How it works?

Insemination is planned within the ovulation cycle. This means the cycle during which the egg, which awaits the fertilisation by a sperm, is released. In women whose menstrual cycle is regular, most usually around 28 days, one ultrasound examination is enough, after which it should be possible to determine the IUI in the following days. Sometimes the ultrasound examination needs to be repeated, especially in women with an irregular or longer menstrual cycle. If the ovulation cycle is not confirmed it is, unfortunately, necessary to postpone the IUI until the next menstrual cycle.

In case of the confirmed ovulation cycle you will be, together with your partner, invited to perform intrauterine insemination. After processing of the ejaculate in the Andrological Laboratory, which takes approx. an hour, you will be informed about the current quality of your spermiogram and the steps following the treatment. The treatment itself is very quick and painless and the processed sperm is introduced by the means of a soft catheter (a thin tube) through the cervix into the uterine cavity. The pregnancy test will then be scheduled 2-3 weeks after the treatment or after the delayed menstruation.

Sometimes the indication to perform an artificial fertilisation cycle (IVF cycle, stimulation cycle) is unanimous and without our help the couple would have a minimal, or zero, chance of conceiving a child naturally (e.g. removal of Fallopian tubes in the female partner), while at other times it is more the length of the attempts at conception or repeated intrauterine insemination. Both reasons can force the couple to take the next step, namely the stimulation cycle. What must be taken into account is that after two to three years of unfruitful attempts at pregnancy the couple has only a minimum chance at successful pregnancy and it is necessary to contact an assisted reproduction centre.

 All must start with consulting the doctor, always by both the male and female partner, when both of you will receive detailed information on the aspects of the stimulation cycle and the potential consequences. Hormone examination must be performed or its results submitted, together with an ultrasound examination or a control spermiogram, should the current values not be known or in case there is the recommendation to check them. Based on many factors (your age, the case history of previous IVF stimulation cycles, ovarian supply based on the ultrasound examination and the results of the hormonal examination) you will be given, on your request, a pre-formulated treatment plan including the optimal stimulation protocol.

 At that moment you will, together with your male partner, sign informed consents with the treatment, and you will have ample space and time to ask any further questions you might find necessary. FertilityPort then sends the request to the health insurance company (if you are eligible for coverage of the treatment by the health insurance company). The request form is typically approved within 2-3 weeks, 30 days by the latest. Then you can, ideally with your male partner, schedule a meeting to discuss your treatment plan. This plan will be explained to you in detail, as will the injection-applied administration of hormones. The request form validity until the production of the plan and prescriptions for the stimulation medicine is 3-6 months depending on the health insurance company type. Then you begin administering the stimulants – application of the medicine based on the pre-defined plan, usually the second or third day of the menstrual cycle or several days before expected menstruation.

 Hormone application is nothing to be feared, only a hypodermic injection by a tiny needle into a skin fold, typically somewhere around the belly. Follicle growth, or in other words the effect of the hormone treatment, must be checked at regular intervals. The first ultrasound check-up is performed on day 5-6 of the stimulation, when the number and size of the growing follicles is assessed, and whether the hormone dosage applied by the woman is adequate. The second and potentially further ultrasound examination is typically scheduled within a couple of days (2-3) and if the follicle growth is optimal, the decision is made regarding the term of the ovarian puncture of the follicles.

 In case of foreign patients the ultrasound examination can be done by your local gynaecologist and so it is not necessary to travel to Prague to perform these. All that is needed is the respective report and ultrasound scans if possible. 

 Follicle puncture is performed during a short period of total anaesthesia, in rare cases under analgosedation or without anaesthesia based on the number of follicles punctured. One egg should mature in one follicle. You will be informed about the total number of the eggs obtained before you are released from our centre. We will require the sperm of our male partner on that same day. Your eggs will be fertilised using IVF or ICSI methods (either fresh or frozen sperm may be used in the fertilisation process). You have to leave accompanied by another adult person on the day of the follicle puncture.

In the following days you will be informed on the number of the successfully fertilised eggs and the number of developing embryos. The embryotransfer itself, or, in other words, the introduction of the embryos back into the uterus, will be performed, depending on the number and quality of the embryos, on day 3 to 6 of the embryotic development (the day of the egg collection is day 0), most typically on day 5 of the development, or in the blastocyst phase. Before the introduction of the embryos you will be informed on their quality, and any questions you might have regarding the therapy will be answered. The embryotransfer itself is most commonly performed without any need of total anaesthesia. A pregnancy test is scheduled for 14 to 21 days after the embryotransfer.

The remaining embryos, which fulfil the qualitative criteria, will then be, based on your wish, frozen for further use without any need of additional hormone stimulation. Such embryotransfer is called an cryoembryotransfer, the embryos are unfrozen on the day of the embryotransfer, and if they are in optimum quality after the defrost procedure they are transferred into the uterus the same way they would be in the “fresh” cycle (the embryo’s “survival” chance after vitrification is approx. 95%). Cryoembryotransfer is nothing to be feared because after successful thawing the chances are comparable or identical to those of a “fresh” transfer.

In case that the female partner does not possess a sufficient number of quality eggs, the ovaries are anatomically inaccessible for extraction, the previous stimulation cycles showed repeatedly insufficient quality of the eggs, or the patient suffers from a genetic defect (which would significantly increase the chance of the affliction of the child), the couple will be advised, based on medical reasons, to use donated eggs. These are eggs obtained from a young and healthy woman who is an anonymous donor. The quality of her eggs should be optimal. We realise that such a decision has to be a bit compromise for all couples/women and we will assist you during this decision-making process as much as possible. We will explain the reasons and the whole course of the treatment to you. You will have enough time to think everything through and ask questions.

A donor will be selected as the closest fit to your requirements. The donation process is fully anonymous and keeping the donor’s/receiver’s anonymity is our main duty and priority. The optimum therapy plan will be compiled based on the stimulation start (start of menstruation) of your donor. In certain cases it is necessary to synchronise your cycle with the donor’s cycle using hormone treatment to shift your menstrual cycle or begin the so-called downregulation – using an injection or multiple injections your natural cycle is “switched off”. This method gives us sufficient time to plan the whole therapy without having to align it to your natural cycle. To ensure quality growth of the endometrium (the mucous membrane of the uterine cavity) an estrogenic therapy will be administered in the form of pills, plaster or transdermal spray. After approx. 10-12 days of oestrogen use the height and quality of the endometrium must be checked by the means of vaginal ultrasound examination. Due to the fact that the length of the female partner’s/anonymous donor’s stimulation is always individualised, we will probably not be able to tell you on the day of the ultrasound check-up the preliminary term of the sampling of fresh sperm and the term of the later embryotransfer. You will be informed on the final terms well in advance by phone or email. You will also get an updated therapeutic plan.

In case of foreign patients the ultrasound examination can be done by your local gynaecologist and so it is not necessary to travel to Prague to perform these. All that is needed is the respective report and ultrasound scans if possible. 

 In case of using your own sperm a sample from the male partner must be available on the day of the puncture of the donor by the latest. To ensure maximum comfort it is possible to freeze sperm in advance (provided that its quality is sufficient). All eggs from the anonymous donor are then fertilised using the ICSI method.

In the following days you will be informed on the number of the fertilised eggs and/or the number the developing embryos. The embryotransfer itself, or the introduction of the embryos back into the uterus, will be performed based on their number and quality, most typically on day 5 of the embryotic development – at the blastocyst phase (egg collection day is 0). Before the introduction of the embryos you will be informed on the embryo quality, the following situation, and any questions regarding the therapy will be answered. The embryotransfer itself is most typically performed without total anaesthesia. The pregnancy test is scheduled 14 to 21 days after the embryotransfer.

The remaining embryos, which fulfil the qualitative criteria, will then be, based on your wish, frozen for further use without any need of additional hormone stimulation. Such embryotransfer is called an cryoembryotransfer, the embryos are unfrozen on the day of the embryotransfer, and if they are in optimum quality after the defrost procedure they are transferred into the uterus the same way they would be in the “fresh” cycle (the embryo’s “survival” chance after vitrification is approx. 95%). Cryoembryotransfer is nothing to be feared because after successful thawing the chances are comparable or identical to those of a “fresh” transfer.

Should the case be that the female partner no longer has a sufficient number of quality eggs, her ovaries are inaccessible, previous stimulation cycles showed repeatedly low egg quality, or the patient suffers from a genetic disorder (which would significantly increase the chances of the affliction of the child), the couple will be, based on medical reasons, recommended the usage of donated eggs as well as sperm. Donated eggs and sperm will be obtained from a young and healthy woman and man, both anonymous donors. The quality of their eggs/sperm should therefore be optimal. We realise that this decision has to be a great compromise to most women/couples, and so we will be there to assist you during the decision making as much as possible. The reasons to choose this therapy and its whole course will be explained to you. You will be given ample time to decide and ask any questions you want.

A donor will be selected as the closest fit to your requirements. The donation process is fully anonymous and keeping the donor’s/receiver’s anonymity is our main duty and priority. The optimum therapy plan will be compiled based on the stimulation start (start of menstruation) of your donor. In certain cases it is necessary to synchronise your cycle with the donor’s cycle using hormone treatment to shift your menstrual cycle or begin the so-called downregulation – using an injection or multiple injections your natural cycle is “switched off”. This method gives us sufficient time to plan the whole therapy without having to align it to your natural cycle. To ensure quality growth of the endometrium (the mucous membrane of the uterine cavity) an estrogenic therapy will be administered in the form of pills, plaster or transdermal spray. After approx. 10-12 days of oestrogen use the height and quality of the endometrium must be checked by the means of vaginal ultrasound examination. Due to the fact that the length of the female partner’s/anonymous donor’s stimulation is always individualised, we will probably not be able to tell you on the day of the ultrasound check-up the preliminary term of the sampling of fresh sperm and the term of the later embryotransfer. You will be informed on the final terms well in advance by phone or email. You will also get an updated therapeutic plan.

In case of foreign patients the ultrasound examination can be done by your local gynaecologist and so it is not necessary to travel to Prague to perform these. All that is needed is the respective report and ultrasound scans if possible.

As soon as it is possible to determine the donor’s term of egg collection we inform the patient about the exact date of the embryotransfer. All eggs obtained are then fertilised using sperm donated through the ICSI method.

In the following days you will be informed on the number of the fertilised eggs and/or the number the developing embryos. The embryotransfer itself, or the introduction of the embryos back into the uterus, will be performed based on their number and quality, most typically on day 5 of the embryotic development – at the blastocyst phase (egg collection day is 0). Before the introduction of the embryos you will be informed on the embryo quality, the following situation, and any questions regarding the therapy will be answered. The embryotransfer itself is most typically performed without total anaesthesia. The pregnancy test is scheduled 14 to 21 days after the embryotransfer.

The remaining embryos, which fulfil the qualitative criteria, will then be, based on your wish, frozen for further use without any need of additional hormone stimulation. Such embryotransfer is called an cryoembryotransfer, the embryos are unfrozen on the day of the embryotransfer, and if they are in optimum quality after the defrost procedure they are transferred into the uterus the same way they would be in the “fresh” cycle (the embryo’s “survival” chance after vitrification is approx. 95%). Cryoembryotransfer is nothing to be feared because after successful thawing the chances are comparable or identical to those of a “fresh” transfer.