FAQ – IVF and infertility

Answers : MUDr. Pavel Texl,  Head Physician
What is the difference between infertility and sterility?
According to the international classification of the term infertility – reduced fertility – is defined as the inability to conceive after a year of regular, unprotected sexual intercourse. After two years, we speak about sterility.
How long does it take for a woman to get pregnant?
A woman should get pregnant within 3-6 months with regular sexual intercourse.
When to investigate causes of infertility?
It very much depends on the woman’s age. For women younger than 35, I would recommend a consultation and basic examination at an IVF clinic after six months. Women over 36 should visit a clinic after three months.
Why not wait longer for the examination? Why for older partners after only  three months?
We recommend only an examination of  the possible causes of infertility, not treatment. Unfortunately, experience has shown that up to 90 % of couples who undergo these tests will need  treatment. Older couples should start the treatment as soon as possible. After the age of 37, the quality of eggs declines  significantly and the risk of congenital defects increases.
Is infertility more common in women or men?
About six years ago there was not a big difference between the frequency of infertility in women or men. At present, the rate of infertility in women is around 30 %. As for men, we find problems in semen analyses of 90 % of men – among couples undergoing treatment for infertility at Sanatorium Helios.
How to treat infertility?
Ideal treatment cannot be determined without a detailed examination of both partners.
Do I need any recommendations for consultation and examination in your surgery?
You do not need any recommendations in order to make an appointment for an examination at our surgery. You can make an appointment by phone on: 549 523 258, 549 523 211 or use the contact form.
My gynaecologist has prescribed me fertility medication to induce ovulation, how long should I be taking it?
First of all, I would like to point out that prior to prescribing fertility medication the partner should undergo a semen analysis. If a woman does not get pregnant  within three months, I recommend a more detailed examination of both partners.
My husband is ashamed to come to the examination.
The presence of a man is not needed during the first examination. In this case you can bring the sperm for  analysis – however, it is necessary to carefully follow instructions for obtaining and transporting the sample.  Contact a member of the andrology laboratory staff on 549 523 257 for all necessary information.
What tests do you recommend me taking?
We have a very individual approach to each couple. The basic examination should include semen analysis, woman’s hormonal profile and immunological and genetic testing. Recently, it has become evident that sperm functional tests are very important, especially the DNA integrity test.
Every doctor will certainly always prefer a less demanding type of treatment such as IUI. To perform IUIsuccessfully, it is also necessary to meet basic criteria – approximately ten million motile sperms must be transferred into the uterus, standard sperm morphology is required, the fallopian tubes must not be blocked and ovulation must take place. Sperm should also be examined for the presence of antibodies – an IBT test. Even after meeting all these criteria, the success rate of IUI is below 10 %.
Before making a decision about performing PICSI, we recommend doing a sperm DNA integrity test. Within the PICSI procedure sperm is collected with respect to their functional properties. The IMSI method involves examining sperm under a high magnification microscope. The best method is not always the most expensive method – leave the choice of fertilization method to our experts and the test results.
How long an embryo should be cultured?
The longer embryos are cultured, the more quality and capability for further development is gained. On  day 2 of culture, embryos have four cells and the chance of getting pregnant is about 25 %. On day 3 they have 7-10 cells and reach the cleavage stage. The chance of getting pregnant is about 35-40 %. On day 5-6 they get to the blastocyst stage and have around 120 to 200 cells. The inner cell mass subsequently forms the embryo, and the outer layer of cells later forms the placenta. However, only a small number of embryos (about 30%) reaches this stage but their chance of further growth in the womb is about 50-55 %. Blastocyst transfer reduces the number of unsuccessful embryo transfers and reduces the number of unnecessary frozen embryos.
Special laboratory equipment, a good embryological team and long-term experience are necessary to obtain good quality blastocysts.
Should a PGD (pre-implantation genetic diagnosis) be performed prior to embryo transfer?
Pre-implantation genetic diagnosis detects up to 50 % of blastocysts with numerical chromosomal errors (NGS methods). With the PCR method we can identify gene mutations causing monogenic diseases. In Sanatorium Helios, we recommend PGD to couples with genetic diseases, women over 37, or those whose embryo transfer has repeatedly failed or with severe disturbances of spermatogenesis. Excluding genetically abnormal embryos, following PGD, we achieve a success rate of more than 65 % per one embryo and per one embryo transfer.
What method of PGD/PGS should we choose?

In SANATORIUM Helios we provide the method – New Generation Sequencing (NGS) for the embryo testing (preimplantation genetic screening). This method replaces the so-called microarray (array) comparative hybridization, aCGH.

The NGS – sequencing of the new generation allows complete and accurate screening of all 24 chromosomes in the embryo’s genetic equipment. Deviations in the number or structure of chromosomes can most often lead to spontaneous abortion in the early stages of pregnancy or the birth of a child with severe disabilities. The most well-known syndrome is theDown syndrome caused by chromosome 21, Edwards syndrome (chromosome 18), Patau syndrome (chromosome 13), Turner syndrome (missing one copy of chromosome X), and Klinefelter syndrome (XXY chromosome condition). Embryos selected by the new generation sequencing have a higher probability of attachment and further correct fetal development in the mother’s uterus. Women are thus spared of unnecessary embryo transfer and possible subsequent reproductive loss due to the non-standard genetic equipment of the embryo.

How many embryos should be transferred into the uterus?
We recommend a transfer of a single embryo – the blastocyst. If more embryos are cultured, in case of failure the others can be gradually thawed and transferred one by one. The chance of getting pregnant in one cycle thus increases significantly (if we have at least 3 good quality embryos transferred one by one, the cumulative success rate is about 94 %).
What are the chances of getting pregnant with a fresh and thawed embryo?
At present we use the VITRIFICATION method to freeze embryos. Vitrification procedures have been improved in collaboration with Genea. Thus the likelihood of pregnancy after a transfer of fresh and thawed embryos is the same, greater than 60 %.