.
The basic procedure is to monitor the assisted reproduction cycle during ovarian gonadotrophin stimulation for intrauterine insemination or the cycle of in vitro fertilisation. Check-ups are performed via vaginal ultrasound. The height of the mucosa in the uterine cavity is measured during the examination. The number and size of follicles in the ovaries are determined.
Cycle monitoring is important for the following reasons:
- monitoring the ovarian response to the dose of gonadotropins and adjusting their dose in the further course of stimulation
- timing of ovulation induction and egg aspiration or intrauterine insemination
Intrauterine insemination is one of the basic methods of assisted reproduction. This method is simple, painless. It is performed during the ovulation period of the woman, when the egg is ready for fertilisation. On the day of insemination, the patient's partner arrives for ejaculate collection. Immobile sperm cells are removed from the ejaculate. The procedure is performed approximately two hours after obtaining the ejaculate. The actual introduction of the insemination dose is performed in the gynaecological position using a special catheter. The procedure is performed by a physician who inserts a uterine catheter into the uterine cavity using gynaecological mirrors and introduces the prepared sample to the uterus. The patient rests in a supine position for about 20 minutes after the procedure. This method is used when the patient has natural ovulation, or ovulation induced by stimulant drugs, and has presumed or confirmed fallopian tube patency.
In vitro fertilisation (IVF)
This process begins with the hormonal stimulation of the woman to induce the maturation of several eggs (oocytes) at once. The growth and number of follicles (a small sac in the ovary containing an egg) are monitored using ultrasound. When follicles are ready, eggs are collected via the vaginal wall using a thin needle under local anaesthesia. This procedure takes about 20 minutes. The acquired eggs are carefully examined (most often it is 5-15 eggs) and only those suitable for fertilisation are selected, i.e., eggs after the 1st meiotic division (the 1st polar body has been eliminated). The partner's ejaculate is acquired on the same day as the egg collection. The partner's sperm cells are washed and purified using one of many purification methods. After sperm cells are prepared, eggs are fertilised using one of the micromanipulation methods (ICSI, PICSI).
If no sperm is detected in the ejaculate, one of the methods intended for the surgical acquisition of sperm (TESE, MESA) is most often indicated after the necessary genetic and urological examination. We carry out this procedure on the day of egg collection in cooperation with a specialist urologist.